Summary of the impact

Norma Daykin's research has improved delivery and evaluation of arts and health programmes for clinical and non clinical populations. It has supported the development of arts on referral schemes and has led to more effective use of arts to benefit patients and staff in mental healthcare settings. It has enabled arts consultants Willis Newson to deliver much needed evaluation services and has shaped CPD provision, enabling artists and commissioners to develop and evaluate arts programmes. Her participation in national and international policy debates has contributed to the formulation of policy and strategy of arts organisations, healthcare providers and third sector organisations.

Underpinning research

The underpinning research has generated findings in two areas: benefits and risks of arts participation; and developing evaluation methodologies for arts and health. Research undertaken in 2002 at UWE by Norma Daykin (Senior Lecturer 1993-1996, Principal Lecturer 1996-2001, Reader 2001-2006, Professor 2006-present) identified benefits and risks of creativity for professional musicians (ref 1). These can transfer into therapeutic environments, including negative beliefs about creativity that shape inclusion and exclusion. From this followed a study in 2004 with Leslie Bunt, Professor of Music Therapy at UWE, which demonstrated the high value that patients place on expressive creativity as well as the complexities of using arts with vulnerable groups (ref 2).

This initial groundwork prompted further research with the UWE research team of Stuart McClean (Lecturer 2000-2004, Senior Lecturer 2004-present), Paul Pilkington (Senior Lecturer 2006-present) and Nick de Viggiani (Lecturer 2001-2002, Senior Lecturer 2002-present) with Daykin. In the evaluation of ArtLift (2008), commissioned by Arts Council England and Gloucestershire County Council (ref 3), Daykin, Pilkington and McClean reviewed an innovative programme of 15 artist residencies in GP and mental healthcare settings across Gloucestershire. The research evidenced benefits, including reduced anxiety and social isolation, of participation in activities such as poetry, ceramics, drawing and painting. The research showed which patients benefitted most, including those with mild to moderate mental health problems and physical conditions such as Parkinson's Disease. The findings included detailed recommendations for improving quantitative and qualitative evaluation practice, highlighting the need for training and support for artists and health practitioners (ref 3).

A long-standing partnership with Willis Newson Arts Consultants has generated findings to both areas described above. Daykin led the evaluation of `Moving On', (2005-7), a programme provided by Avon, Wiltshire Mental Health Partnership NHS Trust. The study, commissioned by the Estates and Facilities division of the Department of Health, used qualitative methods to investigate the impact of arts on patients and staff in mental healthcare environments (ref 4). It revealed the role and contribution of healthcare environments in enhancing patient care and staff morale, illuminating best practice in using creative arts to address stigma. The study demonstrated the value of qualitative methods including documentary analysis, interviews, focus groups and arts based methods such as photography (ref 4).

Evaluation methods were the focus of an evidence review led by Daykin and de Viggiani, commissioned by Youth Music in 2011. This assessed evaluation practice across a wide range of participatory music making, identifying a strong need for improved methodological understanding and appropriate evaluation tools. This has guided the Knowledge Transfer Partnership (2010-2012) between UWE and Willis Newson, led by Daykin (ref 5). In this, methodologies from previous studies have been re-examined for potential relevance to arts and health. These include consensus techniques developed by Daykin in an earlier study of best practice in user involvement in cancer services, led by Avon, Wiltshire and Somerset Cancer Services (ref 6). In this, Daykin refined the use of Nominal Group and Delphi techniques for engaging diverse health communities in service evaluation.

References to the research

Details of the impact

The ArtLift evaluation guided new arts on referral services in primary care. On the strength of it, £200,000 was awarded by NHS Gloucester for art groups reaching approximately 780 patients up to July 2012. The scheme is now embedded in clinical practice, funded by the Clinical Commissioning Group, with up to 60 patients receiving ArtLift `treatment' at any one time (source 1). The lead GP from Walnut Tree Surgery, acknowledges that Daykin's research was key to persuading doctors and funders to continue and enlarge on the work. Because of the evaluation, follow-on activities are targeted at groups that benefit the most. A wider debate was started about the importance of art and, `how we need to de-medicalise mild to moderate mental health issues' (source 2). The research is an acknowledged influence on work in other localities, such as Bristol's ArtShine inner city arts on referral scheme (source 3).

The Moving On evaluation brought together a multidisciplinary team of clinicians, artists and service users who carried out its key recommendations, securing charitable funds (2009) to establish a participatory arts project at a large Bristol NHS mental health hospital. A poet, a musician and two visual artists each delivered successive residencies for approximately 50 patients drawn from adult acute, rehabilitation and psychiatric intensive care wards, and an older adult unit. These patients recorded music and created permanent artworks that continue to enhance the hospital environment. The team created a toolkit and resources so that therapies staff could continue with the activities once the residencies had finished. The patients also took part in public performances and showcasing events. These reduced stigma, generating new community partnerships for the hospital. Therapies staff gained new creative skills and resources, reporting their practice as invigorated by the project. Senior clinicians and managers observed the positive impacts of the arts process, being persuaded to maintain three artists' employment on an ongoing basis. These impacts are documented in the report, co-authored by Daykin with Barbara Feldtkeller, the Trust's arts psychotherapy research lead (source 4).

The Director of Willis Newson acknowledges the significant impact of the KTP research on organisational learning and business development (source 5). By generating a framework for arts and health evaluation and a supporting library of tools, it supported the launch of a new consultancy service (source 6) that has evaluated arts and health programmes for NHS and Third Sector organisations, generating new income of £19,977 up to 31 July 2013. This has enhanced their reputation and strengthened their eligibility for grant funding, supporting sustainability, with new income of over £140,000 projected for evaluation services over the three years from January 2014.

Local impact is acknowledged by LightBox Community Interest Company, a Bristol based arts on referral project providing workshops to promote mental wellbeing. Without the research, `we wouldn't have been able to access the £200,000 funding we were subsequently awarded by BIG Lottery's Reaching Communities Fund' (source 7). The research also, `enabled us to critically appraise out achievements and weaknesses as an organization, and use that knowledge to continually improve how we engage with the public who access our resource' (source 7).

National level impact is also evidenced by Making Music, which represents over 3,200 voluntary groups across the UK. The research findings generated a CPD workshop on arts and health evaluation, well attended and received at their national conference in September 2011. Consequently, they were able to successfully launch a `Manifesto for Music and Wellbeing.' The Head of Development acknowledges the significant influence of Daykin's research on `the thinking behind many of our recent strategic decisions, and the drafting of funding proposals ... for projects in this important and largely misunderstood area' (source 8).

By identifying risks as well as benefits of arts, and linking this with improved evaluation practice, Daykin's research is widely acknowledged as encouraging arts organisations to adopt a more considered approach to their work. This has ensured their sustainability, and has generated wider benefits for the sector, through dissemination by local and national advocacy organisations (source 9). Daykin's research is acknowledged as helping to raise standards and increase effectiveness of arts in health activity across the UK. Over the last five years, it has, `influenced the way in which arts in health work is described, framed and examined.... Over this same period, the field of arts in health ... is much more widely accepted. This is not coincidental. Improved evaluation and a better approach to defining the impact of arts activity on health is a big part of the reason for arts approaches being adopted by clinicians and healthcare providers' (source 10).

Sources to corroborate the impact

1. The Art Lift Project can be accessed by referral by health professionals as well as self referral. Patients can access it through the website at: http://www.artlift.org/.
2. Testimonial available from UWE from a GP at the Walnut Tree Surgery.
3. The ArtShine Project can be accessed by patients through Bristol Arts and Health Forum, a partnership of statutory and non statutory organisations set up to promote and disseminate arts and health information in the locality.
   http://bristolartsandhealth.wordpress.com/2013/09/25/artshine/. A full description of the programme characteristics can be found in the evaluation report authored by the ArtShine team. This can be downloaded from: http://www.artsandhealthsouthwest.org.uk/evaluation.aspx?x=1&id=51.
4. The full report (45 pages) is Daykin, N. & Feldkteller, B. Arts@Callington Rd Project Evaluation Report. UWE Bristol/AWP NHS Partnership Mental Health Trust. September 2009. ISBN: 978-1-86043-448-8. Available from:
   http://hsc.uwe.ac.uk/net/research/Data/Sites/1/CallingRdFin%20(2).pdf. A summary of the project is available from the Willis Newson website: http://www.artshealthandwellbeing.org.uk/case-studies/arts-callington-road-hospital-bristol.
5. Testimonial available from UWE from the Director of Willis Newson.
6. Clients and the public can access information about the evaluation service through the Willis Newson Website: http://www.willisnewson.co.uk/our-evaluation-service.html.
7. Testimonial available from UWE from the Head of Business Development, Light Box Project CIC. Further information about the Light Box Project can be found on their website:
   http://wearelightbox.co.uk/page/about/
8. Testimonial available from UWE from the Head of Development, Making Music, The National Federation of Music Societies, London. The Wellbeing Manifesto was launched at the 2011 conference that had health and wellbeing as its theme and to which Daykin contributed a practitioner workshop on evaluation. Further details can be found on the website at: http://www.makingmusic.org.uk/our-work/music-and-wellbeing/conference-2011.
9. An example is Arts and Health South West, a regional membership organization with over 800 members. Daykin's research is regularly disseminated through their website and has been used to guide policy and strategy. There is a direct link to UWE's arts and health research programme: http://www.ahsw.org.uk/research.aspx?id=56.
10. Testimonial available from UWE from Damien Hebron, Director of London Arts in Health Forum, CAN Mezzanine, 49-51 East Rd, London, N1 6AH.