Ben questions the idea that increasing the scale of arts and health practice will drive up the quality of provision...

In January this year, the outgoing Chair of the Charity Commission, William Shawcross urged charities to “drop their obsessions with the next large public service contract” and to “stop measuring their success simply in terms of growth”. Though rarely someone I personally agreed with...does he not make a good point?

At a recent, impressive arts-and-health conference, the focus of panel conversations, whatever the topic or artform, frequently shifted back to growth. How could we scale it all up? What would be the lightbulb moment when the NHS said “yes, art will solve these problems” and roll programmes out nationally? Hunger for growth amongst speakers and the audience stimulated debate but there was no clear answer or timeframe.

What was clear was that scale was seen as a panacea. A scaled-up, national arts-in-health provider would be the moment we (other providers) got accepted by ‘the Commissioners’ as the consistent, credible alternative to medicalised treatments: no longer the fringe players or the alternative prescription but an easily dispensed, great-value solution to multiple health and social issues.

“As securing long-term funding becomes more challenging for us all, tight resources mean that to keep growing we get spread too thinly...”

But what happens if you already work at scale? If you already deliver programmes from Exeter to Middlesbrough, Cardiff to Ulster, what’s next? Paintings in Hospitals (still the only national visual arts in health charity) has in truth been guilty of what Shawcross cites above for some time: measuring our progress by our own scale, in how many NHS trusts we work and how many people experience our services. (For the record, we work with over 170 health or social care partners, reaching approximately two million people.) But this blunt measure can sometimes make me feel quite far away from the lives we touch and the positive individual experiences or recoveries our work might spark.

As securing long-term funding becomes more challenging for us all, tight resources mean that to keep growing we get spread too thinly or have to work too fleetingly with the people we are here to serve. Doing more with the same (or even less) income and staff is what many charities now take on. Perhaps an alternate definition of an ‘economy of scale’.

Sometimes scale comes at the expense of our own team's wellbeing, as we spend days on trains with dawn starts and run a Central London gallery six days a week to help support it all. Without the new injection of funding hoped for from the All-Party Parliamentary Group on Arts, Health and Wellbeing (APPGAHW) inquiry report, it is down to us to roll out the recommendations on our current resource levels.

'For the record, Paintings in Hospitals works with over 170 health or social care partners.'

The theory argues that scale means health sector acceptance and national buy-in, and that national buy-in means regular income, indefinitely. I would argue that this is probably never going to happen, particularly with the current challenges in NHS funding, Brexit in-fighting, and care crises. We should instead celebrate our moment as a burgeoning, vibrant and often grassroots sector that uniquely supports both wider national wellbeing and individuals’ health in exceptional and sometimes unquantifiable ways.

If scale and integration is the main priority, then would the best body to deliver arts programmes for health not be NHS England? Instead of growth, shouldn’t we focus on quality, particularly in the artforms we each champion? Our role as outsiders, the ‘third’ sector, is key.

At Paintings in Hospitals, we now feel it is okay to do less, but better. To improve wellbeing and quality of life, we have to keep pushing the quality of what we do, to strive to deliver artistic and creative experiences that are the best they can possibly be – whilst still making them person-centred and accessible. Where we need to measure it carefully, let’s of course do so, but let’s not make measurement itself dictate the type and quality of the creative experiences we offer.

“We should celebrate our moment as a burgeoning, vibrant sector that uniquely supports both national wellbeing and individual health in exceptional and unquantifiable ways.”

One definition of arts in health quality we might offer is to ‘deliver creative activity that is tailored, supportive and wellbeing-focused but ultimately indistinguishable from what people might pay for in a national theatre, museum or gallery space’. If we strive to measure quality or impact according to our growth, or continue to overlay the same evaluative methods used for medical drugs, we are immediately diminishing the powerful personal, human experiences and responses people have – and some of which might be lost with a more generic, universal ‘arts experience’? Perhaps growth needs to be seen as sectoral, as a national movement that grows in both quantity and quality.

The ideas of what quality means to us must be central as we endeavour to take the recommendations of the APPGAHW inquiry forward…at scale…but together.

Can you help Paintings in Hospitals and the patients, carers and communities we support?

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This blog was originally written for and published by London Arts in Health Forum