DD2444 Culture Health and Wellbeing Programme
The Mayor’s Culture Strategy, Culture for all Londoners, outlines his goal to promote the benefits of arts and culture to improve the health and wellbeing of all Londoners. The London Health Inequalities Strategy aims to ensure that social prescribing becomes part of routine community support across the capital, particularly for people in vulnerable or deprived communities. Working across these strategies, this decision seeks approval for expenditure to develop cultural and social prescribing activities in London by delivering:
- an A-Z of Social Prescribing Myth Busting Guide to help develop the practice of cultural organisations and health practitioners;
- an inaugural conference bringing together the culture and health sectors with Londoners with lived experiences of social prescribing to promote how social prescribing can improve lives; and
- commissioning up to three Social Prescribing Demonstrator Projects, including through grants to test and evaluate impact. This includes a collaboration with Healthy London Partnership and Arts Council England to support six organisations to deliver and evaluate social prescribing and mental health workshops in Southwark and Merton through an Arts and Health Accelerator pilot.
All activity will be supported by a new GLA Culture, Health and Wellbeing Task Group.
A total of £75,000 expenditure is required, allocated across two financial years: £25,000 in 2019-20 from the Culture and Creative Industries Unit’s existing Culture Strategy budget under cover of MD2451; and £50,000 in 2020-21 funded through the Unit’s proposed Culture, Health and Wellbeing budget.
That the Executive Director of Good Growth approves the following expenditure:
- £15,000 to develop resources for the health and cultural sectors to enable better understanding of social prescribing, including an A-Z guide and web resource, and distribution;
- £10,000 to deliver an inaugural Conference for Culture, Health and Wellbeing; and
- £50,000 to commission Social Prescribing Demonstrator Projects which support training and connections between health and culture practitioners. Of this, £20,000 will be grant funded to Healthy London Partnerships to support the first Social Prescribing Demonstrator Project (an Arts and Health Accelerator pilot in Southwark and Merton) with £30,000 supporting two future commissions.
Part 1: Non-confidential facts and advice
1.1 The Mayor has identified culture as a key priority for London. Culture has a vital role to play in enabling Londoners to come together and forge a sense of belonging, increasing well-being and generating civic pride. At the heart of the Mayor’s Culture Strategy is the vision of a city where everyone can take part in culture and benefit from the city’s global success. In November 2019, the World Health Organisation published its Health Evidence Network report which evidenced the contribution of the arts to the promotion of good health and the prevention of a range of mental and physical health conditions, including the treatment or management of acute and chronic conditions.
1.2 The Mayor made a commitment in his Culture Strategy to promote the benefits of arts and culture for the health and wellbeing of Londoners. Current activity which is helping to deliver this commitment has included:
- a mental health culture festival designed by and aimed at young Londoners;
- funding and supporting new culture-led approaches to working with older people and those living with dementia;
- funding small grants for grassroots culture, including health and wellbeing projects, through Culture Seeds; and
- London Borough of Culture - Cultural Impact Awards, including projects that support the health and wellbeing of older Londoners and those in the social care system.
1.3 There is a growing evidence base to support the role that arts and culture play in improving health and wellbeing, and over the last decade, the culture sector has increasingly embraced this role. Ahead of the Health Evidence Network report, in 2017 the All-Party Parliamentary Group on Arts, Health and Wellbeing published ‘Creative Health: The Arts for Health and Wellbeing’. This drew together rigorous evidence of the positive impact of the arts on health and wellbeing. The report identified the role arts and culture can play in ‘Social Prescribing’, an initiative used to prescribe non-medical help to improve people’s health and wellbeing, usually through referring patients to community and cultural activities delivered by the voluntary community and social enterprise sector (VCSE), which includes the arts.
1.4 As evidenced in the Creative Health report, cultural activities such as dance workshops can help reduce incidents of trips and falls for people living with Parkinson's disease, and young people experiencing mental health issues can benefit from participating in creative writing and spoken word projects, including by building peer support networks.
1.5 Simultaneously, evidence from the health service shows that around 20 per cent of visits to GPs are for non-medical problems. In addition to this, more than 1m Londoners experience the impact of musculoskeletal pain, accounting for a further 20 per cent of GP consultations (London Health Inequalities Strategy, Sept 2018).
1.6 Social prescribing can help with such patients. The responsibility of referral is frequently undertaken by Link Workers. In 2019, the National Health Service announced the creation of 1,000 of these new posts, which will work within newly established Primary Care Networks. The Link Workers, individuals employed by the National Health Service and based within the community, are a critical new part of connecting patients to cultural activities within their communities to support improvements in wellbeing and reducing loneliness.
1.7 External research has evidenced the extent of social isolation and wellbeing issues. 2.2 million people aged 75 and over are living alone in the UK, an increase of almost a quarter in the past 20 years (Office of National Statistics); the number of over-50s experiencing loneliness is set to reach two million by 2025-26 (Age UK 2018, All The Lonely People); nearly 10 per cent of children aged between 5–16 have some form of mental illness (London Health Inequalities Strategy Sept 2018); and 75 per cent of young people who are experiencing mental health problems aren’t receiving treatment (Good Childhood Report, Children’s Society, Aug 2019). In this context, for the first time, the GLA’s Intelligence team has evidenced that participation in culture can help reduce social isolation. In particular, for Londoners who were not working full-time, attending cultural events was found to have produced a fall in the risk of social isolation of around a third, from 38 per cent to 24 per cent. For these reasons, there is increasing need and interest from both the cultural and health sectors to find ways of sharing best practice.
1.8 The recommended Culture, Health and Wellbeing action plan set out three priorities by which the Mayor could help improve Londoners’ health and wellbeing through cultural engagement, by:
- championing and advocating for best practice in cultural social prescribing from across London, nationally and internationally, ensuring equality of sustained access for Londoners and growing the evidence base;
- supporting initiatives that improve young people’s mental health through culture; and
- supporting new culture-led approaches to working with older people and those living with dementia.
1.9 The culture and social prescribing activities outlined in this decision will coordinate a range of partners, networks and projects to maximise existing skills, evidence and expertise within the culture sector. The aim is to improve Londoner’s access to cultural social prescribing and the quality of work delivered by the cultural sector. Partners and networks who will be involved include the World Cities Cultural Forum, Arts Council England, Healthy London Partnership, THRIVE LDN, Baring Foundation, Kings College London, National Social Prescribing Students Network and the London Arts in Health Forum.
1.10 The activity proposed will use the Mayor’s convening role to support the culture sector to develop its role within health and wellbeing settings, and to make strong new connections with NHS local plans, Link Workers, Primary Care Networks and commissioning bodies. This will help both the culture and health sectors in London make the most of opportunities in a fast-developing policy area.
1.11 Proposed Activities led by GLA’s Culture and Creative Industries team:
- Publish an A-Z of Social Prescribing Myth Busting Guide, and a web resource, for cultural organisations and health practitioners, to improve shared understanding of the benefits and best practice for cultural social prescribing. A consultant will be procured to develop online and printed resources including a short guide outlining top ten things to consider when delivering/booking/cultural social prescribing activities, and a pilot pod cast/vlog series giving a range of perspectives on social prescribing from Londoners, health and cultural practitioners.
- Establish an inaugural conference at City Hall in 2020 for the culture and health sectors. This will bring together NHS commissioners, clinicians and the cultural sector with Londoners with lived experience of social prescribing to improve understanding of the benefits and barriers to access for Londoners to quality cultural social prescribing.
- Establish a series of three Social Prescribing Demonstrator Projects through a mix of grant funding and commissions. Demonstrator Projects are activities which champion and advocate for best practice in cultural social prescribing. These will deliver training and connections between health and culture practitioners by bringing together local health services, cultural organisations and academics to deliver and evaluate live projects in order to share the impact of new ways of working. Three Demonstrator Projects will be supported in 2019-20 and 2020-21. The first is outlined below in paragraph 1.11.1 and two further projects and collaborations with other funders and organisations will be identified to meet these goals by the GLA’s Culture and Health teams, with the support of a newly established GLA Culture, Health and Wellbeing Task Group.
1.12 Arts and Health Accelerator Project: The first Social Prescribing Demonstrator project will be a
grant of £20,000 to the Healthy London Partnership to support an Arts and Health Accelerator project within Southwark and Merton. This will be co-funded with £20,000 from Arts Council England and £20,000 from Health London Partnership to make a total project fund of £60,000, bringing expertise from each partner for strategic development and evaluation of the project. It will support up to six cultural organisations to work with NHS Primary Care networks in Southwark and Merton to deliver a programme of workshops lasting between three to six months for Londoners experiencing mental health problems. Up to £10,000 per organisation will be awarded to deliver and evaluate this work, through a process of open application managed by Healthy London Partnership. The terms of reference for the Arts and Health Accelerator Project will include the appointment of a project panel for the duration of the grant to Healthy London Partnership, which will comprise representatives from Healthy London Partnership, Arts Council England, the GLA, Southwark and Merton Councils, and those with lived experience of mental health difficulties. The panel will assess and monitor the awards.
- A new GLA Culture, Health and Wellbeing Task Group will support these activities across 2019-20 and 2020-21. This group will meet up to four times and will comprise up to 15 individuals including leading culture and health practitioners, people with lived experience of social prescribing and GLA officers.
2.1 The objectives of the activities proposed are to:
- improve understanding of best practice and quality of work undertaken by arts organisations in health and wellbeing settings;
- build effective and new connections between link workers, GPs and cultural practitioners;
- enable links between NHS commissioners and cultural organisations to support access for Londoners to culture;
- continue to grow the evidence base for the benefits of culture to the health and wellbeing of Londoners; and
- improve training for both arts and medical practitioners to ensure delivery of high-quality provision.
2.2 These projects will support the objectives set out in the Healthy Communities chapter of the Mayor’s London Health Inequalities Strategy towards the Mayor’s aim that all London’s diverse communities are healthy and thriving, specifically to:
- ensure that Londoners are empowered to improve their own and their communities’ health and wellbeing; and
- ensure that social prescribing becomes a routine part of community support across London.
2.3 The activities will produce the following outputs:
- Publication of a both a printed and downloadable guide about social prescribing. This will be distributed to over 500 cultural organisations, individuals and NHS Primary Care Networks, training institutions and practitioners. The guide will form part of a Culture, Health and Wellbeing web resource with examples of culture, the arts and social prescribing in action. Usage statistics will be collected to monitor take up;
- A conference at City Hall attended by 150 people from the culture and health sectors and Londoners with lived experience of social prescribing, together with speakers and best practice drawn from the GLA’s networks and funded projects;
- Up to three Social Prescribing Demonstrator Projects delivered and evaluated, including an independent evaluation of the Arts and Health Accelerator project by Healthy London Partnership in which 6 organisations will deliver six month programmes of workshops in Southwark and Merton for people experiencing mental health difficulties; and
- 15 advocates within the GLA’s Culture, Health and Wellbeing Task Group promoting best practice in the Culture, Health and Wellbeing realm and supporting the development of improved connection between the culture and health sectors, demonstrated through an increase in funding and sustained social prescribing activity.
2.4 The expected outcomes these projects will achieve are to:
- contribute to strengthening social prescribing best practice and delivery across London, as evidenced through an online survey of GLA funded projects, and establishment of a task force to support the development of the Culture, Health and Wellbeing programme;
- improve the availability and quantity of social prescribing provision through culture and the arts;
- contribute to the increased wellbeing for Londoners, evidenced through Healthy London Partnership and other Demonstrator Project evaluation;
- inform policy development and help improve sustainable delivery of cultural social prescribing nationally by sharing best practice, including with the Government Task Force for Social Prescribing, National Academy for Social Prescribing, Healthy London Partnership, the Mayor’s Cultural Leadership Board, Arts Council England and the World Cities Culture Forum; and
- enable cultural organisations to participate more effectively in developing and delivering services for social prescribing through engagement with service commissioners, Primary Care Networks and other key stakeholders in the culture and health sectors.
3.1 Under Section 149 of the Equality Act 2010, as a public authority, the Mayor of London must have ‘due Regard’ of the need to eliminate unlawful discrimination, harassment and victimisation as well as to advance equality of opportunity and foster good relations between people who have a protected characteristic and those who do not. The development of the activities within this decision aims to increase participation in cultural activities which will improve health and wellbeing of Londoners. The proposed activities will foreground the lived experience of those experiencing social isolation and vulnerabilities caused by mental health difficulties, age, gender, sexual orientation or race in order to develop GLA’s Culture, Health and Wellbeing strategy and future action planning.
3.2 The growth of social prescribing sits within strategic objective 33 of the Mayor’s Equalities Diversity and Inclusion (EDI) Strategy for London: “To co-produce with partners, including the Voluntary and Community Sector, NHS and local authorities, a social prescribing vision and next steps for London that sets out the approach to expanding social prescribing across London and particularly with the most deprived communities including the elderly, those with long term medical conditions and those with complex medical and social needs.”
3.3 Social prescribing, supporting individuals to deal with a range of issues that affect their health and wellbeing, can benefit everyone but is of particularly advantage to those with multiple, complex health and other needs such as housing issues and access to social welfare legal advice. As part of the Demonstrator Project strand the GLA’s Culture and Creative Industries Unit will target support for those with complex health problems, including people with mental health disabilities working with experienced partners including THRIVE LDN. The projects will comply with relevant GLA policies and the Culture and Creative Industries Unit will seek opportunities, through the delivery of the Culture, Health and Wellbeing programme, to ensure commissions and grants have the potential to make a positive impact on multiple groups under the Equality Act 2010. Specifically, the tender for the new resources and conference will be reviewed by people with lived experience of social prescribing, particularly those with mental health difficulties and those experiencing social isolation to ensure accessibility and networks for distribution.
3.4 The issue of loneliness and isolation cuts across many different strands of equality. The appointment of a new GLA Culture, Health and Wellbeing Task Group is intended to ensure the Demonstrator Project and conference planning places communities most in need at the heart of development, delivery and monitoring at all stages. The recruitment process for the GLA Culture, Health and Wellbeing Task group will ensure gender, race, sexual orientation, disability and age is central to the recruitment process, with lived experience of the benefits and challenges of social prescribing to tackling issues of loneliness and isolation as a key criterion for selection to ensure compliance with the Equality Act 2010.
3.5 The Demonstrator Projects will address health inequalities and provide better services for those suffering from ill health. In particular, the Demonstrator Project led by Healthy London Partnership in Southwark and Merton will involve people with lived experience on a project panel in order to drawn on their expertise in the design of future work.
Key risks and issues
4.1 Although social prescribing is not new, the ambition from NHS and service commissioners to formalise the approach whilst also ensuring services remain local and accessible, raises some challenges for delivery by cultural organisations, who already operate on tight margins and with stretched capacity, juggling multiple, complex funding streams. Rapid growth of NHS social prescribing may mean that the culture sector is unable to fulfil demand for social prescribing activities. This proposed approach seeks to build understanding and connection between the culture and health sectors to help alleviate identified challenges, particularly in respect of good practice and ways of working.
4.2 The breadth of engagement and connections required to enable the successful delivery of this area of work requires a range of specialist advice. A Task Group for Culture, Health and Wellbeing will be established to support and advise this developing area of the GLA’s Culture and Health Strategies.
4.3 Demonstrator Projects may not meet aims and objectives effectively. The mitigate this, a panel for the Healthy London Partnership Demonstrator Project in Southwark and Merton will be established This group will meet during the planning and delivery of the project to assess and monitor the six awards.
Links to Mayoral strategies and priorities
4.4 The Mayor’s Culture Strategy, Culture for all Londoners sets out his ambition in Policy 4 to promote the benefits of arts and culture for the health and wellbeing of Londoners.
4.5 The London Health Inequalities Strategy set out the Mayor’s ambition to support the growth of social prescribing in London. The activity in this decision is aligned with Next Steps for Social Prescribing (September 2019), published by the GLA, Healthy London Partnership and the Social Prescribing Network. The activity focuses on three of the five principles in this document: ensuring availability and easy access for all, keeping services localised and personalised and supporting the workforce to deliver.
4.6 The growth of social prescribing also features within the Mayor’s Health, Environment and Sports strategies and the London Food Plan.
Consultations and Impact Assessments
4.7 The GLA’s Culture and Creative Industries Unit is represented on the GLA Social Prescribing Advisory Group. This group meets quarterly to share policy, strategy and intelligence to support emerging grant programmes and build evidence of impact.
4.8 The Mayor is committed to championing, supporting and enabling the culture sector in its role as providers of activities and services on which social prescribing depends. The work streams outlined here have been informed by several engagement exercises including with the Mayor’s Cultural Leadership Board, Arts Council England, the All Parliamentary Party Group for Culture, Health and Wellbeing and consultation undertaken by Nikki Crane Associates.
5.1 Approval is sought for expenditure of £75,000 to develop and deliver Culture, Health and Wellbeing activities within London.
5.2 £20,000 will be issued to the Healthy London Partnership as a contribution towards testing a new model for social prescriptions whilst the outstanding £55,000 will go towards activities specified in the above decision box.
5.3 Of the £75,000, £25,000 will be funded from the existing 2019 Culture Strategy budget as outlined in MD2451. The remaining £50,000 will be funded through the Unit’s proposed 2020-21 Culture, Health and Wellbeing budget which was submitted as part of the Mayor’s 2020-21 draft budget submission.
6.1 Paragraphs 1 to 2 of this report indicate that the decisions requested of the Director concern the exercise of the GLA’s general powers, falling within the GLA’s statutory powers to do such things considered to further or which are facilitative of, conductive or incidental to the promotion of economic development and wealth creation, social development or the promotion of the improvement of the environment in Greater London; and in formulating the proposals in respect of which a decision is sought officers have complied with the GLA’s related statutory duties to:
- Pay due regard to the principle that there should be equality of opportunity for all people;
- Consider how the proposals will promote the improvement of health of persons, health inequalities between persons and to contribute towards the achievement of sustainable development in the United Kingdom; and
- Consult with appropriate bodies.
6.2. In taking the decisions requested, the Director must have due regard to the Public Sector Equality Duty; namely the need to eliminate discrimination, harassment, victimisation and any other conduct prohibited by the Equality Act 2010, and to advance equality of opportunity between persons who share a relevant protected characteristic (race, disability, gender, age, sexual orientation, religion or belief, pregnancy and maternity and gender reassignment) and foster good relations between persons who share a relevant protected characteristic and persons who do not share it (section 149 of the Equality Act 2010). To this end, the Mayor should have particular regard to Section 3 (above) of this report.
6.3 Paragraph 1.11 above indicates that the contribution of £20,000 to Healthy London Partnership amounts to the provision of grant funding and not payment for services. Officers must ensure that the funding is distributed in accordance with the Contracts and Funding Code. Officers must ensure that an appropriate funding agreement is put in place between and executed by the GLA and Healthy London Partnership before any commitment to fund is made.
6.4 Officers have indicated in paragraph 1.11 of this report that a consultant will be procured to develop the online A-Z to Social Prescribing Myth Busting Guide which will be procured in accordance with the GLA’s Contracts and Funding Code.
7.1 The projects will be procured in accordance with the Contracts and Funding Code and other GLA procurement procedures.
Scope brief and procure for a consultant
Delivery Start Date for Demonstrator Project proposals
Delivery End Date for project proposals
Delivery and evaluation of Myth Busting Guide and Conference
Delivery and evaluation of Demonstrator Projects