NHS CaRE Project CNWL NHS Foundation Trust

Aims & Objectives

The primary objectives are to:

• Improve psychological safety, shared sense-making, and collaboration within NHS teams.
• Support workforce wellbeing and resilience under operational pressure.
• Enable teams to surface issues, prioritise needs, and co-create solutions in a safe, inclusive environment.
• Provide leadership consultation and follow-up to embed and sustain positive change.
• Leverage digital methods for cross-site participation, anonymous feedback, and visual mapping.

Outcomes & Measured Impact

Since its launch, CaRE has partnered with 67 teams and engaged 907 staff. Pre–post evaluation using validated measures shows small but meaningful improvements following CaRE arts-based team development away days including: 

Significant gains in:

• Team respect (Psychological Safety Scale subscale): significant improvement
  Pre M=3.59 (SD 0.81) → Post M=3.73 (SD 0.85), t(78) = −2.02, p=0.047, d=0.23 (small effect).
• Significant reduction in Burnout Depersonalisation (MBI-DP): significant reduction using non-parametric analysis Pre M=2.21 (SD 1.10) → Post M=2.05 (SD 0.95); Wilcoxon p=0.022, r=0.23 (small effect).
• Direction-of-change analysis found improvements in emotional exhaustion (60%), depersonalisation (50%), individual safety (52%), team respect (43%), and team learning (42%). 

Qualitative feedback from staff and leaders highlights increased morale, a sense of being valued and heard, and strengthened team dynamics.

Key Enablers

• Senior sponsorship and leadership engagement before, during, and after delivery.
• A clear programme identity anchored in SCARF values (Safe, Compassionate, Accountable, Reflective, Fair).
• Skilled facilitation by arts psychotherapists able to manage group dynamics and translate experience into action.
• Bespoke design for each team, with pre-session scoping and contextual sensitivity.
• Hybrid/online delivery for inclusive access and rapid mobilisation.
• Anonymous digital tools for candid feedback and psychological safety.
• Co-produced visual outputs for ongoing reflection.
• A credible evidence base for feasibility and early impact.
• Strong partnership working across diverse NHS settings.

Key Challenges/Barriers

• Operational pressures and rota constraints limit protected time for team participation.
• Variable digital confidence, equipment, and access can reduce engagement and widen inequalities.
• Online fatigue and challenges in maintaining relational depth in hybrid contexts.
• Balancing anonymity with safe practice and managing safeguarding in digital tools.
• Time-consuming governance for media/visual outputs and consent.
• Heterogeneity of team contexts requires substantial bespoke adaptation.
• Sustaining change beyond sessions depends on leadership follow-through.
• Evaluation constraints in real-world delivery, including incomplete follow-up data and small samples.

Demographics, Settings & Referral Routes

Demographics: CaRE serves working-age adults (26–64) and other staff groups. The programme is relevant to workforce wellbeing, health service redesign, and system transformation, with national reach and implementation.

Settings: Across acute hospitals, mental health hospitals, community health hubs, rehabilitation centres, and allied health settings.

Referral Routes: Teams are engaged through self-referral and leadership nomination, with the programme promoted internally across CNWL NHS Foundation Trust. Participation is supported by leadership sponsorship and organisational development priorities.

Evaluation Methods

Evaluation combines anecdotal feedback, routine monitoring data, validated outcome measures (e.g., WEMWBS, EQ-5D, PHQ-9, GAD-7), and case study/narrative evaluation. The programme prioritises informed consent, confidentiality, and safe storage of digital outputs, with proportionate governance for anonymity tools and media.

Participant & Stakeholder Feedback

Feedback is overwhelmingly positive, with staff describing CaRE as “exceptional,” “enriching,” and “the single best intervention” experienced in their careers. Participants report feeling valued, heard, and more connected to their teams, with lasting improvements in morale and team dynamics. Quotes included:

"I can't tell you how much we appreciate all that went into the design of the day and ensuring that it met our needs as a team. This is an exceptional initiative that we will absolutely be recommending to other teams." – Fran Lepori, CNWL Trust Head of Lived Experience Workforce

"I was pleasantly surprised. The day brought out all the positive aspects of individuals and the team and reminded me of our shared goals and aspirations. I was buzzing with positivity at the end of the day. I felt incredibly proud of the people I am lucky to call colleagues." – Shalini Andrews, Clinical Director for CNWL Bloomsbury Clinic

"I heard some staff commenting on feeling positive about themselves afterwards and feeling seen by the team in this moment. The day and package you offer is brilliant, and I would recommend this to other teams." – Speech and Language Lead, CNWL Brent Learning Disability Service

Alignment with National Strategy & System Learning

CaRE aligns with national priorities for leadership, workforce development, digital technology, evidence and impact, health inequalities, and system transformation. The programme supports system learning by providing a replicable model for arts-based team development, digital innovation, and psychologically informed organisational change.

Further Information: https://www.cnwl.nhs.uk/care-project-creativity-resilience-and-engagement