An inquiry conducted at the House of Lords examining the 360-degree value of music in society
NOTES FROM EVIDENCE MEETING 3
Tuesday 11th December 2018 (5.30pm – 7.00pm)
Committee Room 4
Chair: Sir Muir Gray & Lord Tim Clement-Jones CBE
Secretariat: Dr Julia Jones (Found in Music) / Dr Shain Shapiro (Sound Diplomacy)
Topic to be addressed: The Role of Music in Coping with the Ageing Population
Dr Henry Quinn, Head of Strategic Intelligence, NHS Dementia Village (opening 2019) and Dr Philip Brighton, Clinical Lead for Dementia, East Kent Hospitals NHS University Foundation Trust
Nina Clark, Co-Chair, Folkestone Music Town / Founder, Musical Walkabout CIC
Gordon Anderson, Founder, Memory Tracks
Mike Waters – Director, X-Systems
SUMMARY OF KEY POINTS MADE DURING THE EVIDENCE MEETING:
Dr Julia Jones introduced the session explaining that the purpose of this Music in Society is to begin to drive a convergence of research and evidence in order to fully acknowledge the role that music can play in addressing key governmental issues. The evidence meetings are not intended to cover the same ground as other related APPGs and Parliamentary inquiries and committees. They are designed to look at practical examples that are already in operation and that could provide opportunities or models of best practice to drive a scaled delivery in the UK. This particular session is focused on examining how both human interaction and technology can help encourage adults to age well and to help provide quality care to those who need it in later life.
Dr Phil Brighton outlined the following:
The new EU funded NHS Dementia Village in Dover is to test and build sustainable models of care and to break down the stigma of dementia. The village has been named ‘Harmonia Village’ and will open in October 2019. It will offer full residential services for approximately 35 people living with dementia, plus a day centre and facilities for families who need overnight accommodation. A Music Strategy for Harmonia Village is being written to ensure that music is a central and embedded part of the overall care delivery and village environment. This work has been funded by the Utley Foundation.
Happiness is central to care. It is vital to acknowledge that the happiness of both the carer and those they are caring for is equally important. Happy staff are more likely to be able to deliver a higher quality of care. Wellbeing in the workplace is a central concern in the healthcare service. Music as a tool can deliver instant benefits to both parties. This is true in residential care environments, hospitals and at home. The same effects are visible. At a recent Music & Dementia session with the NHS staff at the William Harvey Hospital in Kent it was recognisable how great an effect music had on breaking the ice and instantly changing the atmosphere from a serious one to a more relaxed and enjoyable setting.
Medical professionals are not widely aware of the full benefits of music in care and are often “clueless” when it comes to the rights issues and how to deliver music on a budget. Consequently it happens on an ad hoc basis in many hospitals and care facilities, rather than being embedded into the formal strategy.
We shouldn’t put a price tag on happiness but when budgets are restricted it simply isn’t practical to deliver as much music in care as we’d like. So technology provides additional opportunities that can complement the live performance moments. We are embedding technology innovations into our research ambitions at Harmonia Village.
We are just in the early stages of developing our music strategy but it’s already becoming evident that forging close bonds with the local music industry and ‘enthusiastic amateur’ performers can offer a more affordable model. We want staff, families and volunteers to enjoy the visiting experience.
Nina Clark outlined the following:
The Folkestone Music Town project is an extension of the music strategy work at Harmonia Village and is also funded by the Utley Foundation. The objective is to replicate the Music City model that destinations around the world are adopting and embed it at a local level.
A ‘Music Board’ consisting of representatives from the local music businesses, musicians, schools, care homes and local authority has been formed in the town. Several networking events have been held and have resulted in much greater music collaborations.
The power of music is transformative for those living with dementia and their carers. But there are cultural challenges. Staff are reluctant to sing or try to deliver music because they believe they are not capable of it. This is largely due to music being stripped from curriculums and receiving very little attention is medical training. Members of staff have often had very little experience of singing and are lacking in confidence. X Factor has also not helped in this regard because its model is based upon mocking and criticising those who “can’t sing”.
Financially speaking the main issue concerning the delivery of music in care homes is the fact that these services are being allocated to the wrong budget. They should be coming from the pharmaceutical budget not the events budget.
The Folkestone Music Town project is focused on creating an environment that encourages adults to “age well” using music. Increased communications across the town has created and promoted new opportunities to sing, dance, attend live music events, socialise through music, learn instruments, write songs and get involved in organising events.
The response from the local music community and local population has been enthusiastic but engaging the local GPs and local authority has proven to be labour intensive. Schools have also been very difficult to engage. There is a recognisable apathy that needs to be overcome. This is partly due to workload but also probably associated with a “professional arrogance” that often exists between senior officials and “the music scene”. The Folkestone Music Town project has made great ground in breaking down those barriers and fostering a more positive and collaborative environment in the town.
Douglas Noble and Evan Dawson from Live Music Now kindly gave a brief update regarding their recent published research in this field:
Live Music Now contributed to the Music & Dementia Commission funded by The Utley Foundation in 2017.
More recently their Live Music in Care report identified the same issues outlined above. There is a definite need to shift skills in care staff and empower them to break through the lack of confidence. It was evident that it was only when their management formally “gave permission” that the staff really relaxed into the new culture of delivering music.
Sir Muir Gray invited the attendees to put forward questions / comments or outline their own experiences in this field.
Ben Heaney from Creative Dementia explained that he had successfully approached companies to fund his music activities in local care homes. This came from their Social Corporate Responsibility budgets. This is a model that can be replicated around the UK.
Helena Muller from Lost Chord highlighted that care homes do have activity budgets but they are a small and shrinking pot. CQC must make sure that music is present and valued. The quality of delivery is important. Some care homes advertise they have gardens but if there is no access to the garden it doesn’t deliver as much value. Music is undervalued and is being allocated from the wrong budget. It should be coming from the medical budget. It’s an investment. It can lead to reduced medication and improved staff retention (which is a significant issue).
Sir Muir Gray asked “what about the people who are still in their own homes?”
Dr Phil Brighton replied “interaction is essential and music is a catalyst that can bring people together and stimulate engagement”.
Helena Muller also replied saying that Day Centres and Dementia Cafes are vital in regards to maintaining quality of life for those living at home and their families.
Tracey Williamson the Dementia Carers Count Professor of Family Care in Dementia at the Association of Dementia Studies, University of Worcester commented that embedding music in care staff training is essential.
Sir Muir Gray agreed that it’s essential that music is present in medical training curriculums so that the future generations of medical and care professionals are aware of its value. Dr Julia Jones mentioned that this had also come up in the previous evidence session examining the role of music in public health. The new Kent & Medway Medical School will be embedding music and social prescribing into it’s new curriculum from the outset. In the previous evidence meeting a BMA Briefing Paper had also been proposed by Professor Catherine Loveday, to help ensure that medical professionals are aware of the key facts regarding music in healthcare.
Douglas Noble commented that music professionals and medical professionals both spend several years learning and perfecting their skills. Yet there is a difference in perceived value.
Sir Muir Gray commented that technology can bring about significant change and opportunity. Technology people tend to “just get on with it”. We are in a new tech era. Sir Muir is on a quest to ensure that all UK residents aged 60+ have access to broadband internet so they are connected and can be engaged at home.
Gordon Anderson outlined the following:
Memory Tracks is an app that can currently be run on any Android device (and iOS in future). It is designed to provide a simple way of embedding song-task association into daily life and care. Users choose favourite songs from aged 2 – 12 and they are assigned to specific buttons on the screen (for getting dressed, brushing teeth, taking medication etc). The carer presses the relevant button each time the activity happens. The desired outcome is that as the disease progresses the songs can be used to trigger the desired behaviour. Small pilot tests at a care home in Wales have produced very encouraging results.
This practice is intended to facilitate a relaxed environment and to dial down agitation in stressful situations (like trying to get the person out of bed). It can also be useful in encouraging water consumption – something that is often difficult and essential.
The android tablets are used by all the care staff so there is a consistency of delivery. They are relatively affordable and robust.
The tests to date have been small but significant. The most apparent result is the instant positive effect it has had on the staff. They have in all cases enjoyed using the app, it has given the opportunity to sing along with the songs, and has made their job easier and more enjoyable. All staff wanted to continue using the app after the research period ended.
The pilot study was small but Dr Julia Jones has suggested that this research should be continued at the Harmonia Village so that a longer trial can be conducted (and with more sophisticated behavioural response data attached to it).
They have focused on songs from early years (aged 2-12 years) because they think these might be most recognisable. But they recognise that in situations in earlier diagnosis where those living with dementia can participate in the selection of their favourite songs.
We are also exploring the possibility of creating a radio station for care homes with I Like Music (called Blue Moon Radio)
Baroness Sally Greengross and a number of attendees tested the android tablets during the evidence meeting.
Dr Henry Quinn outlined the following:
We will be using technology as our foundation at Harmonia Village
The telehealth field offers a range of opportunities to use sensors to measure behaviour and track norms. This means that we can very accurately monitor how music affects our residents. For example, we can see if they sleep better, if they stay in social areas longer etc.
We can monitor the difference between the responses to live performance experiences and recorded music experiences.
AI will be used at Harmonia Village to ensure that the best quality of care can be delivered.
Technology will be built into the village infrastructure so that every resident has easy access to music. Playlists will be used via streaming music services.
Harmonia Village can be a unique and significant test bed to strengthen the evidence base regarding the effect of music in dementia care.
In the initial planning stages they had not really considered music to be a key component of the build. But now they realise that it is one of the most important and fundamental assets and they have therefore ensured there is a defined music strategy in place. This will ensure that they can maximise the value that music can deliver and ALSO produce significant research projects to help better communicate this value to the medical field.
One of our priorities is to ensure that our residents have choices. So wherever possible we will allow them to choose their own music rather than prescribing it. This can also help us track what choices they make and monitor that over time.
These logged preferences will also enable us to ensure that in instances where they may be taken into hospital the medical staff know the music that can keep them calm and comfortable in a stressful and alien environment.
“I was originally music agnostic but now I consider music to be a vital part of the village and I’m looking forward to being able to help deliver an evidence base for music and dementia”.
Sir Muir Gray asked how the Village will also reach those who are still living in their homes in Dover.
Henry replied saying that they aim to use an app and video to ensure that everyone can be connect with the Village care staff. So that if anyone has a problem at home they can easily make contact.
Mike Waters outlined the following:
X Systems has been developed as an extension of the work by Professor Nigel Osborne examining how music can affect people and influence behaviour. Nigel briefly talked about this at the previous evidence meeting.
The team have been modelling innate brain response for several years and can now predict physical metabolic response (arousal) with great accuracy.
They are now working on improving their prediction rates regarding valence but it is more difficult to measure happiness. Although they have had some initial success linking happiness to heart rate variability).
This ability to predict brain response allows them to use the technology to achieve a desired behavioural state using music. This has been used in restaurants, spas, hotels and retail for many years. X Systems have been improving the reliability of the technology so that it can be deployed in medical setting to reduce anxiety, manage pain for example.
The app delivers entrainment over a 20-minute period, monitoring the response throughout the delivery and adjusting the song selection accordingly.
The aim is to provide a tool that staff can quickly and easily deploy when appropriate in order to improve the quality of care for the patient and carers.
Dr Julia Jones has suggested that X Systems could work in partnership with Memory Tracks to conduct a larger research trial at Harmonia Village in partnership with the NHS.
Save the Date:
Music in Society - Evidence Meeting 4
Tuesday 26th February 2019 / 5.30pm – 7pm
Committee Room 4
Topic to be addressed: The role of music in driving economic growth
Lord Tim Clement-Jones CBE
Dr Julia Jones (Found in Music) & Dr Shain Shapiro (Sound Diplomacy)
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