Chris Annus is a trustee of Paintings in Hospitals and Service Innovation and Evaluation Manager for the British Heart Foundation. Chris joins our 60 Years, 60 Voices series to tell us about the history of art in healthcare and where the sector needs to go from here...

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When the north wing of St Bartholomew’s Hospital was being built in 1733, the governors were considering offering a commission to the Venetian artist Jacopo Amigoni to paint a mural for the new building. Not to be upstaged, and in a gesture of supreme self-promotion and a PR coup, William Hogarth offered his services for free. The result is a huge, bombastic theatrical backdrop of a painting, striding the stairs to the great hall depicting a sorry group of diseased and ailing bodies presented like a dystopian line-up of X Factor hopefuls.

‘The Pool of Bethesda’ is ostensibly a religious-themed painting of Christ healing the sick (it is in a hospital after all). The perceived wisdom is that it was also an aide-mémoire for medical students to recognise the common symptoms that they were likely to encounter in 18th century England. (Never good to confuse your dropsy with a bit of gout tinged with a spot of melancholy...) Interestingly, it’s not the only hospital that Hogarth had links with, he also became an active Governor of the Foundling Hospital established just a few years later in 1739.

William Hogarth, Christ at the Pool of Bethesda (detail), 1735–1736

'The Pool of Bethesda' remains in exactly the same place where it was first installed all those years ago. I used to walk past this painting regularly for years whist working at Barts in the 1990s. The great hall is now used for meetings, exams and special events. It’s a stunning (if somewhat hideous) piece, though not one likely to instil confidence or calm in any patients who may have seen it at the time. (Their thoughts are, perhaps thankfully, not recorded.) Fast forward a few centuries and we have come a long way in terms of recognising the significant and moving impact that the arts can play in supporting healing and wellbeing and the profound difference it can make to peoples’ lives.

It’s interesting to consider some of the early pioneers. ‘A room without pictures is as bad as a room without windows’ commented a newspaper reporter in the Dumfries Herald in 1881, when commenting approvingly on the therapeutic environment of the Southern Counties Asylum in Dumfries. John Langdon Down commissioned paintings by the artist Marianne Moore for people with learning difficulties at the Normansfield Hospital in 1868. Theo Hyslop, superintendent of the Royal Bethlem Hospital from 1898–1911 was a keen artist himself who exhibited at the RA and encouraged his patients to paint and organise exhibitions. Imagination and creativity were seen as important therapeutic elements of the human psyche by many practitioners of the time providing an opportunity for self-expression, supporting the healing of both mind and spirit. Art in the asylum served multiple functions as it still does today in its contemporary Bethlem Museum of the Mind, which exhibits and celebrates the achievements of people with mental health conditions, while engaged in multidisciplinary research and developing partnerships across the UK and beyond. Our own wonderful and charismatic Sheridan Russell, founder of Paintings in Hospitals, began in 1959 to systematically acquire superb original works of art to more effectively humanise what were then quite cold and detached clinical settings.

'Life Under Water 4' and '...5' by Quentin Blake. Part of the Paintings in Hospitals collection. © courtesy of the artist, Paintings in Hospitals

The evidence for the efficacy of such programmes grew significantly from the 1970s onward, sparked by groundbreaking studies by researchers such as Roger S Ulrich, who demonstrated that post-operative patients who had a view of a natural tree-lined park from their hospital window, compared with a group staring at a brick wall, demonstrated more positive wellbeing scores, needed less pain medication and had shorter lengths of stay in hospital. The point made by one of the researchers was that ‘most ordinary perceptions have a way of entering the body and influencing the rates of healing and degrees of pain.’ Ulrich’s study sparked interest from doctors, administrators and art consultants alike. Similar programmes and studies demonstrated that high-quality, patient-focused arts programmes can provide significant therapeutic benefit to both patients and the system.

“Some patients will engage on intellectual levels with the works, while others will enjoy the visual stimulation the artwork provides: either way, their state of mind is altered by the presence of art.”

Rebecca Jennings, The Fine Art Group

Further fast-forward to two years ago when the All-Party Parliamentary Group on Arts, Health and Wellbeing published its landmark report Creative Health: The Arts for Health and Wellbeing in 2017.

This followed two years of extensive research, alongside roundtables and discussions with health and social care professionals, service users, artists, policymakers and parliamentarians from all parties to produce the most comprehensive overview of evidence in the field to date. The key findings of the report were that:

• The arts can keep us well, aid recovery and support longer lives better lived.
• The arts can help meet major challenges facing health and social care; ageing, long-term conditions, loneliness and mental health.
• The arts can help save money in the health service and in social care.

“If we want more health, we may need to shift our profile of investments away from health care towards other social investments that are more closely related to health outcomes.”

Greg Fell, Director of Public Health

The jury is no longer out; the case is proven for the systematic implementation of arts and wellbeing programmes in the health and social care sector as evidence-based best practice in service delivery and the evidence continues to build up.

Paintings in Hospitals has its own growing and expanding portfolio of evidence here.

“The conundrum that we have found ourselves pondering is why, if there is so much evidence of the efficacy of the arts in health and social care, it is so little appreciated and acted upon.”

Rt Hon. Lord Howard of Newport, Co-Chair, All-Party Parliamentary Group on Arts, Health and Wellbeing

We’ve come a long way since Hogarth, but we still have some way to go…

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Find out more about Paintings in Hospitals' art for health and social care…

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Chris Annus is a trustee of Paintings in Hospitals and Chair of the charity's Engagement Committee. Chris is also Service Innovation and Evaluation Manager for the British Heart Foundation. His team oversees the evaluation of new models of care, influencing policy and supporting the dissemination of evidence-based best practice. Chris has over 25 years’ experience establishing, commissioning and evaluating a range of Public Health and change management programmes across the NHS.