Summary of the impact

The Department's impact on health and care has two strands that are mutually enriching: creative interventions in health and social care designed to benefit NHS service users and therapeutic client groups, and the application of innovative arts methodologies to health settings. The research impacts on health professionals, `user' groups and charities by:

• generating new arts-based methodologies for artists and health professionals that impact on the culture of care settings;
• challenging the culture of performance management and clinical governance by developing creative approaches to patient and carers' wellbeing;
• expanding the conceptual framework for creative practice in health settings.

Underpinning research

The research was undertaken by Professor Helen Nicholson and Senior Lecturer Emma Brodzinski who have been academics at Royal Holloway's since 2000, both members of Applied and Participatory Theatre Research Group. Their research investigates how cutting-edge performance practices challenge and expand conceptual frameworks in creativity and health, and how instrumental aims are met (and enhanced) by creative practice that is artistically innovative. Partnership with stakeholders is a defining feature of this research, where impact is generated through dialogue with stakeholders and researchers in cognate disciplines. This approach is evident in all cited publications.

The research questions address points of connection between creative practitioners and health professionals:

• How do artists contribute to the wellbeing, active citizenship and social capital of patients in health and social care?
• What are the implications of cultural policies that encourage creativity within the health and care sectors?
• How might cutting-edge arts practices generate new methodologies for creativity in health and care settings?

These research questions have been addressed systematically through two strands of funded research. Both strands of the research problematize the culture of performance management and clinical governance that permeates the NHS, arguing that arts interventions in health and care have the potential to serve a positive social function; enhancing well-being through performance.

Creativity in health and care: Interdisciplinary and inter-agency research

Brodzinski was funded by a joint funding scheme `The Nature of Creativity' supported by the AHRC/ESRC/DTI/Arts Council England and required researchers to work with non-academic partners to consider the nature of creativity and its relationships with innovation and risk. One of the key outcomes from this project was a Special Edition of Health Care Analysis which published inter-disciplinary papers authored by researchers and non-academic partners around the theme of creativity in health and care. Brodzinski's interest in creativity within the risk averse culture of the NHS led to a critique of toolkits, developed with an arts in health practitioner working with Open Art, an organisation that facilitate workforce training for healthcare settings. Her research shaped the training that practitioners were delivering to front-line NHS workers. The research addresses the application of theatre practices to hospital care, in medical training and as an advocacy tool for service users (2010).

The Arts in Dementia Care

Nicholson's research into dementia responds to national and international concerns about ageing populations. Working in partnership with the NHS and leading charities, this research challenges notions of `loss', `decline' and `failure' associated with dementia. It provides new insights into role of the arts in creating an emotional geography of home and sustaining relationship-centred care within NHS residential `units' for older adults. The research builds on a book co-authored with Brodzinski and Normington on devised theatre (2007), her monograph on applied drama (2005) and her research into performance and memory (2003, 2009). The research project supports two full-time PGRs, Jayne Lloyd (funded by Guy's and St Thomas's Charity) and Nicola Hatton (funded by AHRC).

References to the research

Research Grants

Brodzinski

• AHRC Small Grant in the Creative and Performing Arts: Theatre in Health and Care November 2005 — July 2006. £2838.42

• AHRC/Arts Council/ESRC/DTI Nature of Creativity Research Workshops Scheme: Creativity in Health and Care, May 2007 — April 2008. £14,527.65

Nicholson

• AHRB Research Leave to complete monograph, Applied Drama: The Gift of Theatre, January — March 2004. £14000

• London Creative and Cultural Exchange (LCACE) Grant to share training practices with Age Exchange Theatre Trust for artists working with older adults living with dementia, January 2008, £5000

• Nippon Foundation, Training for Artists and Professionals in Geriatric Care, Hiroshima, Japan, 2008. £6500

• AHRC Research Leave to complete monograph, Theatre, Education and Performance. January to May 2009. £45,066

• Age Exchange Theatre Trust and South London and Maudsley Charitable Foundation, Research and Evaluation of Hearts and Minds: A Reminiscence and Arts programme with people living with dementia and other mental health issues in residential care, January 2010- December 2013. £22,000.

• Guys and St Thomas' Charity. Research on creative methodologies and impact of artists on patient wellbeing and the culture of dementia care, January 2013-January 2016. £140,000 (with Dr Frank Keating, Department of Social Work).

Details of the impact

This research reaches two priority areas named in the Department's Impact Strategy: professional artists and the health and charitable sectors. By undertaking research with (rather than on) these sectors, the impact of the research builds incrementally as it is applied, tested and analysed.

Brodzinski's research into creativity in health and care has benefitted arts organisations, health and care professionals and medical education. As PI for a funded network on Creativity in Health and Care (2007-8), she worked in partnership with fourteen professionals from a range of health, care and creative sectors, including Arts Council England. This research has impacted on a range of settings. Within the NHS it shaped training sessions within the Strategic Health Authority and Regional Public Health Group for Yorkshire and Humber region. The director of We do (formally Open Art) acknowledges observes that the research project provided a framework within which to explain her arts practice in health settings. It provided the intellectual basis for `Culture Club' an initiative that provides a health messaging project for over 55s in Kirklees, attracting 350 members in the first year. She also acknowledges that the enquiry undertaken as part of the research project has fed directly into her strategic work as a regional representative on the National Alliance for Arts Health and Wellbeing — a national voice for Arts in Health supported by Arts Council England.

The collaborators on the creativity in health and care project contributed to a special edition of Health Care Analysis. The editor writes:

"Dr Emma Brodzinski's special issue of Health Care Analysis, the journal I edit, was extremely well regarded. I received very positive feedback during conferences on the philosophy of health care that I attended, particularly from people interested in the medical humanities and in the role that artistic and other creative activity can play in the provision of health care and therapy. This feedback came not just from academics but also from general practitioners of a number of European countries. I am myself drawing on this special issue in preliminary discussions that I am having with the National Library of Wales on the place of library provision and literature in the support of the 'expert patient'."

Brodzinski's research also impacts on medical education It has been used on the `Performing Medicine' course with medical students from St.Bartholomew's and King's College, where she was visiting lecturer 2006-8. The Chair of North East & Cumbria Learning Disability Clinical Network and Executive Director of Operating Theatre, a theatre company specialising in medical education and health care, acknowledges that Brodzinski's analysis of role play in Theatre in Health and Care has impacted on their training with medical students and health care professionals.

Nicholson's research into the arts in dementia care has impacted on professional artists and health professionals. Working with South London and Maudsley NHS Foundation Trust (SLaM), Guys and St Thomas's Charity, Age Exchange Theatre Trust and artists working in geriatric care, it has brought benefit in three distinct ways:

1) analyzing dementia as a cultural practice (as distinct from social or medical models of dementia) is influencing dementia care in London. The research has provided evidence of the benefits of creative involvement of professional carers, ancillary staff and family members as well as artists and activity co-ordinators in residents' care and care plans. This approach to care is reaching older adult services across South London (working with over 60 care staff, 100 residents and 25 artists).

2) It has brought a paradigm shift in the artistic practice of cultural organizations working in dementia care, particularly Age Exchange Theatre Trust, from person-centred reminiscence, which relies on the memory and cognition of people with dementia, to creating multi-sensory environments that encourage embodied memory and responses. This has benefitted over 100 people living with advanced dementia, and particularly those who are post-verbal.

3) The impact of this research is sustainable because improves the culture of dementia care; previous studies have measured the effects of the arts on individuals. Research findings underpinned Age Exchange's successful application to Guys and St Thomas's Charity (2012, £600,000), building capacity for the arts in dementia care.

Training in the arts and dementia care has been offered at: The King's Fund, April 2012 (120 artists and health professionals working with people experiencing dementia); SLaM and Age Exchange, December 2012 (30 managers of residential care settings); Trinity Laban, Age Gap Symposium (Paul Hamlyn funded) April 2013 (70 artists); Training workshops in Hiroshima, Japan in 2008, for 40 health professionals in geriatric care.

Sources to corroborate the impact

1. Director of the organization We do; statement on the usefulness of health professionals working with academic partners on creativity
   www.wedocreativity.co.uk/news/post.php?s=2013-02-07-partnerships-with-universities
2. The Chair of North East & Cumbria Learning Disability Clinical Network and Executive Director of Operating Theatre
3. Editor of Health Care Analysis
4. Artistic Director of Age Exchange Theatre Trust, www.age-exchange.org.uk for impact of research into the arts in dementia care.
5. Head of Mental Health Services for Older Adults at South London and Maudsley HNS Foundation Trust.
6. Director of Theatre Planning Network, and Japan Arts Council.
7. www.artworksphf.org.uk/page/resources-and-research (Report on Nicholson's contribution to Age Gap Symposium).