Gaining credibility

It is hard to quantify the impact of arts in health, but in current times where quality of care at a reduced cost is the order of the day, unless we can demonstrate the ability of the arts to make a tangible improvement to health outcomes, then it is not going to be taken seriously by those who hold the purse strings. Our mission is to tap in to mainstream NHS funds and to have our services commissioned, rather than relying solely on grants. Therefore medical research and economic evaluation are essential.

Before setting up Breathe Arts Health Research last year I worked as Performing Arts Manager for Guy’s and St Thomas’ Charity. I developed projects across a wide range of acute and primary healthcare settings, ranging from using creative writing to tackle postnatal depression in young mothers, to commissioning plays to raise awareness of relatively unknown medical conditions such as Lupus disease. The value of these activities was never in doubt in my mind, but I was always aware of the difficulty of disseminating the project more broadly across the health system and sustaining it beyond the charity’s funding.

With support from Guy’s and St Thomas’ Charity, I founded Breathe as a spin-out social enterprise. As an independent organisation we are able to work on a far greater scale, to work in new geographical regions and to tap in to a wider pot of funds. We continue to work as a strategic partner to the charity, while also working in partnership with other hospitals and healthcare providers. Within our first year we have worked with a range of pioneering health, cultural and academic organisations including Great Ormond Street Hospital, King’s College Hospital NHS Foundation Trust, the Thackray Medical Museum in Leeds and Arts Health Institute, Australia.

An analysis of this data revealed that the intervention significantly improved the ability of the participating children

We are very fortunate to have Dr Dido Green, Reader in Rehabilitation at Oxford Brookes University as our Director of Research and Evaluation. As a trained ballet dancer and a highly respected clinician, academic and researcher, she epitomises the Breathe ethos of promoting the creative potential of arts in health, combined with robust scientific evidence. Under her lead, we have had our research articles published in medical journals and have presented our work at a number of prestigious health conferences nationally and internationally.

One of our beacon initiatives, which grew out of an exploratory exercise funded by Guy’s and St Thomas’ Charity in 2008, is an innovative programme of therapy for children with hemiplegia, a paralysis affecting one side of the body. ‘Breathe Magic’ is a ten-day intensive therapy programme (camp) that teaches specially adapted and scaled magic tricks that incorporate therapeutic exercises required to improve hard/arm function. The camp culminates in the young people performing alongside Magic Circle magicians in a professional theatre. Participants attend a ‘refresher’ magic club for six months to help sustain their newly acquired skills and motivation.

The intervention came about as a result of collaboration between magicians from the Magic Circle and occupational therapists at the Evelina Children’s Hospital, and led by Dr Dido Green who was the Head of Paediatric Occupational Therapy at the time. The pilot innovation was based on the hand-arm-bimanual-intensive-therapy protocol which evidences that a minimum of 60 hours of intensive therapy over two weeks is required to have an impact on motor skills. The programme is also in line with the National Institute for Clinical Excellence (NICE) guidelines for the management of spasticity in children.

We have carefully researched and refined the programme over the last five years to develop a clinically effective intervention which has a demonstrable impact on children’s motor skills An analysis of this data revealed that the intervention significantly improved the ability of the participating children to complete everyday tasks independently, such as dressing themselves or cutting up food, with many children reporting more confidence and a more positive outlook. Before the camp participants could only perform 25% of activities independently, whereas ten days later they could do 93% of activities. This improvement in the children’s motor skills and dexterity has had a profound effect on their independence with a corresponding reduction in the amount of time parents have to put in to supporting their child across activities.

It was a real milestone for us when NHS Lambeth Clinical Commissioning Group (CCG) commissioned Breathe Magic as a clinical service this year, as it showed that the NHS are open to creative approaches to healthcare, if the impact is demonstrable.

Breathe Magic is a strong example of our methodological approach to project design. We do not deliver lots of one-off projects. We work for many years to design, adapt and improve our programmes so we can demonstrate that they are clinically effective and sustainable within the health service. Successful interventions are then scaled up to benefit patients in new geographical regions or adapted to benefit different patient groups. For example, Breathe Magic is soon to be rolled out in Australia to benefit children with hemiplegia and we have also piloted an adapted version of it for children with mental health problems at Great Ormond Street Hospital. We are also adapting the programme for adults who have had a stroke.

The credibility of arts and health work has evolved greatly over recent years thanks to initiatives such as the National Alliance for Arts Health and Wellbeing, the London Arts and Health Forum, The Royal Society of Public Health and the work of Lord Howarth. Partnership is at the heart of everything we do, and I am looking forward to working with others with allied goals to pioneer new creative solutions to healthcare that can make a demonstrable impact on the health of individuals and communities on a national scale.