Following the success of an initial six week pilot, English National Opera (ENO) today announces that ENO Breathe is to be rolled out nationally, beginning today.
A partnership between ENO and Imperial College Healthcare NHS Trust, ENO Breathe is an integrated social prescribing programme of singing, breathing and wellbeing, breaking new ground as the first of its kind created to provide crucial support to people recovering from COVID-19.
The programme’s combined approach brings together musical and medical expertise to combat the increasing need for support for those experiencing long-COVID symptoms. Building on techniques used by singers, the holistic online programme offers self-management tools for patients experiencing breathlessness, and the anxiety that this can produce.
Following an initial six week trial with 12 participants from September – November 2020, the programme will now be rolled out to up to 1,000 patients by participating healthcare networks across London and the North of England with a view to continuing to work with more post-COVID services across the country over the coming months.
The initial six week pilot proved to be successful following independent evaluation, with the participants reporting definite improvements in symptoms and wellbeing, indicating that ENO Breathe has had positive impacts for them both emotionally and physically.
Led by Baylis, ENO’s learning and participation programme, ENO Breathe uses weekly group online sessions and digital resources to empower participants with tools and techniques to help them focus constructively on their breathing. The programme focuses on breathing retraining through singing, using lullabies as its musical starting point. Traditional lullabies cross boundaries of culture, are accessible to all and their very purpose is to calm. Led by professional singing specialists, participants learn breathing and singing exercises, using an approach that mirrors techniques employed by opera singers who achieve the physical coordination required for singing via emotional connection and imagery, rather than by giving their bodies explicit physiological instructions. Participants are then equipped with exercises to practice these techniques in their own time, aided by online resources specifically designed to support their progress.
Jenny Mollica, Director of ENO Baylis said: ‘The ENO are committed to making a difference to the lives of people and communities recovering from COVID-19, using our unique skills and resources in ways that are relevant and useful – and that matter to people. Following our successful pilot programme, we are hugely proud to be able to roll out ENO Breathe nationally, enabling us to support many more patients in their recovery from COVID and journey back to wellness. Combining cutting edge musical and medical expertise, we look forward to continuing our partnership with Imperial College Healthcare NHS Trust, and to working with post-COVID assessment clinics across the country in this next phase of the programme.’
Dr Sarah Elkin, Consultant in Respiratory Medicine & Clinical Director Integrated Care at Imperial Healthcare NHS Trust said: ‘It has been a pleasure to work with ENO Baylis on this programme. As we continue to respond to the latest surge in COVID-19 cases in the UK, we must also remember those patients who are still suffering with COVID symptoms long after their initial disease. Ongoing breathlessness is debilitating and can be frightening. We hope this programme will support people to improve and help reduce their symptoms. We look forward to widening participation as the programme rolls out across the country.’
Health and Social Care Secretary Matt Hancock said: ‘I am very grateful for the work of the ENO and Imperial College Healthcare Trust in helping those suffering from the impact of this terrible virus.
‘For many of those who have had the disease, the effects are felt months after the original infection and often acutely.
‘I’m sure this programme will help long-COVID sufferers both physically and emotionally.’
Culture Minister Caroline Dinenage said: ‘The success of the ENO pilot has clearly shown how breathing through singing can help those suffering with breathlessness. I am grateful to ENO for partnering with the Imperial College Healthcare NHS Trust to deliver this important programme which provides crucial support to people recovering from COVID-19.’
Tonya Nelson, Area Director, London, Arts Council England, said: ‘The results shown to date by ENO Breathe are very impressive, providing important physical and emotional support to those experiencing the effects of long-COVID. ENO’s partnership with Imperial College Healthcare is very welcome, illustrating what is possible when creative organisations partner with healthcare settings. I hope the national rollout brings support to many more people across the country.’
Harry Brunjes, ENO Chair: ‘Medicine and the Arts have come to understand that they have more in common than they knew. ENO Breathe, this astonishing project led by Jenny Mollica, is the unprecedented interface of the ‘Art of Medicine’ and the ‘Science of the Arts’. I am also extremely grateful to fellow ENO Board member, Professor Ajit Lalvani, who along with Dr Sarah Elkin, his colleague at Imperial, has been incredibly supportive of this momentous project.’
Stuart Murphy, ENO Chief Executive: ‘ENO has long been committed to using music to support others, in local communities, schools and vulnerable groups. ENO Breathe, led inspirationally by our Director of Baylis, Jenny Mollica, will now continue this work on a national level, bringing support to anyone who has been unlucky enough to be affected by this terrible virus. The ENO Breathe programme demonstrates the power of music, and how the arts and sciences can work brilliantly together. Huge thanks to our Chair, Harry Brunjes, Dr Ajit Lalvani and Dr Sarah Elkin for helping us to bring this pioneering social prescribing programme to the NHS, across the country.’
About the ENO Breathe pilot
Patients for the six week pilot were referred onto the programme by Imperial College Healthcare. They all had ongoing symptoms of breathlessness and anxiety 8-12 weeks after initial infection with COVID-19. The make-up of the group of participants was diverse. Participant ages ranged from early 30s to late 70s, 41% were ethnically diverse (including 25% Black/Black British and 8% Asian/Asian British), and 25% had English as a second language. There was a high participant retention rate – only one from the original 13 participants had to withdraw (for health reasons).
ENO commissioned an independent evaluation to assess the efficacy and impact of the programme for participants. The evaluation methodology included participant focus groups and patient self-assessments pre and post programme, using validated metrics including RAND-36 General Wellbeing index, GAD-7 Anxiety Index and Breathlessness scores.
By the end of the pilot programme, participants reported definite improvements in symptoms and wellbeing. 90% reported positive improvement in their breathlessness and 91% of participants felt their levels of anxiety had dropped. Prior to the programme, the group’s mean Generalised Anxiety Disorder Assessment score was 6.7. By the end of the six weeks, this had dropped to 3.2. Notable improvements were also seen in areas such as fatigue.
Participant Richard says: ‘My experience with ENO Breathe has been fantastic, it has really aided me enormously with my breathlessness and also my anxiety a little around re-integrating myself back into society.’
The programme also positively impacted other areas of their life. An overall increase in general wellbeing and confidence was reported across the group, with many overcoming previous uncertainty about singing. Participant Ludmila comments: ‘I never before had an experience like this. I didn’t think things like singing could help me with my breathing and improve my recovery from COVID and it has really helped me emotionally and physically.’
Many participants felt that the group aspect of the programme was an important part of their positive experience, often lessening the isolation they had felt before by feeling part of a supportive community. Participant Wayne says: ‘You are not in it alone, there is a supportive community out there – those who can relate to your experiences and a supportive team who also form part of the community and make you feel comfortable.’
The results of the pilot indicate that the programme gives participants tools and techniques that they will be able to use beyond the duration of the sessions, helping them to continue on their path to recovery. Participant Jen says: ‘I definitely know that during my day to day life, I’m calling upon things that I’ve done in the course. I’ve no doubt that ENO has been one of the causes of my progress over the last six weeks.’
When asked if they will continue to use the breathing exercises after the pilot finished, 100% of participants responded ‘yes definitely’. 91% felt that taking part in ENO Breathe sessions has given them increased confidence in managing their symptoms. All participants stated they would “definitely recommend” the programme to others experiencing long-COVID symptoms, and many endorsed the idea of wider roll out of the programme. Sheeba comments: ‘I would recommend this programme to anyone who is suffering the way some post-COVID patients are suffering. It’s something we really need to have access to.’
ENO Breathe will be offered to up to 1,000 patients and 25+ post-COVID clinics in this next phase, including London and the North of England. ENO are expanding the online material available to participants during the programme, along with making dedicated groups available to NHS Healthcare staff recovering from COVID.
Additionally, support continues for those who complete the ENO Breathe six-week programme. A dedicated post programme site of digital resources will be available to support participants to continue to self-manage their ongoing recovery, along with a chance to join a drop-in virtual singing group in order to continue to benefit from ENO Breathe’s community and support.
Strict monitoring and evaluation of the programme will continue in this next phase, with plans for a more in-depth research trial currently underway.
Participating post-COVID clinics
Cheshire & Merseyside
- Liverpool University Hospitals NHS Foundation Trust
(includes Cheshire East, Cheshire West, Halton, Knowsley, Liverpool, St Helens, South Sefton, Southport & Formby, Warrington and Wirral)
- Royal Victoria Infirmary, Newcastle
- Royal Oldham Hospital, Manchester
- North Manchester General Hospital
- University College London Hospital Trust
- Homerton University Hospital Foundation Trust (City & Hackney)
- Imperial College Healthcare NHS Trust (St Mary’s Hospital/Charing Cross Hospital/Hammersmith Hospital)
- Guys and St Thomas NHS Foundation Trust – St Thomas’ Hospital
- King’s College Hospital NHS Foundation Trust – King’s College Hospital, Princess Royal University Hospital
- Royal Free London NHS Foundation Trust (Royal Free Hospital and Barnet Hospital)
‘It is carefully constructed in a way that is inclusive, helpful and encouraging at every step.’
‘Having been a part of ENO Breathe, I now have the confidence to quietly undertake the singing and breathing exercises on my own – which can only be a good thing for my long term personal health.’
‘As a non-native English speaker, I wasn’t sure I was going to fit in with ENO, but it has been a fantastic tool that has given me my confidence back.’
‘This programme has actually helped me in my personal life, so when I’m reading books to my children now and I have to do these voices, these areas of my life are coming back together.’
‘It’s prevented me from calling my GP about anxiety brought on by breathing issues. I genuinely believe it will take pressure off medical facilities.’
‘Even though some of us are not singers, it doesn’t really matter. It just feels that you want to be in that gang, you want to join in. And I just want to say thank you.’
ENO Breathe ‘certainly supported me in the longer term recovery, that’s where I’ve seen the most improvement, because I know that my breath control is better. I know that and my posture is better. I can go into meetings. I can certainly get my point across a lot better without suffocating on each breath.’
Notes to Editors
About English National Opera
English National Opera is the national opera company dedicated to one simple aim: making opera for everyone. We sing in English to be accessible to the widest possible audience, as well as offering free tickets for Under 18’s and for as little as ten pounds for everyone else. We create opera that feels different, theatrical and creatively daring and have been doing this to an internationally recognised standard since being founded in 1931 as Sadler’s Wells Opera.
We are determined to open up the genre: nearly half of our audiences in the 2018/19 season were first-time bookers and more than 10% of our bookings were by under 30s. Our learning and participation programme ENO Baylis reaches more than 20,000 school children and community groups, and we bring opera into schools, allowing more than 5,000 schoolchildren to experience opera for the first time.
Giving new talent a platform and showcasing the wealth of nationwide operatic talent is fundamental to the ENO’s vision. Our talent development programmes continue to nurture the careers of singers (the ENO Harewood Artist programme), of conductors (the Charles Mackerras Fellowship) and of musicians (ENO Evolve). Demonstrating our ongoing support and development of British talent, 85% of the cast in the 2018-19 season were British or British trained, up 5% from the previous season.
Prior to the outbreak of Covid-19, the proportion of our ethnically diverse audience increased from 4% to 10%. 20% of ENO’s principal freelance performers in our last season were people who are ethnically diverse and wea are committed to ensuring this level of representation on stage is maintained whenever possible. 13% of our Chorus is similarly represented and 16% of our Board – to be transparent, that is two out of 12 people. In 2019, we announced an ongoing commitment to increasing representation within our Chorus and Orchestra, hiring four new members of the former in order to do so, and starting the process of hiring five new string players from ethnically diverse backgrounds. Similarly, we offer paid Director Observerships every year to those who are currently underrepresented in our industry. We are committed to making the opera industry more inclusive and representative of the society in which we live which stretches across our organisation including the ENO Board and Management. This also means that we are committed to telling a wider range of stories both on and off stage. In summer 2020 we commissioned ‘What do you hope for?’ – a series of short films, featuring world-class operatic artists responding to the Black Lives Matter movement.
In 2020, despite the challenges presented by the global pandemic, ENO remained committed to its remit as a national arts organisation and dedicated to bringing world-class opera to everyone.
We immediately announced we would be honouring the contracts for those brought on board for productions that had to be cancelled, setting the precedent that many other arts companies subsequently followed. We are proud to support our talented freelancers who work tirelessly to bring the magic of ENO to the stage.
One of the most amazing contributions ENO employees made over the lockdown is down to our phenomenal costume department. Moving away from the captivating costumes of the 2019/20 Season operas, the team dedicated themselves to sewing scrubs and producing PPE for London hospitals facing shortages. Raising a remarkable £26,000, the team produced 1,700 pairs of scrubs, 500 hats and 1,000 visors and donated the remaining money to NHS charities.
We partnered with Imperial College Healthcare NHS Trust to develop a social prescribing intervention that will provide crucial support to people recovering from COVID-19, in the first partnership of its kind between a leading arts organisation and an NHS Trust. Led by ENO Baylis, our learning and participation programme, this holistic online programme – ENO Breathe – brings together medical and musical expertise and will provide novel ways to support and empower those recovering from COVID-19, offering tools for self-management, particularly with regards to posture, breath and anxiety.
ENO Drive & Live, the world’s first large scale drive-in opera wowed audiences in September, marking the first time the company performed together in person since March. Held in the grounds of London’s Alexandra Palace and based on a huge festival-sized stage, the performances of Puccini’s La bohème were rehearsed and performed by two casts and crews in separate bubbles, whilst audiences enjoyed the spectacle from the safety of their vehicles. Additionally, a recorded version of one of the casts aired on Sky Arts, broadcasting Puccini’s magnum opus to the nation.
Returning from the country’s first lockdown, we wanted to perform a work that resonated with our scattered audience, as well as our talented artists and musicians. Despite an impending second lockdown, English National Opera convened to perform Mozart’s Requiem on the London Coliseum stage. Despite no live audience due to restrictions, the poignant requiem was warmly received when it broadcasted on BBC Two, accomplishing what we set out to do – take a moment of remembrance in a time of chaos.
During the summer, we invited young people to submit personal expressions of their lockdown experience, and to help us create a ‘lockdown aria’. We received 50 submissions across several art forms, including music, painting, photography, poetry and more. This culminated in an online exhibition in partnership with Google Arts & Culture and Arts Council England, showcasing and celebrating our participants’ creativity. We commissioned spoken word artist Kieron Rennie to write a new piece weaving the voices of our participants’ voices together.
Simultaneously, we continued to amuse our audiences through social media content created by our brilliant singers and musicians as far ranging as a Gilbert and Sullivan tribute to our NHS and a collaboration with Matt Lucas on his smash-hit record Baked Potato.
ENO is for everyone, and always will be.