Online Network: Music in Hospitals and Healthcare Settings

On June 2nd, Youth Music and Songbirds Music for Health Specialist, Ros Hawley, from Lime Music for Health, hosted an online network session which brought together grant holders from 10 projects around the UK working in hospital, hospice or healthcare settings. The session allowed grant holders to share experiences of the impact of the COVID-19 pandemic on music projects in hospital settings, to reflect on current challenges with colleagues in a supportive environment and share ideas for pivoting programmes and practice whilst unable to carry out face to face music activity.  This post shares key points from the discussion and more detailed reflections. It offers an insight into the impact of the COVID-19 pandemic on music projects in hospital settings and highlights the current challenges faced by grant holders and music leaders as they begin to re -navigate their programmes within a new and evolving landscape.

Key points that were discussed in the session:

• An update from grant holders on the status of their individual projects
• Changes to hospital infrastructures and site settings due to NHS COVID-19 response  
• Current challenges faced by grant holders in reconnecting and maintaining contact with key colleagues within NHS institutions due to COVID-19 restrictions
• Adapting skills and delivery to remote working platforms when this has been possible
• Challenges (and learning gained) from delivering online music sessions (where this has been possible) with children and young people with complex healthcare needs and disabilities
• Safeguarding in specific relation to NHS directives and online platforms
• Content, creation and application of online/media resources
• Support for healthcare staff in delivering music activity
• Access to NHS internet and communications systems
• Quality and accessibility of hospital Wi-Fi and audio/computer systems; limitations for access to recorded music and audio/visual content 
• Reduced access to projects/music/musicians/resources for hospital patients
• Thoughts on future steps for individual programmes and the online network       
• The impact of lockdown on projects in hospital and healthcare settings

In mid-March, many hospital arts programmes were abruptly put on hold due to the emerging situation with COVID-19 and anticipation of the national lockdown. It was no longer safe for musicians (or patients and staff) to continue to engage with live music making practices in hospitals. This valuable work is often focused on the creation of personalised, 1:1 musical interaction in the intimate spaces of bedside areas, hospital bedrooms and hospital ward areas, or on co-creative work with small groups of children and young people to make music together.

The musical and social connections made between musicians, children and young people, and their families and staff during music making, lie at the very heart of all work in these contexts; music promotes wellbeing at times when it is most needed, and brings respite from the challenges of hospitalisation in whatever form these might take. The music sociologist, Tia DeNora (2013) describes how such forms of music making create safe spaces of ‘music asylum’ where people can listen, create and shape their surroundings through music, taking control, at a time in life when this opportunity is much needed and the experience much cherished.     

It goes without saying, that COVID-19 has brought its own specific set of challenges for musicians working in hospital and related healthcare and hospice settings. The network session allowed us all to take time to reflect on these and talk through our current experiences.  In such challenging times, when the people we work with and care about are even harder to reach, it has been a great help to come together; the discussion helped us all to get a broader picture of the impact of COVID-19 on musician programmes in hospital settings and take some comfort in knowing that all our projects are facing challenges. 

With one eye on the future, the session also prompted time to think how we all might pivot and adapt our practice, and how we can keep the essence of what we do ‘live’ as we explore what these adaptations might be.

Challenges – gatekeepers to children and meaningful interaction

Within the NHS there are specific challenges in terms of accessing children and young people. Surrounded by numerous gatekeepers, many of these children and young people are extremely vulnerable and are often experiencing health inequality and socio-economic disadvantages brought about by their individual situations. The children and young people who stayed in hospital throughout the lockdown have potentially included some of the most isolated children and young people in our society – the very people our projects desire to reach.

Overnight, key contacts enabling access to these groups vanished when play specialists and arts programme co-ordinators were redeployed to support their colleagues and the NHS adapted its hospitals and services in anticipation of the peak of the pandemic. Wards in children’s hospitals became overflow wards for adult patients; children were moved to other areas of hospitals. Music programmes were outside of this bubble and lost connection; sensitive too to the enormous strain being placed on the NHS, music programmes knew they had to wait until communication was initiated by hospital colleagues, until staff were ready, and mentally and physically able to make contact.

For projects based in hospital wards, especially where children and young people have the most complex medical needs or are non-verbal such as in critical care units, rehabilitation, oncology or neonatology wards,  the challenges of negotiating hospital internet connections and poor quality sound systems combined with the sensitivity of the contexts, make online music sessions unsuitable. Many projects have created listening resources, such as SoundCloud pages, YouTube channels, and music activity videos, but at this stage knowing who is able to access these, how often, and the quality of the sound production when they are accessed are concerns for musicians who pride themselves on creating the best sound they can, to improve hospital acoustic environments. TV channels, available in some hospitals are another area being explored to get musical content into wards and keep projects ‘live’. However not every hospital has this resource and where they do, access is not always easily available to arts programmes, and in some cases not free of charge for patients to use. The pandemic has brought to light the huge variety in the quality and accessibility of online media communication systems across the hospital Trusts where projects are hosted, and highlights the impact on patients in being able to access their music projects remotely at a time when human contact is severely limited.

Adapting to the ‘now’

At the time of the online network meeting, some projects had managed to contact NHS colleagues and doors were slowly beginning to open. However, for most projects, the reality of continuing with music making is still far away. For those who had managed to pivot their sessions to Zoom (mostly outside of hospital settings, and working directly with families) the same challenges arose as those discussed in the Youth Music network meeting on working with disabled children and young people online  during social distancing (06/05/20), namely the effects of latency on music making, choice of activities, including parents as music makers and music facilitators, getting up to speed with technology and good practice in safeguarding. 

Some inroads have been made in accessing mental health settings and in situations where children are outpatients and families can be directly accessed. The team at Quench Arts

(www.quench-arts.co.uk)  are working to develop YouTube resources for their young people. Director Nic Briggs shared an example of a work in progress project video created for their Plugin settings:

 “We are just awaiting contributions from young people so can't share the end result yet but you can see what our team have put together as one example of what we are doing (we are doing lots of instructional videos, worksheets, backing tracks as well)”: https://youtu.be/0ixfQ1Cz3v8

Our own Flying the Nest project, which supports children and young people with complex needs who transition between hospital services, has been able to launch due to us being able to directly communicate with parents to run our sessions. Our current weekly session with one family has now turned into a research pilot for delivering remote music sessions as an embedded part of our programme in the future. We are working to create a piece of music and film with a young musician who loves the sea. Keeping a personalised approach to activities - holding on to the essence of what the work is about - has made this a new and exciting way to work, with sessions including conducting games and compositional activities just as they would at a hospital bedside.

As with all arts and health programmes across the UK, this time of restriction from access to our young music makers on wards has provided valuable time to reflect on practice, and given CPD time for organisations and their musicians: projects have compiled case studies, run team days, and led upskilling meetings to strengthen their organisations whilst delivery is on hold.  

Making resources for staff has proved to be a way of keeping projects profiled within hospital Trusts. But also, for musicians, being able to offer music has been a way of giving something back to NHS colleagues at a time of need, of giving support and saying, ‘we’re still here.’  At Lime Music for Health we created a SoundCloud page for staff and patients to celebrate music from all our projects. The page was blocked by the hospital firewall however we have worked with the hospital IT to allow permission for individual staff such as the play team to access the page through their NHS email accounts: https://soundcloud.com/m4h2020 

Developing this page provided a way for us to pivot our practice and respond to wider need during the pandemic. We went on to work with Dr. Rachel Grimaldi, adding music to her newly created Cardmedic flashcard programme, designed in response to medics’ experiences of distressed COVID- 19 patients in ICU’s who were unable to understand what doctors in PPE were saying. Cardmedic is now used in several countries. Through this we were able to raise awareness of live music in critical care settings and contribute our music to the programme: www.cardmedic.com/music

At Opus Music the team have used the situation to record their own song to support their NHS colleagues (www.opusmusic.org/twll)

Director Nick Cutts explains:

  “This Won’t Last Long’ is a song written, recorded and produced by OPUS musicians during the lockdown, reaching out to our healthcare partners, and offering a message of hope and support during these challenging times (and raising some funds for the Hospital Charities with which we work).  We feel frustrated that we can’t be there to work alongside our healthcare partners at this time, but we can still offer our musical support.”   

 At a time when it is impossible to know exactly how our NHS colleagues have been impacted, offering music in these forms has enabled many programmes to feel that they are able to contribute some kind of support until contact can be made and more in-depth conversations held to discuss ways forward. COVID-19 has brought this aspect of music delivery into hospital musician programmes where previously it may not have been considered so essential; now new spaces are opening up where programmes who haven’t previously worked to develop resources to support healthcare staff deliver music have the opportunity to begin to. It was acknowledged in our discussions that in such exceptional circumstances there is no formula for this; being open to trying new formats, and approaches to designing creative materials for staff to use is important just now; being happy to try to see what works in your own situation (and not be worried if things are not perfect) is important, and perhaps an adjustment when as musicians, we set our standards high and want to achieve the best we can.  

Looking to the future: “Music is care”

Music projects linked to hospital settings are some of those closest to our country’s public health crisis, embedded in the very institutions who have saved so many lives over the last 12 weeks. We are all watching and waiting to see how COVID-19 will impact and shape our work in the longer term, and, as we explore new models of working now, look to see how these may grow into the creative music projects of the future.

There are many practical considerations for our programmes regarding infection control, and the openings created over the years for musicians to be an almost everyday sight on hospital wards remain firmly shut for the foreseeable future. Social distancing has also altered the types of musical interactions that will be possible. Outdoor spaces and visitor ‘bubbles’ may become the musical interaction spaces of the future, and remote music making may well become an essential part of hospital music programming. The role of music in supporting staff wellbeing also cannot be ignored as time moves on, we embrace the new and deal with the impact of the past.

For musicians, having time to reflect due to the pandemic, brings a chance to initiate changes to our own practice – Dave McKenny at Pulse Arts ( http://www.pulsearts.co.uk/) reflected that for him “having time to think about what is important to you as a practitioner and how that responds to the needs of the children and young people you work with” – is part of the current conversation as hospital music making evolves and responds to change.     

At the heart of all our discussions, the thought that in hospital and healthcare contexts ‘Music is care’, and therefore brings creative expression central to models of holistic patient centred treatment, remains strong, and key to sustaining our connections in hospital settings as we work with them to build a way forward. 

Case Study: Impact of COVID-19 on Alder Hey Children’s Hospital

Vicky Charnock, Arts Coordinator, Alder Hey Children’s Hospital

As Arts Coordinator for Alder Hey Children’s Hospital, I manage a large and diverse programme of participatory arts for our patients, covering areas such as music, dance, animation, visual arts, performance, creative writing and film making. The programme has been running successfully since 2006, and every year we work with over 8,000 children and young people directly through our arts programmes, giving them new cultural experiences and skills, as well improving the experience of being in hospital.

On Friday 13th March, I received notification from the hospital that all activities with patients would be stopping with immediate effect due to the growing health risks presented by the spread of the Corona virus, and that the in-patient wards within the hospital would essentially be going into lockdown. All non-essential, non-clinical visits to the wards would be prohibited and this also included limiting parental visits to just one parent or carer. Furthermore, all outpatient appointments were to be stopped and non-essential procedures such as planned surgeries would also be put on hold.

Clearly, this will have had a profound and devastating effect on patients and families, who had previously enjoyed a regular and varied participatory arts programme that would often be the positive focal point of the week. Two months down the line, I worry enormously on what impact this will have on our children and young people who will be spending long periods of time in hospital, without any positive stimulation.

As manager of a large team of highly skilled and talented freelance arts practitioners, I also worry about both the financial and emotional impact the pandemic will have on them. Having to tell these individuals that they could no longer come into the hospital to deliver their sessions was devastating. With the Youth Music funded project, Music as Medicine, we have tried to think about how we can maintain elements of the project, through writing reflective texts about their experiences, writing case studies, holding team meetings together to offer support and reflect upon practice, and offering musicians the opportunity to create online performances as a way of keeping in touch with the patients that they miss.

Many of the musicians had formed strong bonds with the long-term patients that they worked with. We’ve also offered a range of support networks from the hospital that the musicians can tap into, if they are struggling with their mental wellbeing during this crisis. The enforced break has also given us all chance to reflect upon our practice and think about how we can do things differently in the future.

We hope to start music delivery again in the autumn, although it is far from clear whether it will be safe for us to do so at that point. If we can re-start then, we will no doubt be incorporating social distancing procedures into our general practice, which will present us all with a range of new challenges to conquer.