The King’s Fund is celebrating its 120th anniversary this year and, as part of our celebrations, we are asking people whose lives have been touched by the Fund to share their stories with us.
Improving the caring environment
Throughout our history, improving patients’ experience has been a core part of our work. From 2000 to 2012, the Enhancing the Healing Environment programme (EHE) supported more than 250 health and social care organisations to improve care settings for patients in acute, mental health and community NHS trusts, care homes, hospices and HM prisons.
The final stage of the programme enabled multidisciplinary teams to work in partnership with patients to improve the care environment for patients with dementia. It involved 23 teams from acute, community and mental health NHS trusts, working on a wide range of projects to make hospital environments less alienating and distressing for people with dementia.
For the third story in our series to celebrate our 120th anniversary, we talked to Carrie Clarke, an occupational therapist working on Belvedere ward, an inpatient unit for people with dementia at Franklyn Hospital in Exeter. In 2010, Carrie led a team to transform the ward and improve the quality and outcomes of care for people with dementia.
Carrie first heard about the EHE programme from an art therapist colleague who had already secured funding; she applied and was delighted to be awarded a grant of £50,000 to develop Belvedere ward. Her vision was to transform a ward that was ‘full of dead ends and dark corners which caused lots of frustration and distress’ into a calming environment that created a sense of connection: ‘We wanted the environment to give people with dementia opportunities to connect to their sense of self, to connect with others and to people and places they’d known.’
Carrie explains how the project was started: ‘We did a huge amount of consultation with people with dementia, their families and staff. We wanted to understand what they felt was important and what people needed from the environment. People were really positive and interested in what we were trying to do, and their input shaped the whole project, leading us to create a more fluid space.’ The ward is now designed to engage people through all the senses, with sensory trails linking the inside and outside and artwork, photography and lighting that all combine to create a safe and stimulating environment.
The support provided by the EHE team was a key factor in the success of the project for Carrie: ‘They were fantastic, right from the beginning with an inspiring introduction; it was real quality stuff and clear that the EHE team was really passionate about what they were doing. We covered a lot of ground – the use of colour, lighting, general design for dementia, stakeholder engagement, commissioning artwork – and heard from a number of experts too. There was a real sense of opportunity but also one of responsibility; this was a chance to transform the environment for our patients and have a real impact on their care.’
The wider impact
As an occupational therapist, Carrie has always been aware of how important the environment of care is, particularly for people with dementia. Now, as a result of the EHE project, ‘patients have more choice and control about where they spend their time, whether that might be a social space or a quieter area. This has had a significant impact on reducing levels of distressed behaviour.’ She’s seen her colleagues become much more aware of how to use the environment to enhance patient care, by using the space as a therapeutic tool: ‘For example, if a patient is becoming agitated, they might guide the person to a quieter area, as an alternative intervention to medication.’
The changes support relatives and friends of patients too: ‘Visitors can build up a negative picture of what the hospital environment might be like, which can cause anxiety, but seeing it for the first time takes that away. Having that space to move around is really important for visitors, it takes away some of the pressure to just sit and talk, particularly if someone’s verbal skills are impaired – being able to walk around the building and interact with different aspects of the environment really helps.’
For Carrie, the programme was affirmative – it emphasised what she knew about the importance of the care environment and seeing this applied in practice has provided a springboard for her to offer support and advice to others. ‘I have had colleagues from community services and other hospitals come to me for advice and it’s good to be able to share that; I’ll often point people to the assessment tools on The King’s Fund website.’ That affirmation has given her confidence too: ‘I’ve spoken at a number of conferences and I was invited to give a TED talk; I’m not a natural public speaker but I’m so glad that I did it. I remember my colleague [who recommended the programme] telling me that if I went ahead as project lead, it would probably change my life. I thought at the time that he was being rather dramatic but, actually, it was quite life changing.’