(28 January 2021) 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.”

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.