Read on to discover how doctors are using music's amazing healing powers to treat pain and mental health issues...
Music at the bedside... just another day in hospitals
It is mid-morning at Addenbrooke’s Hospital in Cambridge. The main adult ICU ward is a scene of calm, professional bustle as critical care nurses and doctors attend patients, discuss medication and huddle in consultation. There is also the sound of Stravinsky coming from one of the patient side rooms. A flautist, violist and cellist are at the foot of a patient’s bed, playing the sparkling Gavotte from the Pulcinella Suite. When the same musicians visited a week previously, the patient was too anxious to let them in the room, but today she listens and watches intently, thanks them warmly and requests a rendition of ‘Over the Rainbow’.
In another room, an extremely ill young patient, facing major surgery and many months in the ICU, is invited to take a conductor’s baton. With immense effort and focus she gently lifts and lowers the stick just a few inches above the bed covers as the violist improvises a tender melody. The intimacy and vulnerability of this reciprocal connection is palpable, and so is the patient’s strength of will to sustain two minutes of musical co-creation.
Orchestral musicians teaming up with hospitals... from oncology to psychiatric care
Britten Sinfonia flautist Sarah O’Flynn and violist Bridget Carey are at Addenbrooke’s with cellist and facilitator Sam Glazer as part of a pilot ICU residency developed by the orchestra with Cambridge University Hospitals’ arts-in-health programme CUH Arts and the critical care nursing team. It’s one of many examples of the work that orchestral musicians across the UK are doing in health and social care settings, often in partnership with local NHS trusts.
A landmark Orchestras in Healthcare review in 2021 revealed that orchestras contribute more than £1.6m annually to the public health sector, with nearly two thirds of UK professional orchestras working in health, wellbeing and social care. Going to wherever their audience is, musicians are working in clinical settings from neonatal and palliative care to oncology, dialysis and neurosurgery wards, plus high-security psychiatric hospitals and dementia care homes, bringing music to patients, staff and families. Increasingly, orchestras are also running group sessions in community settings as part of social prescribing programmes, where interactive experiences give psychosocial support to those referred with anxiety, depression, isolation or chronic pain.
The science behind music as medicine in hospitals
Central to the work musicians do in healthcare settings is using music to engage with patients on a personal level and, if they are anxious or in pain, trying to make them feel better. Instinctively we know that slow, gentle classical music can be calming and soothing – BBC Radio 3 Unwind taps into this – and that faster and joyful pieces can lift our spirits. But the science of how music can act as a kind of medicine is still being investigated.
The scientific literature includes numerous clinical studies of the positive effects that listening to classical music can have on the nervous, cardiovascular and respiratory systems. Researchers have shown how classical music can have beneficial effects on heart rates, blood pressure, breathing and mood states, improve quality of life for patients with heart failure, calm patients during minor surgery, and help reduce the frequency of seizures in children with epilepsy.
The 'Schubert treatment'... and the power of Bach
For all the quantitative data and scientific reporting, some of the most powerful testimony of music’s therapeutic effects comes from the musicians making in-the-moment connections with patients. The Tchaikovsky Conservatory-trained French cellist and art therapist Claire Oppert wrote movingly in her 2020 book Le Pansement Schubert (published in 2024 in English as The Schubert Treatment) about how playing the opening cello theme from the Andante of Schubert’s Piano Trio in E flat major, Op. 100 was the only way of easing the violent distress of a dementia patient as nurses tried to re-dress her wound. When Oppert developed a ‘Schubert treatment’ protocol at the Sainte-Périne Hospital in Paris, working with over 100 patients in the hospital’s palliative care unit, the head of department observed that ‘Ten minutes of Schubert is the equivalent of five milligrams of oxy’ (oxycodone is a powerful analgesic).
Children, babies and music in hospitals
The Liverpool-based cellist and music and health practitioner Georgina Aasgaard often takes her instrument into the neonatal unit and other intensive care wards at Alder Hey Children’s Hospital. ‘Tiny babies and small children can’t take their eyes off the cello,’ she says. ‘I think it’s the size of the instrument and the vibrations it brings into the room.
I was playing three movements from Bach’s First Suite recently to a baby and his parents in the NICU; I love using the Bach Suites, as they are episodic like life, with reflective moments and celebratory moments, and ending with a Gigue that always gives a sense of hope. As I began playing the Gigue, after the Prelude and Sarabande, it was incredible to watch this baby, who was fighting for his life, fixate on my left hand as my fingers moved faster. I could clearly see the effects on the baby’s heart rate and breathing.’
Music as a means of expression in hospitals
As a lead musician with the Royal Liverpool Philharmonic Orchestra’s long-established Music and Health programme, Aasgaard regularly works in mental health settings, including a high-secure hospital. In her experience, classical music can trigger the imaginations of people with severe conditions who may have been ‘locked in’ for many years. ‘It breaks down hierarchies,’ she says, ‘opens up connections between staff and patients and leads to dialogues where people suddenly find a way to express what they are going through.’
Sparking these conversations through music does not mean playing safe with repertoire, and Aasgaard likes exposing patients to spiky contemporary pieces. ‘I invited Simon Cowen, the RLPO’s principal trombone, to a session where he performed Berio’s Sequenza V, ’ she says. ‘Seeing the effect this piece had on patients and the conversation it stimulated confirmed to me that I can take risks with classical music.’
Giving patients agency through music improvisation in hospitals
At the Addenbrooke’s ICU, what stood out most for Bridget Carey was the agency that interactions with the musicians gave to patients rendered powerless by their health crises. ‘To hear something that they really wanted to hear in that moment, or to have a feeling evoked through an improvisation, and having that interaction be a partnership with us was an empowering experience for the patients,’ she says. Fellow musician Sam Glazer says that it’s often in the most vulnerable of situations that the connection with music is at its strongest. ‘Music is such a powerful thing to bring into intensive care,’ he says, ‘because the patients are ready to connect deeply and authentically with it.’
Although Glazer came to the ICU with a variety of classical and folk pieces which were necessarily short to accommodate the energy and focus limitations of patients, he was also keen to introduce improvisation and more participatory music-making where it felt appropriate. ‘In hospitals and dementia care settings, one of the strengths of improvisation is that it can help you find the right music for the moment, so you can achieve that fleeting but profound connection with a patient,’ he says.
‘It’s important that you bring music that you love playing, because that translates – patients can tell when you play with love and commitment, and they can feed off that. Above all, in an environment such as intensive care, you need to have a very high degree of sensitivity to the kinds of engagement people are open to. You need to pick up on the smallest cues, but also be ready to step back if a patient’s energy level drops or a consultant comes in on a ward round.’
The importance of rhythm
In one of his many illuminating lectures about music and the brain, the British neurologist and classical music lover Oliver Sacks talked about how the perception of pitch and tonality can easily be lost with neurological damage but the primordial sense of rhythm always remains. In situations where a patient struggles to communicate verbally, it is often rhythmic cues that musicians pick up on as a starting point for creating a connection.
Such cues might take the form of a patient’s involuntary finger movement or simply the rhythm of their breathing, explains clarinettist Katherine Spencer. ‘Their breathing not only gives you a rhythm,’ she says. ‘It gives you a feel for who they are and where they are in that moment. It’s a kind of bottom line for what you offer up to them musically. And then if they give a little finger movement, you can tease out something from that, and sometimes they might notice and start offering a gesture back.’
‘You are there to make that person better, not just to play some nice music'
In her work with the City of London Sinfonia, where she is principal clarinet, Spencer uses this improvisatory approach in the orchestra’s Room to Room Music programme at care homes in north London, working with residents who are isolated in their rooms. At the end of one visit, a resident said to Spencer, ‘That piece was lovely. What was it?’, to which she responded, ‘It was you. I was just following you.’
When she works in children’s hospitals, Spencer takes some repertoire to every session. ‘It’s part of bringing main-stage work into different settings,’ she says. ‘If I bring in some Bartók, I might not discuss the music as being by Bartók but we might talk about the rhythms in the piece and how these make us feel and what we can take from that music. In this way they see music as something they can use themselves.’
Music in hospitals... 'One-on-one connection is at the heart of health'
It’s clear that musicians working in healthcare are acutely aware of the impact of their work and of their responsibility to the individuals they are interacting with. ‘You are there to make that person better, not just to play some nice music,’ says Spencer. ‘You have a function to change their life in some way, and you have to find a way to do that through your music. In the concert hall we can get wrapped up in the music and serving the composer, but we must never forget the responsibility we have to each individual in the audience. That one-on-one connection is at the heart of health and wellbeing work, and without it, I don’t know what future music has, because it has to be relevant to anyone.’