Bringing NHS perspectives to the Senedd - Culture, Cymraeg and Sports Committee

The Welsh NHS Confederation is the only membership body representing all organisations making up the NHS in Wales: the seven local health boards, three NHS trusts (Velindre University NHS Trust, Welsh Ambulance Services University NHS Trust and Public Health Wales NHS Trust) and two special health authorities (Digital Health and Care Wales and Health Education and Improvement Wales). We also host NHS Wales Employers and are part of the NHS Alliance.

As the largest recipient of public funding in Wales, it is vital that the NHS is held accountable, and Senedd inquiries play an important role in supporting that scrutiny. The Welsh NHS Confederation has built strong relationships with Clerking teams across a range of Senedd Committees. These relationships have helped NHS organisations contribute evidence directly to Committee work and have supported previous Committee members to hear from NHS representatives. We hope this continues during the Seventh Senedd term so that Committees can draw on NHS expertise, understand how the NHS works with arts, culture and sport organisations, and scrutinise how the Welsh language is embedded into health and care services.

Alongside our work with NHS leaders in Wales, we work with wider stakeholders across the public sector and beyond. This includes key partners such as the Welsh Language Commissioner, Sport Wales, the Arts Council of Wales and the Office of the Future Generations Commissioner for Wales. We recommend that the Committee prioritises scrutiny of how arts, culture and sport contribute to health and wellbeing, with a particular focus on prevention, reducing inequalities, strengthening cross-sector partnerships and scaling evidence-based practice across Wales.

How culture and sport support people’s health and wellbeing

We recommend that the Committee undertakes an inquiry into how culture and sport support people’s health and wellbeing across Wales, including how existing partnerships can be strengthened and how effective practice can be scaled.

We welcome the Welsh Government’s dedicated Deputy Minister for Public and Preventative Health. Improving population health requires action on the wider determinants of health, including access to sport, arts and leisure. As our explainer on population health highlighted, many of the factors that shape people’s health and wellbeing sit outside the NHS.

We are aware of significant cross-sector work taking place across Wales to support people’s health and wellbeing. There is an opportunity for the Committee to examine what is working well, what barriers remain and where improvements are needed to support more consistent delivery across Wales.

We know that investing in arts, culture and sport is essential for improving health outcomes and securing better value for taxpayers’ money. Despite the fragility of public sector finances, now is the time to prioritise prevention and focus on how every pound spent can help reverse the decline in the nation’s health, address the root causes of health inequalities and enable people in Wales to live longer, healthier and happier lives.

Sport Wales has evidenced that for every £1 invested in sport, there is a £4.44 return. A 2023 study by Public Health Wales also found that, even at 2021-22 funding levels, around 113,000 cases of ill-health were prevented annually due to sport. With mental health issues increasing, sport and physical activity remain powerful but underutilised tools. Findings for 2022-23 showed better mental wellbeing among those who participated in sport at least three times a week.

In relation to arts and culture, Bangor University research commissioned by the Arts Council of Wales (ACW) revealed that ACW’s investment generated £11 in health benefits (quality of life gains, productivity gains and health and social care savings) for every £1 they invested.

How arts and culture have supported patients and the wider population

We recommend that the Committee considers how arts and culture have supported patients and the wider population’s health and wellbeing. An inquiry into arts and health would allow the Committee to examine the available evidence on the benefits of the arts for people’s health and wellbeing, as well as the barriers to further implementation across Wales.

Wales is leading the way in embedding arts and culture in NHS services. Dedicated arts projects in health settings support patient treatment, management and recovery. Following a mapping study of its activity in 2018, the Arts Council of Wales invested in several strategic programmes in this area, including co-funding arts and health coordinator posts in local health boards and Velindre University NHS Trust, supporting the ‘Health Arts Research People’ (HARP) innovation and research programme and creating a dedicated funding stream for arts and health projects in Wales.

A significant number of arts and health initiatives are being delivered across Wales. The examples below provide a snapshot of the range of activity the Committee could explore in considering how successful approaches can be supported, evaluated and scaled.

• Musical Hospitals in Swansea Bay University Health Board have empowered healthcare support workers and nurses to use more creative approaches by bringing artists in to support both patients and staff to be more creative day-to-day. This is especially effective in wards with high stress and staff sickness levels. Musical Hospitals led to a 30% reduction in sickness for nurses and 50% reduction in sickness for healthcare support workers.
• The Welsh National Opera (WNO)’s online singing programme for persistent pain led to 67% improvement in pain and discomfort and a 67% improvement in anxiety and depression for people participating. Hundreds of people are accessing the service every year.
• Iechyd Da-wns!/ Dance to Health structured falls prevention dance programme for the over 60s, which was devised by the charity Aesop Arts and Society Ltd. Iechyd Da-wns!/ Dance to Health is currently operating in four locations in Swansea. The Sheffield Hallam University Evaluation of Dance to Health’s UK programme suggested the sessions had the potential to save over £79m per year to NHS England by reducing the healthcare costs associated with falls.
• Working with local health boards, Arts Council of Wales and Baring Foundation have made a strategic investment in this area through their ‘Arts and Minds’ programme, funding arts activities for young people in NHS Children and Adolescent Mental Health Services (CAMHS) across Wales. Within this, Hywel Dda University Health Board's Arts & Minds project, Arts Boost, offers creative activities for CYP who are experiencing mild-moderate mental health problems and are known to the CAMHS team.
• Further examples and case studies can be found on Wales Arts Health and Well-being Network website.

The Committee could add value by examining what further national support is needed to move successful arts and health initiatives from isolated projects to sustainable, mainstreamed practice across NHS Wales and community settings. A significant amount of arts in health work happens at grass-roots level, through community-based programmes that address both clinical and social determinants of health. There is a need to scale up this work, increase public awareness and improve understanding of the role of arts in health. We need to encourage best practice, research and evaluation while celebrating and supporting the passion and drive of the many arts in health activities that make a difference. 

The Welsh Government’s key national objectives include improving health through prevention, delivering sustainable economic growth and quality jobs, and strengthening Wales’s national identity, including its language and culture.

Given the complexity and breadth of prevention, we would like the Committee to monitor how the new Welsh Government takes this agenda forward. This should include scrutiny of cross-government working, simplified healthcare planning and reporting processes, clearer priorities and fewer, more focused and realistic targets.

Our members strongly support a cross-government national strategy to improve health and reduce inequalities. Our joint report with the Royal College of Physicians, Mind the gap: what’s stopping change?, highlights the need for coordinated national action on the wider determinants of health - housing, green spaces, transport, food quality, and access to arts and leisure.

We welcome that the Deputy Minister for Public and Preventative Health is working on a definition of prevention. The Office of the Future Generations Commissioner for Wales has previously done significant work in this area, including on preventative budgeting, and we would urge the Deputy Minister to work closely with the Office of Future Generations Commissioner on prevention definitions and costings. 

The NHS has to balance prevention priorities with the need to reduce waiting lists. Prevention as default should apply across all levels of prevention, and the Welsh Government and NHS Wales Performance and Improvement should ensure prevention is embedded at the start of all clinical pathways, with performance measures adjusted to reflect this shift.

There needs to be a targeted focus on chronic conditions, including obesity and Type 2 diabetes. Obesity costs the Welsh economy an estimated £3bn per year and is exacerbating huge avoidable pressures facing our NHS. Excess weight can lead to many diseases, including type-2 diabetes, cardiovascular disease (CVD), liver disease, many types of cancer, musculoskeletal conditions and poor mental health.

While physical activity is only one part of tackling obesity, the current challenge in Wales means that sport must make an active contribution to a collective response. Sport and physical activity have the potential to be among the most effective preventative health tools in Wales. However, this will only be realised if their full potential is maximised across health services. We know that sport is already making a significant contribution to Wales through the nation’s Social Return on Investment Study.

Public Health Wales NHS Trust is leading a Whole Systems Approach to tackling obesity. This approach looks at the wider system and shows how different factors are connected in ways that can make it challenging for people to stay healthy. It brings together partners such as health organisations, local councils, businesses and schools to change the environments that shape health. By embracing this complexity, the approach can support stronger and more effective solutions with a better chance of making a real difference. This includes empowering local authorities to prioritise health and wellbeing when assessing planning applications for new takeaways. Betsi Cadwaladr University Health Board has been working with local authorities in North Wales on objecting to planning applications based on health and wellbeing grounds. The number of fast-food outlets in Wales has increased by 48% from 2010 to 2018, with 670 new establishments opening during this time.

We would also like the Committee to ensure that current community structures are working effectively, for example the Public Services Boards and Regional Partnership Boards using population needs assessment to identify the most significant inequalities in their populations and develop targeted plans to close the equity gap in health outcomes.

As the Committee’s remit is broad, we would encourage it to focus on a small number of tangible goals where the evidence for effective change is strongest. This should include the role of sport as a preventative health tool, the impact of arts and culture on health and wellbeing, and the practical steps needed to embed good practice more consistently across Wales. This would help ensure that scrutiny focuses not only on ambition, but on delivery, implementation and measurable impact for people across Wales.