Episode 5. Karen Duval — Making the Door

Anthea

Hello and welcome to the Joyful Institute for Adequate Studies. What you just heard there was a rehearsal from the really terrible orchestra based here in Edinburgh. Thank you, RTO. You are an inspiration to GS. The Joyful Institute for Adequate Studies is a place for learning, for collective exploration, and for the kind of study that happens when you stop trying to win. It is currently in its research and development phase, supported by a creative Scotland's go see share fund. These podcasts are part of that development. Nine conversations with practitioners, artists, academics, weirdos, and tricksters, exploring what it means to sustain a practice, hold a trickster relationship with institutions, and stay genuinely yourself inside the structures that fund you. Your 2nd best unfinished self is very much welcome here. Let's begin. Karen came to Tonic Arts via over 2 decades of participatory arts work in the United States, leading programs at major... Museums and cultural institutions focused on adults with disabilities and communities who don't usually see themselves reflected in art spaces. She joined Tonic Arts in 2025, stepping into one of the most unusual positions in Scottish arts, embedded inside NHS Lothian, working at the intersection of health, care and creative practice. Tonic Arts is NHS Lothian's arts charity, which means current isn't working with the health system from outside. She's working inside it. That's proximity is exactly what makes this conversation so interesting for the Joyful Institute for Adequate Studies research. What does it mean to hold an arts practice inside one of the most outcome driven evidence hungry institutions there is? Thank you, Karen, for joining us today.

Karen

I started with Tonic Arts last August, so it'll be coming up almost almost a year since I began with them. And I, my job title is participation officer. Tonic Arts is part of NHS Lothian Charity, as you probably know, so it's kind of sitting underneath that charity umbrella, there's the Tonic Arts program which kind of embeds arts within the hospital system and then running alongside that. There's actually a green health program as well, working with, as you might, kind of environment and the kind of outdoor spaces and grounds and they have a couple of positions for rehabilitation rangers that are stationed at different sites. Tonic Arts has been kind of going for quite a long time with the charity and there are some different strands to the organization. There's a hospital art collection. So there are about 2000 works of art. That are. managed and kind of looked after by a small team who also worked for the Royal Scottish Academy. And they are the works are kind of on view across NHS Lothian sites. Staff can also, there is a process for staff to also request artworks for clinical spaces, office spaces. There's back of house spaces as well. And then we have an exhibition program. There are 9 different tonic art galleries that are. across different hospitals and different clinical spaces, rotating exhibitions kind of happen there, each exhibition is on for about 6 months or so, and then it kind of switches, then some of those shows kind of tour around the different different hospital sites. There's also an enhancement program. Sometimes with artist designers, focusing on those kind of clinical spaces and clinical care sensings and how to design them to be more welcoming environments that kind of help promote wellness and moving very far away from your kind of beige gloss, kind of hospital role and kind of really uninspiring linoleum floor and nothing on the walls. Transforming those kind of spaces through different kind of conditions and enhancements. And then there's participatory programming, which is the area that I work in. And I work across different NHS living and hospitals. It's quite a wide, kind of broad geographical area. And my job is basically kind of looking after coordinating, scheduling, managing programs that are for, you know, those kind of interactive engagements with patients, sometimes it's with purely just with staff, staff and patients, staff patients, and visitors, of which Trolley Darity was one of those projects, and that was one of my 1st projects to kind of work on when I came into post. I work with other organizations like Edinburgh International Festival who do an annual series of NHS sessions that involves bringing music performances into different hospitals and we have a schedule and a rotative for that. It's kind of in its 4th year. And at the moment, I'm also picking up, I'm working on a project that's a grand funded project that is aimed specifically at NHL Lithian staff, and it is connecting with them to provide them with creative opportunities to help reduce. Instances that will help reduce mental health and stress and anxiety and kind of like burnout from work and then also connect with the tonic art collection. So it's kind of like finding work with the staff, bring awareness of the collection, utilize the collection for those kind of benefits and for those interactions and engagements. And then there are other solid, smaller programs, like music volunteer programs, and other things that kind of crop up through the year that are different partnerships. that we have with other kind of 3rd sector organizations that come in to do stuff in the hospital and we help to kind of partner with them and steward those processes.

Anthea

Amazing. Such a breadth of area. That's quite huge, actually. It's quite a bread... sort of 7 people or so. There's a sort of broad scope and we do as much as we can within within that, I would say.

Anthea

Amazing. I want just back up just a tiny bit for those who really don't like. I'm just wondering, like for you, like, how did you come to this work? I think you came, well, the background that you used to work in America if I'm not mistaken?

Karen

Yeah, yeah, from Edinburgh originally. Yeah. And a real kid came back to Edinburgh from Buffalo last year. and to back up, going back a long time ago because I'm kind of getting rolled now, when I 1st graduated from art school, I went to Edinburgh College of Art, I actually started working with Art Link, Edinburgh and Lothians. I don't know if you're aware of their work. They've been embedded within the hospitals, certainly at the Royal Edinburgh hospital. Psychiatric Hospital. They do work at St. John's. They do work at the Western General, but they've, they've had a long presence at the Royal Edinburgh Hospital, the Psychiatric Hospital, and many years ago I started working with Art Link in, in that kind of program. It kind of started me on a journey. Working with them, broadening that work, beyond the hospital, working with people with disabilities, and then when I lived and worked in the states, But then I moved, I moved to London and I worked in community arts and I worked in mental health. I worked for an organization called Core Arts. And then I moved to America and worked in museum education for sort of 15 years. So when we moved back to Edinburgh, this job opened up.

Anthea

It's a full circle, yeah. And then it's so funny to be back and sort of seeing Artlink from the other side, or what, 25 years later?

Karen

Well, it's nice to see some of the same people as well, doing this and engaged in this work. I think it just sort of proves that there's like a lot of longevity to people who are interested in it, and there's a lot of value in doing it. So, yeah, I'm working with ArtLink in the hospital system all those many years ago, definitely kind of put me on a path to working in kind of health, arts and health, and community arts. It kind of started me on a journey, working with them, broadening that work beyond the hospital, working with people with disabilities. And then when I lived and worked in the States, I worked in the museum sector as a museum educator. So I've kind of come back with all of that experience, but then experience of working in hospitals at the very start of my career. And now I kind of saw that opportunity coming up last year with Tonic Arts for participation program position. And yeah, I was like, oh, you know, that's interesting. It'd be nice to kind of come back and and kind of immerse myself in that and see what, see what that's all about and and what is going on. So that's my kind of like personal, how I came into this work, really. Thank you. Thanks for sharing the test because I just find it interesting like how we actually come to these places of work. You know, what is the thing that drives you or inspires you to do this work? So for me, I think it's a combination of things that I like community, you know, I like, well, I like sort of, you know, the idea of,

Karen

I like socially engaged kind of work and I like working with people. I like, you know, have had many years of working with, you know, adults, mainly adults with disabilities, folks with dementia, all of those kind of specialized programming. And I just, yeah, I find that it's really, I find that that really kind of fuels me, the idea of working creatively in a creative environment, working creatively with people. and seeing the impacts and the benefits of that. And doing it within tonic art, doing it within the NHS. It's a very big, you know, it's a broad sort of sweep, really. We're seeing people on lots of different levels and more kind of episodically, seeing people sort of infrequently. Every hospital environment is very different. kind of it's kind of fascinating. It's a very, very big institution to work for. And do you think there's been like an increase? I'm going a bit off script here, but like, is there a bit of an increase in terms of like participatory arts, like in terms of Alan's work, has that always been happening, or is it like more so becoming more accepted as a way of interacting with patience and staff, or?

Karen

I think that was it. I mean, certainly the Trolley Darity project was a pilot project. I think there's certainly been, you know, it's not new necessarily that the idea of bringing performances or music or theater art into the hospital, clear setting is not new per se, but I do think the person who manages participatory programs, who's, you know, the art manager for Tonic Arts, Len McCaffir. He comes from a theatre background and has interest very much and a long history and career of working, you know, with communities in West Lothian. And I think his, a lot of his work, when he started atomic arts, was to start to build bridges and partnerships with some of the national organizations, and in part to kind of support the programming, but introduce those organizations to the idea, what is it like to work in health and clinical settings, you know, and lots of people have that remit, national organizations have that remit to work in the community, but I don't know that many of them have done an awful law in terms of kind the health and wellness in that field, working very directly in the hospitals. And I think he saw that opportunity as a kind of way to build bridges, build the partnership. You know, we can support, support one another, build the capacity for these things to happen. So I would say that. And that's just with, that's with my observations from being here over the past year. I can't, I can't sort of say to you, oh, what is the kind of like, what's the increase being like over the last 10 years or 15 years? But I would think a lot of it is dependent on these kind of active partnerships that are happening conversations where people can lean in and say, oh, yeah, we could support that to happen and we're interested in making it happen, but we'll need to work together to kind of accomplish it. Yeah.

Anthea

Lovely. Thank you. I'm going to go back to my questions here a bit. So when an artist or practitioner wants to work with Tonic Arts, who'll get into NHS social prescribing roots. What's the real pathway in? Who do they need to know or kind of what language do they need to speak? Where do most people go wrong, do you think, before they even get through the door? I'm just thinking about the students that I'll be presenting with in October and anyone else who may be listening to them? Yeah. I'm just looking really where those kind of pathways exist. It's not, it's not, we're not, I'm not seeing social prescribing being really embedded yet. I think we're kind of a long ways of figuring out how to resource and staff that and how, you know, how that's sort of going. I'm not I'm not sure kind of how that's beginning to happen in NHS Lothian. I think when artists with an interest in doing this work, they have, there's different channels, maybe trying to work with the organizations like art, like Edinburgh, and load the ends, things that tonic, for example, art and hospitals kind of have, have going. So there's kind of open application processes, for example, were just hired to filmmakers to be in residence at the Royal Edinburgh Hospital for the next 18 months. So there's kind of open application processes for those things. There's, I think registering a kind of interest. I mean, there was the healing art Scotland conference was a couple of weeks ago. I don't know if you went to that or heard about that. But there was, you know, there's a couple of people I met there that said, oh, you know, I'm an artist, I'm interested in the enhancements program, I'm interested in teaching and, it would be great to have opportunities, of course, to offer everybody, but it's nice to gather those names in those contacts, to kind of like be aware of the next time we have a project coming up, the next time there's a need for somebody with these skills or there's an interest in this. There's a kind of like, you know, awareness of who in the field is is interesting and able to work with best partner with this on that.

Anthea

Yes. Yes, yes, yes. It's about building relationships, a lot of it, isn't it? I think. Yes. Yeah. Yeah. Yeah, definitely, a lot of relationship. shipbuilding. Yeah, I would say. And I think there's no substitute for just kind of getting in and getting a bit of experience, you know? Some of the ways in or things that, like volunteering time, you know, nobody wants to volunteer their time for free, of course, but it's a good way to get in and to kind of observe and to learn and to figure out if that is a good fit, you know? If you're a good fit for that kind of environment, if it is something you're interested in, but yeah, volunteer opportunities, I think, can be really valuable.

Anthea

I agree, I agree. The next question is about social prescribing, but I mean, maybe it doesn't, maybe I can skip it because, you haven't seen it that much, eh, in terms of your, in terms of NHS work, which hasn't been that developed, which is also, that's also important, that's important for this research. Yeah, yeah. But I don't, I don't think it's, I don't see the tips really fully developed. I mean, there was a lot of chat about it and there were some presentations about it. As part of healing art, Scotland. I think there are certain NHS, what you call it, just sort of NHS service areas. I think we heard from somebody in England who had been kind of piloting it, but I think it's yet to be really developed with, with the kind of, Yeah, real clarity in kind of NHS in Scotland. I think it's a I think it's a great idea. I'm just not sure who, you know, how it would be staffed, managed, who's resourcing it, how are different are different NHFs, service areas. You know, it is to be budgeted for. I think there's a lot of conversations that are still happening that need to happen, in order for, you know, Health practitioners also to know and understand how they can budget better and how they can support this work. And I think that, that's a lot of the, the sort of, what makes it hard at the moment is that there's still this kind of view that it's art, as a sort of extra, that it's not really seen as a holistic part of healthcare. It's part of the challenge, I think.

Anthea

For me, there's like this, there's a tension between what makes participary arts work very powerful and then what makes it legible to NHS funding and evaluation structures, right? So how do we navigate this? And how do you, as Tonic Arts? What do you come up against? You know, how do you navigate this on a daily basis?

Karen

Yeah, well, I mean, I think there's a lot of work. I mean, certainly that goes into these conversations about bringing, you know, health, bringing art into hospitals and into healthcare spaces, and there's a lot of, you know, I was aware, when I 1st came in, traumatized, who was the 1st project that I worked on, now, Len, my supervisor and art managed and managing the participatory program had had a long lead in time to work with the national theatre, to develop a pilot, things had to be piloted 1st of all, and evaluated after the pilot, you know, it's kind of things are very slow moving in this environment. That's also part of a kind of challenge of it. There's a lot of trust that needs to be, you know, made really, between folks, site managers, those in charge, and there's a real hierarchy within the system as well. So it's kind of like you have to agree with, with site managers with senior charge nurses, you know, who would win is allowed to sort of come onto the ward and you have to be there as sort of the invitation has to be made for you to be in the space. It's not like you can just kind of walk in and create a project. And then when you're coming into that environment, I would say it's really fascinating. I think that's where there's a kind of, sometimes tensions as well between, you know, what, like you're saying, what makes really a powerful participatory art piece is not always what, what can be possible to execute or implement in a hospital, which is extremely public and very public space. It's like dealing with a sort of public programming where you've got every kind of audience, demographic, imaginable, in one place. There's, There's other kind of restrictions too. You know, you're kind of there, also to promote, there's, well, there's duty of care to, to take on board and, you know, think about, you know, health and wellness and the hospital is there to promote health and wellness. So you can't go into topics that are going to sort of contradict that, you know, if you were kind of, you've got to keep it appropriate, not be sort of like amplifying things that are like, you know, drinking alcohol or drugs or those kind of like, you know, those things are not going to be kind of supported. So it's kind of knowing, I think, as part of the language, I think, that you're talking about. what language are people speaking in this kind of environment and then, you know, anything that's really heavily politicized, for example, is also a kind of like a no go. And it's been interesting even just in the last year of working there. You know, we've had a sort of artistic expression policy that we've kind of implemented and we've talked about it and on the basis of being able to support artists better to do their work in this environment, but also to set expectations at the start of a project, that, you know, there's certain things that we have to kind of like abide by or take care on where it's like we're not going to be supported or taken sort of seriously if we, if we, you know, do this in this environment. And so there's certain things that you have to. Yeah, suppose that I suppose depending on the artist, some artists might see that as kind of curbing self-expression, but the other way you could look at that is kind of like with certain boundaries or limitations. It's an opportunity to think more creatively around that. It's a challenge. and an opportunity. Yeah, yeah.

Anthea

Absolutely. have you ever, like, had to protect an artwork, like, where you really wanted to be a certain way or, and then you come up against maybe someone who doesn't, and then you have to, I've not had to protect an artwork, but, We had, we had a sort of discussion about, yeah, something that was part of an exhibition that was a political piece that, unfortunately, while some political viewpoints might empathize with one side of this. We knew it was kind of not possible to put something heavily politicized in the public sphere. in a hospital gallery. So it's been part why this sort of artistic expression, kind of content and expression policy sort of came about. and I think it's, yeah, it's like having, having those kind of conversations. It's difficult subject. I mean, I have an arts background. So it's kind of different. Sometimes you're kind of very empathizing with an artist who wants to sort of create, but you've also got to think about, something about the impact that that might have, to audiences, you know. And certainly when it goes back to that duty of care, you know, that you go back to that, that sometimes I would, I would say the learning in this environment for artists is that you need to have the ability to compromise and be flexible. And then really think about things from that other side, you know?

Anthea

Yeah, flexible, adaptable, and see it as material, like the rules can be material to work with, right? That can also be something. As an artist myself. I also see that as like material itself. You spoke of a policy. Where, can we, can we find, can people find that policy on Tonic Arts website or? I'm not sure if it's shared on the website, but it's

Karen

something that we has been developed and written and that is shared with artists who we contract with or partners that we have. And so it's kind of, it's sort of, yeah, it's passed. part of that kind of like package of, you know, the initial agreement. It's kind of this is our, yeah, policy for artistic content and so it's kind of spreading that way. Yeah, I worked in a hospice at St. Christopher's Hospice for a year in London and there was as a community learning facilitator, but also as an artist. And so, yeah, to navigating that kind of space of, yeah, the limitations of what you can and cannot do, even just like working in the garden space, if you wanted to do, often, that was also, you know, what could happen in the garden, what could not happen in the garden. There were also, it also gets quite political as well. I suppose in any institution or organization, you're going to come up against, you know, the politics of the space. Yeah. Anyway. Yeah. And some of those things are, yes, I mean, I think, yeah, you have to sort of try to work around it sometimes. The Trolley Darity project was really great. Yeah, can you speak to us about that? That's great. It worked really, it worked well, and I know you'll have talked to Alan about it, but I think it was a very, a very solid concept. And just introducing a lot of fun and playfulness into that, these kind of environments where people, you're not seeing people on their best days. You know, you're not seeing people in always happy or calm sort of circumstances, and it was short experiences, the fully made it so that it was mobile to go, you know, to almost anywhere in the hospital and it was really great. We were able to kind of really cover a lot of ground, span a lot of different wards. Some we visited on repeat. There were back of house spaces, like the portage break room at the Western general hospitals, staff wellness areas. We even got invited in to a medical records of this one day to do the Trolley Darity experience with 10 people at their desks that were just desperate for a kind of work break in the day and their manager was like, I would love to do this for my team who really do deserve a break today. you know, they've been under a lot of pressure and strength. And, you know, equally very moving to take it to, you know, elderly patients with dementia, living on the wards. We had it in an enhanced care unit. you know, it was just amazing and lots of stuff. Although it's very hard for staff to feel like they can give themselves permission to take a break, a lot of people did join us, and it was lovely to see almost as many stamps as there were patients and visitors taking part in engaging. And I think that for me it was come back. It was very eliminating. It was quite a kind of breakthrough to kind of get the staff excited and talking about it and kind of taking part. And it gave me as somebody kind of quite new into working the organization, a huge contact list, which was just great. It was kind of like, this is a really great way to meet people. It's a really great way to meet the hospital staff, learn about the different wards, the different departments, the structures of the hospital so that when you kind of go back in with other programs, it's kind of like you can be that kind of face at that point of contact. And I think, especially when you're navigating these spaces. They're really complex space age hospitals. And when you're on a ward, it's like you don't have a lot of flexibility there, you know, you have to be very flexible in the swing of things to fit in with the meal range, the medicine range, the doctor's visit, how the structure of the day is kind of stepped out, and you have to kind of like find the way to weave in the in-between spaces to make things happen. So it's kind of just fascinating really. and it was great. It was just a great project. And then we got the opportunity to take it to 3 different hospitals and see and see that kind of workout.

Anthea

Wow, I didn't know it was 3 different hospitals. That amazing.

Karen

Yeah, there were 2 teams. Yeah. Shona and Alan, who the project originated with, did the 1st block, which was 10 10 weeks with one week at the Royal Edinburgh Hospital, actually, as well thrown in. so they were there for the 1st 10 weeks and then 2 other artists came in and we did the project with them taking the lead on the performance at St. John's and also East Lothian Community Hospital. So yeah, we got to do a lot of different spaces, different hospitals, different structures. We even took it out to 2 care homes that were part of St. John's Hospital in Livingston. So it was a good pilot in this regard, you know, being able to really test it. test it out for all of these kind of different settings. And it was, you know, I think it just, it was, it went over. it went over well. It was something that people really look forward to and enjoyed and those people were having repeat visits, were just thrilled to see it come back again. But it was short and it was temporary. Yes, kind of. And it's like, okay, what do we, what do we do? what are we moving on to next?

Anthea

It's good. I love that. I mean, that's one of my favorite things about it. I love the project itself, the scratch and sniff, the sound, the whole experience that they've designed, that you go on, that it's also like this individual moment, you know, 2 minutes for you, you know, and then it moves on. What do you think, like, if you were to go back before, like when you were reading the proposal, I don't know how it worked, exactly, like how you decided curating, I suppose, of choosing the artworks. But when you 1st heard it, were there any reservations or like, how did you think it was going to go?

Karen

There was one or 2 experiences that were kind of, there was one set in a disco and then had some concerns about going to the bar in the disco. So there was kind of like, okay. Sounds like Adam. getting straddling that edge here and kind of like, what? we've got to, we've got to remember that we're kind of like in promoting health and wellness, having fun, but we don't need to kind of promote alcohol as part of that heavily. You know what I mean? So there was kind of, there was these moments and that's what I think was quite interesting about it. It was kind of like, oh, I didn't, we, I wasn't involved in, in the curating. I came on where that had been set and it was my job to basically go and schedule it all out and go, connect with all the wards, give them a heads up, hey, what's, this is what's coming. Can we come visit you? Can we set this kind of schedule? for the hospital. So it wasn't really until we were kind of rolling it out that I was like, oh, okay, you know, we're here are our stories. This is our menu, this is what we've, this is what we've got and we hear all the postcards and everything. And did anything, This, the, just staying with the Trolley Darity for, for a moment. Did anything like, because

Anthea

at the beginning of the interview or the chat, you mentioned briefly of some challenges that you come up against, right? how this is only seen as like an afterthought, how the arts you have are like frivolous or it's like an add-on. You know, it's not actually embedded. It's not embedded or there's no like holistic kind of view of it. Do you think like anything shifted or changed after this Trolley Darity thing?

Karen

I think so. I think there was the, I know, to clarify, that's not everybody's opinion. Oh, yeah, yeah, yeah. When you bring, when you bring the kind of project round to, certainly senior charge nurses and ward nurses, the kind of frontline kind of staff that are doing the kind of bedside care. They are generally very on board and very supportive because they see the impact and the joy that it brings. I think the hardest staff to engage are the clinical staff. You know, they're kind of just feeling that pressure where it's kind of like anything, like any minute of the day, that is kind of a break from the serious business of like kind of, yeah, giving care, focusing on people's treatment plans, educating training doctors, you know, and again, it's just it's very hard to kind of connect with those with those staff, I think, to sort of make them feel like, oh, this is also, This is also part of care giving. This can also be part of care, and that the staff in the ward when they engage with something, when they leave, feeling like they've had 2 minute micro break, and they've had a bit of refreshment, they're in a better place to provide care now for somebody else because they're a little bit more, just a little bit more relaxed. We're not, we're not saying that we're kind of like changing the world, but we are able to provide something in there that is kind of out with the rhythm of the hospital, the kind of strict bendaries, that kind of process of diagnosis and treatment. And when you remove those sort of hierarchies. you get people just connecting as people, people to people. It was lovely to see nurses and patients doing the same thing together. It's like, it's another moment where it's kind of like, okay, then you're not, you're just, you're just 2 people with headphones on now in the same journey. You're not kind of like the dynamic is shifted or changed. It's a different way to look at the relationship. And I like that just being able to take people out of themselves for even that brief time, just to be suspended in space, in this thing, you know, and at least in many and funny.

Anthea

Absolutely. I think play, well, this is my area in play studies and I think play has that capacity, right, for us to step into this kind of other world, just for that moment, that temporary space where we are just human beings with headphones on, as you say, just for that little 2 minutes, what that does, you know, in terms of like relationships, like interrelation, like relational stuff, and then also inside you, gives you just a tiny bit more energy to continue, as you say. So, yeah. I suppose in terms of like, you've answered it in terms of like change out there, but also change insight. Like when someone experiences that, they're more willing to to play again, I suppose, or to let this happen again, you know, like, okay, I had this tiny moment there and I'm more tiny but more open-minded to, you know, this work, which is just, yeah. And

Karen

I think that's probably our role as artists and within the organization to see those little moments where it's kind of like and it takes trust, doesn't it? to kind of build trust to get there with people to say, will you meet me just to do this thing and we'll see it a little moment or an experience and then, like you said, I think it makes people say, oh, you know, if we've done it once, we'll do, we could do it again, you know, we'll try and find the time for that. And hopefully you're, hopefully the changes that you can try and find time to build on that. And that maybe, you know, some of those experiences are longer, more, more sustained or that we see that they're having a kind of impact that we need to be able to resource it more. Yeah, yeah, yeah.

Anthea

Amazing. Thank you. What should an independent practitioner realistically expect to be paid? How does the contracting process actually work and what do people most commonly get wrong when they 1st approach this kind of work? Well, I would say, I mean, to say, I was advising somebody to approaching this from the age side. I think I would, as an artist, a guy as an individual practitioner, I would look at what the artist union rates are, kind of, I would work from that as a standard. I would expect to work from that as a standard. Certainly, Sands you with a more solid foundation for which to negotiate, whether it's kind of like a daily rate or a half day or early rate. But that's where I would begin if I was giving advice to another artist. as far as contracting within the NHS, that's, it's a kind of separate financial system, it, you basically, it's a sort of complicated process where you basically list yourself as a supplier, you become like a supplier of goods. And then it's a player of good vibes. Yes, there you go. And you have to kind of go through it's a procurement kind of process, basically. And there are things to be aware of too in this environment with all the policies, checks, PVG checks and so on. And it's fine if you have your own PBG check, but I think additionally, if somebody's working within the NHS, I think we still have to run an NHS, PBG check. And that's just another thing that's good to know that you can expect.

Anthea

Amazing. Great. Another layer.

Karen

Yes, another layer. Participatory arts practitioner is just starting to think about working in health or social prescribing context. What's the one thing they should know that nobody puts in the guidance documents. What do you think they should know if they're going into this area?

Karen

Well, you know, I think one of the things that came out of doing Trolley Darity with the with the different teams as well, was that sort of thing about taking care of your own health. And what does it mean to kind of carry the load? Because it's quite an emotional experience for people to be in close connection with patients, you know, some of whom are really, you know, maybe not going to have a good outcome. Oh, there's people going, yes, people going through all kinds of different experiences. And I think when, especially when you're in a kind of performing role as well, you're connecting very strongly with people, I think it's hard not to sort of feel like you're carrying a bit of that load afterwards. So I think it's kind of like, yeah, looking after, taking care of your own health and sort of well-being as part of the package or realizing that that's that's a part and piece and part of what you need to do. Also establishing there's kind of like boundaries for yourself too, you know, having what does a healthy boundary look like for an art practitioner in these kind of environments? And then I think it's kind of flexibility. I think that's just key. It's kind of like knowing that the plan that you go in with may not work. Well, there's a lot of things that are predictable. There's also some wild cards in hospitals as well that you have to kind of be a little bit more aware of. So having a plan, but knowing that you might have to sort of go to plan B and maybe even a plan C. On certain given days is kind of important to realize. And then I think going back to that idea of not everybody is kind of looking at this as, you know, they've got different ways to measure those kind of outcomes. It goes back to the evaluation, really, kind of understanding and speaking the language, understanding the impact of what you're doing in terms of like art can be a health. It can have a health impact and that could be the outcomes for that can be health related. So sort of switches a little bit, how you think about projects and programs. Mm, mm, mm. And do you think people can artists? Do they know a lot of the stuff when they come in or no, yeah?

Karen

Yeah. My observation has been not, not so, I mean, and that's just, that is just based on my experience this year with, with who I have worked with, but, all of the people that worked with Trollidarity, it was the 1st time doing things more sort of intensively in that type of environment. So there's a lot of coming to things for the 1st time. I think the theater had done a project previously, a photography project, but I don't think they had done anything that was sustained like this kind of over time where you're doing, you know, kind of face to face and it was more like a residency. I think there is, I think there's quite a lot of work and it's funny because I don't know how, I don't know how much more you would prepare people for it. You know, there's kind of, it's one of these things that's kind of like, There's no substitute really for the experience of it. I mean, I think you can say to people, Well, here, you know, here's what this word is, for example, or this, you know, you can expect to see. If you go into a dialysis ward, you can expect to see, you know, up to 50 patients. They are on these, you know, machines. They are very restrictive. They won't be able to clap while they, you know, listen to your performance, receiver performance because they're tied up and hooked up the machines. Some people just won't be willing to, or, you know, it's all these things, what does it, what does it look like? What does it feel like? What is it like when you kind of go in? And I don't know, you can say all that. But I don't know that it necessarily sinks in until you're there and then people are kind of like, oh, okay, this is this is what this is like, you know, you're having to kind of navigate. And there's not like a blueprint for that or a kind of roadmap for that. And every day is different, right? So, I think it's quite hard to sort of give that advice. There were certainly discussions that we had. But with both Trolley Darity teams and they were like, to, you know, I think it was just their, Observations were like, oh, it was really quite emotional and I wasn't necessarily prepared for that on certain days.

Anthea

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