The Culture Strategy for Scotland, which is still in draft form, provides a renewed focus on the role of art and culture in all aspects of our society. As the Cabinet Secretary for Culture said in her address to launch the development of the Culture Strategy in June 2017: “We know that culture has intrinsic value and that it also contributes both directly and indirectly to the health, wealth and success of our nation.”
So how do we reconcile the intrinsic value of culture with specific and sometime urgent demands of health and social care? What are the prerequisites for a dynamic where arts and cultural production have relevance to wider health and social care concerns? What environment do we need to create where culture and health occupy a shared space? With the integration of health and social care still in its infancy and public health reform underway it feels that this might be the right time to try and address some of the questions.
As we explore the role of culture within this wider context, we should recognise that it already successfully plays an important part of the health and care experience in a multitude of situations across Scotland delivered by a range of dedicated arts and cultural practitioners. Arts and cultural input provide purposeful diversion from the monotony of care. Thoughtful art interventions and quality design enhance the healthcare environment and contribute directly to more positive healthcare experiences.
Articulating Care Experiences
Art can also play a significant role in improving and changing the care experience by giving that experience voice. Effective change is often achieved by carefully listening and understanding individual and collective situations and then creatively thinking as to how we might give the individual greater prominence in influencing what is happening around them. Art making and cultural activity have immense power in supporting change by creating an open space that offers new perspectives; articulating individual experiences simply and powerfully; promoting different ways of thinking and stimulating different actions as a result.
Without a different way of engaging with people and their experiences we very often tend to fall into usual patterns of behaviour. Arts and creativity free up a space where we can explore individual experience and capacity differently. Where through seeing people differently we can explore and experiment with different responses and through creatively thinking bring positive change not only to their situation but also the systems and structures that support them.
The act of making art is so much more than providing good quality positive diversion to people or a better physical caring environment; it is also about engaging with the systems of treatment and support and recognising that those systems are very often far from perfect. Promoting high quality arts practice within this context is important in that it sets the bar high and supports the deep thinking that is required to make the necessary changes.
Complex Adaptive Systems
Our health and social care needs are not predictable which means that the health and social care systems need to be incredibly responsive and ideally flex with our changing needs. There are of course many other pressures at play some which come with the complexity of running large health and social care systems and the lack of ongoing investment. The health and social care system demands nearly 40% of the total Scottish Government Budget making it a multi-billion pound operation. As with most large systems this demands regularly review and structural change. However, often these changes don’t bring the results that are needed. One reason for this is that the systems are just too big and can’t adapt to individual need and other changes needed quickly enough. Their response to change can also suffer from being unimaginative as the ‘lines of command’ are so long that if there is a good idea then it is often risk assessed and nuanced into a marginal adjustment when it hits the ground.
We know that these systems need to change more radically and that means that real innovation needs to be embedded. This is where the real potential of an arts approach lies. It is creative problem solving that is at the heart of the potential of sustainable creative involvement within health and social care. The emphasis needs to be on creative problem solving from the person’s point of view and informed by their lived experience – and not by introducing new ‘systems interventions’ such as digital solutions, change or service re-design methodologies alone.
With that assertion comes a responsibility. In the arts we need to work much harder on how those working in health or care see and understand the value of arts supporting them to make positive decisions about its relative worth. A simple approach to explore that further is to look more closely at the specific Government supported initiatives that support investment in specific outcomes and priorities. It feels that there is a better fit for added value if the creative input contributes directly to a change agenda and creates the opportunity to bring other ‘players’ in such as universities, trusts & foundations and Creative Scotland.
There is plenty of independently and academically validated research that supports the positive individual and social outcomes that involvement in arts and culture create. Personally, it doesn’t take a huge leap of the imagination to work out that if a patient receives improved creative & social stimulation and is personally valued, their recovery rates and healthcare outcomes will improve. Caring positively for people only has good outcomes. Still these ‘softer’ outcomes have not been clinically tested or proven which lessens its perceived value to the primary objective of treating a healthcare condition.
Experience tells me is that is difficult to ‘compete’ with clinical interests in this way. What has been more successful is to offer a new and different perspective of a care situation through arts processes which articulate individual experience. This approach offers an opportunity for all to explore how we change the way we understand and support people. It also allows us to work alongside clinical concerns.
A shared space
There is always great potential in working collaboratively and looking at issues holistically. As we move forward and health and social care integration further develops, and public health reform establishes itself there is a window of opportunity for culture to deliver on the assertion of the Cabinet Secretary to it contributes directly to the health of the nation. It requires us to take risks, to be open to a wide range of experiences and see the potential of creating a shared space where health, social care and culture interact purposefully and positively. David Greig, the theatre director, often talks about making theatre as a constructed space where you can explore ideas and address specific issues that affect us all. Perhaps not all that far removed from the process that has led to the advances made in operating theatres over the years.
Jan-Bert van den Berg is Director of Artlink Edinburgh and the Lothians