Innovation in Dementia Care: Positive Impact of Visual Arts Interventions [REF2021]

Description of impact

Knowledge and understanding generated by Bangor-led research resulted in impacts on: i) quality
of life; ii) dementia care improvement; iii) enhanced service provision; iv) public awareness of
dementia; v) public policy.
Improvements to quality of life
Bangor-led research showed that 37% of people with dementia experienced an increase in
wellbeing from the arts interventions [3.4]. As a consequence, Bangor researchers developed a
‘dementia supportive practice community’, initially bringing together 70 people living with
dementia, researchers, carers, health and social care providers to improve the quality of life of
those affected by dementia. This is now an established network with 540 members (acrossWales), utilising research findings and creative approaches to engagement. In 2019, 20 members
with dementia and their carers [5.1] were empowered to become advocates, representing people
living with dementia on international platforms, and becoming an established group of ‘dementia
educators’ working alongside research and teaching at Bangor University and undertaking audits
of public spaces (e.g. National Slate Museum) to guide improvements. In 2019, 1 person living
with dementia was formally recognised as an honorary fellow in the School of Health Sciences at
Bangor University [5.1].
Care improvement
Bangor’s collaborative research demonstrating the clinical and cost benefits of arts interventions
in dementia care [3.1, 3.2, 3.3, 3.4] informed the jointly-produced (with Manchester Metropolitan
University) practitioners’ guide for arts service delivery [5.2]. The guide exemplifies best practice
and enables care practitioners and providers to develop successful arts interventions, beneficial
for people with dementia and their carers. The guide has received over 10,000 downloads (up to
July 2020) and over 200 artists and health practitioners in England and Wales benefited from
Bangor-led training sessions. The 2015 training evaluation [5.3] indicates improved skills, e.g. “I
will introduce objects into my art sessions with older adults and allow more time for participants to
reflect and create” and being able to “take back new ideas to my workplace”.
Hedd Jones was awarded an Academic Fellowship by the National Assembly for Wales (2017),
working closely with Assembly Members to identify and implement best practice in dementia care.
She was a member of Social Care Wales committee (2018) developing a website of resources for
dementia care professionals, with the practitioners’ guide [5.2] selected to be part of the resources
[5.4]. In 2019 Bangor-led research was included in a Wales Public Health Network e-bulletin
(circulation: 1,415) showcasing arts and health projects in Wales [5.5].
Enhancing service provision
As a result of Bangor’s research collaboration, Denbighshire county council reported the beneficial
effects to their organisation of improving dementia service provision (via the arts) and were
consequently recognised as the best local authority arts project in the UK for encouraging
community cohesion, winning an award from the National Campaign for the Arts' Hearts for the
Arts Awards 2018 [5.6]. As a consequence of the research Flintshire Social Services secured
further funding in 2018 for a first round of wider (arts interventions in dementia care) delivery targeted at 81 new staff and extended it to 62 family carers. Feedback indicates the positive impact
of the training on carers [5.7].
The findings of the cARTrefu evaluation, and Bangor’s recommendations [3.5] led to changes to
national dementia service delivery. Age Cymru secured additional funding to extend the arts
interventions in dementia care service for 2 years. Changes were made, and the service delivered
an additional 864 arts sessions across care homes in Wales. A total of 1840 art sessions have
been delivered to 25% of care homes across Wales [5.8].
Improving awareness and understanding of dementia
The Dementia and Imagination research [3.1, 3.2, 3.3, 3.4] and the practitioners’ guide [5.2]
underpinned the delivery of Bangor-led workshops on living with dementia to 107 care
professionals in 3 venues in England and Wales. A workshop evaluation (2015) reported that
before the workshop, the most prominent words used to describe dementia were ‘loss’, ‘disease’
and ‘memory’. At the end of the session, perceptions changed, with ‘misunderstood’, ‘individual’,
‘support’ and ‘different’ receiving more responses [5.3]. Workshops in 2016 with over 150
members of the public and care professionals found similar changes in perceptions before and
after taking part. Care staff noted how “It helps me in terms of thinking about my career/ future: it
is a good example of how psychology and art can be used together” and it “raised awareness of
what is possible” [5.3].
Bangor curated some of the work generated by research participants and held 7 exhibitions in
national galleries (e.g. The Menier, London) and regional (e.g. public galleries, libraries and
hospitals in England and Wales) between 2017 and 2019. These art exhibitions provided members
of the public the opportunity to view dementia differently, illustrated by the quotes: “these works of
art are a reminder that even difficulties we may face, and weaknesses we may have cannot
overwhelm or overcome who we are as humans” and “a pleasure to see how dementia does not
have to be a barrier to achievement”.
Public Policy
The contribution of Dementia Services Development Centre Wales (DSDC Wales) to advancing
dementia care research is recognised in the 2018 Dementia Action Plan for Wales [5.9]. Bangor’s
expertise led to appointments to the Welsh Government taskforce for Implementation of the
Dementia Action Plan (Windle), and the Cross Party Group (CPG) for Arts and Health (Windle and
Algar-Skaife). Bangor-led research featured in case studies and was cited as a research exemplar
in an Arts Council Wales report informing how the arts are benefiting health in Wales, for a publicfacing campaign on arts and health [5.10]. Summaries of these studies were presented to the
CPG and circulated by the NHS Confederation in Wales to all Welsh Assembly Members
(February 2020). This led to plenary questions to the Minister for Health and Social Services
querying how the Welsh Government is supporting the use of arts to improve health and wellbeing in social care settings.

Impact Summary for the General Public

Dementia is a global public health priority with no cure and limited medical treatment. Bangor University leads interdisciplinary research in dementia care, with a focus on visual arts interventions. Through a combination of training, public events and the success of the collaboratively-produced online practitioners’ guide, ‘Dementia & Imagination’, for arts and health service delivery (with over 10,000 downloads) many people with dementia and their carers have benefited. Bangor-led research demonstrated how arts interventions improved the quality of life of people affected by dementia, with GBP5 of social value generated for every GBP1 invested (518% social value return on investment). Bangor research also led to enhanced dementia care serviceprovision, improved public perceptions and public policy influence.

Description of the underpinning research

Over the last decade, dementia policy rhetoric has changed, with WHO dementia policy calling for
creative approaches to improve societal attitudes towards dementia, acknowledging the potential
of arts activities for quality of life. Three Bangor-led studies developed evidence, training materials
and key insights, leading to integration of the arts into mainstream dementia care delivery. The
research was conducted in England and Wales by Professor Gill Windle, Director of Dementia
Services Development Centre Wales (DSDC Wales) and her team (Dr Catrin Hedd Jones, Dr
Katherine Algar-Skaife and Dr Carys Jones), combining quantitative and qualitative methods with
public involvement to address:
Health and cost benefits of the arts in dementia care
Windle led ‘Dementia and Imagination’ [3.a], an AHRC funded longitudinal mixed-methods
research programme (England and Wales), reflecting academic interdisciplinary collaborations
between six universities, one charity, two cultural organisations, one local authority and fifteen
artists. She led the development of a theoretically-informed visual-arts intervention consisting of
twelve 2-hour participative art viewing/making activities led by an experienced arts/health
professional [3.1]. This intervention emphasised provision of a stimulating, high-qualityexperience, demonstrating benefits to 115 people living with mild-to-severe dementia in diverse
settings (community, care homes, hospital day-centres) through validated measures of well-being,
quality-of-life and communication [3.2] (with Hedd Jones providing expertise in systematic
behavioural observation, generating novel quantitative ‘in the moment’ data on wellbeing). For 146
family or professional carers across the same settings, Windle found a positive impact on social
connectedness and wellbeing, improvements in how carers perceived the person with dementia
and enhancement of professional practice [3.3]. Jones and Windle found the cost of delivering the
programme was GBP189,498, but the social value generated was GBP980,717, leading to a base
case ratio of benefit to investment of GBP5.18 of social value generated for every GBP1 invested
in the intervention, demonstrating value for money [3.4].
The benefits of arts in care homes
Algar-Skaife led the Wales-wide evaluation of Age Cymru’s ‘cARTrefu’, an arts in care homes
project [3.5], the largest research evaluation of its kind in the UK. Arts activities (visual arts, music,
song and dance) were delivered by arts and health professionals in 2-hour workshops to 122 care
homes across Wales (19% of the sector), with 1543 residents taking part in at least one activity.
793 residents contributed to the evaluation, which found significant improvements to their
wellbeing. 272 care staff took part and reported qualitative improvements in skills and confidence.
Significant improvements in a validated measure of attitudes to dementia care were reported by
the 149 care staff who completed it before and after the arts interventions.
Developing the skills of the dementia care workforce
Windle and Algar-Skaife conducted research to examine the effect of ‘Creative Conversations’
[3.b] an arts-based intervention for developing the care and communication skills of the dementia
care workforce through a feasibility study, representing a partnership with a local authority and the
private sector. In four 2-hour workshops, care staff explored dementia education topics such as
‘understanding mood changes in people with dementia’ using novel creative materials (poetry,
film, music, visual art) to influence the development of compassionate communication. Led by
experienced arts and health professionals and delivered to 53 care staff in 14 care homes (50%
of care homes in Flintshire), the intervention validated staff skills and confidence, and provided
them with new ways to initiate, support and understand communication (verbal and non-verbal)
with their clients [3.6].

Beneficiaries and reach of impact

General Notes

[Previous title:Arts and Science for Dementia Care Innovation] This version of the REF2021 ICS was updated by the REF team to match the latest version of the ICS on 15.03.21.
Impact Evidence had already been added by ICS authors so have left in place (although may differ from ICS)
Additional output listed by previous authors of this Impact entry (The role of the visual arts..). All other outputs match REF2021 ICS.

Impact status	Ongoing
Impact date	2014 → 2020
Category of impact	Policy and Public Services, Health/Quality of life
Impact level	Benefit