A popular dance-based falls prevention programme offers effective treatment on the NHS, with a growing network of local groups helping older people maintain the benefits afterwards. Tim Joss tells the story.
Dance to Health started with a hunch: that the arts have the potential to deliver health improvement more effectively and more cost-effectively than the NHS. We needed a major health challenge that the arts might solve. We lighted upon older people falling over.
Falls are traumatic for an older person: they can destroy confidence, increase isolation and reduce independence. They cost the NHS £2.3 billion a year. Its response is well-evidenced exercise programmes to boost strength and balance. If older people stick at them, that’s great - but many find them boring and drop out. And there’s a further problem. Even if you complete the programme, opportunities to maintain your improvements are rare.
The sector has long had a concern about being instrumentalised – just an additional resource for health and other sectors – but not valued artistically
Dance to Health smuggles the exercise programmes into creative, sociable dance activities and adds maintenance programmes. A £350,000 pilot programme in 2015 and 2016 showed we were on to something.
A sustainable model
We are now just past halfway through a £2.1m expansion, which is testing and refining a sustainable model. We begin with ‘Improvement Programmes’ - dance versions of the exercise programmes that are offered as a free NHS treatment. These then lead on to a 12-month ‘Maintenance to Sustainable’ transition, helping older people maintain their physical improvements and establish local Dance to Health groups based on subscriptions and local fundraising. This will create a growing national family of self-run, financially sustainable groups with central support.
Dance Partners recruit and manage the dance teams who deliver the sessions. All are funded by Arts Council England and are experts in working with older people: Birmingham Royal Ballet, Cheshire Dance, DanceEast, National Dance Company Wales, South East Dance, Take Art and Yorkshire Dance.
The NHS and local authority public health departments are our health partners, and we are also supported by ‘Dialogue Partners’ who are invaluable sources of advice, support and constructive criticism (see lists of these partners at the foot of this article).
Evaluation and research are carried out by ourselves, Dance Partners and Sheffield Hallam University Sport Industry Research Centre (the health aspects), People Dancing (who conducted the first national survey of older people’s dance activities for us) and the polling organisation ComRes (who monitor changes in GPs’ attitudes to the arts).
39 of the planned 40 Improvement Programmes have finished, with positive results for the 800 participants. We are monitoring dance ability, interest in dance, falls, GP visits, hospitalisations and physical and mental health improvements. This is complemented by participant focus groups. The drop-out rate has been low as we see more people than expected joining the Maintenance to Sustainable stage, paying their weekly subs.
650 volunteers make crucial contributions: Peer motivators help with the delivery of sessions, Buddies support participants and Champions help run the local groups.
35 dance artists have completed training in the exercise programmes. Sheffield Hallam has confirmed that the dance sessions are faithful to the exercise programmes. And dance artists find the requirements artistically stimulating, not restrictive.
The transition to sustainability has just begun. Much still needs testing, but we take heart from the People Dancing survey, which found that 90% of older people’s dance groups are ongoing and regular.
Lessons to share
There are three big lessons worth sharing. They apply to all artforms and across the health sector.
First, we now have a checklist for what makes an arts programme sutiable to be taken up by health:
- A response to a major health challenge.
- You can plug it into the complex health system.
- A national service, so when a GP asks if it is available in their area the answer will be 'yes'.
- People want it – in health jargon, there is ‘patient pull’.
- Consistency of artistic and health quality.
- Evidence-based from a health point of view, so that NICE will approve it.
- Place-based, locally co-designed and co-produced with older people and health partners.
- Inclusive and diverse.
- Effective and cost-effective.
It should also be sustainable – the model for Dance to Health is that the NHS pays for Improvement Programmes and the development of local Dance to Health groups. Thereafter, the local groups are viable through weekly subscriptions and local fundraising.
Second, Dance to Health is not ‘arts on prescription’. There is a current buzz about this idea, where the NHS refers patients out of the health system to existing local arts groups, usually with no money following the patient. Our Improvement Programme sits within the NHS, as an alternative to other treatments. The sustainable local groups are dance and health groups led by a specialist dance artist qualified in falls prevention.
Finally, we now have a picture of Dance to Health’s artistic contributions – the ‘artistic active ingredients’ – that explain why dance works when exercise doesn’t. This should be a confidence-booster for the arts sector, which for at least 20 years has had a concern about being instrumentalised – just an additional resource for health and other sectors – but not valued artistically.. Being able to communicate the power of the arts helps our sector reposition itself as a proud partner of health.
Health partners: ABM University Health Board (Swansea), Cheshire East Council, Active Norfolk/Norfolk County Council/Norwich Clinical Commissioning Group, a NHS Vanguard (site of innovation) in Birmingham, two other NHS Clinical Commissioning Groups (Oxfordshire and Sheffield) and the Royal British Legion (for programmes in their care homes).
Dialogue partners: Age UK, Age Cymru, Arts Council England, Arts Council Wales, Centre for Ageing Better, NHS England, NHS Horizons, NHS Improvement, One Dance UK, People Dancing, Public Health England, Social Prescribing Network, Sydney Medical School and University of Oxford Institute of Musculoskeletal Studies.