Category Archives: Health

Arts can help recovery from illness and keep people well, report says

GPs prescribing arts activities to some ill patients could lead to a dramatic fall in hospital admissions and save the NHS money, according to a new report into the subject of arts, health and wellbeing published after two years of evidence-gathering.

The inquiry report was published on Wednesday; a huge document that includes hundreds of interviews and dozens of case studies showing how powerfully the arts can contribute to people’s health and wellbeing.

David Shrigley illustration


Illustration: David Shrigley

Co-chaired by former arts ministers Alan Howarth and Ed Vaizey, the all-party inquiry contends that the arts can keep people well, aid recovery from illness, help people to live longer, better lives and save money in health and social services.

Lord Howarth said it was a comprehensive review of evidence that had never been produced before. “Sceptics say where is the evidence of the efficacy of the arts in health? Where is the evidence of the value for money it can provide? We show it in this report.

“The arts can help people take responsibility for their own health and wellbeing in ways that will be crucial to the health of the nation.”

Art helps you see


Illustration: David Shrigley

The report was welcomed by the current arts minister, John Glen, appointed five weeks ago. He pledged to act on its recommendations, saying: “This sort of work isn’t window-dressing, please don’t be cynical about it. It gives a dataset and some real stories that we can use as we go through the treacle of Whitehall.”

The case studies include an Artlift arts-on-prescription project in Gloucestershire where patients with a wide range of conditions, from depression to chronic pain to stroke, were referred to an eight-week course involving poetry, ceramics, drawing, mosaic or painting.

A cost-benefit analysis showed a 37% drop in GP consultation rates and a 27% reduction in hospital admissions. That represents an NHS saving of £216 per patient.

The Strokestra project between the Royal Philharmonic Orchestra and Hull stroke service running a music-making service for patients


The Strokestra project between the Royal Philharmonic Orchestra and Hull stroke service running a music-making service for patients.

Strokestra, a collaboration between the Royal Philharmonic Orchestra and Hull stroke service, found that 86% of patients felt music-making sessions – which included percussion and conducting – relieved their symptoms and improved their sleep.

The report also includes contributions from artists including David Shrigley, who has provided illustrations, and Grayson Perry, who writes: “Making and consuming art lifts our spirits and keeps us sane. Art, like science and religion, helps us make meaning from our lives, and to make meaning is to make us feel better.”

Howarth said there were many examples of good practice and innovation around the UK, but also areas where little was going on.

'The arts' sun shining on a sunflower


Illustration: David Shrigley

“We are calling for an informed and open-minded willingness to accept that the arts can make a significant contribution to addressing a number of the pressing issues faced by our health and social care systems.”

The report makes 10 “modest and feasible” recommendations that would not need additional public spending or require new legislation, the report authors said.

They include setting up a philanthropically funded strategic centre to support good practice, promote collaboration and coordinate research.

There are also recommendations about politicians and policymakers from different areas working better together, something Vaizey acknowledged was an issue.

Arts minister for six years until being sacked by Theresa May, Vaizey added: “I was very conscious as a minister that I worked in a silo and it was incredibly hard to break out of that silo, incredibly hard to engage with ministers from other government departments. The arts, almost more than any sector, is a classic example where silo working does not work.”

The All-Party Parliamentary Group on Arts, Health and Wellbeing report is available here.

Senior doctors call for public inquiry into use of vaginal mesh surgery in UK

Senior doctors have called for a public inquiry into the use of vaginal mesh surgery amid mounting concerns that a significant proportion of patients have been left with traumatic complications.

Speaking at a meeting in parliament, Carl Heneghan, professor of evidence-based medicine at the University of Oxford, drew comparisons with the thalidomide scandal, saying that there was evidence that mesh procedures, used to treat complications from childbirth, carry significantly more risk than official figures suggest.

“With thalidomide you could see the visual representation. [With mesh] you can’t see it,” Heneghan told the meeting. “We should have a public inquiry.”

Between 2007 and 2016, more than 126,000 women in England were treated with mesh implants, tapes and slings, for urinary incontinence and organ prolapse, according to figures obtained by the Guardian.

The procedures involve inserting a plastic mesh into the vagina to support the bladder, womb or bowel. In the majority of cases these operations are quick and successful.

However, speaking at the meeting in parliament, Heneghan and Sohier Elneil, a consultant urogynaecologist at University College Hospital, said that complication rates for some types of procedure appeared to be unacceptably high, and raised questions about whether the surgery was being used inappropriately.

Elneil said that unpublished research by her team, based on Hospital Episode Statistics, suggest that urinary incontinence surgery has a readmission rate of 8.9% and that most of these patients required some form of subsequent procedure. “These are not minor complications,” she said.

By contrast, a report by the Medicines and Healthcare Products Regulatory Agency (MHRA), the government watchdog, suggested a roughly 1-2% rate of pain or “erosion” for mesh procedures related to incontinence.

Heneghan cited a Lancet study, which showed that the readmission rate for one form of mesh surgery for prolapse was 19% – although the figure varied depending on the type of procedure.

The meeting came as a group of patients in the UK are preparing a class action against manufacturers. David Golten, a partner at Wedlake Bell LLP, claims his firm is already representing 200 women. Previously, there have been huge payouts linked to lawsuits in the US and a major trial against Johnson & Johnson began in Australia last week.

Lawyer Rebecca Jancauskas, left, with Gai Thompson, Joanne Maninon and Carina Anderson, members of the class action against Johnson & Johnson which began in Sydney last week.


Lawyer Rebecca Jancauskas, left, with Gai Thompson, Joanne Maninon and Carina Anderson, members of the class action against Johnson & Johnson which began in Sydney last week. Photograph: Paul Miller/AAP

The meeting also heard a series of harrowing testimonies from patients who had experienced life-altering complications due to surgery.

Karen Preater, 40, from Rhyl, described how she was left with intense pain after having mesh surgery to treat incontinence. “My kids don’t remember the mum from three and a half years ago. I don’t do the things I used to do,” she said. “I can categorically say, if I didn’t have my children I wouldn’t be here today.”

Carol Williams, 58, also from North Wales, broke down in tears as she told the meeting how she had been admitted to the Priory clinic after becoming suicidal due to an escalating series of complications brought about by her surgery for pelvic prolapse.

Others spoke of “cheese wire” pain, removal of organs that had become ensnared in the mesh, loss of their sex lives and the psychological toll of not being listened to by their doctors. One women said she was being treated for post-traumatic stress disorder “like a soldier coming back from Afghanistan”.

In some cases, the patients had opted for what they said was presented as a “quick fix” to treat problems that were annoying but not debilitating, such as mild urinary incontinence.

John Osborne, a retired gynaecologist, said that when the procedure was introduced in the 1990s, it was used far too liberally, in the absence of good evidence on the risks.

“Surgeons were saying ‘no problem, I can fix you up with a little mesh’,” he said. “The mesh was being put in too many people, too easily. I’m not saying that mesh should be totally banned, but not used in the numbers that it has been.”

If problems occur, having the procedure reversed is a complex and risky procedure because the mesh, which is designed to be permanent, becomes embedded in the surrounding tissue. Kath Sansom, founder of Sling the Mesh campaign, described this as like “trying to remove chewing gum from matted hair”.

The meeting in parliament was organised by Owen Smith, the Labour MP for Pontypridd, and Sling the Mesh, a campaign group that is calling for the procedure to be banned.

However, other doctors have cautioned that problems have arisen mostly due to aggressive marketing of substandard products by companies and, in some cases, inadequate training on the part of doctors.

Mark Slack, a consultant gynaecologist at Addenbrookes Hospital in Cambridge, said: “The TVT [the most common mesh procedure] is a good operation if done by the right people by the right indications,” he said.

“We now for the first time have masses of patients coming in and saying ‘You’re not going to put mesh in me are you?’” he added. “There’s a danger of creating a massive problem.”

Alternative treatments for incontinence and prolapse also carry risks, he said – and in some cases the complication rates could be worse.

In a statement, the MHRA said: “Patient safety is our highest priority and we sympathise with women who have suffered complications after surgery.

“We are committed to help address the serious concerns raised by some patients. We have undertaken a great deal of work to continuously assess findings of studies undertaken by the clinical community over many years, as well as considering the feedback from all sources in that time.

“What we continue to see is that evidence supports the use of these devices in the UK for treatment of the distressing conditions of incontinence and organ prolapse, in appropriate circumstances. This is supported by the greater proportion of the clinical community and patients.

“In common with other medical device regulators worldwide, none of whom have removed these devices from the market, we are not aware of a robust body of evidence which would lead to the conclusion these devices are unsafe if used as intended.”

Music and poetry aren’t luxuries: they literally saved my life | Sam Walker

I’ve suffered from severe anxiety and depression since the age of 20. I tried again and again with many approaches to fight back against mental illness: therapy and exercise; cognitive behavioural therapy; medication; trying to be more open with the people closest to me. All of these things helped in different ways but they didn’t completely fix me.

Towards the end of my 20s I couldn’t cope. On numerous occasions I fantasised about taking my own life. I was in a lot of pain but it was a pain that nobody else could see, so it didn’t feel justifiable to me. It didn’t feel like it should have been there.

In my darkest time, I made a decision that I had one last thing to try – and that was to stop hiding. I couldn’t keep up this double life, portraying happiness to everybody. It started with a poem. I found that putting my thoughts and feelings into poetry somehow made them easier to say.

When I’d written poetry previously, I didn’t feel that I could share it as it was still too exposing for me, but this time, as a last attempt, I did something terrifying that later turned out to be absolutely necessary for me. I filmed myself performing the poem and posted it online.

The response I got turned out to be life-changing. It transformed how I saw everything that was happening to me because for the first time I was showing that I wasn’t afraid to talk about it. That was the biggest step I’d taken.

Poetry then turned into music when I realised that these words could be lyrics. That became my next weapon in the battle against depression. When I write a song like Smile All the Time, I’m able to be far more honest than I would be if I was in a general conversation. When I perform as Samantics, I release so much energy that it becomes very cathartic. I’ve experienced huge benefits from both writing and performing.

Since that first video went live, I’ve been contacted by so many people thanking me for saying what they feel yet couldn’t bring themselves to say. That gives me a purpose and makes me feel happy to be me, which is rare. I’ve been told that I’ve helped explain something that somebody didn’t fully understand before. Music has a way of reaching people without being intrusive – I feel that’s especially important when supporting young people through mental illness.

Medication and therapy can be helpful for some but for many young people who are struggling to express themselves and end up bottling their emotions, music and poetry offer hope, something to hold on to, plus a new focus with new methods of release. It’s something that they can keep coming back to as a positive anchor, something that doesn’t trigger worry around potential side effects or cost, and that can be a source of connection and community with other people.

That’s why I believe healthcare professionals, clinicians and commissioners need to listen to young people’s voices when shaping services and open up to the health and wellbeing benefits that the arts can bring. For me, music and poetry haven’t been some kind of nicety or luxury add-on, they literally saved my life. If our health services could embrace the opportunities presented by creative activities like writing, music-making and performing, they could save other people’s lives too.

Samantics contributed to the all-party parliamentary group on arts, health and wellbeing’s inquiry report, Creative Health, released tomorrow. It recommendsthat arts on prescription in the NHS into their commissioning plans and to redesign care pathways where appropriate. Also, that Healthwatch, the Patients Association and other representative organisations, along with arts and cultural providers, work with patients and service users to advocate the health and wellbeing benefits of arts engagement to health and social care professionals and the wider public.

Rise in life expectancy has stalled since 2010, research shows

A century-long rise in life expectancy has stalled since 2010 when austerity brought about deep cuts in NHS and social care spending, according to research by a former government adviser on the links between poverty and ill-health.

Life expectancy at birth had been going up so fast that women were gaining an extra year of life every five years and men an additional 12 months every three-and-a-half years.

But those trends have almost halved since ministers made a “political decision” in 2010 to reduce the amount of money it put into the public sector, said Sir Michael Marmot. The upward trend in longer life that began in Britain just after the first world war has slowed so dramatically that women now only gain an extra year after a decade while for men the same gain now takes six years to arrive.

The rate of increase was “pretty close to having ground to a halt”, Marmot said.

“I am deeply concerned with the levelling off; I expected it to just keep getting better. Since 2009-2015 it’s pretty flat, whereas we are used to it getting better and better all the time,” added Marmot, who published a major review of health inequalities for Gordon Brown’s Labour government in early 2010.

In 1919 men lived for an average of 52.5 years and women for 56.1 years. That rose to 64.1 years and 68.7 years respectively by 1946. Life expectancy then rose in an almost unbroken gradual upward curve to 77.1 years for men and 81.4 years for women in 2005 and again to 78.7 and 82.6 in 2010, the year David Cameron’s Conservative-Liberal Democrat coalition took office.

Since then life expectancy has continued to creep upwards, but at a slower rate, according to Marmot’s latest analysis. In 2015 average life expectancy in Britain was 79.6 years for men and 83.1 years for women, according to the latest Office for National Statistics data.

Marmot, who is the director of the Institute of Health Equity at University College London, denied the rise had stalled because there was a natural limit to how much life expectancy can increase. “It is not inevitable that it should have levelled off,” he said.

There is no reason why the UK could not emulate Hong Kong, where life expectancy for men is 81.1 years for men and 87.3 for women – the highest in the world – Marmot added. Hong Kong has overtaken Japan in terms of how long citizens can expect to live.

Marmot, who has also advised the World Health Organisation, did not claim that the introduction of austerity had led directly to life expectancy stagnating. But he highlighted that “miserly” levels of spending on health and social care in recent years – at a time of rising health need linked to the ageing population – had affected the amount and quality of care older people receive.

The long-term trend for NHS budget increases is 3.8% a year, with rises of 1.1% a year since 2010. “If we don’t spend appropriately on social care, if we don’t spend appropriately on health care, the quality of life will get worse for older people and maybe the length of life, too,” he added.

Marmot cited the growing numbers of deaths among the over-75s and over-85s and continuing high death rates from heart disease as other key potential factors in the stalling rise in life expectancy.

“Life expectancy has been increasing year on year for a generation, to the extent that we had begun to take it for granted as inevitable. But this authoritative analysis suggests this long period of improvement may now be coming to an end, with big implications for us all,” said a spokesman for the charity Age UK.

Cases of dementia and Alzheimer’s have been rising so rapidly that they are now the leading cause of death for both sexes, among women 80 and over and men 85+.

The increase in dementia and needs of the ageing population will place the NHS and social care services “under considerable strain” in the near future, Marmot added.

Dr Matthew Norton, director of policy at Alzheimer’s Research UK, said: “This report shines a spotlight on a hard truth: that unless we can find ways to prevent and treat dementia, deaths from the condition will continue to rise as our population ages. The reality today is that with no treatments to stop or slow the underlying diseases, the condition is placing an ever-growing strain on our health services.”

The Department of Health played down Marmot’s findings. A spokesman pointed out that the NHS had just last week been judged to be the best, safest and most affordable healthcare system out of 11 rich countries analysed in a major review published by the Commonwealth Fund, a respected US thinktank.

“Life expectancy continues to increase, with cancer survival rates at a record high whilst smoking rates are at an all-time low. We continue to invest to ensure our ageing population is well cared-for, with £6bn extra going into the NHS [in England] over the last two years and an additional £2bn for the social care system,” he added.

What’s the least stressful way to commute?

According to recent research, cycling to work can reduce your risk of early death by 40%. But if avoiding an early demise isn’t enough to get you on a bike, there’s also a more immediate benefit – if you commute by bike, you will feel less stressed and be more productive at work. A study last week in the International Journal of Workplace Health Management found that, for the first 45 minutes of work, employees who cycled in had less stress than those who travelled by car. And how stressed you feel early in the morning is apparently a strong predictor for how you will feel throughout the day. The authors say it “can shape how subsequent events are perceived, interpreted and acted upon”.

The solution

Given that cycle commutes in cities can be blighted by air pollution and heavy traffic, that there is a reduction in stress levels by biking to work may seem counterintuitive. Or it could be that other commutes are even worse. The study was done in Montreal on 123 employees at an information technology company and it was small – only 25 were cyclists. This is actually more than the country’s national average – only 6% of Canadians cycle to work. In Britain about 4% of commutes are on bikes. In contrast, in Copenhagen, which has prioritised cycling so that no car or bus can travel faster through the city than a bike, about 40% of commuter trips are by bike.

Even allowing for injuries and pollution, the risk-versus-benefit analysis for cycling comes down firmly in favour of pedalling as much as possible. A study of 264,377 people from the UK Biobank who were asked to record how they commuted found that during the five years of the study, those who did their commute by bike were less likely than any other commuters to die of anything. Walking to work reduced heart disease but not dying from cancer, and benefits were only seen at more than six miles a week. Studies show that, while cars are the favourite way to commute because they provide freedom and control, driving in heavy traffic and having to concentrate is stressful. Public transport may be even more stressful because it can be boring and you can’t control it. Think Southern Rail. Research shows that cycling wins out because commutes by bike are rated more interesting and exciting. Cycling isn’t always feasible – but some research suggests a third of people who drive to work live within a comfortable cycling distance. And the benefits of a cycling commute are also going to be felt after the journey home.

Art can be a powerful medicine against dementia | Nicci Gerrard

A few weeks ago, turning on the radio, I hear a voice saying that creative writing can help wounds heal faster. Startled, I turn the volume up. Volunteers were given small wounds; half were then asked to write about something distressing in their life, the other half about something mundane. The wounds of the confessional writers healed substantially more quickly. A thought or a feeling is felt on the skin. Our minds, which have power over our bodies, are in our bodies and are our bodies: we cannot separate the two. Words, self-expression, can tangibly help pain and suffering. Art can be medicine, for body and soul.

Over and over again, I am reminded of the transformative power of art. Answering the phone, I hear a deep and husky voice: “Doe, a deer, a female deer.” My mother, 85, frail, registered blind, bashed about by cancer and several strokes, is having singing lessons. At school, she was made to mouth the words of songs and she never sang again until now. Eighty years after being told she was tone deaf, her voice is being released. “Me, a name I call myself…”

Or recently I found myself in a hall in London, holding hands with a tiny woman from Jamaica and a large man from Birmingham, we dance. Bit by bit, our self-consciousness falls away and we grin at each other, laugh. Dementia has robbed them of their verbal ability – but there are many different languages, many different forms of embodied knowledge and ways that we can connect with each other.


Dementia can look like solitary confinement – and solitary confinement is a torture that drives most people mad

Or sitting in a church in Essex on a Sunday in June, I look across at my friend’s mother. She is in her 90s and has dementia. There are days when she is wretched, chaotic and scared, but each Sunday she is soothed and even enraptured by singing the hymns that she sang when she was a girl. The music has worn grooves in her memory and while she may not be able to speak in full sentences any more, she can sing Abide With Me in a true voice and her face, lifted up, looks young, eager, washed clean of anxiety. My friend thinks that at these moments her mother’s brain comes together, “like a flower reviving when it’s being soaked in water”. People with dementia, she says, need to be drenched in art.

And this is precisely what the report of an all-party parliamentary group inquiry into arts, health and wellbeing, to be launched on Wednesday 19 July, will say. After two years of evidence gathering, roundtables and discussions with service users, health and social care professionals, artists and arts organisations, academics, policy-makers and parliamentarians, its unambiguous findings are that the arts can help keep us well, aid our recovery and support longer lives better lived; they can help meet major challenges facing health and social care – ageing, long-term conditions, loneliness and mental health; and they can help save money in the health service and in social care.

Dementia is an area where the arts can radically enhance quality of life by finding a common language and by focusing on everyday, in-the-moment creativity. As Lord Howarth of Newport, co-chair of the all-party parliamentary group, said: “The arts have a vital role to play for people with dementia. Research demonstrates that visual arts, music, dance, digital creativity and other cultural activities can help to delay the onset of dementia and diminish its severity. This not only makes a huge difference to many individuals but also leads to cost savings. If the onset of Alzheimer’s disease (which accounts for 62% of dementias) could be delayed by five years, savings between 2020 and 2035 are estimated at £100bn. Those are powerful statistics, but this isn’t just about money; the arts can play a powerful role in improving the quality of life for people with dementia and for their carers.”

It’s what Seb Crutch and his team are exploring in their inspiring project at the Wellcome Foundation. It’s what is happening with Manchester Camerata’s Music in Mind or with Music for a While, a project led by Arts and Health South West with the Bournemouth Symphony Orchestra, with Wigmore Hall’s participatory Music for Life, with the project A Choir in Every Home and Singing for the Brain; with dance classes in hospitals and residential homes; with art galleries and museums that encourage those with dementia to come and talk about art.

One of a number of drawings by the artist David Shrigley, reflecting on individuals’ stories, that will be published with the report on arts, health and wellbeing on Wednesday.


One of a number of drawings by the artist David Shrigley, reflecting on individuals’ stories, that will be published with the report on arts, health and wellbeing on Wednesday. Photograph: David Shrigley

There are optimistic, imaginative endeavours going on all over the country, in theatres, galleries, cinemas, community centres, pubs, bookshops, peoples’ houses. It’s happening at a macro- and a micro-level. At a conference run by the Creative Dementia Arts Network, where arts organisations and practitioners gathered to share experience, I met two young students from an Oxford school who with fellow students go into local old people’s homes to make art: not the young and healthy doing something for the old and the frail, but doing it with them, each helping the other: this is the kind of project that is springing up all over the country.

I attended one of the monthly sessions at the Royal Academy in London where people with dementia who have been art-lovers through their life – and are art-lovers still – come to talk about a particular work, led by two practising artists. We sat in front of an enigmatic painting by John Singer Sargent, and there was an air of calmness, patience and above all, time, and there were no wrong opinions. There are many ways of seeing. People with dementia are continually contradicted and corrected, their versions of reality denied: it’s Sunday not Friday; you’ve already eaten your breakfast; I’m your wife not your mother; anyway, you are old and she is dead …. In this humanising democratic space, people were encouraged to see, think, feel, remember and express themselves. Slowly at first, they began to talk. There was a sense of language returning and of thoughts feeding off each other. They were listened to with respect and were validated.

Validation is crucial. We are social beings and exist in dialogue; we need to be recognised. In health, we live in a world rich with meanings that we can call upon as a conductor calls upon the orchestra, and are linked to each other by a delicate web of communications. To be human is to have a voice that is heard (by voice I mean that which connects the inner self with the outer world). Sometimes, advanced dementia can look like a form of solitary confinement – and solitary confinement is a torture that drives most people mad. To be trapped inside a brain that is failing, inside a body that is disintegrating, and to have no way of escaping. If evidence is needed, this report robustly demonstrates that the arts can come to our rescue when traditional language has failed: to sing, to dance, to put paint on paper, making a mark that says I am still here, to be touched again (rather than simply handled), to hear music or poems that you used to hear when you were a child, to be part of the great flow of life.

I think of the wonderful film Alive Inside, made about a project in a huge care home in America: an old man with advanced dementia sits slumped in a wheelchair. He drools; his eyes are half closed and it’s impossible to know if he is asleep or awake. A few times a day, soft food is pushed into his mouth. Then someone puts earphones on his head and suddenly the music that he loved when he was a strong young man is pouring into him. Appreciation of music is one of the last things to go. His head lifts. His eyes open and knowledge comes into them. His toothless mouth splits into a beatific grin. And now he is dancing in his chair, swaying. And then this man – who doesn’t speak any longer – is actually singing. The music has reached him, found him, gladdened him and brought him back into life.

It’s like a miracle – but one that happens every day, in care homes, in community halls, in hospitals, wherever kind and imaginative people are realising that the everyday creativity is not an add-on to the basic essentials of life, but woven into its fabric. Oliver Sacks wrote “the function of scientific medicine… is to rectify the ‘It’.” Medical intervention is costly, often short-term and in some cases can be like a wrecking ball swinging through the fragile structures of a life. But art calls upon the “I”. It is an existential medicine that allows us to be subjects once more.

Nicci Gerrard is a novelist and author and co-founder of John’s Campaign johnscampaign.org.uk

Art can be a powerful medicine against dementia | Nicci Gerrard

A few weeks ago, turning on the radio, I hear a voice saying that creative writing can help wounds heal faster. Startled, I turn the volume up. Volunteers were given small wounds; half were then asked to write about something distressing in their life, the other half about something mundane. The wounds of the confessional writers healed substantially more quickly. A thought or a feeling is felt on the skin. Our minds, which have power over our bodies, are in our bodies and are our bodies: we cannot separate the two. Words, self-expression, can tangibly help pain and suffering. Art can be medicine, for body and soul.

Over and over again, I am reminded of the transformative power of art. Answering the phone, I hear a deep and husky voice: “Doe, a deer, a female deer.” My mother, 85, frail, registered blind, bashed about by cancer and several strokes, is having singing lessons. At school, she was made to mouth the words of songs and she never sang again until now. Eighty years after being told she was tone deaf, her voice is being released. “Me, a name I call myself…”

Or recently I found myself in a hall in London, holding hands with a tiny woman from Jamaica and a large man from Birmingham, we dance. Bit by bit, our self-consciousness falls away and we grin at each other, laugh. Dementia has robbed them of their verbal ability – but there are many different languages, many different forms of embodied knowledge and ways that we can connect with each other.


Dementia can look like solitary confinement – and solitary confinement is a torture that drives most people mad

Or sitting in a church in Essex on a Sunday in June, I look across at my friend’s mother. She is in her 90s and has dementia. There are days when she is wretched, chaotic and scared, but each Sunday she is soothed and even enraptured by singing the hymns that she sang when she was a girl. The music has worn grooves in her memory and while she may not be able to speak in full sentences any more, she can sing Abide With Me in a true voice and her face, lifted up, looks young, eager, washed clean of anxiety. My friend thinks that at these moments her mother’s brain comes together, “like a flower reviving when it’s being soaked in water”. People with dementia, she says, need to be drenched in art.

And this is precisely what the report of an all-party parliamentary group inquiry into arts, health and wellbeing, to be launched on Wednesday 19 July, will say. After two years of evidence gathering, roundtables and discussions with service users, health and social care professionals, artists and arts organisations, academics, policy-makers and parliamentarians, its unambiguous findings are that the arts can help keep us well, aid our recovery and support longer lives better lived; they can help meet major challenges facing health and social care – ageing, long-term conditions, loneliness and mental health; and they can help save money in the health service and in social care.

Dementia is an area where the arts can radically enhance quality of life by finding a common language and by focusing on everyday, in-the-moment creativity. As Lord Howarth of Newport, co-chair of the all-party parliamentary group, said: “The arts have a vital role to play for people with dementia. Research demonstrates that visual arts, music, dance, digital creativity and other cultural activities can help to delay the onset of dementia and diminish its severity. This not only makes a huge difference to many individuals but also leads to cost savings. If the onset of Alzheimer’s disease (which accounts for 62% of dementias) could be delayed by five years, savings between 2020 and 2035 are estimated at £100bn. Those are powerful statistics, but this isn’t just about money; the arts can play a powerful role in improving the quality of life for people with dementia and for their carers.”

It’s what Seb Crutch and his team are exploring in their inspiring project at the Wellcome Foundation. It’s what is happening with Manchester Camerata’s Music in Mind or with Music for a While, a project led by Arts and Health South West with the Bournemouth Symphony Orchestra, with Wigmore Hall’s participatory Music for Life, with the project A Choir in Every Home and Singing for the Brain; with dance classes in hospitals and residential homes; with art galleries and museums that encourage those with dementia to come and talk about art.

One of a number of drawings by the artist David Shrigley, reflecting on individuals’ stories, that will be published with the report on arts, health and wellbeing on Wednesday.


One of a number of drawings by the artist David Shrigley, reflecting on individuals’ stories, that will be published with the report on arts, health and wellbeing on Wednesday. Photograph: David Shrigley

There are optimistic, imaginative endeavours going on all over the country, in theatres, galleries, cinemas, community centres, pubs, bookshops, peoples’ houses. It’s happening at a macro- and a micro-level. At a conference run by the Creative Dementia Arts Network, where arts organisations and practitioners gathered to share experience, I met two young students from an Oxford school who with fellow students go into local old people’s homes to make art: not the young and healthy doing something for the old and the frail, but doing it with them, each helping the other: this is the kind of project that is springing up all over the country.

I attended one of the monthly sessions at the Royal Academy in London where people with dementia who have been art-lovers through their life – and are art-lovers still – come to talk about a particular work, led by two practising artists. We sat in front of an enigmatic painting by John Singer Sargent, and there was an air of calmness, patience and above all, time, and there were no wrong opinions. There are many ways of seeing. People with dementia are continually contradicted and corrected, their versions of reality denied: it’s Sunday not Friday; you’ve already eaten your breakfast; I’m your wife not your mother; anyway, you are old and she is dead …. In this humanising democratic space, people were encouraged to see, think, feel, remember and express themselves. Slowly at first, they began to talk. There was a sense of language returning and of thoughts feeding off each other. They were listened to with respect and were validated.

Validation is crucial. We are social beings and exist in dialogue; we need to be recognised. In health, we live in a world rich with meanings that we can call upon as a conductor calls upon the orchestra, and are linked to each other by a delicate web of communications. To be human is to have a voice that is heard (by voice I mean that which connects the inner self with the outer world). Sometimes, advanced dementia can look like a form of solitary confinement – and solitary confinement is a torture that drives most people mad. To be trapped inside a brain that is failing, inside a body that is disintegrating, and to have no way of escaping. If evidence is needed, this report robustly demonstrates that the arts can come to our rescue when traditional language has failed: to sing, to dance, to put paint on paper, making a mark that says I am still here, to be touched again (rather than simply handled), to hear music or poems that you used to hear when you were a child, to be part of the great flow of life.

I think of the wonderful film Alive Inside, made about a project in a huge care home in America: an old man with advanced dementia sits slumped in a wheelchair. He drools; his eyes are half closed and it’s impossible to know if he is asleep or awake. A few times a day, soft food is pushed into his mouth. Then someone puts earphones on his head and suddenly the music that he loved when he was a strong young man is pouring into him. Appreciation of music is one of the last things to go. His head lifts. His eyes open and knowledge comes into them. His toothless mouth splits into a beatific grin. And now he is dancing in his chair, swaying. And then this man – who doesn’t speak any longer – is actually singing. The music has reached him, found him, gladdened him and brought him back into life.

It’s like a miracle – but one that happens every day, in care homes, in community halls, in hospitals, wherever kind and imaginative people are realising that the everyday creativity is not an add-on to the basic essentials of life, but woven into its fabric. Oliver Sacks wrote “the function of scientific medicine… is to rectify the ‘It’.” Medical intervention is costly, often short-term and in some cases can be like a wrecking ball swinging through the fragile structures of a life. But art calls upon the “I”. It is an existential medicine that allows us to be subjects once more.

Nicci Gerrard is a novelist and author and co-founder of John’s Campaign johnscampaign.org.uk

The man who may have secretly fathered 200 children

Twenty five years ago, when she was 35, Esther-Louise Heij made two decisions that would shape the rest of her life. The first decision went entirely to plan: it gave her the children she longed for. But the second decision would play out in a bizarre twist she could never have imagined, and would plunge her family into a sea of heartache that continues to this day.

Both decisions were brave to make a quarter of a century ago, and are testament to Heij’s judgment as well as her tenacity. First, she decided that although she was single, and had recently ended a 12-year relationship, she would forge ahead with her plans to become a mother by opting for IVF with donor sperm.

Second, and no less unusual at the time, she would make sure that her children would be able to trace their genetic father.

“Back then, the accepted wisdom was that donor children didn’t need to know,” she says. “But I felt it was their right to know. Where we come from, who our parents are – these things are important in anyone’s life, and I wanted them for my children.”

She heard about a clinic near Rotterdam whose director sounded forward-thinking, went along for a consultation, and was impressed.

“The doctor seemed very good at what he did,” she says. “He was a pioneer in his attitudes. He talked me through what it would be like to raise children on my own; he seemed very serious and professional.”

And he was supportive, too, of her hope that any children she had would be able to know their father. “He assured me that would be possible. He was an important doctor in a white coat. I trusted him; it never crossed my mind that I couldn’t.”

The doctor, Jan Karbaat, told Heij that he would find a donor whose physical attributes fitted into her family. “He asked me for pictures of my relatives, so he could find a good match. And he said he would make sure the donor was a man who would be open to being traced later.”

The Heij family.


The Heij family. Photograph: Joanna Moorhead

Heij and her children live in the southernmost tip of the Netherlands: their village, she tells me proudly, is on the only mountain in the country. “You won’t see scenery anywhere else in Holland like this,” she says, as we drive up the hill towards their house. Its hilltop position is fitting, because there have been many peaks and troughs to navigate for the Heij family.

During a long relationship with a partner, the one that lasted 12 years, she was pregnant twice; both times it ended in a stillbirth. Once she got the go-ahead for IVF from Karbaat, there would be nine unsuccessful attempts before she got a positive result. A daughter, Lotte, now 23, was born in 1994. Almost two years later, in 1995, Heij gave birth to a second child, Yonathan; Karbaat assured her the sperm was from the same donor.

Being a single mother of two was tough; but it was also the life she had wanted, and Heij has no complaints. The family moved around, supported by her work as a physiotherapist: living first in a village on an island in the north of Holland, then on an island in Norway.

She tried to be as open as possible with the children about their roots. “I told them: ‘A man gave his seed and that’s how you were born: if you want to know who he is you will get the chance to do that one day.’”

There were many children in the neighbourhood who didn’t live with both parents; but people asked questions that weren’t always easy to deal with, particularly for Yonathan. “They would say, ‘Where is your father?’ I made up a story about him being a man called Peter from Rotterdam, who was the captain of a ship, which explained why he was never around.”

One of the things that brought them back to Holland was Yonathan’s academic prowess: he was bright, and teachers at the small school in Norway felt they couldn’t challenge him sufficiently. Back in Holland, though, he flourished; Lotte, too.

When Lotte reached 16, she turned out not to have a burning desire to contact their father. Two years later, Yonathan took a different view. “For a boy to grow up without a father figure is a big thing; a father is important, especially for a boy. I wanted to know who he was: there were things I wanted to ask him. And I wanted to find out whether certain ways I behaved were connected with him – things that made me seem different from my mother and my sister, like that I’m much more laid back than they are.”

In 2011, Yonathan and his mother approached the organisations that should have been able to get the information she needed from Karbaat’s clinic. The news that came back was worrying: the files were in disarray, records had not been properly kept, and it was going to be difficult to find out who their donor was. What had originally seemed like an easy quest was going to be a much tougher haul; but they pressed on, making phone calls and filling in forms and requesting information.

Yonathan and Lotte speak to journalists prior to a court decision last month.


Yonathan and Lotte speak to journalists prior to a court decision last month. Photograph: Remko de Waal/EPA

At the same time, though, they became aware of growing suspicions about Karbaat’s clinic. “Rumours were rife,” says Yonathan. There were stories starting to circulate that the sperm donors had been fellow doctors, medical students; but the biggest upset of all were rumours that Jan Karbaat himself had provided much of the sperm that had impregnated his patients.

“We were in shock – it was a feeling of total disbelief. Karbaat was a doctor, and to use his own sperm to get women pregnant would have been totally prohibited. It was difficult to process the enormity of what this meant. But right away I thought: ‘This man could be my father.’ I was scouring pictures of him, looking for physical similarities.”

Yonathan was thrown into emotional turmoil. He had previously written to Karbaat asking for information about his father, and the letters had been returned unopened. “I thought, is that how little he cares? He seemed so cold, so arrogant. And this man could be my father – it was all very hard to come to terms with.”

Then a documentary about the clinic, shown on Dutch TV, raised the disturbing possibility that as many as 200 children could have been fathered by the same sperm donor.

“Yonathan was watching the television, saying: ‘These could be our brothers and sisters,’” says Heij. “A lot of them were very intelligent, just like him; and we were looking at them thinking: ‘Do they look like Yonathan and Lotte?’”

The family was thrown into a quandary, and found themselves at the centre of a very public controversy: eventually, both children gave DNA samples to find out whether they were related to any of the others conceived at the clinic who were now seeking answers.

Groups of individuals were found who were related to each other, but there seemed to be no sibling match for Yonathan and Lotte. “It was disappointing,” says Yonathan. “I hoped I would find at least some siblings. But I still wanted to know who my father was. Some people were saying: ‘If your father was Karbaat, maybe it would be better not to know.’ After all, he’s turned out to be an unscrupulous man. But I said no, I still want to know – however bad he was, he must have had some good qualities. It was like part of my identity was missing. I knew I needed to find out the truth.”

Over the past 18 months, a group of families whose children were born via IVF at Karbaat’s clinic have started legal proceedings to allow them to do DNA tests using cells from Karbaat.

Karbaat opposed the move, but he died, aged 89, in April this year. Police seized personal objects from his home, including his toothbrush, and a ruling on whether the DNA taken can be released to the families is expected shortly. In the meantime, though, the Heij family’s own DNA tests have proved Yonathan and Lotte are definitely full siblings, and that their father is most likely to come from central Europe.

The Heij family.


The Heij family. Photograph: Courtesy Esther-Louise Heij

The situation is changing all the time, says Yonathan: one of Karbaat’s acknowledged children has now been DNA-tested, and the results of that test suggest it’s less likely the Heij children are Karbaat’s, though by no means certain.

“Everything is up in the air now. I’m conscious that I may get a phone call tomorrow telling me who my father was, or I might have to wait 20 years,” he says. “It feels like waiting to find out whether you’ve won the lottery, but knowing you probably will.”

Indeed, according to Laura Bosch, of Defence for Children in Leiden – the legal organisation representing the Heijes and other families – that is precisely the point: technological advances, she says, have made ethical issues concerning paternity identification redundant.

“The existence of large DNA databases mean it’s getting easier and easier to trace a donor parent – it’s no longer feasible for anyone to say donors have the right to anonymity. I would argue that in any case the child’s right to information should prevail, and takes precedence over the donor’s right to anonymity, but the landscape is shifting.”

The health minister of the Netherlands, Edith Schippers, has asked men who donated sperm pre-2005, when the right to anonymity was lifted, to do “a second good deed” and come forward to make it easier for their children to trace them.

The emotional turmoil has taken its toll on 58-year-old Heij, who seems tired, and is tearful discussing all she’s been up against. But when it comes to Karbaat, she finds it impossible to condemn him out of hand. “He made me a mother,” she says simply. “He gave me these wonderful children. But he was also arrogant and narcissistic. He seems to have thought he was better than other donors, that he was doing women a favour to get them pregnant using his sperm.”

For Yonathan, meanwhile, the saga has led to what might seem a surprising decision. “I’ve decided to become a sperm donor myself,” he says.

As he explains it, it makes perfect sense. “I know that any children born as a result will be able to find me in the future. And I feel I will be able to help them, I will understand their situation in a way some donors can’t, because I’ve been through everything they’re going through. I will be able to relate.”

On Karbaat, his feelings are mixed. “He was a clever man but it’s dangerous to allow someone to work with no brakes; he had a lot of power, and a big ego. He wasn’t honest with my mother or with other patients – he didn’t tell the whole truth. I feel he had good intentions but his methods were wrong – he didn’t do things the way they should have been done, and some of the things he should never have done at all.”

NHS holds on to top spot in healthcare survey

The NHS has been judged the best, safest and most affordable healthcare system out of 11 countries analysed and ranked by experts from the influential Commonwealth Fund health thinktank.

It is the second time in a row that the study, which is undertaken every three years, has found the UK to have the highest-rated health system.

The NHS has held on to the top spot despite the longest budget squeeze in its 69-year history, serious understaffing and the disruption caused by a radical restructuring of the service in England in 2013.

Its ranking is even more notable because the thinktank found the UK to put the fourth smallest amount of GDP into healthcare among the 11 nations. While the US spends 16.6% of its national income on health, the UK comes near the bottom, investing just 9.9%. Only New Zealand (9.4%), Norway (9.3%) and Australia (9%) put in less.

The UK emerged with the best healthcare system overall, just ahead of Australia, with the Netherlands a little further behind. A group of experts assessed them against 11 criteria designed to measure the effectiveness of different health systems.

“The UK stands out as a top performer in most categories except for healthcare outcomes, where it ranks with the US near the bottom,” according to the Mirror, Mirror 2017 report from the US-based Commonwealth Fund.

“In contrast to the US, over the last decade the UK saw a larger decline in mortality amenable to healthcare than the other countries studied,” the report says. Experts view that as a key measure, because it captures how well a health system is doing at preventing, detecting and treating illness.

Jeremy Hunt, the UK’s health secretary, lauded the NHS’s top ranking. “These outstanding results are a testament to the dedication of NHS staff, who despite pressure on the frontline are delivering safer, more compassionate care than ever,” he said.

“Ranked the best healthcare system of 11 wealthy countries, the NHS has again showed why it is the single thing that makes us most proud to be British.”

Supporters of the NHS are likely to use the Commonwealth Fund’s findings to rebut claims that the NHS is wasteful and inefficient. Theresa May has told the chief executive of NHS England, Simon Stevens, to ensure that the service uses its £120bn annual budget more efficiently.

The US was again judged to be the worst system, despite investing far more money than all the other countries. It spends 5.2 percentage points more of its GDP on health than France, which invests the second largest amount (11.4%).

The UK came first in four of the 11 categories. It was judged to deliver the safest care, be the best at “care processes”, provide the most affordable care and offer the most equity.

However, the gap between the UK and the next best-placed countries is narrowing. Those four categories are only half of the eight in which the UK came top in 2014, when the fund last undertook its in-depth multi-country research. The UK also came second for providing preventative and well-coordinated care.

But the NHS came 10th on healthcare outcomes, a category that measures how successful treatment has been – a significant weakness that was also identified in 2014. The experts concluded that the UK does very poorly in relative terms on five-year survival rates for breast and bowel cancer, and deaths among people admitted to hospital after a stroke, for example.

An NHS England spokesperson said: “This international research is a welcome reminder of the fundamental strengths of the NHS, and a call to arms in support of the NHS Forward View practical plan to improve cancer, mental health and other outcomes of care.”

Richard Murray, the director of policy at the London-based King’s Fund thinktank, said: “The UK’s ranking is welcome and reflects the strong fundamentals of the NHS. Universal access to health services, a founding principle of the NHS, is rightly recognised by the Commonwealth Fund ranking.

“Other international comparisons that are largely based on measuring the health of the population of the country do not always rank the UK as highly. The Commonwealth Fund also recognises these poorer health outcomes, and this is particularly stark given the cuts to public health spending that were announced recently.”