LAUSR

Social prescribing is an active partnership between community and physician. Its foundation lies in the truism that health is ultimately defined by genetic, social and environmental factors. Social prescribing is a discipline which has increased in status in recent years, becoming more widely accepted and is now in receipt of both Government support and funding. It is an integrated approach and some view the concept as the sort of professional care that doctors were once able to offer when the pressures were not as great as they are today. There has been a growing understanding of the relationship and potential of the arts to promote health, prevent disease and accelerate rehabilitation from illness. ENO Breathe is a joint project between English National Opera and Imperial College NHS Trust treating respiratory problems post-COVID with three specific missions. First, to improve the recovery and wellbeing of the patient. Second, to evaluate and evidence the impact of the work. Finally, to roll out ENO Breathe as a national programme. The project is all part of ENO’s aspiration to be a leading arts provider in social prescribing working at the cuttingedge intersection of arts and health utilising the art form of opera for an integrated, holistic recovery programme that would support both body and mind. English National Opera presents mainstage opera at its home in the London Coliseum and elsewhere but the company also does much more. ENO Baylis is English National Opera’s learning and participation programme, offering people of all ages a range of opportunities to engage with opera. The whole concept is rooted in the socially driven work of ENO founder, Lilian Baylis, who believed that opera and the arts can make a positive difference to people’s lives. Therefore (continuing the theme and aspiration of the founder), the modern ENO believes it can both empower and employ social prescribing to transform the lives of people and communities. To plagiarise a metaphor, ‘ask what can opera do for the country and not just what can the country do for opera?’ Lilian Baylis was indeed an early pioneer for social prescribing. Coronavirus disease (COVID-19) became a global pandemic in 2020 with an unparalleled impact on individual health, the resilience of healthcare systems and the wide-ranging wellbeing of sovereign nations. A significant minority of COVID-19 patients report on-going symptoms beyond one month from symptom onset. The most commonly reported are shortness of breath and fatigue. Other symptoms include headache, cough, joint pain, chest pain, gastro-intestinal disturbances, dysphagia, anosmia, anxiety and depression. Shortness of breath is well documented as a frequent and problematic presentation of long COVID. Clinical abnormalities (on follow-up imaging) are reported as mixed inflammatory and fibrotic. Lung function studies report a predominance of a restrictive pattern and reduced lung diffusing capacity. COVID-associated coagulopathy is widely reported but associated with severe disease and venothromboembolism. Imperial NHS Trust already employs singing as part of integrated care for people with chronic respiratory issues and often those specifically related to smoking and asthma. Imperial considered that ENO Breathe could help with the breathlessness patients experience when recovering from COVID19. The physiological problems with breathing are compounded by psychological complications manifesting as anxiety in shallow, panicky breaths as opposed to deep inhalation. An integrated six-week pilot of weekly, one-hour sessions involving singing, breathing and wellbeing was structured, aimed at enhancing the recovery of patients experiencing symptoms after their initial COVID-19 illness. Patients are referred into the pilot by Imperial NHS Trust. The criteria is that all patients had been hospitalised with COVID-19, had been discharged to the community but are still Journal of the Royal Society of Medicine; 2021, Vol. 114(5) 246–249