Creating with Care

Creating with Care

Paula Har

Safeguarding Lead Community Hospitals/Dementia Nurse Specialist

Oxford Health NHS Foundation Trust

Winner 2020 CHA Award Innovation and Best Practice improving Patient Care

Summary:

The arts-based activities have given patients not just meaningful activity but an opportunity to be seen, to be heard and for someone to listen and feel valued.

Case studies;

One patient who had been admitted for rehabilitation following a serious suicide attempt was resisting engaging with any rehabilitative therapy and proving quite a challenge for staff.  The catalyst to changing the engagement was mosaics.  During discussion with me the patient mentioned they had a previous interest and we just happened to have a mosaic artist in residence at the time. With encouragement the patient attended sessions, completely transforming the patient’s ability to engage. The transformation was not just during the activity itself but with the occupational and physiotherapists who would sit and support the patient. The activity fostered a therapeutic relationship which transferred back into rehabilitation, recovery and successful discharge to independence.

A much older gentleman who would come along to weekly dance session “even though it wasn’t his thing” but would come along “for the craic and the chat.”   He did not identify with being in the age bracket of those attending (he was) but remembered himself as someone who was part of his community whose role (volunteer driver) was to pick up those in the group and bring to day centres.  He would occasionally join in, but much preferred the social aspect afterwards of tea and chatting.  He did volunteer to participate in a PhD student photography session who was looking at perceptions of age around the world. There were some stunning photographs of him taken and one was chosen for the student’s exhibition and became the front cover of our Trust magazine, Insight. He reveled in the idea of being a “poster boy” or “pin up” and got a lot of “craic” out of it.  Sadly, he passed away shortly after discharge and Angela was able to have the photograph printed onto canvass and given to family along with some of the magazines, we were sure he would have been thrilled.

We have collected lots of data over the four years; patient attendance, well-being scores etc. (we have attached lots). Where I feel this programme of interventions has made a difference is in each patient experience and engagement. We have heard their stories, listened to their woes, told us about being evacuated as a child or heard about their careers, their children and grandchildren.

Whenever Angela and I are asked to speak about Creating with Care (CWC) and the impact it has made, we have an ability to fill any allotted time.  We are so proud the impact the programme has made, we are even more proud to discuss the individual stories and patient experiences as that is where it matters and the difference the programme has made. The stories often highlight challenges faced by patients, the CWC team, the artists and the staff along with the little successes which are valued just as much as the bigger accomplishments.

Background:

This project began following a conversation with representatives of West Oxfordshire District Council (WODC) Heather and Hannah who were the Community Well-Being Manager and Arts and Leisure Development Managers respectively. They had wanted to install a piece of art in the hospital.  We had extensive discussions, I felt we needed resources as we had no budget for activities and little therapeutic activity was happening in the hospital in Witney where I was based then. Following these conversations, they agreed to fund an artist initially for 1 year, provide a substantial budget and have the year independently evaluated by University of Oxford.

Dr Kate Hamblin from the Department of Population and Ageing was tasked to carry this out (report attached). Angela Conlan was then recruited and contracted for 1 year to work at Witney Hospital alongside myself (Clinical Nurse Specialist Dementia) to develop a program of Arts interventions. This was a unique way of funding a project both for the council and for the hospital, funds were being channeled through a community development fund.

The then new role of an Arts Co-ordinator was created in January 2017 as part of West Oxfordshire District Council’s priority to enable residents, particularly those in vulnerable groups, to have better access to health and wellbeing services and activities. It has been funded from developer contributions received by the Council for Public Art and not from public sources. This type of investment must be spent on activity which produces work which has good public access and benefit.

The purpose of the new Artist Co-ordinator role is to introduce and coordinate regular creative interventions in the hospital environment with the intention of enhancing the patient and carer experience and sense of wellbeing.  This was the first programme of its type in West Oxfordshire though the Council has had a long track record of securing contributions towards Public Art going back 20 years.

There are significant challenges facing NHS services nationally and locally, given growing demand and remodeling of services. This programme is intended to contribute positively to the already highly valued work of the dedicated staff team. The programme parameters have been carefully crafted with clinicians to ensure it is appropriate, safe and additional to the existing core services. Programmes such as Creating with Care represent a style of ‘temporary public art’ commissioning which puts people and their wellbeing centre stage.

From the very beginning Angela and I decided that the core value was to be inclusion and inclusiveness where possible in all activities. The hospital at the time also had 10 stroke rehabilitation beds on the 60-bed unit, furthermore a high percentage of those admitted to the hospital would have varying levels of cognitive impairment. The aim of the program was to improve the patient experience and well-being, while also supporting and including carers, while improving the patient environment. The aims and values have remained consistent since the inception of Creating with Care and still very evident.

Description:

Before Creating with Care there was little in terms of creative and therapeutic activity happening on the wards. Any activity then was centred around particular groups such as the stroke therapist working with stroke patients or the physio working with those that required that specific therapy.  I would often see the apathy of those watching these activities wondering why they were not involved, not understanding the different patient pathways. On days where there is activity there is a different vibe and a buzz that would carry on long afterwards with stories and experiences being retold when visitors would arrive. 

The change when Creating with Care was formed was not just that I had someone who would work alongside me to develop a program of activity but also WODC had also provided a generous budget to enable the Arts Co-ordinator to engage a wonderful array of artists with different specialties to work with our patients.

On reflection we realised early on that it would require both of us working as a team to make this project a success. Angela who had no Clinical background as a professional dancer and me, a nurse not having much in terms of creative ability would need to support each other due to the complexity of patients attending sessions.

Anyone who has clinical experience finds out quickly as Angela did and often refers to, that even a simple activity such as having a cup of tea and cake can be fraught with risks, who has thickener in drinks? Who is diabetic? Usually the person asking for three sugars!!  Who needs adaptive cups or cutlery?  Factor in people with advanced dementia or recent stroke who may want to wander away from the activity or who may need emotional support, a simple event can become complex to manage without support.

What was key to the success of CWC was the shared vision of improving the patient experience through participation in arts-based activities. We had drive and determination to be inclusive and open for those for all abilities to attend, we find a way to include and involve a patient in a way that was meaningful for them. At the beginning we wanted to make a difference and improve the experience of patients in hospital. Hearing patient stories and watching the positive outcomes through the array of interventions has kept the drive and determination as fresh as those early days four years ago.

The expansion across all six hospitals continues to grow and foster essential community links while increasing opportunity for patient engagement.  Angela’s expertise and creativity has ensured that the core values and aims have been embedded and maintained.

During Covid, with reduced visiting it became even more apparent to have meaningful activity to keep patients connected to both the ward environment and their families. Staff have also been able to benefit significantly from the dance and activities to offer an outlet for stress and improve well-being, this has been well received and much appreciated opportunity.

Outcome and Impact

Wellbeing has been enhanced through a programme of activities for staff, patients and their families. The programme has included dance, mime, film, music, visual arts, crafts, cabaret, photography, exhibitions, museum and heritage visits.

During the first year of the programme, there were a total of:

790 patient’s attendances and 281 staff attendances on its participatory arts programme at Witney Community Hospital including:

• 43 group dance sessions with 383 attendances (314 patients, 68   staff and 2 visitors).
• 118 patients and 10 visitors took part in 1-2-1 dance sessions with the arts coordinator (32 male and 86 female patients and 10 visitors).
• 218 patients engaged in concerts, museum visits and afternoon tea parties,
• 281 staff attendances giving staff the opportunity to learn mosaic making, acrylics, watercolours, poetry, film, reminiscence and dance. The arts-coordinator has worked with six young people on work experience and three student nurses over the year.
• 71 members of staff engaged with staff dance sessions and the Flash Mob film, which had 424 views online and 6 public showings for 68 patients and staff.

Visiting artists worked with 140 patients.

• - 49 poems and short stories penned by patients and writer Pat Winslow which will be included in a booklet for display and distribution on the wards.
• -

During 2018 Creating with Care has had a total of 1107 patient’s attendances and 321 staff attendances on its participatory arts programme at Witney Community Hospital.

The programme has also delivered 8 outreach workshops and 3 fundraising events raising £3000 towards arts activities over the year.

Projects have included both group and 1-2-1 sessions at the bedside.

The Arts Co-ordinator Angela, who is a professional dance practitioner, has provided 35 hours of group dance classes. Attendances were 111 male patients, 182 female patients, 76 staff. (group dance classes occur outside visiting hours).

92 patients and visitors have benefited from 1-2-1 dance sessions with the Arts Co-ordinator. (32 male and 60 female patients).

304 patients engaged in concerts, museum visits and afternoon tea parties, providing 32 hours of activity.

Visiting artists worked with 317 patients, providing an additional 39 hours of activity.

Music has played a big part in the programme of activities at Witney: this year we have: -

• Established a regular programme of local musicians able to play from bed to bed.

• Developed a partnership with the Serious Trust’s LEAP Artist Development residency to host workshops with patients.

• Worked with Witney Music Society to put on an evening with Cotswold Voices as a fundraiser for the hospital.

• Delivered bedside concerts with Classical guitarist Giacomo Susani in partnership with Witney Music Society.

• Established relationships with two local school choirs who have performed at the hospital.

• Programmed a music making workshop with Oxford Concert Party.

Meanwhile the program has continued to expand during 2019 and 2020 across 6 hospitals with similar activities happening across them all.  We have attached detailed reports with additional films and photographs

The Creating with Care team were nominated for an inclusion award at the Oxford Health Linking Leaders Equality and Diversity Conference in 2018.

The diverse programme of activities has been well-received and achieved a high level of engagement and enthusiasm from all at Witney Community Hospital over the first two years.

The project demonstrated the important role arts have in healthcare settings in promoting wellbeing for patients, visitors and staff alike while enhancing hospital environments. The expansion to cover six community hospitals in 2019 ensured a greater opportunity for patient and staff engagement in a varied range of activities. The core value of inclusiveness is demonstrated through the engagement and multi-generational activities that have been developed. The project has forged stronger community links into the hospital settings, and this is ongoing and becoming stronger all the time. The expansion of CWC enables Angela in her role to be flexible and adaptable to changing needs of patients, finding new and innovative ways of engaging patients in meaningful activities. While working directly with patients there has been a parallel focus on the environment and participatory Arts such as completing mosaic installations or wall art such as murals reflecting local landscapes.

Creating with Care team has had opportunities to share the project at the following events:

• 15^th UK Dementia Congress. (11/11/ 2020)
• Oxford Brookes University/Oxford Health MSc Advancing Practice in Dementia Care Module.  Creating with Care is presenting Non-Pharmacological Interventions for people with Dementia developing best practice. (November 2020).
• Arts 4 Dementia Oxford meeting to advance social prescribing to arts Programmes for diagnostic practice for dementia. (May2020)
• Delivered 2-day training including Dementia Friends session at The Cooper School to 6th form students Bicester (Jan-Mar 2020)
• Delivered Dementia Friends session to our Hospital Volunteers (Dementia Awareness Week)
• BBC Radio Oxford interviews (Feb & April 2020)
• Banbury International Women’s Day event (Mar 20)
• Creative Dementia Arts Network special event (Mar20)
• Creative Dementia Arts Network Conference (CDAN) MAC Birmingham (24/09/2019)
• Innovations in Person Centered Approaches Conference May 2019 Oxford Academic Science Network (OASN), Kassam Stadium Oxford (May 2019)
• NHS30 in Reading NHS England.  (November 2018)

The value of brought in by Creating with Care for projects and artists fees exceeds £14k over the year 2020 and includes: -

• Waitrose (Community Matters Scheme) – Successful £309 for City Community Hospital Bird Project
• o Oxford Health Charity (Successful) £1000 City Community Hospital Bird Project
• o Friends of Didcot Hospital (successful) £2900 for large garden mosaic
• o Oxford Health Charity (Successful) £500 for craft kits
• o Oxford Health Charity (Successful) £500 for printing Creative Connections booklets
• o Oxford Health Charity (Successful) £4125 large mural Abbey Ward day room (starting Sep20)
• o Oxford Health Charity (successful) £1800 large mural for OSRU therapy Kitchen (starting Sep20)
• o Oxford Health Charity – Margaret Tapley Garden Mosaic and plaque
• o Vale of White Horse DC (successful) £500 Visual Arts Workshops Dec19/Jan 20
• o Abingdon and Witney College (City) value £500 (Successful) took place virtually of 8 weeks June/July 2020
• o The Mill Arts Centre/Abingdon and Cherwell College projects x2 for 2020 value £1000(Successful)
• o Singing for Fun Sessions, West Oxfordshire District Council £500
• o OYAP Trust/ Cherwell District Council – Intergenerational Project (Jan-Feb20) Bicester £500
• o West Oxfordshire District Council – Witney Town Film £200 & Link
• o West Oxfordshire District Council – Mary-Lou Garden Concert for VJ day £250
• o Oxford University Museums (Pitt Rivers/Ashmolean) outreach team held a series of object handling sessions in community hospitals Jan-Mar 20 (a total of 4 workshops) – worth £400 in in-kind support.
• o Instruments of time and change concerts £300 (July-Sep)
• o Witney Music Society – Harp and Flute concert February 2020 (in kind) £250

o UK Crafters Network Oxfordshire and other craft groups, laundry bags, Twiddle Mats and Muffs, Teddies, Ear Savers, Scrubs https://www.oxfordhealth.nhs.uk/news/letters-to-a-little-one-bring-delight-to-children-of-oxford-health-staff/

For further information contact: [email protected]