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Pulse Arts at Richard House Hospice

This piece has been written by Pulse Arts Director, Joe Danks, a recipient of investment through Sound Connections 2017/18 Innovate Programme, funded by the National Foundation for Youth Music. 



Pulse Arts is a Music in Healthcare organisation, that delivers person centred music practice in healthcare settings in London and East Anglia. Alongside our regular delivery programmes in paediatric hospitals, we have delivered a wide range of projects in specialist settings (surgical wards, care of the elderly, dementia wards). From our limited experience we know that music in hospices is not statutory, and much like other healthcare settings hospices are struggling to fund external services like us. Each hospice is unique and has its own partnerships and external partners, some will have more of an artistic offer than others.


The project

Our project at Richard House Hospice came out of a desire to challenge ourselves and work in a new setting. We find getting out of our comfort zone and working in new environments positively impacts all of our work. We investigated music provision in hospices, and found an opportunity to trial something new and provide meaningful interventions to young people with life-limiting health conditions. We applied to the Sound Connections Innovate Programme which funded 8 x 2.5 hour Saturday morning sessions at the hospice as well as some training using iPad apps. This project was also supported by Newham Music Hub, who lent us iPads for the duration of the project.


A musician’s perspective

The first element of the project was a day of training with Peter Keserue, an iPad music specialist. We spent a day surrounded by cables, speakers and 5 iPads, trialling a wide range of apps and considering them for use in our setting. Peter was a font of knowledge and enthusiasm, and I was reminded of the powerful music making tools we carry in our pockets each day. I was out of my comfort zone with musicians that I know inside out. We were all in it together. We spent the day trying each app one by one with expert guidance. We then had a go at using multiple apps at once and making some music with the apps and our normal hospital instruments. We used an app called ‘Bloom’ a lot that day. It is an app created by Brian Eno which generates beautiful ambient sound. It creates a fantastic bed for interaction and improvisation.

Our first morning at the hospice was quite daunting. We had visited the hospice for meetings in the run up to the project and met some staff and played a little music but our first session was certainly a little nerve wracking.

‘The first thing that struck me about the hospice setting is that it is a very different environment to much of the hospitals we work in. The hospice was extremely quiet on Saturday mornings, and we were met by the security guard who helped us get our instruments from the cupboard and left us to a cup of tea. The silence and tranquillity was so different from the bustling ward environments we are used to that at first it was quite disconcerting. This soon subsided and presenting music into the environment became normal. The environment is extremely ‘home like’ which is very deliberate, but can present challenges to an external musician.’ – Musicians’ Reflections immediately after the project.

The young people at the hospice had often been visiting Richards House for many years, sometimes for a week at a time. Some young people would be with their parents and siblings, and some would be staying for a week on respite care, away from their parents. The hospice has a small flat for whole families to move into for 7 days at a time, and this is almost always in use. We would also be working with existing service users visiting for the day. All of this meant that we were working with young people in familiar surroundings, and a setting they knew well. This is quite different to our work in surgical units or outpatient clinics, but is similar to some of the long stay wards we work on at Great Ormond St or Evelina London.

Each session was incredibly varied, and demanded flexibility and adaptability from us as musicians. Sometimes our work at the hospice resembled an informal workshop, with patients and families gathered around a collection of instruments, trying new ideas and sounds. Sometimes we would be working with individuals at their bedsides, playing music for them as they lay down and relaxed. The hospice also has an enormous playroom, and more than once we played for staff and young people sat on the sofas as they relaxed, played with toys and had a normal Saturday morning.

It was really important as a musician not to demand anything. This is a key principle of our work in hospitals, but we are human and I think routine and expectation can creep into our work. This project forced us to put that aside, as we were doing something new. This had a positive impact on my other work, reminding me to keep an open mind, explore new ideas and keep adapting.


Working in hospices and managing emotions

Lots of our work is in complex and emotionally intense environments, with young people facing significant hardship and trauma. We work in paediatric intensive care units, children’s burns units and even in A&E. We were careful to protect our self-care time in the hospice, and always had around 15 minutes first thing in the morning, and 30 minutes at the end of the session for musicians to chat, reflect and write in our musicians logs. I personally found the hospice to be a place of real joy and fun, with young people exploring new things and staff providing incredible personalised care. Our work at the hospice was full of laughter and I thoroughly enjoyed delivering the project. Richard House does an incredible job of creating a homely environment that manages anxiety and stress, and leaves lots of room for us to create meaningful musical interactions with young people. I found the hospice to be welcoming and less intense than many of the environments we already work in. Many hospices are trying to expand their artistic offer and I think community artists could have a real key role to play in this. We are already working on the next phase of this project, and I can’t wait.


Case Studies

Joe & Mel

We worked with a family in a side room with a teenage boy who only had a very small amount of movement, and could only express decision using his eyes. His mother and father were keen on the music, and we played some relaxed Beatles as we entered. The young person was able to confirm that he was enjoying the music, and ask for more with the help of his parent’s prompts. His parents were very moved by the music, and it was an emotionally intense situation for musicians and staff alike. I decided to offer an iPad instrument (Cello) to the young person, and held it up to his hand. He showed real enjoyment during this. I then offered the iPad to Dad, who knelt down beside the bed and moved the iPad across his son’s hand, making different notes. He was visibly moved by this, and we played a song whilst they played along together. It was in interaction that wouldn’t have been possible with our current instruments as the young person was unable to grip or move his hand. The iPad, coupled with our music, facilitated a shared musical experience for a whole family.


Joe & Mel

We arrived to find all of the young people in the large day room and two young boys (approx. 7 years old) bouncing off the walls. They were dashing around the room, jumping in the ball pit, constantly changing channel on the TV. The staff were sat making sure they didn’t do any damage but were fairly relaxed so we deduced this was fairly normal behaviour. We decided to position ourselves in one corner of the room, sit down and start playing. We had some initial interest but they were soon back bouncing around the room. I then got my drum out and we played ‘One Day Like This’ with just drum and violin. One of the boys took a real shine to this and within 5 minutes he was sat with 5 drums around him as a drum kit. He sat and played, copying phrases and leading me and Mel. Carol said ‘that’s the longest I’ve seen him focused on anything’. He would often stand and do a lap of the room but would then come back. We probably played for around 20 minutes in all. He then left and the other boy remained in the room. He went and chose a book from the book selection, which happened to be a nursery rhyme book. He sat with two female staff, who would turn to a page and sing a song, which he really enjoyed. We observed this for a couple of minutes, then started to accompany the activity. We played a simple ostinato underneath their conversation, and then as soon as they would break into song we would accompany them the best we could. This then developed into us all gathered around the young person, who would name a song that we would then all play and sing for him. He would then shriek with joy! It was a magic moment. He enjoyed the power of being able to control the live jukebox and this lasted for about 25 minutes. This was all filmed on his iPad for his parents to see later.


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