Funding miracles
Sarah Waller demonstrates how one innovative development programme sustained Florence Nightingale’s vision of a healing environment
KEY POINTS
- Transformation is possible on low budgets
- Patients, local groups and charities involved in early stages
- Project grants kick started additional fundraising
Charities have performed an increasing and vital role in supporting the development and sustainability of environmental improvement projects, which have transformed the patient and user experience of healthcare across England.
Effect of surroundings on wellbeing
Back in 1863, it was Florence Nightingale who observed: “Little as we know about the way in which we are affected by form, colour, by light, we do know this, that they have a physical effect. Variety of form and brilliancy of colour in the objects presented to patients is the actual means of recovery.”
The environments in which we live and work have a profound influence on our physical and psychological wellbeing. Research has repeatedly confirmed that a supportive and welcoming environment can have positive effects both on those who visit hospitals – whether as patients or their loved ones – and those who work in them. It has shown that these spaces can contribute to healing and can boost staff morale. But hospital buildings are not always designed with these principles in mind. As a result, some can feel bewildering, alienating or gloomy.
Sceptics might assume that improving the appearance and usability of an area must be an expensive, time-consuming activity and a luxury that the NHS cannot afford – especially in the current economic climate. But The King’s Fund’s Enhancing the Healing Environment (EHE) programme has repeatedly proved, through its work with over 202 teams of staff, patients and carers over the past decade, that it is possible to transform environments of care with minimum outlay – and that the benefits are enormous.1 These projects show that, even in the most uninspiring environments, it is possible to create welcoming and comfortable spaces that are fit for purpose, good value for money, and that can improve quality of care and the patient experience.
EHE programme
The programme was launched in 2000 by HRH, The Prince of Wales, president of The King’s Fund, as part of the charity’s activities to mark the millennium. It encourages and enables local teams, led by clinical staff, to work in partnership with service users in order to improve the environment in which they deliver care and consists of two main elements:
- A development programme to support clinically led multidisciplinary teams, which include estates and facilities staff, arts co-ordinators, modern matrons and other staff, alongside patients and carers.
- Project grants (capital allocations) provided for each team to undertake a project to improve the patient environment. Projects must be in an area of the hospital used by patients and be conceived in a way that promotes service-user wellbeing and fosters a healing environment. The emphasis is on high-quality, value-for-money schemes that make maximum impact with the resources available and that exemplify good design principles.
The Department of Health has funded the programme since 2003 and this has latterly focused on improving the environment of care for those that are dying, their relatives and the bereaved, and to support the implementation of the national end of life care strategy. Current work includes improvements to the care environment for people with dementia.
Consultation and engagement
A key principle of the EHE programme is consultation and engagement with a wide variety of key stakeholders not just the patients and staff who use a particular area. Teams have been encouraged to launch their projects locally to gain maximum publicity and to start the consultation process. A wide range of charities and groups have acted as important links to local communities, facilitating arrangements for public consultations on schemes. The EHE teams have used the opportunities presented by these events to raise awareness and, for example with local Alzheimer’s Society branches, increase understanding of how people with dementia can be supported in the community.
Patients, local groups and charities have been keen to be involved in the early stages of project design often challenging the project team to review and amend plans so that schemes improve care delivery as well as the care environment. In many of the schemes to improve environments of care for end of life, a key issue for visitors has been their ability to make a drink without disturbing nursing staff. Their feedback has led to the provision of kitchenettes. Other feedback also indicated that those wishing to stay overnight in hospitals asked for comfortable reclining chairs rather than beds.
Fundraising
Although each team has a small project grant at the start of the programme, typically £35,000, their enthusiasm and ambitions grow and the majority have sought extra funds for their schemes. Many trusts have been very supportive by providing additional capital but this has not been possible for all schemes and the teams have engaged the support of hospital charities, external organisations and often gone to extraordinary lengths to fundraise themselves.
Two recently completed bereavement suite schemes were part financed by legacies and leagues of friends have supported a number of schemes that have improved mortuary viewing facilities for the bereaved.
Community support
The teams have been amazed at the level of support they have received from individuals and groups not only in terms of fundraising but also very practical longer term support. In Hull a charity has now been formed to continue to support the continuing work of the Memory Clinic which has recently been refurbished through the EHE programme.
EHE has also acted as a catalyst to the establishment of a range of volunteer schemes including support services for relatives of those receiving palliative care and gardening groups to help keep outside spaces in good order. Local societies have contributed some very special photographs and historical memorabilia and the Yorkshire Film Archive is working with a number of teams to support reminiscence work for people with dementia.
In Lancashire the local authority and volunteer groups have helped make the reclamation of an old barn into a living hive of activity for people with learning disabilities. The facility, which is surrounded by newly planted woodland, is now shared with the local community.
The EHE programme, as well as effecting transformations in the care environment, continues to raise the profile of services that have been little understood. Recent work to improve the environment of care at end of life and for those with dementia has again highlighted the need for PCTs to fully engage with local charities and support groups as one of the ways they can better understand the needs of their communities. The role that charities have played and continue to play in the programme cannot be underestimated not only in the early stages but in helping to assure the sustainability of revitalised buildings and improved services.
1. The King’s Fund is a charity that seeks to understand how the health system in England can be improved. Using that insight, it helps to shape policy, transform services and bring about behaviour change.
Author: Sarah Waller
Sarah Waller is the programme director of the Enhancing the Healing Environment Programme.
She joined the King’s Fund in 2000 to develop this following a career in nursing and human resources management in the NHS and the Department of Health.
A former vice chairman of the London Ambulance Service NHS Trust, she was appointed CBE in 2008.
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