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Investing in arts reduces GP demand

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Creative Alternatives, the arts-on-prescription service of Sefton MBC, was founded in 2006 with the award of £210,000 from the Treasury’s Invest to Save budget.

  • Project: Creative Alternatives
  • Objectives: To improve mental health and wellbeing of local people through arts activities
  • Cost to authority: £70,000 per annum
  • Number of staff working on project: Eight
  • Outcomes: Average of 5.5 point improvement on Warwick and Edinburgh Mental Wellbeing scale as a result of programme access. A baseline for someone with average mental health is 27.7 in Sefton. Those entering Creative Alternatives display an average score of 18.45 and leave with an average of 23
  • Officer contact details: Philip Wroe

The programme was a pioneer in the use of cultural and arts programming to support adults with depression, stress or anxiety.

Since 2012, Sefton’s arts service has been transformed and reshaped both by restructuring and by the completion of a new multi-art form cultural venue: the Atkinson in Southport. The Atkinson is the result of an investment of over £17.8m from art fund Seachange, the North West Development Agency, Arts Council England, Sefton MBC and the Heritage Lottery Fund. It was one of the last major publicly funded cultural investments before the economic downturn and continues to be owned and run by Sefton MBC.

A social return on investment analysis said every £1 of Creative Alternatives expenditure results in £6.95 worth of benefits

This investment placed on the Atkinson the duty to support the wellbeing needs of Sefton’s large population of elderly people, mitigate the impact of social isolation and use culture to help promote social engagement, resilience and coping skills. The Atkinson became a wellbeing hub with Creative Alternatives playing a key role in serving this agenda as the in-house specialist wellbeing programme.

This opportunity allowed therapeutic arts to be embedded within a cultural centre from the outset, which is unique to Sefton MBC, rather than operating within designated healthcare or hospital settings as is the norm.

The Atkinson consolidates all of Sefton MBC’s arts and cultural programming on one site and incorporates theatres, cinemas, art galleries, a museum, a cafe, a library and tourist information. It also hosts the services of a number of partner organisations offering health-related support, activity and advice.



The current imperative for public and local authority services to forge new working relationships, along with the Atkinson’s multidisciplinary cultural offer, provides the unique chance to promote active, healthy and positive ageing in a co-ordinated way.

Creative Alternatives is now poised to drive home its message that the arts can serve the wellbeing of people with multiple needs in spite of economically challenging times, while operating alongside traditional services such as counselling, cognitive and behavioural therapies and life skills training.

A recent social return on investment analysis said every £1 of Creative Alternatives expenditure results in £6.95 worth of benefits. Over the eight years of operations, Creative Alternatives has achieved:

  • Demonstrable improvements to mental wellbeing among participants
  • Improvement in such lifestyle factors as diet, smoking and alcohol reduction and increased physical activity
  • Improved participant confidence, resilience and independence
  • Strong evaluation data for influencing public health policies and strategies
  • Fewer demands made on traditional healthcare or support services.

From the outset, Creative Alternatives was developed as a partnership between the arts service of Sefton MBC and the health improvement support service of NHS Sefton (now the public health directorate of Sefton MBC), which respectively oversaw arts management and health-related good practice and guidance.

The team engaged to deliver Creative Alternatives was a collective of freelance artists working across a range of disciplines, directly commissioned on rolling annual contracts by the arts service. This approach ensured that the delivery team was responsive to changing conditions and that costs associated with formal council employee status were avoided.

The core freelance commissions of referral officer and arts officer developed and operated the promotional, client management, evaluation, programming and artist recruitment aspects of Creative Alternatives. These roles were directly answerable to the arts service but took strong guidance on healthcare policy, networks, evaluation, targets and processes from the health improvement team.

During the first three years of programming we evolved, tested and matured client pathways, evaluation systems, data management, and arts commissioning and captured the impact of the programme on mental wellbeing.



Evaluation over this period demonstrated the effectiveness of arts interventions in significantly raising participant mental health and reducing GP visits, leading to a decline in the use of prescription medication and promoting independence and functioning. A number of ancillary benefits recorded included improvements to diet, smoking cessation and physical activity. All evaluation data gathered uses the Warwick and Edinburgh Mental Wellbeing Scale system and was collected by public health as part of its mapping of cross-programme healthcare impacts.

Following the ending of Invest to Save funding in 2009, Creative Alternatives operations continued through a cost-sharing partnership between the arts service and public health. The arts service benefited from the increased uptake of arts engagement by those isolated by ill health, while the public health team saw a decline in the reliance on traditional and more expensive interventions.

Creative Alternatives provides a schedule of arts-based workshops which run on a weekly basis in five-week blocks. The workshops are held in three locations across the borough in the Atkinson in Southport, the Bowersdale Centre in Seaforth and the May Logan Centre in Bootle. All of the programme’s clients are invited to make a weekly two-hour commitment to one of these workshops with each workshop accommodating up to 12 clients and facilitated by two artists with complementary skill sets. The creative processes explored reach range from more process-oriented, self-exploratory activities such as mindfulness meditation to product-oriented projects, focusing on the creation of particular artistic outcomes such as an exhibition or film.

Ancillary benefits included improvements to diet, smoking cessation and physical activity

Clients are invited to participate in an occasional specialist workshop programme which covers more technically complex or otherwise more demanding art forms, such as photography, drama, dance, and drumming. Each client is also invited to a varied social outings programme which includes visits to galleries, festivals, concerts and theatres. Invitations to the group outings also include former clients as a way of maintaining social and creative friendships.

Creative Alternatives is entirely free of charge to clients and all materials for activities are provided. The service has a rolling intake; new clients can join at the start of a workshop block as soon as a place becomes available. The service has approximately 96 places per year. Clients, on completing their time with the programme, are signposted to a number of mainstream arts workshops delivered by Creative Alternatives artists who provide a reassuring and familiar presence in order to ensure that programme benefits are sustained.

Creative Alternatives now delivers training, workshops and programmes for a number of organisations including Homestart (which works with vulnerable families), the Stroke Association, Positive Futures (which supports vulnerable children) and One Vision Housing and is sought by arts or healthcare professionals across the UK for advice and guidance as an example of good practise. While core Creative Alternatives programmes are non-profit, income is generated through delivering external workshops to staff or service users of other organisations. Creative Alternatives is a recognised brand in the field of arts in health and capitalises on its reputation by exporting its expertise for the delivery of other services across health or social care.

Philip Wroe, partnerships manager, The Atkinson


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