Who Pays for Arts on Prescription, and What Happens When the Money Stops

Free at the point of use means somebody else is paying, and in arts on prescription that somebody is almost always paying from a grant with an end date. That single structural fact explains more about the sector than any amount of discussion about what the activities achieve: why schemes appear and vanish, why a class recommended online has often closed, and why the most useful question to ask a scheme is how long it is funded for.

I am paid differently by the two care homes I work in, and the difference is instructive. One pays me from its activities budget, which is small, recurring and controlled by the home manager, so the arrangement has survived two changes of ownership and a refurbishment. The other pays through a charitable grant secured by a local arts organisation, which was for three years and is now in its final one. The sessions are identical. The residents cannot tell them apart. One will still be running in two years and the other almost certainly will not, and nothing about that has anything to do with the quality of the work.

Where a claim about effect appears below it carries a tier (Tier 1 supported, Tier 2 promising but limited, Tier 3 practice and anecdote), explained on reading arts in health research.

Where the money comes from

Four sources, usually in combination, and each with a different rhythm.

Health commissioning. Money from the health system, typically for the social prescribing infrastructure rather than for the arts activity itself. In England the link worker role sits within primary care networks, and the national body describes what that role covers¹. This is the most stable of the four and it more often pays for the connector than for the thing people are connected to.

Local authority. Public health teams, culture and libraries budgets, adult social care prevention money. Variable between areas, and the first thing cut when a council is under pressure.

Arts funding. National and regional arts funders, generally on project grants of one to three years, often with a requirement to reach new audiences that shapes who a scheme is allowed to recruit.

Charitable trusts and foundations. Frequently the largest single contributor to any given scheme, almost always time limited, and almost always for something new rather than for continuing something that already works.

The pattern that results is a scheme assembled from three or four pots with different end dates, reporting requirements and eligibility rules. That is why criteria can look arbitrary from the outside: an age band or a postcode boundary usually belongs to a funder rather than to the activity.

What it costs to provide

One traceable UK figure exists on this site, and it should be read narrowly.

The Artlift evaluation in Gloucestershire gives the scheme cost as £180,000 across roughly 500 patients referred, which works out at £360 per patient². That is one scheme, in one county, covering 2009 to 2012. It is not a national average, it is not current, and it should not be used as a price list.

What it is useful for is scale. A referred place on a creative course is a several hundred pound intervention, not a several thousand pound one, and not a free one either. The costs behind that figure are the ordinary ones: artist fees, materials, venue hire, coordination, the administration of referrals, and evaluation. Coordination is the line most often underestimated, because someone has to take referrals, fill groups, chase attendance and report to funders, and that person is rarely in the budget at the hours the job actually takes.

Courses typically run 8 to 10 weeks, which the 2024 systematic review found across its 25 included programmes³, so the per place cost is spread across a fixed and fairly short block. What a ten week arts course involves sets out the shape of one.

Why schemes close

Because grants end, and almost nothing in this sector is funded from a recurring budget.

The cycle is predictable. A scheme is funded for one to three years. It spends year one setting up, year two working well, and year three simultaneously delivering and applying for the next grant, which is unpaid work usually done by the person also running the sessions. If the application succeeds, the scheme continues, often reshaped to fit whatever the new funder wanted to buy. If it fails, the scheme stops, the artist moves on, the referral pathway quietly closes, and the group’s members go back to whatever they were doing before.

Nobody in that chain is at fault. Funders are entitled to fund new things; that is frequently their stated purpose. Commissioners are working with budgets that have their own cycles. The organisations are doing their best. The result is nonetheless a sector where provision has a half life, and where the person most affected is somebody who has just built a Tuesday around something.

For a reader, the consequence is direct and worth acting on. A class praised in an article, a case study or a forum post may not exist any more, and the more prominent the case study the older it tends to be. The sector’s own reports and case studies are gathered in one place⁴, and reading several in sequence is an education in how many named schemes have quietly closed since publication. That habit of reading is the subject of creative health policy and reports.

The savings argument, and why it does not fix the funding problem

The economic case is the sector’s standard answer to the sustainability question, and it is the weakest thing it says.

The figures in circulation trace to one document: a cost benefit summary of the Artlift scheme written by a GP in December 2011, which analysed 90 patients out of roughly 500 referred, had no control group, described itself as “a simple observational study”, and stated in its own conclusion that it “does not imply causality”². The per patient saving people quote is a subtraction between two figures computed on different populations: a saving side containing £471, which is £42,423 divided by the 90 patients analysed, plus £105 of GP time, against a cost side of £360, which is £180,000 divided by the 500 patients referred. The full arithmetic is on does arts on prescription save money.

Behind that, the 2024 systematic review screened 7,805 records, included 25 studies, and found no randomised controlled trials at all³. So every economic claim about arts on prescription sits at Tier 3.

Tier 3 is not a verdict that these schemes waste money. It means the question has not been answered. But it does have a practical consequence for anybody writing a bid: a case built on a per patient saving is a case that falls over when a commissioner checks it, and commissioners increasingly do. The case that survives is the one built on what is documented, which is that people value the courses and that a service exists to connect them to something.

There is a related trap worth knowing, because it catches people who think they are being careful. The MATISSE trial found that total costs in the group art therapy arm were lower than in its comparison arms, and that referral was nonetheless judged not to be a cost effective use of resources⁵. Cheaper without being better is not value. Cost effectiveness compares what you get against what you spend, and it cannot be established from the spending side alone.

The other market: paying for a registered therapy

Private arts therapy is priced quite differently, and the figures come from professional bodies rather than from schemes.

In the UK, the British Association for Music Therapy recommends a floor of from £52.00 upwards for individual music therapy⁶. That is a recommended minimum, which is exactly what this site quotes it as, and not an average or a typical price. In the United States, the median rate for music therapy was $79 an hour in the 2021 workforce analysis⁷, which should be dated every time it is used because it is not a current figure.

No fee figure anywhere on this site is attributed to the British Association of Art Therapists, whose fee guidance is members only. If a number appears somewhere attributed to it, it has come from elsewhere and been misattributed.

Group work generally costs less per person than individual work, some charities and schools fund places outright, and sliding scales are common. The routes into a registered therapy, which are not the same as the routes into a community course, are on how to find a music therapist and art therapy.

The most durable arrangements

Worth knowing if you are trying to set something up rather than find something.

A recurring internal budget. A care home’s activities budget, a hospital charity’s annual programme, a school’s pupil premium spend. Small, unglamorous, and far more likely to be there in three years than a project grant. It is also the arrangement most vulnerable to a change of manager, so the practical protection is to get it written into something rather than left as an understanding.

Participants paying, where they can. A modest fee for those who can pay, with funded places for those who cannot, removes the cliff entirely. It is unfashionable in a sector that prizes being free at the point of use, and it is the model under which most ordinary community classes have survived for decades.

Being part of a venue’s core programme. A museum learning team or an arts centre participation programme has its own institutional life, which is longer than a project’s.

A stated succession plan. Who runs this when the current person stops. Schemes built around one person’s enthusiasm end when that enthusiasm moves house, and this is the commonest cause of closure after funding.

The practical detail of setting one up, including insurance, safeguarding, infection control and who owns it internally, is on starting an arts programme in a care setting.

What to ask, as a participant

Two questions, asked early.

How long is this funded for? It is fair, it is not rude, and any decent scheme answers it directly.

What happens at the end? A scheme with a concrete answer, meaning a named group on a named day, has thought about the part that matters most to the people in it. A scheme with a leaflet has not.

If you are being referred rather than choosing, the ask that works and what to do when there is nothing locally are on how to get referred to an arts scheme, the wider machinery is on social prescribing explained, and what the term itself does and does not mean is on arts on prescription. Nothing on this page is a reason to change, delay or decline any part of anybody’s treatment, and no arts scheme substitutes for one.