Intended for healthcare professionals

Feature Christmas 2019: Shiny Happy People

Dogs and cats and miniature ponies, oh my! Meet the therapy pets

BMJ 2019; 367 doi: (Published 17 December 2019) Cite this as: BMJ 2019;367:l6771
  1. Matthew Limb, freelance journalist
  1. London, UK
  1. limb{at}

Animal assisted interventions in healthcare settings take all sorts, finds Matthew Limb

Therapy pets are in demand these days—and not just at Christmas. Staff may be in short supply but animals seem to be increasingly popping up in caring roles in hospitals and other settings.

Dogs are the most common therapy pet. Owners or handlers and their dogs are usually approved by a recognised organisation for so called “animal assisted interventions.” Pets as Therapy and Therapet are two prominent visiting programmes in the UK.

Sometimes people just need a cuddle

Pets as Therapy has 6000 registered volunteers with their “behaviourally assessed” animals—overwhelmingly dogs. Candice Hughes, a New Yorker and retired foreign correspondent living in London, signed up with her bouncy, affable Australian labradoodle named Broadway. They passed the charity’s assessments for suitability, temperament, and handling control and work “as a team” at the Royal Free Hospital. They regularly spend time with patients with dementia and on acute kidney care and some general wards.

“If patients can, we take a walk up and down the hallway,” says Hughes, who loves to hear their stories. Visits can be emotionally charged and produce tender moments. “There is something about a dog. Sometimes people just need a cuddle or a break in their routine,” she says.

Children often warm to dogs in hospital, especially if anxious before undergoing treatment, scans, or physiotherapy, says Suzy Emsden, a consultant paediatric intensivist. She takes her “laid back and emotionally intelligent” pug, Alfie, to the Royal Manchester Children’s Hospital and other facilities. He will do what’s needed—sit quietly being stroked or submit to being dressed up or ferried around on a toy tractor. Children who have raged against doing their physiotherapy suddenly mobilise to take him for a walk.

“I don’t know how you quantify that and say, ‘We’ve got x percent improvement,’” says Emsden, whose day job is with North West and North Wales Paediatric Transport Service. “Maybe you could measure the length of smile on a scale?”

Pugs and similar breeds of dog can struggle with their own health problems. “People say they can’t breathe and they’re badly bred,” but Alfie, Emsden says, “is very fit and very healthy. He just gets on with it.”

Cats may seem unsuited

Cats may also seem unsuited to this kind of work—but not all are too aloof, solitary, or antisocial for “therapeutic” roles. Josie Hughes, a senior manager with the Open University’s nursing programme, is a pet therapy volunteer in Northampton. She takes her two long haired Maine Coon cats, Benjen and Allie, to visit residents at nursing homes and enjoys the impact they have.

The cats are “very interactive, affectionate, and love attention,” she says, and the residents (the ones who like cats) “love to hang out with them.” Margaret Jeffs, aged 104, looks forward to Benjen coming to lie on her lap and table.

“She finds it comforting and says he is absolutely gorgeous,” her niece, Veronica Downing, confirms.

When Jeffs was ill, and home staff feared she might not survive the night, Downing and Hughes sped there, only to find her dressed and sat up in her chair. Staff said it was the thought of Benjen coming that had perked her up. “It turned out she had a bad chest infection,” says Hughes.

Horses are the right height

Meanwhile, horses are no stranger to seeing seriously ill humans at Blackpool Teaching Hospitals NHS Foundation Trust. The idea “sort of sneaked in under the radar,” says Jason Cupitt, a consultant in anaesthetics and critical care. Emma Jackson, an intensive care trainee and horse lover, suggested it as the next step from therapy dogs. “Horses are the right height for patients in bed,” she says—and they’re unusual.

Kindly, “trained” miniature horses are brought in every few months from an owner (KL Pony Therapy) in north Yorkshire.

At first, older patients reached for their purses, sensing yet another charity fundraiser. But it’s free at the point of care, save for Cupitt settling the transport costs, and “makes everyone’s day,” he says, particularly children and elderly patients.

Miniature horses do wonders to change patients’ psychological wellbeing, he says, despite what cynics may think. Jackson agrees, “They are never going to cure your heart attack but they are going to make you smile.” Blackpool Zoo, located nearby, is proving inspiration for what comes next. Cupitt says, “I’d love to bring a chimpanzee in. But that might go wrong.”

It would also not be recommended. The Society for Companion Animal Studies, a UK charity that raises awareness about the importance of pets in society, has a code of practice for animal assisted interventions that aims to ensure visits are safe for all involved.1 It says that only domesticated species—such as dogs, cats, equids, farm species, guinea pigs, pet birds, and so on—“can be involved.”

“Suitable bird species” include zebra finches, lovebirds, canaries, budgerigars, cockatiels, pigeons, and doves. But parrots are deemed “unsuitable, as they are prone to behaviour problems, including stress related self mutilation, and are very noisy.”

Wild and exotic species

The BMJ has spoken to people who knew of skunks, chinchillas, snakes, lizards, ferrets, insects, and other creatures having been brought into UK hospitals, psychiatric units, care homes, schools, baby hospices, and prisons for “therapy sessions,” demonstrations, and workshops. However, using wild animals and exotic species like these, and amphibians, dolphins, and pygmy hedgehogs, is strongly opposed by the charity.

They mustn’t be involved, it says, “even if they have been tamed,” because of “high risks from zoonotic infection” such as salmonella. Nor can their welfare needs be properly met to protect them from stress.

Elizabeth Ormerod, a veterinary surgeon who chairs the charity, says that many organisations that use such animals don’t understand the risks they pose to patients. “We cannot provide for the welfare for those species,” she says, “even experts find it difficult to give optimum conditions. We’re extremely worried at what we see going on.”

Encouragingly, though, she says that the NHS has become more open to allowing people animal companionship if they want it. Psychologists, psychiatrists, and mental health and social work teams are expressing most interest, she finds. She has heard of nurses allowing people to smuggle small dogs into hospitals, but recommends properly planned visits.

Hygiene and infection control must be the priority, say experts. The Royal College of Nursing has published a “pet protocol” for dogs in healthcare settings, including guidance for managing risk, which has been welcomed by the British Veterinary Association.2

Among other things, it says dogs should visit patients after surgical wounds only “providing the patient’s wounds are covered.” They should not be allowed to lick anyone, nor to sit fully on the bed, especially not near a person’s face.

Rigorous safety protocols

NHS trusts, of course, profess rigorous safety protocols. Taunton and Somerset NHS Trust, which accepts miniature horses, dogs, budgies, and donkeys, says infection control guidelines “are shared with ward sisters and nurses in charge of wards where pets as therapy visits take place.”

The hospitals are warm, so Alfie wears a “cooling jacket” designed for dogs, says owner Emsden. For visits he may wear a costume on top of that. Everything he wears—uniform, bandana, harness, and lead—gets an antimicrobial wash before every visit.

About three times a month he’s washed with antiseptic dog shampoo. When he goes into hospital, his paws are wiped with microbicide and he’s given antibacterial mouth gel. As per Pets as Therapy rules, he is not fed on raw food and is up to date with vaccinations. He does not see patients who are severely immunocompromised or infectious.

Jackson says staff in Blackpool always check with the patients, families, and staff “for any allergies or phobias” ahead of animal visits. The miniature horses, reveals Cupitt, wear “little bags on their bums to collect anything” but “small accidents” may occur and a bucket, for spillages, has proved handy.

Education for all is key and much greater awareness is needed, say experts. The Animal Behaviour and Training Council is a voluntary regulator for therapy animals. Anne McBride, a trustee, recommends animal handlers have some formal training. The animals should be assessed, suitably trained, monitored, and healthy, with all required vaccinations and boosters.

She says, “If you’re going into hospital, there’ll be ultrasound (which dogs and cats can hear), shiny floors, different noises, and strange smells. Not every animal will be able to cope.” Doctors may well empathise with that, especially at Christmas.


  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Competing interests: I have read and understood BMJ policy on declaration of interests and have no relevant interests to declare.


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