Nursing Times Award Winner

Outside in

Across the country, the young people come from local choirs, brownie and cub packs, dance troupes, drama classes, nurseries, primary and secondary schools, colleges and universities. Not all at once but in small, manageable groups. All come with appropriate supervision. They all have specialized skills and they all arrive determined to make a difference to older people, many of whom are frail, feel isolated and have some degree of dementia.

From the moment our groups arrive, all of them help dispel the acute isolation many patients feel when they come into a hospital or Care Home setting. Dressed for the season, sometimes in a costume linked to a time of year or special event, they help connect the most vulnerable older people with the outside world. Last year, a resident in a Care Home shocked the visiting group when she commented on someone's cold hands.

'That's because I've been playing in the snow,' the young girl explained.

'Has it been snowing?' the resident of the Care Home asked.

It had been snowing, off and on, for three weeks but the lady's chair was nowhere near a window. In the warmth of her upstairs dayroom, no one had thought to show her the beautiful snowy scenery. For her, it could have been any day of the year.

So, whether it's a simple story about the weather, some local news or an anecdote about their schools, it can make people smile and, in the simplest of ways, feel a connection to the world beyond their four walls. And the chatter of the young people has other benefits too. Older people, in the main, don't want to be reminded about their age. Most would far rather recall their own childhood and, hearing the young people's stories, quickly reminds them of theirs. Being local, some of the patients will have attended the same schools. It soon makes for great conversation, some of it, in the case of the older people, extremely mischievous.

Many of our groups are very nervous before they arrive. We prepare them meticulously but it can be very daunting to come onto a ward for older people or Care Home if you haven't done it before.

So, the way the staff welcome those groups is very important if the patients are to receive the maximum benefit.

In some hospitals and Care Homes, staff often appear to be too busy to give the groups any time when they first come onto the ward. They may have heard they are coming but not taken much notice when they arrive as they are so busy getting through their own day. Senior staff may not have fully informed them about the range of skills these groups can offer and how they can best deliver them. We always tell them we are coming but whoever answers the phone or reads the email, often doesn't fully undestand our purpose.

So, the young people arrive and, all too often, are left to stand in a corner until someone tells them who might most appreciate their time. While they wait, they feel they are in the way and generally not wanted. This can make them feel awkward and very uncomfortable. People stare at them and wonder why they have come. That makes them feel even more awkward and uncomfortable. It's a vicious circle.

It would be easy to blame the front-line staff. But that would be unfair. Over-stretched staff have to prioritise, and groups, particularly in hospitals, who come to lift spirits and trigger memories by reading much-loved poetry, singing familair songs, offering free beauty therapy treatments, hairstyling, etc may seem trivial compared to managing someone's complex treatment regime. But, in reality, the services provided by the young people can not only make a huge difference to someone's hospital experience, they can also help their recovery too.

Whether it's the lady who spoke for the first time, following her stroke, while she was having a beauty treatment, the visitor who watched as their dying father opened his eyes and gently sang along with one of our choirs, the grandmother who, surrounded by her family, smiled in recognition as we read The Daffodils by Wordsworth, or the lady, who had just lost her sight, who cried when she told us that, although she would never see her manicured hands, she knew her partner would admire them and that meant a lot to her. These are just a few of the thousands of stories we could tell many, of which, are on our website.

Time and again, the skills offered by our teams hugely lift the energy wherever we work. Staff are always encouraged to be involved - to stop, if only for a few moments, to share the experience. It may be to have a five minute hand massage, to enjoy a choir sing, or to stroke visiting pets brought in by animal care students. It all helps to lighten the atmosphere and make people smile and talk to each other. How often have connections been made as older ladies, whilst admiring each others nails, discover that they only live streets apart and have friends in common? Or to hear patients, staff and visitors talk about their own pets whilst stroking a visiting labradoodle.

Energised patients are more likely to move, talk and smile. Energised staff are likely to work more efficiently, to engage better with patients, to think of other ideas that may help to lift spirits. Over the years, we have discovered, through our visits, hospital and Care Home staff who are singers, beauty therapists or actors in their spare time and we have hugely encouraged them to use those skills, where appropriate, in their work setting. Part of their role is to lift spirits and if those skills can make a difference, they should be encouraged to use them. How many of us at Christmas have begged a talented relative to sing, recite or do a magic trick?

And, when we leave, we hope we leave behind a buzz of energy -the legacy of a successful session. People with dementia may not remember the details but they will feel more uplifted afterwards and their visitors will notice that difference. Seeing a patient stretch their fingers to admire a manicure not only brings a smile, it can also be useful physiotherapy. Hearing that person chat to a patient in the next bed is great speech therapy for someone who may have had a stroke or who who has dementia.

Yes, we offer entertainment. But staff must understand that, by guiding us in the direction of patients who will most benefit, it is far more than that. It will be of enormous value to patients, visitors and staff but it will also do much to improve the communication skills of those young people who offer their special talents freely. And that's important too.

But, without that preparation, the most vulnerable patients miss out. It is very difficult for us to approach them unless we are guided by ward staff who know what a difference it might make for them to hear a favourite song or to have a gentle hand massage. And the students miss out too. And that affects their confidence, making them reluctant to come again.

Many Trusts ensure their key staff know all about the groups before we arrive and thank them when they leave. Those are the Trusts that gain the most from us. Their enthusiasm and gratitude mean that the number of visits grows year by year.

Many of the young people who work with us have now started to look at careers in healthcare. They have had the opportunity to see, at first hand, how simple things can make a huge difference to someone's care.

So, please can senior staff ensure that, if you want us to visit, your wondeful ward teams fully understand why we come. Many are under enormous pressure. Our aim is to relieve some of that pressure by providing activities for their patients that can be enjoyed by everyone. To this end, we offer training, that is informative, entertaining and hugely interactive whist, at the same time, working with each Hospital Trust and Care Home group individually, we ensure that everyone has clear guidelines of how to get the most from it, safely.

But, above all, it must be fun.

For more information, please see the films and BBC interviews on our website

And finally some feedback..

“If I was given one million pounds, I'd give it to Kissing it Better, a wonderful charity of which I am patron that uses community volunteers to put fun, compassion and painted nails back into hospitals and care homes. It's a brilliant idea.” Dr Phil Hammond, GP, comedian and political commentator

"Kissing it Better does untold good. By connecting people suffering with dementia to melodies and poetries still living inside them, it connects them with their richest selves and also with the world outside them. The beneficial effects are extraordinary.” Sir Andrew Motion, former Poet Laureate

The work of @Kissingitbetter is so important in cultural change in the #NHS sincerely grateful for all you are doing xx ???? #thankyou

Kath Evans, Head of Patient Experience, NHS England( from twitter)

Happy New Year

Jill Fraser

Jill Fraser

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