The art of recovery

For years hospitals have used art and design to improve patient wellbeing, but commissions are now allied to specific areas of treatment and care

This September, Alder Hey Children’s Hospital in Liverpool will move into its brand new site. Alongside new clinical areas and theatres, spacious wards, rooms and play areas, the hospital will also unveil several artistic commissions, including a huge hanging sculpture in its main atrium by Lucy Casson that features 100 animals and birds. The new building is envisaged as a warm, inviting place, a home-from-home for its patients and their families, and its use of art and design will be key to its transformation. When its doors open, the new Alder Hey will become the latest institution to restate the benefits that creativity can bring to our wellbeing and recovery while in hospital.

Throughout the public consultation process at Alder Hey, one of the biggest ever carried out by the NHS, architects and designers collaborated with the Children and Young People’s Design Group at the hospital. As well as suggesting that a connection with nature should be integral to the design of the new build (it will be surrounded by parkland), the group helped to select the artists whose work would feature in the hospital as part of Alder Hey’s art strategy. Art will be everywhere – from pieces used as part of a wayfinding system and work created for bespoke healing spaces, to site-specific installations such as Casson’s Roost sculpture.

While a number of high-profile projects and innovative organisations, such as Vital Arts in London and Lime Projects in Manchester, have increased the focus on arts in healthcare over the last two decades, a recognition of the postitive effects of visual stimulation on hospital patients goes back to the mid-19th century. In Notes on Nursing (1859), Florence Nightingale complained that within these environments the effect of “beautiful objects, of variety of objects, and especially of brilliancy of colour is hardly at all appreciated”. When people were sick, she wrote, their desire to look at interesting things was too readily dismissed as a whim: “Much more often, their (so-called) ‘fancies’ are the most valuable indications of what is necessary for their recovery.” Rather than improving the condition of the mind alone, exposure to shapes, colour and light could also register on the body. “They have an actual physical effect,” Nightingale claimed. “Variety of form and brilliancy of colour in the objects presented to patients are actual means of recovery.”

This was revolutionary thinking. It challenged the way hospitals were designed and organised 2 3 and brought into focus the relationship between art and medical treatment. For hundreds of years, hospitals had been extensions of the welfare branch of religious organisations; the purpose of much of the art they displayed was to show that the higher powers understood (and could heal) suffering. In early 16th-century France, for example, the Monastery of St. Anthony in Isenheim proudly displayed an alterpiece by Niclaus of Haguenau and Matthias Grünewald. Amid the monks’ work caring for plague sufferers and attending to skin diseases, a sore-ridden Christ figure looked on compassionately. William Hogarth’s mural, Jesus at the Pool of Bethesda, one of two paintings created for the grand staircase at London’s St Bartholomew’s Hospital in 1737 went further and presented a multitude of sickly characters with various ailments. It celebrated the healing of the sick, but provided a rather depressing scene in which to do it.

By the 1960s, Nightingale’s thoughts on how effective a “variety of objects” could be within a hospital setting were becoming more widely applied. Sheridan Russell, ‘almoner’ at the National Hospital for Neurology and Neurosurgery in London launched Paintings in Hospitals in 1959, now a national charity which loans artworks to hospitals and medical centres and an early champion of the benefits that art might have on patient recovery. Russell had been exhibiting paintings by contemporary artists in waiting rooms, corridors and wards at the hospital and noticed the effect they had on levels of wellbeing. “Though the NHS has changed immeasurably since Sheridan’s time, the founding ideas are very much still at our heart,” says the charity’s director, Ben Pearce. “Our art and activities offset the clinical, sometimes cold-feeling environment – brightening up wards and busy areas on a day-to-day basis. We try to help people feel calmer, bringing distractions, pauses and something different to engage with.”

To create this engagement, Paintings in Hospitals now works closely with ‘arts coordinators’ within several institutions, a relatively new role which began to emerge in hospitals in the 1980s. According to a Nuffield Trust paper on the creative arts in healthcare, it was at this time that nursing in the UK, influenced by work that was happening in the US and Australia, really “began to integrate the arts and humanities into caring curricula, lifelong learning support, and reflective practice across nursing disciplines”. In the mid-1970s, the Manchester Hospitals Arts Project had broken new ground by managing to obtain grants for the development of a programme of work in visual, performance, craft and aural art forms, which enabled the fledgling organisation to put together a team of artists to make work for the city’s healthcare system. (The group became a charity in 1987 and rebranded as Lime Projects in 2000).

Since then, arts programmes have sprung up within hospitals across the country, supported by bodies and organisations promoting artistic and cultural activity in healthcare environments, such as the London Arts in Health Forum. The LAHF recently developed the National Alliance for Arts, Health and Wellbeing and its own 2012 charter is a brief but emboldening document: “We believe the arts will contribute to a culture within health services that is more supportive, empowering, enlightened, personal and humane.”

Ruth Charity has been an arts advisor to the Oxford University Hospital NHS Trust – which encompasses two hospitals in Oxford and one in Banbury – since 2007 and, through the trust’s ‘artlink’ programme, has seen first hand the transformational effects of bringing art, music and performance into clinical spaces. “There is great potential for really good art and design to improve patients’ time in hospital,” she explains, “whether helping patients relax a little by providing a more reassuring, less intimidating space to come to; or providing something that takes their mind off their anxieties and offers up a talking point for family and friends. Good design gives people a sense that they will receive good care – and therefore increases their confidence in this.”

At Alder Hey, an arts group has existed since 2002, chaired by Dr Jane Ratcliffe, a consultant in paediatric intensive care. Its current arts administrator, Vicky Charnock, has been in the post since 2006 where she has continued the hospital’s work with some of the north west’s leading arts organisations, including Tate Liverpool, Merseyside Dance Initiative and Live Music Now. “The benefits for patients in running an ‘arts for health’ programme are clear and tangible, and we’ve conducted several pieces of research to demonstrate not just the feel-good factor but the clinical benefits also,” says Charnock. “A piece of research using clinical assessment tools into our dance and movement programme in 2013 showed that 92% of patients who undertook a dance session with our dancers felt less pain than they had before the session.”

Charnock says that Alder Hey has also used dance as part of a specially designed programme for asthma patients, called Breathe, and that hospital clinicians noted some improved lung function in the patients taking part. “The arts are an opportunity to forget about hospital life, to be distracted from procedures and treatment, to learn skills and share new experiences, and to boost confidence and self esteem,” adds Charnock. “Our ongoing evaluation of the service shows the fun and enjoyment that can be had through the arts, even when patients and their families are faced with the most challenging of situations.” Ratcliffe also notes that the participatory aspects to Alder Hey’s arts programme can impact greatly on recovery and that involvement in a creative experience can have widespread health benefits. “If children and young people are happy, so are their families,” she says. “As an example, mobilisation after surgery may be limited by [the] perception of inducing pain. Engaging with the dancers and dance programme facilitates movement without it being an issue. It’s a pleasurable experience and well recognised that pleasure releases endorphin-type hormones, the body’s intrinsic analgesics.”

This kind of medical knowledge is not only useful for the direct treatment of patients, but important in showing that the principles behind putting art into hospitals actually bear fruit. What is remarkable about all of the organisations included here is that each one is charitably funded – one way of maintaining the grants and donations that support them is to account for the measurable difference that artworks can make on patient health. In 1984, Roger S Ulrich’s eye-opening study into how the view through a window might influence recovery from surgery suggested that a patient’s visual experience while in a hospital bed could directly affect the levels of pain relief they required. (In the US, the Health Environments Research & Design Journal also looks at these kinds of ‘evidence-based design’ investigations.) Yet by 2006, research conducted for the UK’s Arts Council had done similar for art and design. Its report, The Power of Art – Visual Arts: Evidence of Impact included several case studies within the healthcare sector which offered compelling results. For example, research at Chelsea and Westminster Hospital revealed that “chemotherapy patients who were able to view rotating art exhibitions during recovery reported reduced rates of anxiety and depression”; while at Conquest Hospital in East Sussex “weekly art sessions for stroke patients that focused on handling materials and tools, using both hands, refining motor skills and practising good hand-eye coordination, helped alleviate the mental and physical effects of stroke”.

In 2015, arts programmes in hospitals have plenty of evidence to reinforce the positive impact their role can have. But there is still scope to take things further. Since 1996, Vital Arts in London has been working on a revolution of its own, offering an intensely focused and curated service for the six hospitals – and one million people who pass through them each year – in its care. As the arts organisation of Barts Health Trust, which casts its hospitals as “ideal places to introduce a new audience to the transformative power of art”, Vital Arts commissions site-specific work for the Trust’s public spaces, specialist centres, wards and treatment rooms. “What’s really important from a commissions point of view is that we always think about the demographic,” says commissions manager, Catsou Roberts. “So we always identify an artist we think would be appropriate for a particular hospital.” The bespoke nature of each project then ensures work is tailored even further, says Roberts. “Maternity is completely different from renal,” she says. “If it’s cancer, is the treatment chemotherapy or radiotherapy? We think about who’s there and at what point in their illness and recovery they encounter a particular work of art.”

As a curator, Roberts’ job is to think about the viewer and in what situation they will be absorbing the art – from sitting in a waiting room or walking down a corridor, to lying on a hospital bed. “When you’re having radiotherapy you have to lie very still, the viewer is supine,” she says. “So we commissioned site-specific artworks to be embedded within the ceiling – that’s an example of our curatorial strategy that runs through all of our programming.” While Vital Arts has made its name for its commissions with artists and designers from Cornelia Parker and Julian Opie to Morag Myerscough and Tord Boontje, Roberts also points to the work being done by the group’s arts participation manager, Rachel Louis, who works directly with patients and therapists. For example, as renal patients will have a particularly strict diet to follow, a recent project has involved making a cookbook specific to their needs in collaboration with a chef and nutrionist. “It’s that kind of hands-on way of working that has a total praxis, a practical application, and is very creative,” says Roberts.

Vital Arts has thrived because it also takes risks, something that perhaps sounds out of place in the hospital environment where art is also subject to scrutiny by health and safety. But great art takes risks, too, and whether it is installed in a gallery or a cancer ward shouldn’t, as Roberts suggests, affect the quality of work on display. “We’re looking at bringing museum-quality artwork to a very public setting; for the patients to find distraction, to be uplifted, but also to have their minds opened and actually get involved and engaged with culture,” she says. “We’re not interested in presenting little anodyne landscapes and boats bobbing on the water just because they’re pleasant. It’s about art, proper art.”

Over 150 years after Florence Nightingale’s appeal for “variety of form and brilliancy of colour”, hospitals are now seeing how art and design can be an active part of patient care and recovery. “People are recognising how important really good art is – and how important it is to make it ‘art’ and not just ‘decoration’,” says Roberts. “In the best of all possible worlds, every hospital would just be a delight to be in, based on how it energises and feeds you.” 1

See vitalarts.org.uk, alderhey.nhs.uk and ouh.nhs.uk/artlink

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