My Lords, in this suite of amendments to Clause 20, which lays down duties on integrated care boards, I am proposing that we should articulate a duty for ICBs to embrace non-clinical practice in their whole way of working. By non-clinical practice, I am referring to a range of services and interventions that promote human flourishing, such as: engagement with the arts and culture to stimulate the creative imagination; a healthy discovery of meaning, self and personal agency; engagement with nature to provide a sense of wholeness, wonder and well-being; physical exercise and sport to energise the body and mind; engagement in voluntary work to lift people from self-absorption and melancholy, and to enable them so they are useful and valued members of society; and meditation to impart calm and perspective. All this is ancient wisdom that is being rediscovered by more and more people. This rediscovery is, indeed, innovative and the Bill requires ICBs to promote innovation.
In no sense am I suggesting that such practices should substitute for modern medicine where diagnosis and good sense indicate that modern medicine is needed. Modern medicine achieves extraordinary things, but too often we resort to it without first considering non-clinical approaches. As a society, we are over- medicating; witness the almost exponential growth in the prescribing of antidepressants. Our national passion for the NHS should not be an addiction. The NHS needs, gently but firmly, to steer us into asking less of it and taking more responsibility for maintaining our own health. That should be a new norm built into the legislative framework for the NHS that the Bill provides. Unless that happens, the system will collapse under the burden of the demands and expectations that it has created.
Unless the Government systemically address the social determinants of health, we shall not have a healthy society. The Bill, harking back to the time of Aneurin Bevan, who as Minister for Health was also Minister for Housing, rightly describes the provision of housing as a health-related service. Amendment 90 goes further, to insist on well-designed housing and urban and green environments. Research evidence shows that living in greener urban areas is associated with lower probabilities of cardiovascular disease, obesity, diabetes, asthma and mental distress among adults, and obesity, poor cognitive development and myopia in children. In every place that ICBs serve, they should be promoting debate about what good urban design should mean and how it should be achieved. Encouragingly, in the new Ebbsfleet Garden City planners are co-locating cultural facilities alongside a health and well-being hub.
There is a substantial and growing body of high-quality research and evaluation demonstrating that creative health and other non-clinical approaches, as the All-Party Parliamentary Group on Arts, Health and Wellbeing said in its report, Creative Health,
“can help keep us well, aid our recovery from illness and support longer lives better lived … the arts can help meet major challenges facing health and social care: ageing, longterm conditions, loneliness and mental health”,
and
“the arts can save money in the health service and social care”.
Since the publication of that report in 2017, there has been increased recognition of this among health policymakers and in the clinical establishment. Research has been commissioned. The NHS long-term plan, with its new emphasis on prevention, acknowledged the benefits of social prescribing. The National Academy for Social Prescribing was set up. Link workers, linking GPs with community providers, are being funded, though not the community providers themselves. NASP has allocated £1.8 million to its thriving communities fund to increase the scale of social prescribing activities, and the Government have a £5.8 million cross-departmental project aimed at preventing and tackling mental health through green social prescribing.
However, this activity is still marginal and its funding almost indiscernible in the NHS budget. Amendments 104 and 105 make clear that an ICB has the power to fund non-clinical providers and that there must be financial equity between clinical and non-clinical providers. If the NHS will struggle to provide enough initially, the wider levelling-up strategy should enable that funding.
Non-clinical health providers cost a fraction of conventional medicine and represent remarkable value for money. The Evaluation Report of the Social Prescribing Demonstrator Site in Shropshire showed significant improvements in health factors such as weight, physical activity, smoking and blood pressure, and a reduction of up to 40% in GP appointments. Dance is inexpensive to lay on. As the Dancing in Time project in Leeds showed, by improving gait, flexibility and strength, it reduces falls among the elderly, who are expensive to repair.
To fail to invest on a reasonable scale in creative health and other non-clinical services is to look a gift horse in the mouth. This is recognised in some ICSs, with which the National Centre for Creative Health, a charity which I chair, is working on pilot schemes. In the Shropshire, Telford and Wrekin ICS, the personalised care team is using creative health and co-production methods with children and young people suffering from asthma. In the Suffolk and North East Essex ICS, clinicians looking for ways to support patients with long Covid have introduced singing for breathing, which is beneficial for lungs and loneliness. Creative Minds in the South West Yorkshire trust has developed creative activities that now benefit the physical and psychological well-being of 6,500 people a year. One user of the Creative Minds “Art for Well-being” programme, Debs Teale, a trustee of the NCCH, said:
“I am eternally grateful to … Creative Minds for giving me the wonderful opportunity to discover a mind released from the fog of depression. I have been five and a half years medication-free”.
5.30 pm
The Lived Experience Network, or LENs, brings together people with lived experience of ill health who provide powerful personal testimonies of the benefits of creativity and the arts to their own health and well-being. As the Bill recognises in the requirement for ICBs to promote the involvement of each patient, the voices of people with lived experience should always be heeded as we shape the health service and consider the prescriptions and treatments that are appropriate.
The culture of the NHS is predominantly science-based, technical and bureaucratic. Doctors and nurses of course seek to imbue their practice with empathy. Some of the wise among them recognise, in the words of Dr Elaine Yeo, in a recent letter to the Guardian, that
“general practice is an art—the art being when to use the science.”
It is time the science knew when to use the art.
Medical education and training, which the Bill states it is the duty of ICBs to promote, must be the fountainhead of culture change in the NHS. The education of clinicians, public health specialists and other health and care professionals should follow the example of pioneering medical schools, such as the University of Exeter Medical School, which has a compulsory study unit enabling students to work with creative practitioners. A new master’s in creative health at UCL has a strong practice-based component, delivered in partnership with community organisations. In York, Dr Nicola Gill delivers a CPD course for GPs on the power of the arts and the value of community-based resources for self-care and care of patients.
Noble Lords will have understood the purport of the amendments in this group and it would be excessively laborious for me to explain each one. I invite the Committee to look at them as a whole and to consider whether ICBs should be under a legislative duty to work in full partnership with non-clinical providers to gain the benefits they can offer for the health and well-being of individuals and communities.
As the noble Lord, Lord Mawson, reminded us in an earlier debate:
“A human being is fundamentally a creative being.”—[Official Report, 13/1/22; col. 1237.]
I know that the Minister, the noble Lord, Lord Kamall, will need no persuasion of the salutogenic virtues of the arts. He is himself a musician—a bass guitarist, indeed. I do not know whether his band is still called Exiled in Brussels; I hope he has not renamed it Exiled in Whitehall, because, like all of us, he needs to think positive, not least in accepting these amendments. I beg to move.