Abstract
Introduction
The Creative Health Quality Framework (CHQF) is a ground-breaking resource that clearly articulates what ‘good’ looks like for creative and cultural initiatives that aim to support people’s health and wellbeing. Launched in September 2023, it consists of a set of downloadable PDF resources based on eight Creative Health Quality Principles:
It offers clear guidance on how to use these principles to deliver safe and effective projects in a way that is flexible and adaptable to the wide range of contexts, scales and ways of working that characterises the creative health sector: ‘The Quality Framework does not seek to test or rank Creative Health work. Rather, it aims to acknowledge and celebrate the work, supporting us all to work together to reflect, develop and improve what we do’. (p. 3)
1
Why We Built a Framework
Culture, Health & Wellbeing Alliance (CHWA) Board discussions around ethics and the need for a code of practice began in 2020. Subsequent consultations and surveys identified several issues that a framework could help address:
Tension between calls to ‘standardise’ Creative Health work and the need to preserve its breadth and flexibility.
The absence of a shared language across creativity, culture, health and social care.
Concerns about managing risk, particularly with the expansion of social prescribing.
The persistent devaluation of practitioners’ expertise contributes to reduced confidence and marginalisation within both cultural and health systems.
Growing evidence of practitioner wellbeing challenges, exacerbated by reduced statutory support and the pandemic.
In 2019, Naismith’s research on affective support for artists 2 created momentum for more structured sector-wide work on quality and ethical practice. In 2021, the Baring Foundation commissioned CHWA to develop a ‘Model for Thriving Practice’ for creativity and mental health (p. 5). 3 The following year, Arts Council England convened a roundtable on quality. Building on this, Jane Willis – who had previously led Creative Health training on ‘The Question of Quality’ – approached CHWA to propose the development of a co-produced framework. CHWA, its members and Willis then led the process with support from Arts Council England.
How We Built The Framework
The CHQF was developed across 2021–2022 through a literature review and participatory process involving over 200 specialists from across England, including creative practitioners, participants, health commissioners and researchers. The iterative, reflective and co-produced development of the CHQF was informed by the emerging quality principles (see above).
The Framework’s Impacts
Evidence of the CHQF’s impact comes from several sources:
Independent evaluation by Outskirts Research involving more than 200 participants from arts, public and community sector contexts, engaging through surveys, polls, interviews, group reflections and in-depth case studies. 4
Responses to CHWA’s annual impact survey and biennial State of the Sector survey.
Feedback and intelligence gathered through training activity and requests for support from colleagues in the UK and internationally.
Overall, Outskirts Research found that the CHQF was widely regarded as flexible, accessible and thoughtfully designed. Participants noted that additional formats – including easy-read, audio and visual resources – would further improve access, subject to future funding. The framework was seen as adaptable across a range of contexts, supporting both practice development and partnership working with health colleagues.
Importantly, the CHQF was reported to increase confidence among freelance creative practitioners by validating their work and providing a shared cross-sector language for quality. It encouraged reflective practice and continuous learning, highlighting the importance of safeguarding and personal wellbeing. It has also helped freelancers and organisations initiate conversations about more supportive working conditions, including fair pay.
The evaluation concluded that the CHQF strengthened partnerships, improved ethical co-creation and informed responsive, sustainable project planning and continuous learning. It also ‘shows promise in fostering a shared language between commissioners, funders, and applicants’, with potential to enable more collaborative and sustainable creative health practice.
Although researchers and educators were involved in both the framework’s development and evaluation, they were not a primary focus of the evaluation. Nonetheless, findings suggest the CHQF ‘has potential to foster collaboration between practice and research’ including participant-led research approaches.
Reach
Google Analytics indicates that almost 13,000 individual users have accessed the CHQF via the CHWA website, making it the second most visited page on the site after the home page. (For context, there are roughly 7000 people signed up to CHWA’s mailing list, the majority of whom deliver creative health work.)
Evidence of uptake is also reflected in survey data. In CHWA’s 2025 impact survey (n = 38), over 60% of respondents reported using the framework. More than a third of respondents to the 2025 State of the Sector survey (61 of 175) had also used it, although only two-thirds of that cohort were based in England: “The CHQF is a brilliant tool that makes advocating, planning,” and talking about CH work so much better. Honestly can’t rave about it enough. More needs to be done to help other people become familiar with, adopt and benefit from it. (Impact Survey)
Perhaps more significant is the framework’s ongoing dissemination through professional networks and training activity. Arts Council England now encourages applicants for creative health funding to reference the CHQF in its guidance (p. 8), 5 and the Creative Industries Council Health & Wellbeing Forum has recommended that it be shared through trade and industry networks (p. 14). 6 The framework features in postgraduate Creative Health training at University College London (UCL), in regional training programmes such as Greater Manchester’s training programme for the health, social care and voluntary sectors, and in workshops and events across the country. The framework is also cited in recent national guidance on arts in hospital settings (p. 4). 7 CHWA has also embedded it within its volunteer champions’ leadership programme, regional initiatives and partnership training for museums.
While hundreds of practitioners have been introduced to the framework directly through CHWA staff or Jane Willis, the intention has been to encourage wider sector ownership. As a result, it is increasingly used as a reference point in presentations, training and project planning across the UK and internationally. It has informed activity by Culture Action Europe, and funding has recently been sought to develop a Welsh-specific version through the Wales Arts, Health & Wellbeing Network.
In some places, its influence is becoming more embedded structurally. For example, new public health commissioning arrangements in Doncaster will require creative health tenders to draw on the CHQF, while in Greater London, applications for a putative new Creative Health Borough scheme will be expected to demonstrate a commitment to the framework.
Use of the CHQF has also helped identify areas where practitioners feel less confident in applying the Quality Principles – particularly those relating to being Realistic, Equitable and Reflective (p. 4). 4
Conclusions
The CHQF is beginning to make a tangible contribution to strengthening both practice and partnership across the creative health sector. Developed through a collaborative and participatory process, it offers a shared language for quality that respects the diversity and flexibility of creative health work while providing clear guidance on safe, ethical and effective delivery.
Evidence from independent evaluation, sector surveys and ongoing training activity suggests that the framework is helping practitioners build confidence, embed reflective learning and initiate conversations about fair and sustainable working conditions. It is also supporting organisations and commissioners to develop more joined-up, ethically grounded approaches, contributing to stronger partnerships and more responsive project planning. Evaluation of the Manchester programme will help guide further work with health and social care colleagues to ensure it is embedded as much in these sectors as in creative practice.
Growing levels of reach and uptake, alongside its inclusion in national guidance, funding criteria and professional development programmes, indicate that the CHQF is becoming an important reference point for the sector. At the same time, its use is helping to identify areas where further support and skills development are needed.
As dissemination continues and new resources are developed to widen access, the framework has significant potential to support more coherent, collaborative and sustainable creative health practice. By fostering shared understanding between practitioners, partners and funders, it offers a foundation for continued learning and collective improvement across the field.
Footnotes
Acknowledgements
The development and evaluation of the Creative Health Quality Framework was funded by Arts Council England. The authors are extremely grateful to both the Steering and Reference Group, as well as all those who attended workshops to support the framework’s development. The authors have no competing interests to declare. No ethical approval was required for this article.
Declaration of conflicting interests
The authors declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: One Special Issue editor, Jemma Channing, was on the Steering Group for the development of the framework. The NCCH was on the Reference Group.
Funding
The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: The development and evaluation of the Creative Health Quality Framework was funded by Arts Council England (ACE).
