Eno Breathe

1. London and culture

London is the capital and largest city of England and the United Kingdom, with a population of just under 9 million. The English National Opera (ENO) is an opera company based in London and it is one of the two principal opera companies in the city. In 2020, the English National Opera initiated conversations with doctors and medics at London’s Imperial College Healthcare NHS Trust about the role the ENO could play to support the health and wellbeing of communities in London and across the UK. Devised in response to the growing number of long-COVID cases in the UK and across the world, ENO Breathe was developed. It was designed to specifically meet the needs of the community, where many patients were still suffering with breathlessness and its major impact on their dayto-day lives and wellbeing, even after recovering from the other physical side-effects of COVID. Bringing together medical and musical expertise, ENO Breathe is the first programme of its kind to provide crucial support to people recovering from COVID-19.

In 2020, the English National Opera (ENO) initiated conversations with doctors and medics about the role the ENO could play to support the health and wellbeing of communities.

2. Project goals and implementation

2.1. Main goal and specific objectives

ENO Breathe is an integrated social prescribing programme of singing, breathing and wellbeing. Devised in summer 2020 in response to the growing cases of long-COVID, the ENO partnered with respiratory experts at Imperial College Healthcare London to carefully develop a 6-week online programme that offers self-management tools for sufferers of long-COVID experiencing breathlessness and the anxiety this can produce. The aim of ENO Breathe is to bring together the expertise of an arts organisation and medical experts to help solve the problem of breathlessness in long-COVID sufferers.

2.2. Project development

The weekly programme, led by ENO vocal specialists via Zoom, focuses on breathing retraining through singing, using lullabies as its musical starting point to empower participants with tools and techniques that help them focus constructively on their breathing. Between sessions, participants are equipped with exercises to practice these techniques in their own time, aided by online resources specifically designed and created to support their progress. ENO Breathe started with a pilot in Autumn 2020 with a group of 12 participants referred from Imperial College NHS Trust. Following this successful pilot programme, the ENO Breathe programme was rolled out nationally in January 2021. Since then, the ENO has developed partnerships with other post COVID NHS services across England to refer patients, and now works with over 73 of these services across the country. This means that long-COVID sufferers in localities outside the capital can access the benefits this programme offers too. As of May 2022, the programme now works in partnership with 73 NHS post-COVID services and has reached over 1,000 patients.

The programme is currently run with a budget of £190,000 (€215,000) per year, excluding the ENO staff salaries working on the programme. This budget encompasses freelance fees, creation of digital resources, evaluation, training, marketing/admin and allows us to offer the programme for free to 55 groups of 20 individuals per year.

The aim of ENO Breathe is to bring together the expertise of an arts organisation and medical experts to help solve the problem of breathlessness in long-Covid sufferers.

3. Impacts

3.1. Direct impacts

Evaluation findings indicate that ENO Breathe has a positive impact on participants. Of the first 782 participants to have completed the programme, 93% said that the programme met their expectations, and 98% would recommend it to others experiencing long-COVID symptoms. Overall, improvements in general wellbeing, anxiety and breathlessness are reported by those who complete the programme.

A Randomised Controlled Trial, led by Imperial College conducted further investigation into the efficacy of the programme by comparing participants on the programme with a control group. The study found that ENO Breathe participants experienced a 10.48-point (out of 100) reduction in breathlessness while running, compared to the control group. They also experienced a 2.42-point improvement in the mental component of quality of life.

Crucially, this programme has powerfully evidenced the impact of cross-sectoral collaborations between arts and health organisations. ENO Breathe allows arts organisations to reconsider the positive role they can play to support the health and wellbeing of communities.

3.2. Assessment

ENO Breathe is evaluated by an independent evaluator following an evaluation methodology co-designed with the Imperial College. The methodology uses standardised healthcare metrics recognised by the NHS. The evaluation data is analysed periodically. A Randomised Controlled Trial has also been conducted on the programme.

3.3. Key factors

The programme experiences great success thanks to a number of key aspects:

• The creative curating of the scheme of work in the sessions (lullabies joined with carefully chosen and creatively devised exercises), which connect the participants with the techniques in a memorable and emotional way;
• The strength of the partnership between the English National Opera and Imperial College NHS Trust and the dedication of both teams to develop a programme that responds to a specific need, which has captured minds, built recognition and advocacy for the work;
• The care and person-centred approach of the programme – with one to ones with each individual participant before they join the group, and a welcome gift sent to each participant to welcome them on the programme – at a time when these individuals felt unheard;
• The opportunity for participants to meet others with similar symptoms during the group sessions, and through that combat their sense of isolation;
• The evaluation methodology that has supported advocacy and learning throughout the development of the programme, and continues to provide proof of impact through the recent RCT.

3.4. Continuity

This project is a key case study within the Social Prescribing Myth Buster, a comprehensive guide by London Arts and Health designed to dispel some of the myths surrounding social prescribing in the arts and cultural sector. It forms part of their examples of best practice and development of effective partnerships between culture and health sectors.

As of May 2022, the programme now works in partnership with 73 national health service (NHS) post-Covid services and has reached over 1,000 patients.

4. Further information

London was a candidate for the fifth “UCLG – Mexico City – Culture 21” International Award (February – June 2022). The jury for the award drew up its final report in September 2022, and requested that the Committee on Culture promote this project as one of the good practices to be implemented through Agenda 21 for culture.

This article was written by Ella Baker, External Communications Manager, The English National Opera, London United Kingdom.

Contact: ebaker (at) eno.org

Website: www.london.gov.uk/