Let’s Listen Part 2 by Karen Robertson

NES AHP Career Fellowship Project by Karen Robertson, Occupational Therapist for Children and Young People     

What does effective family-centred AHP neonatal and developmental follow up really look like? Part 2

Context

In Part 1 of this blog, I shared my perspective on the earlier stages of my NES AHP Career Fellowship experience.  I discussed the opportunity and learning that has come from rich lived experience conversations with our local families who are accessing our AHP neonatal and developmental follow up service. 

National guidelines informing neonatal and follow-up services advise around evaluating infants’ needs and promoting family-centeredness is a key recommendation (NICE 2017).  Locally, our AHP neonatal and developmental follow up service is delivered by an existing pool of CYPF AHP’s and therefore capacity to do so remains limited, not ring-fenced and essentially fragile.  Our AHP team wished to better understand what family-centeredness looks like within deliverable practice locally while recognising the constraints of our service.  We wanted to explore the question;

“If we only have a limited time with this family and their baby, what will make the most positive impact for them now, and for the future?”

Policy informing healthcare in Scotland is underpinned by values such as partnership and integration and participation and engagement advocating continual improvement, creating the opportunity and environment to co-design services and honesty about priorities and constraints around what can be co-produced (Scottish Government 2016; 2022).  This project has involved a response to families lived experience stories of participation to “further upskill AHPs and influence our future decisions about our ways of working and creating environments in which participation and participative relationships are possible.” (Scottish Government 2016)

Immersing in local lived experience

I recall feeling a sense of privilege to hold such rich information, as well as a responsibility to make sure it was handled with sensitivity, respect and managed in a way that would have the greatest impact for local families.  Our next step was to make sure we could truly understand the wealth of information and what it could enable us to think about. 

Key themes with underpinning sub-themes very quickly and consistently emerged from local lived experience stories which we immersed ourselves in as a team:

– Parenting on the Neonatal Unit

– Empowering families to access therapy support and the team around the family

– Supporting parental wellbeing

– Communication and resources

– The focus of developmental follow-up appointments

– Empowering parents to advocate for their child beyond follow-up

Family-Centred & Family Integrated Care

It was important to understand how local lived experience could be considered within wider frameworks informing on family-centred care.  Within healthcare for the neonatal population, the British Association of Perinatal Medicine highlights the augmented nature of family-integrated care beside family-centred care.  With the key being to not only ‘involve’ but to ‘enable families as partners in care’, as AHP’s our core skills within CYPF practice most certainly stood us in good stead for applying this framework to our neonatal and follow up practice.

(BAPM 2021)

BAPM (2021) highlight 5 key principles of family-integrated care when working with this healthcare population within neonatal care. 

https://hubble-live-assets.s3.eu-west-1.amazonaws.com/bapm/file_asset/file/793/BAPM_FICare_Framework_November_2021.pdfre

Co-designing as a team

As an AHP team, we met to explore how we could realistically approach service improvement, within the scope of the project itself, our AHP roles and remit while holding on to the fact that our service is not ring-fenced and fragile.  At this point, it felt enormous as all the data, with every parental quote felt important.  This is when QI tools such as the high/low effort/impact scale became our friend to enable us to set realistic project goals.  Another key asset was to consider what was within our circle of control and influence versus what would be reliant on wider complex systems. 

Throughout December and January, we met as a team to collaboratively embed the local lived experience themes within each stage of our own AHP neonatal and developmental follow up care pathway.

We aimed to approach our service redesign to….

• concentrate resource utilisation on where it is of most value and will have the most impact by responding to local lived experience
• reflect the underpinnings of AHP policy in Scotland & existing models of family-centred care for this healthcare population
• outline delivery of a realistic and sustainable local AHP service

Sense checking with families

In February, we were delighted to host a ‘together session’ with participating families as an opportunity to share our thoughts so far on our service redesign based on their lived experience.  This brought about a further opportunity to sense check with families that we were going in the right direction, and equally to prompt us to do so if we weren’t!  Via a questionnaire following the event, 3 participating families shared with us that they think our service redesign proposal…

Key outcomes from the project

As an AHP team together with local families, we have been able to create

• an AHP service name, role and remit with an ability to be recognised for what we are and can do more of for local babies and families.  We will be able to measure our impact and measure, manage and report on mitigation of risk with any incidence of unmet need.
• an AHP Neonatal Service Leaflet, outlining the roles and remit of the team, and to provide families with agency over when and how to seek support. 
• A value based co-redesign proposal for an AHP Neonatal and Developmental Follow-Up Service based on lived experience of local families
• A journey map of resources for this population including available evidence based resources, and co-produced resources with visual supports across AHP team with family consultation.

If you would like to know more about this project, including the lived experience theme and sub themes, the co-redesign proposal our team are planning to implement and test and our long term vision, you can access a SWAY via this link: https://sway.cloud.microsoft/PoaVloHapya97zaH?ref=Link

So what’ next?

With supportive leadership across our AHP team leads and AHP management, we have permission to proceed with the next phase to test our service redesign proposal.

As well as being able to audit our requests for support quantitatively with this healthcare population, we have now embedded lived experience feedback opportunities for families into our core pathway to understand the impact.

Non ring-fenced AHP capacity means that service fragility is still a very real constraint facing CYPF AHP services.  Our approach moving forward must be fluid, dynamic and responsive to needs of our local families balanced with wider CYPF service constraints.

In line with Ready to Act (Scottish Government 2016) in increasing appropriate access to interventions at universal and targeted levels of service as needed for improved well-being outcomes; we aim to explore how the journey map of resources can be made available for all neonatal families who are not receiving follow up.

Personal reflections – together truly is better!

As I approach the final weeks of the project phase, I am considering the impact that the experience has had on me.  To mention my main learning outcomes would be a blog in itself, and so Ill skip to the headline; my most valuable (and unsurprising to me) learning outcome.  This is that working together to co-redesign and co-produce really is better.  When I review what we have achieved locally, I am full of pride to notice a part of each and every one of our local families and colleagues who participated and I thank each and every one of them.  I would extend this understanding of co-redesign and therefore thanks to everyone locally and further afield who helped in any way to support his project.  Service improvement relies on wider ingredients from supportive leaders to advising teams behind the scenes. Thank you!

If you would like to know more about the AHP Neonatal & Developmental Follow Up role, any aspect of our local practice for this health care population, or about this Career AHP Fellowship project, please get in touch.

Karen Robertson Karen.Robertson8@nhs.scot; @KarenOTRob

Blog part 1- AHPs across health and social care.

NICE 2017 – Overview | Developmental follow-up of children and young people born preterm | Guidance | NICE

Scottish Government 2016 – Ready to Act – A transformational plan for Children and young people, their parents, carers and families who require support from allied health professionals (AHPs)

Scottish Government 2022 – National Workforce Strategy for Health and Social Care in Scotland.

International Day of Elimination of Racial Discrimination: working towards a more culturally sensitive workplace

To mark International Day of Elimination of Racial Discrimination, some of the recent participants in the Culturally Sensitive Support in Multicultural Healthcare Teams share their thoughts on their experience of the programme and their thoughts on  how we can all play  a role in eliminating racial discrimination across Health and Social Care in Dumfries and Galloway. 

We’re very grateful to Emma, Aurelia, Katie and Anthea for sharing their thoughts and to all those who have participated in the programme, which has been offered to four cohorts by external consultant Gillian Neish.  100% of participants have said they would recommend the course to colleagues:

‘This training is really essential and I hope it can be made available or extended to everyone’  

‘Very effective session, important for moving forward in tackling racism and discrimination’

‘Helpful to learn about mitigating racism, facilitated in a way that kept us all open and honest’

The learning and conversations that the programme facilitates are part of ongoing work within the HSCP to open up dialogue about how we can all play a role in the Elimination of Racial Discrimination within the workplace and wider society.

Lynsey Fitzpatrick and Kerry Riddell, E&D Team, NHS Dumfries and Galloway

‘The biggest point that stood out for me during this programme was seeing and hearing the pain from colleagues who have experienced racial discrimination by both patients – and unbelievably – staff members. It left me feeling saddened and outraged that here in Dumfries and Galloway this happens more regularly than we know about. The session made me go away and think about what I am willing to know about and not do anything about – very little after this. It has given me more confidence challenging discrimination overall and thinking about my own beliefs and power imbalances overall – even if not intentional’

Emma Reid, Advanced Practice Physiotherapist

‘The course has been an eye opener and has opened conversation in a safe space,where participants were able to express their views and learn more about what is happening in members working lives.’

Aurelia Kungu, Staff Nurse

‘I recently attended the Mentoring Across Difference workshop provided by the Health Board because eliminating racial discrimination in the workplace is important to me, but I sometimes feel awkward discussing race and racism. What did I take away from the workshop? That individually we have more in common than our differences, but the systemic and cultural differences between working and living in the UK versus elsewhere can put our new starts on the back foot when it comes to getting on and getting ahead in their career.’

Katie Percival, Clinical Teaching Fellow

‘Enlightening, engaging and interesting.’

Anthea Banks, Executive Assistant

Participants in Cohort Two consider actions that can be taken to implement a more culturally sensitive workplace

If you would like to become an Ally to the D&G HSCP Ethnic Minority Network, please get in touch at dg.ethnicminoritynetwork@nhs.scot. 

International Women’s Day

To mark International Women’s Day, the Dumfries & Galloway HSCP Women’s Network reached out to members to ask them what the day means to them.  We’re delighted to share reflections on from four members: Anthea Banks, Elise Tamburrini, Claire Thirlwall and Marsali Caig and are very grateful to them for their contributions.

The Women’s Network provides opportunities for women working within the Dumfries and Galloway Health and Social Care Partnership to connect, support each other, improve wellbeing and knowledge and be part of a collective voice for positive change.  If you’d like to join the Network, get in touch at dg.womensnetwork@nhs.scot

Sonia Cherian, D&G HSCP Women’s Network Chair

International Women’s Day provides me with the knowledge and understanding that I am included, supported and valued.  We are all different, we have all different life experiences and can learn and support each other through the tough times and relish the good times together.

Anthea Banks, Executive Assistant, Nurse Director

International Women’s Day holds immense significance for me as it serves as a poignant reminder to celebrate and honor the invaluable contributions of women throughout history and in our daily lives. It is a day to recognizes the resilience, strength, and achievements of women across the globe.

Women’s Day is not just about acknowledging the progress made, but also about reflecting on the challenges that persist and committing to fostering a more equitable and inclusive future. It is a call to empower and support the women in our lives, ensuring they have equal opportunities to thrive in all aspects of society. Personally, Women’s Day inspires me to champion gender equality, challenge stereotypes and actively contribute to creating a world where every woman’s potential is recognised and celebrated

Elise Tamburrini, Delivery Agent, Learning & Development

We are all different. That’s the joy of being human. But when those differences are made all the harder by inequality, bias and prejudice, we need to work together to challenge and overcome them.

Women, right across the world, are hit hard by the double whammy of prejudice and inequality. I think of the girls and women in Afghanistan who are forbidden an education. A campaigning lawyer called Sara Ahmad tells stories of women being abducted and held in slavery by the Taliban – 26 women to a cell. Child marriages there have skyrocketed, in part because of the economic collapse of the country, and girls become a valuable commodity when there are mouths to feed.

Closer to home, we know that women have been hit hardest by the cost of living crisis. Going without to be able to put food on the table or turn on the heating. There will be women who are too embarrassed to tell their stories about how difficult life in 21^st century Britain is for them.

Gender equality has a long way to go. But we can advocate, campaign and work collectively to influence change. It’s up to all of us to speak up and support how we can be a more gender equal society. How we can build support networks for women, regardless of where they are and what they do.

Women helping women is a powerful force for change. Female allyship feels empowering and safe. But men helping women is vital. I’ve been incredibly fortunate to have had some amazing men in my life, starting with my lovely dad, who’ve shown me that being a woman is a gift. On this International Women’s Day, I want to shout out to all the people who believe in gender equality and seek to do something about it, through small actions or grand gestures. If we work together, it can only get better.

Marsali Caig, NHS Dumfries & Galloway Board Vice Chair

Everyone benefits from gender equality. It helps prevent violence against women, is good for the economy, and makes our communities safer and healthier. However, throughout most of history women generally have had fewer legal rights and career opportunities than men. These include the gender pay gap, sexual harassment, an unequal share of parenting duties and difficulty finding opportunities for career progression.

International Womens Day …. is a day to celebrate and recognise the contribution by the many women throughout history who have helped advance gender inequalities, to promote and drive forward change but also to reflect and remember!

Most importantly,  an opportunity to  appreciate and celebrate the everyday efforts that women make to society and the workplace but also to  say thank you to those who over the years have provided support, a listening ear or simply an act of kindness. 

Claire Thirlwall, ​Project Manager – Working Well Staff Support Projects

With so many fantastic women doing amazing things  – how will you show your appreciation today?

On being an LGBT+ Ally

To mark LGBT History Month, the Dumfries & Galloway HSCP LGBT+ Staff Network reached out to our Allies to ask them what being an LGBT+ Ally means to them. These wonderful folk have signed up to the Pride Pledge to show their support and understanding for members of the LGBT+ and ethnic minority communities working within NHS Dumfries and Galloway Health & Social Care Partnership.

Wearing the Pride badge has a huge impact for both staff and patients/clients, knowing they can approach and speak to a person who is supportive, understanding and non-judgemental towards their specific characteristics is massively reassuring.  You can sign up for the Pride Pledge and Badge by contacting dg.ODL@nhs.scot. 

We’re delighted to share reflections on allyship and the value of the Pride Badge from four of our Allies: Karen Clapperton, Jan Crooks, Euan MacLeod and Nick Morriss and are very grateful to them for their contributions.

If you’d like to join the LGBT+ Staff Network, or support us as an ally, get in touch at dg.LGBTNetwork@nhs.scot

Anne Allison

Chair,  LGBT+ Staff Network

Karen Clapperton, St Michaels and New Abbey Community Nursing Teams

I am very happy to be a LGBT+ ally and I wear my badge with pride (see what I did there?). I have a lovely story I would really like to share.

Some time ago, I had arranged to meet a student who was joining my team to do her penultimate nursing placement. I went to the meeting place arranged and was met with a wee bit nervous, but warm and friendly smile. I introduced myself and off we went.

We had a lovely day, she was friendly, down to earth, keen to learn and very good with the patients.

A few weeks into her placement, she told me that she had never come out as gay during her placements until the very end and usually after she had been graded. I asked why and she said that she normally felt uncomfortable because she had heard people talking unkindly about gay people she was always guarded. She said on the first day when I went to meet her, she noticed I was wearing my NHS pride badge and she felt relaxed and that she could be herself.

I can’t deny that it is a bit disappointing that it took nearly to the end of her 3 years of training to feel comfortable enough to be open and be herself but she wasn’t like that with me simply because I was wearing my wee badge! You never know the difference the smallest gesture can make to someone. Congratulations to the team responsible for the badge pledge project. It has made a difference!

I am happy also to report that she qualified and has made an excellent, caring, compassionate and conscientious nurse. She wears the wee badge too!

Jan Crooks, Family Nurse Partnership

I pledge to ensure within my work, volunteering and personal life that;

• I welcome the entire diversity of LGBT and community
• I try my best to never make assumptions about pronouns 
• I will never be judgmental 
• When I ask anyone’s names, I will also ask how they want me to address them 
• I will respect and use the pronouns my clients and everyone I meet in my life asks to be called
•  I will apologise if I get things wrong and will reflectively learn if I do 
• I value individuals for who they are
• I ensure that within my clinical practice I promote and practice the health, well being and equality of everyone 
• If I am unsure about anything I will ask the individual and will seek advice from recognised LGBT support networks
•  I will support my colleagues, friends, family, volunteers I meet, to prioritise all the things I pledge 

Euan McLeod, Strategic Planning and Commissioning

Prejudice has many faces – sometimes it is overt and destructive-sometimes it is more subtle and disguised-but whatever form or face it presents it needs challenged. That is why being an ally is important – I am happy to do my bit to challenge that prejudice.

I know many people who have faced prejudice because of their orientation – within my Christian circles this has provoked much dialogue – some of it constructive, some less so.

Rob Bell in his book “Love Wins” writes about the need to recover the message of love within the Christian doctrine, “Love Wins” is an affirmation to triumph over hate, discrimination, and other negative energies. It calls for people to recognize the power of love and its ability to overcome obstacles encouraging understanding and nurturing balance. Why wouldn’t you?

Nick Morris, Chair, NHS Dumfries and Galloway

I have spent 43 years working in Health and Social care across a range of organisations, and throughout that time the most enjoyable times have been spent in teams where we challenge each other, learn from each other and value the contributions that others have brought to the work we deliver

No one person will have the answers to all the challenges we face. A strong team that draws on the diversity of its members is more likely to develop an approach that best meets the needs of the patient, the staff and the organisation. To gain this advantage however, all members of the team need to respect the contribution of all the members. We all walk in our own shoes and whilst we might try to gain an understanding of someone else’s lived experience, we can never truly feel or think as others do – hence we need to enable a culture that enables the voice of all members so that we all feel an equal part of the team that benefits from the unique insights we all bring 

How does this relate to the LBTI+ workforce and my role as an LGBT+ Ally?

An organisation that respects the diversity of thought and opinion of all its members is one that is likely to effectively meet the needs of the people who look to us for support. An organisation that is in conversation with itself, encourager debate, is curious to learn and to challenge what we do, why and how we do it and how we can improve, is safer for its staff and its patients. (Michael West et al).

Such an organisation will have a thorough respect and a positive attitude to all the diversity of its membership. The equality and respect with which this organisation provides to the LGBT+ community within us and as part of the D&G population is a test of the approach we take generally, and if, as an LBTG+ Ally, I sense that all members of that community are being treated fairly, equitable and respectfully then it gives me confidence that we would treat all other individuals in a similar manner.

Not all of us will get it right at all times – as I said we cannot walk in each others shoes. So sometime our divergent life experiences will mean we believe, say or do something that is unintentionally contrary to that which best affords respect to the LGBT+ community. However a curiosity in the colleagues you work with and an open dialogue leading to new learning will mean we all develop and grow more harmoniously as time goes by.

While ‘unintentional’ actions and statements are part of the learning process of complex societies, purposeful disrespect is never tolerable. So whilst our collective work is to improve harmony and respect through positive conversations about difference, similarity and learning, we must all stand together to call out purposeful disrespect to each other    

Can’t find the words by Helen Bogle

In October last year I was given the chance to partake in the multiagency self evaluation file reading. This is where professionals from different multiagency sectors (e.g. health, social care, police) who have experience of working with those under Adult Support and Protection legislation, review how the multiagency acted when a vulnerable person was identified as potentially requiring some more support following referral. It was a great opportunity to step away from the concerns in real time, reflect on how our teams worked individually and together, and reflect on how we could improve outcomes for people who are often at their most vulnerable.  We reviewed 50 referrals at this time and gained a lot of valuable insight into good practice, and areas for improvement.

One file I read really struck me as an important one to explore and learn from. An adult who was struggling a lot with his mental health, advised during an inpatient assessment that he had always struggled with his reading and writing, and left school early with no qualifications because of this. He had recently ended his relationship with his partner, and had been supporting him with general tasks like dealing with letters at home. Previously he had been offered support via a mental health support app,vbut said that he struggled accessing it due to communication barriers with reading and understanding how to access the app from written instructions.  This information was not passed on to the multiagency teams that he was referred to and he was sent all communication about support and appointments by letter. He did not opt in or engage and sadly was discharged from the service; and he was also informed about this via letter. Had the information of his reading and writing details been communicated between staff dealing with his care he may have been enabled to access the help and support that he needed.  

It is important to consider all communication needs and think of how you often receive information yourself. If you think of an appointment letter you received, if this other person received it would they be able to understand the information given to them and act on this as they wished? Would they feel involved and empowered through this to make an informed decision about the care they are receiving?

It reminded me of when I was beginning in my nursing career, and there was a patient who was very quiet, he did not read or do crossword puzzles like many did to pass the time.  He did not have visitors and just sat quietly all day, every day, between the ward rounds and procedures. He would be given his menu daily to complete but would hand it back empty saying he was not hungry, or that he couldn’t face food that day. It was only when talking to him about how good the hospital macaroni and cheese was that he said he liked the sound of that. I told him I’d go back and mark this on his menu, I asked if there was anything else he wanted added in as it had been a couple of days since he had something, from memory he could have ice-cream and jelly for pudding, he asked for this happily and ate everything on his tray. The next day he was without breakfast as his previous form was empty for breakfast, I said we had some cereal spare if he wanted some and again he happily had this all. As you’ve probably already guessed, this gentleman also had reading difficulties that he did not want to share, I never asked him about them but just sat and read his menu to him as he happily said his choices, and when I was coming to the end of my shift I added to the handover sheet that he may require support filling in forms. This simple handover of information about communication meant he could now fill in his menu, and get his nutrition when in hospital. He could now be read his medical documents, and give informed consent of forms for procedures. When he was being discharged, it was handed over to Social Work that he was for communication through visits or phone, and district nurses were also aware and would read directions or instructions to support him take his medication.

What is literacy?

Literacy is the ability to read, write, speak and listen in a way that lets us communicate effectively and make sense of the world.

The most recent statistics for adult literacy levels in Scotland (2009) show that In Scotland 1 in 4 (26.7%) of adults experience challenges due to their lack of literacy skills, this is the highest in the UK, within this, 1 in 28 (3.6%) face serious challenges in their literacy practices. (National Literacy Trust). https://literacytrust.org.uk/parents-and-families/adult-literacy/#:~:text=poor%20literacy%20skills.-,Scotland,their%20lack%20of%20literacy%20skills.

Such literacy difficulties can lead to ongoing challenges with navigating everyday life; accessing employment, finances, housing, support, and many more important things we can take for granted when we do not face this same struggle.

Whilst it seems a little bit of information to share, it is so important and can make the world of difference in someone’s care and journey.

Please think:

Are there any communication barriers for this patient?

Would they understand this better if I read it out loud to them or showed pictures?

If they do have a communication barrier, how will this impact them in the care they receive from other agencies and what can I do to help?

How can I effectively hand this over to other teams involved in their care?

If submitting an AP1 form, consider ticking communication barrier and providing more information.

Helen Bogle, Public Protection Advisor, Dumfries and Galloway NHS

Contact Us

The Public Protection Team can offer supervision, advice and support to anyone who wishes to discuss concerns about any person at risk of harm.

Phone: 01387 244300 

Email: dg.asp@nhs.scot or dg.childprotectionteam@nhs.scot

For information on Dumfries and Galloway Public Protection Week 2024 events please see https://www.dgppp.org.uk/article/24123/Dumfries-and-Galloway-Public-Protection-Week-2024-Programme

Let’s Listen by Karen Robertson

NES AHP Career Fellowship Project by Karen Robertson, Occupational Therapist for Children and Young People          – Part one!

When I set out to undertake an Allied Health Professional Fellowship project with NES, I wasn’t fully sure what the opportunity and journey would bring.  As I now approach the half way mark, I can honestly say that I am blown away by the experience so far and the learning along the way.  This has not been from webinars, text books or journals or indeed any other CPD resource.  It is from immersing in the ‘lived experience’ of our local families who are using our service. 

Growing an idea from local dedication and passion

My Fellowship project is titled ‘What does effective family-centred AHP service delivery within neonatal and developmental follow- up really look like?’  On behalf of our close working AHP team, I set out to explore at a local level how our joint Occupational Therapy, Physiotherapy and Speech and Language Therapy team could learn from our local families’ lived experience.  As our capacity to offer this additional enhanced surveillance service continues to be pulled from our general Children and Young People Service services, protecting therapists time while enabling growth of local knowledge and skills necessary to do so, is quite a challenge.  While our post-discharge developmental follow up service mirrors some of the recommendations outlined in the relevant NICE guideline (2017), our capacity to offer a service to babies and families during their neonatal in-patient stay is very limited.  We also offer follow up only until 2 years of age rather than until 4 years of age for this healthcare population.  While what we offer is in keeping with many areas in Scotland, It is fair to say that I, together with my therapy colleagues often feel the weight of this responsibility.  We are passionate about ensuring we use this limited capacity in the most effective ways for those needing and using our service.  I believe on reflection that this is what has motivated me to shelf my imposter syndrome, and try to do something about it!

Discovering Values Based Health Care

In my early research to better understand what Family-Centred Care really looks like, I was quickly introduced to the concept of ‘Values Based Healthcare’ VBHC. 

 “The definition of VBH&C for Scotland is based on the primary principle of person centred care – care that is not only high in quality but also delivers the outcomes and experiences that really matter to people, defined by and reported by them. In addition, VBH&C seeks to reduce the waste, harm and unwarranted variation that exist across our health and care system.”

(Scottish Government 2022).  

I was encouraged to notice that my project aims align quite significantly with VBHC.  I like the concept as it acknowledges that budgets and capacity for offering and growing health care services in this current climate is not fruitful, and asks us to be realistic with what we can offer.  As a children’s therapist for over 20 years, it isn’t my first or favourite thought process when I consider how we can be doing better, but it is a necessary one to have nonetheless!  In our local predicament with our neonatal and follow up service, this is most certainly the case! 

On learning more about VBHC, I have been able to progress with more confidence that I was on to something in my quest to listen to what really matters most to our local families in order to provide care that they really value.  It has also been necessary to enquire about what wasn’t of value in order to redirect capacity to where it will have the most benefit.  Together, I hope that this will enable me to ensure I can recommend on and begin to test out a more sustainable and appropriate resource utilisation across our three teams. 

The art of listening

As I found myself sinking further into how to I could approach this Lived Experience project, I noticed that I had a steep learning curve ahead!  I thought I knew what active and effective listening looked like; but did I really?  It is fair to say that a realisation hit me; I have become hard-wired a CYPF therapist to offer advice and solve problems!  With a focus on patients’ health care problems, it can often feel like we have to offer answers and solutions with little time for silence to accommodate ponderings and wonderings!  By stark contrast, strengths based frameworks such as Appreciative Inquiry lead us into communicating in a different way, to actively listen, curiously enquire and facilitate reflection to support our communication partner to self-discover and problem-solve.

Very quickly, I pressed delete on my reams of ‘possible questions to ask’ our local families! Instead, I began preparations for an unscripted approach to explore what families really think about their neonatal and follow up journey with us locally.

Image from: https://integralcare.org

We won’t know if we don’t ask!

At the time of writing this blog, I am approaching the final project based conversation with our local families I am considering my most important lesson so far?  We as the professionals are not always the experts, as we have not lived through what our patients and service users have.  What we don’t know we may assume and so, let’s be courageous, show our vulnerabilities and ask them.  Most importantly, as David Letterman reminds us, “life experience is our best teacher”, so let’s LISTEN!

So what next?

In Part 2 of this blog, as my project nears its end I will share an update on how our teams have taken on board the lived experience shared by our local families, and essentially redesigned what we would like to offer locally to this healthcare population.

If you would like to know more about the Neonatal AHP role, any aspect of our local practice for this health care population, or about this Career AHP Fellowship project, please get in touch.

Karen Robertson Karen.Robertson8@nhs.scot; @KarenOTRob

NICE 2017  Guidance for developmental follow-up of children born preterm. NICE guideline [NG72] Published: 09 August 2017

Scottish Government 2022.  Delivering Values Based Healthcare; A Vision for Scotland. www.gov.scot

 https://integralcare.org accessed 14/09/2023

Making Space for Feedback in Busy Clinical Environments by Laura Lennox

Giving and receiving feedback is an integral part of working in health care; it is essential in remaining competent to practice ultimately keeping patients safe. I have recently completed an online Assessment for Learning module with QMU and it has helped me to consider the knowledge and skills involved in feedback and as a Practice Educator, how I design learning activities and feedback processes as part of assessment for learning. A particular area that I find interesting is the emotional impact: How can we avoid or minimise the harm that can come with giving and receiving feedback?

When I consider the power dynamics involved, typically the scales will tip in favour of the person giving feedback. In health care, this is likely a practice assessor, supervisor or manager. A learner’s fear of failure is described in the education literature when discussing what makes feedback work (Gibbs, 2015) and failure in health care comes at a high risk. However, when we aim to stay safe or please others, we do not allow ourselves to engage in the type of critical thinking or creative decision making that enables us to be and become confident and capable practitioners.

Algiraigri (2014) argues that feedback practices in clinical settings are suboptimal because they only focus on the teacher. Learners need to be empowered with the skills to receive and use feedback whilst compensating for ‘less than ideal’ feedback delivery when working in a busy clinical environment. When leading on enhancing assessment processes perhaps this is where I should now focus my attention but it feels like there is still something missing. Even if the learner is skilled in feedback, can we really expect them to feel the level of trust needed to give an honest contribution to the dialogue involved in the feedback process. This has led me to explore compassionate feedback in the context of leadership.

I am already familiar with compassionate leadership in health care (The Kings Fund, 2022). Perhaps this is why compassionate feedback feels more meaningful to me as a facilitator of learning in this environment. The Interrogating Spaces (2023) podcast on compassionate feedback uses Grahams definition of compassion; the act of noticing distress or disadvantage in yourself or others with a commitment to take action on it. Compassionate feedback therefore seems social and relational as well as skills based and I wonder if this approach to feedback would therefore have an impact on shifting the power imbalance as an indirect result?

A key component of compassionate feedback is the sense of belonging. Inclusion drives human behaviour. The learner feels valued and respected. Essentially the learner feels like the person giving feedback really cares about their learning. It’s about making space to connect and then being able to be your authentic self in that space. The benefits of regular supervision as part of reflective practice are well recognised within the allied health professions (Scotland’s AHP Position Statement, 2018. HCPC, 2021). The biggest reason given for not engaging with supervision is the time taken out of clinical practice to do it. Yet, when I watch Chris Turner (2019) talk about how “civility saves lives” then perhaps as Evans (2013) suggests, we need to be clearer about what is important as well as what is urgent.

Kumagai & Naidu (2015) ask the question on what does it mean to devote space for those types of exchanges in busy clinical environments i.e. what is this space, how can it be identified or designed? They suggest reflective space is fluid, in that it includes the opportunities and circumstances that happen in the moment as well as within the more formal learning activities, or time set aside for supervision. This makes me think of the everyday conversations we have with each other – all of us, at all levels of practice, in all workplace areas – and how this space can be opportunities to provide compassionate feedback. We still need to create space for this exchange to take place but only for a considered moment.

My action for my own professional development is to understand what reflective space means within the learning environments in which I lead facilitation of learning. This will involve considering who else needs to be involved and how we collaborate to better design spaces that support compassionate feedback as a normal aspect of activity in our everyday practice.

Batista. Ed. (2022). Make Feedback Normal, Not a Performance Review. Available at: https://www.edbatista.com/2022/03/make-feedback-normal-not-a-performance-review.html. (Accessed on 05/12/2023).

Laura Lennox is an AHP Practice Education Lead for NHS Dumfries and Galloway

References:

Algiraigri, A. H. (2014). Ten Tips for Receiving Feedback Effectively in Clinical Practice. Medical Education Online. Vol. 19. Issue 1.

Evans, C. (2013). Making Sense of Assessment Feedback in Higher Education. Review of Educational Research. Vol. 83. No. 1. pp70-120.

HCPC. (2021). Available at: Supervision. (Accessed 05/12/2023)

Interrogating Spaces. (2021). Compassionate Feedback. UAL Teaching, Learning and Employability Exchange. Season 3. Episode 1. Available at: https://interrogatingspaces.buzzsprout.com/683798/11480939-compassionate-feedback. (Accessed on 02/12/2023).

Scotlands Position Statement on Supervision for Allied Health Professions. (2018). Available at: (Scotland’s position statement on supervision for allied health … (Accessed on 04/12/2023)

The Kings Fund. (2022). Available at: What is compassionate leadership?. (Accessed on 03/12/23)

Turner, C. (2019). When Rudeness in Teams Turns Deadly. Ted Talk. Available at: When rudeness in teams turns deadly | Chris Turner – YouTube. (Accessed on 03/12/2023).

Inspiring Stories to mark Disability History Month by Liz Forsyth & Clark Adams

As Co-Chairs of the Disability Network we’ve had a look at some people with disabilities who have inspired generations of people with their incredible achievements and some inspiring local young people: Libby Clegg and Zoe Irving.  We asked Scottish paralympic sprinter and tandem track cyclist Libby Clegg, MBE to contribute to our blog.  Libby has Stargardt’s Macular Dystrophy disease, which has left her registered blind.  Her contribution is below. 

Despite being a 2 x Paralympic Gold medallist, 3 x Paralympic Silver medallist, having a host of other medals, coming 3^rd on Dancing on Ice, being a Mum to a young son and being a published author, Libby remains modest and humble as you will see in the her words below. 

Libby makes no mention of her accolades such as the MBE that she got in 2017 for services to athletics and charity, or the fact that she was given an honorary Doctorate from Glasgow Caledonian University in November 2023 for her outstanding achievements. Libby appeared on Great British Dog Walks with Phil Spencer with both Hatti and her new dog Bramble earlier this year.

Libby Clegg MBE

‘Many people may have seen me on television, running on the international stage at Paralympic Games or competing on “Dancing on Ice”.

I’ve been incredibly fortunate to have had many opportunities and unbelievable experiences over the years. When I got diagnosed with my condition at nine years old, I would never have imagined my life would have turned out this way. Disability growing up was never seen in a positive way, it was always about what you couldn’t do not about what was possible.

During my successful career, I’ve had many ups and downs and sometimes what is seen on television isn’t always the whole story. In my day to day life I face the biggest struggles, navigating new places, meeting new people, trying to read post, labels, just to name a few.

These challenges and barriers can leave me feeling very anxious, awkward and uncomfortable at times. It’s something I don’t look forward to experiencing. However, I’ve managed to learn how to push through some of these difficulties, predominantly because I wanted to fulfil my dreams and ambitions in sport. I knew it wouldn’t be possible if I didn’t work through these things.

I’ve managed to do this by pretending to feel confident and not care what people think of me. It’s taken me a long time to get to a place where I feel secure in who I am. I’d encourage anyone who has had a similar experience to keep persevering and be kind to yourself. 

Libby’s book ‘My life with Hatti: Six Years with a Dog Who Does Everything’ is available on Amazon.

We would like to sincerely thank Libby for making time to share her experience with us and her Mum (Moira) for being our go between.

Zoe Irving

Zoe Irving is a young athlete from Langholm, she has a learning disability and is visually impaired. This has not stopped her from excelling at her chosen sports.

Zoe is a very active member of the Dumfries and Galloway Disability Sport team and she has participated in competitions at all levels in the UK and as far afield as Abu Dhabi in the United Arab Emirates (UAE) where she participated in the Special Olympic World Games in 2019 and won gold in the bocce.

This year’s achievements alone have included gold medals at boccia competitions in Dundee, Perth and Stirling.

Although Zoe has played boccia and bocce for a few years she took up tennis fairly recently. She is a natural and has already won several medals. In July she won gold in the singles and silver in the doubles at Stirling. At the LTA National Finals in Bolton she won a silver medal. The very next day she travelled to Newcastle to finish this years completion’s with another gold medal in boccia.

Zoe’s family and friends are extremely proud of all her achievements. Zoe’s sporting accomplishments are down to her own skill and determination but also a testament to unstinting support of her parents and the hard work and dedication of the fantastic coaches at Dumfries and Galloway Disability Sport.

For more information about disability sport in Scotland please look up http://www.scottishdisabilitysport.com or check out the Dumfries and Galloway Disability Sport Facebook page.

Franklin.D. Roosevelt

Franklin Delano Roosevelt was first elected President of the United States in 1932 the 32nd American president. Stricken with polio in 1921, when he was thirty-nine years old Roosevelt spent much of his adult life in a wheelchair.

Franklin Roosevelt’s crusade to defeat polio actually began more than 10 years before he created the group that would become known as the March of Dimes. His first efforts centered on a therapeutic spa in Warm Springs, Georgia, famed for the recuperative benefits of its water treatments.

Roosevelt was first treated at Warm Springs in 1924–three years after his own devastating bout with polio–and was immediately impressed with the results. He soon became a frequent visitor, and within three years he had bought the property and created the nonprofit Warm Springs Foundation, which established the springs as the first hospital in the nation to focus entirely on the treatment of polio victims.

Re-elected by comfortable margins in 1936, 1940 and 1944, FDR led the United States from isolationism to victory over Nazi Germany and its allies, FDR, as he was often called, led the United States through the Great Depression and greatly expanding the powers of the federal government through a series of programs and reforms known as the New Deal.

The New Deal Roosevelt began to take shape immediately after his inauguration in March 1933. Based on the assumption that the power of the federal government was needed to get the country out of the depression, the first days of Roosevelt’s administration saw the passage of banking reform laws, emergency relief programs, work relief programs, and agricultural programs.

 Later, a second New Deal was to evolve; it included union protection programs, the Social Security Act, and programs to aid tenant farmers and migrant workers. New Deal programs helped improve the lives of people suffering from the events of the depression. In the long run, New Deal programs set a precedent for the federal government to play a key role in the economic and social affairs of the nation.

He spearheaded the successful wartime alliance between Britain, the Soviet Union and the United States and helped lay the groundwork for the post-war peace organization that would become the United Nations. The only American president in history to be elected four times, Roosevelt died in office in April 1945 from a cerebral haemorrhage.

Ralph Braun

Ralph Braun when he was six years old, doctors diagnosed him with muscular dystrophy. He started using a wheelchair at the age of 14. At the age of 15, he created a motorized wagon with his father to help him get around. Five years later, Braun created a motorized scooter, which he called the Tri-Wheeler, using various parts from his cousin’s farm. Ralph rode the Tri-Wheeler to and from his day job as a Quality Control Manager for a nearby manufacturer. When the facility moved several miles away, he equipped an old mail carrier Jeep with hand controls and a hydraulic lift, enabling him to drive his Tri-Wheeler in and out of the vehicle unassisted.

In 1970, Dodge manufactured the first full-sized, front engine van. Braun retrofitted a Dodge van with a lift and called this new invention the “Lift-A-Way” wheelchair lift. When word spread about this new invention, Braun assembled a team to help fill orders across the nation, all from his parents’ garage. As demand increased, Braun decided to quit his full-time job to focus on his part-time business

Braun started “Save-A-Step” manufacturing in 1963 to build the first motorized scooter, made from a lawnmower differential, four big wheelbarrow tyres, two 6-volt automotive batteries, makeshift wiring and switches from a hardware store, a kitchen chair, and a motor from a 1957 kid’s car that he rescued from a mortician’s dustbin”. In 1966 Braun created the first wheelchair accessible vehicle, by creating a wheelchair platform lift and hand controls that were added to an old Post Office Jeep. In 1970, Ralph added wheelchair platform lifts to full-sized vans. “Save-A-Step” was incorporated under a new name, The Braun Corporation, in 1972.

Stephen Hawking

Stephen Hawking is a world renowned theoretical physicist, cosmologist and best selling science author. He also had regular cameo appearances in the Big Bang Theory. He got his PhD at 24 years old, 3 years after being diagnosed with amyotrophic lateral sclerosis (also known as motor neurone disease or MND). He said that being given 3 years to live when he was diagnosed motivated him to achieve his goals.

As the disease progressed, Hawking became a wheelchair user and ultimately became paralysed and lost his ability to speak. He thereafter used technology which translated his eye movements to generate a digitised voice to enable him to communicate and carry on his work.

Hawking was the Lucasian Professor of Mathematics at the University of Cambridge for most of his career. Sir Isaac Newton also held this position when he was a professor there.

Hawking was a renowned and respected science communicator. His achievements are deeply impressive on their own, but it could be said that this was even more remarkable given the physical impact the disease had on his body.

His book “A Brief History of Time,” published in 1988 was on the Sunday Times bestsellers list for 237 weeks.

Such was his respected status, when Hawking died in 2018, his ashes were placed in London’s Westminster Abbey between the final resting places of Sir Isaac Newton and Charles Darwin.

Jamie Oliver

Jamie Oliver was diagnosed with ADHD (attention-deficit hyperactivity disorder) and dyslexia as a child. He has since advocated for a healthy diet to help ease the symptoms (for ADHD, the NHS cites these as fidgeting, an inability to still and concentrate, while for dyslexia, these include reading slowly or making errors when reading and writing), and often speaks out about his own experience.

Dyslexia and ADHD often overlap (three in 10 people with dyslexia also have ADHD), and in a past video shared by charities Made by Dyslexia and the ADHD Foundation, Jamie opened up about the challenges he faced in education as a result of suffering with both disorders.

When Jamie was at school, dyslexia was never really a thing; you were either almost blind or not dyslexic. Jamie was just put in special needs class because of his dyslexia..

“Jamie has expressed his love of debate about education. Who said education is what we say it is? Like a couple of people from 500 years ago sort of set up the structure of it, English, maths, science. Ok, so if you’re not good at black and white and traditional academia you’re thick, therefore you have no value, so for me personally I’ve always been passionate since leaving school about different types of intelligence and everyone has the ability to be brilliant.

“School really should be about facilitating kids to find their inner genius and inner confidence.” Jamie left school with no qualifications but went on to secure a place at Westminster Catering College, where he nurtured his passion for healthy children’s cooking.

Liz Forsyth is a Strategy Support Manager and Clark Adams is a Carer Facilitator and both Co-chair the Disability Network

Winter is Coming by Pauline Kirk

Well it has to be said that despite the beauty of falling leaves and the winter sunshine, this time of year also brings its additional stresses.  Even more so with the cost of living crisis still in our midst, our monthly bills are sitting at an all-time high. 

Not only do we have the worry of being able to put food on the table, and heat our homes, it is very much, ‘The most expensive time of the year’.

It is often said that it is the little things which can make the biggest difference, and this can be said about our financial wellbeing.

The Health and Social Care Partnership Financial Wellbeing Project is here to help and you can find advice and support through the link to the HSCP site or you can contact us confidentially through the direct link:

So, what can we do to help ourselves through this winter?

Let’s start with Budgeting

A good budget is helped with forward planning. However, we are here now, so what can we do from right this very minute?   

It is not about what we would like.  The first question to ask ourselves is, what can I afford to spend? One day of the year should not ruin the next 12 months with worry and debts. Quoting from Martin Lewis,

“Why don’t we work together to release each other from the obligation of gifting unnecessary gifts”

If we are honest with ourselves, we are all probably guilty of gifting out of obligation.  So why not start today, make a list of unnecessary gifts and as I like to say, ‘pull on our big pants’ and speak to those to whom we give these gifts.  In doing so, you may just actually be gifting them with one less worry.

Budget Smart – Take the time to sit down and work out what you have available to spend.  Make a list & check it twice!! Write down what you need to buy, work out how much you can spend on each item and stick to it.

Shop Smart – Look out for discounts and buy early, use free cashback sites and earn money as you spend. 

Looking for a personal ‘gift’?  Why not consider a free Christmas cheque gift?  This can be in the form of a handmade IOU for say, breakfast in bed or a romantic picnic; for kids, you could let them have the TV control for the day, or for a games or film night? For a friend or relative, it could be as simple as setting time aside to catch up on a walk or an invite to your home for a home cooked lunch.  The options are truly endless.

For food, buy cheaper alternatives, ‘posh’ isn’t always better. Again, buy any staples when discounted and put them away in advance.

What can we do about Energy?

Our energy bills are another source of worry again this year. We are all still paying more than ever to keep warm and heat our homes.  Unfortunately, climate change means increased chances of a tougher, colder winter.

Although we do not have control over how much it costs, we do have some control over how much we actually use. I am not talking about switching off your much-needed heating, it is all about the little things, so that we can balance this with what we do need such as heat and hot food.

Look out for Energy Education Session video coming soon to the HSPC site for lots of tips and advice.  You can also find some tips here at the Home Energy Scotland Site.

It is always good to know if you are eligible for some additional financial help, such as, the warm home discount, winter fuel payment or winter heating payment.  There is also assistance with fuel vouchers if you are running out of energy with no way to pay or top up.

Finally, let’s talk about Food.

Food is something that many of us have taken for granted for a long time, however the cost of living crisis has had a huge effect on the cost of our food bills. For some this will now be one of your most expensive monthly bills, whilst many others are really struggling to put food on their tables. 

Tips for cutting your food bill include, making packet lunches, switching your supermarket and using own branded products.  Nightly yellow sticker deals mean great prices on soon to be out of date products which can be frozen. 

What I would like people to know is that you are not alone, and to remember, that there is help out there for you and your family to help you through these difficult times.  Whether this is in the form of a food parcel or hot meal, help with your energy bills or for help with budgeting and debt.

All you have to do is reach out.  We are here to help each and every one of you.

What we have achieved so far.

Since the project started we have provided advice to 46 clients on a range of issues from help with energy, to identifying and applying for benefits and grants, to helping with sickness and ill-health, bereavement, debts, council tax, foodbanks and many more. 

To date, 18 of those clients are now in receipt of financial help amounting to a grand total of £42,575.22 with many more still waiting to hear about their entitlements.

If there is one thing you can do today, then take the time to visit the HSPC website to see what type of advice and support we can offer.  Use the self-help tools or the referral link.  You might just be surprised. A quick chat may be all that is needed to set you on the right path to be financially better off even in some small way.

I would like to take this opportunity to wish you

 all a merry Christmas season.

Pauline

If you require any further information then I can be contacted via email at pauline.kirk@dagcas.org or by phone on 0300 303 4321.

Appendix:

Cost of Living Crisis

The present cost of living crisis is taking its toll on the British pubic with around half of people now shopping around.

The rise in food costs equates to an annual increase around 9%.

What are you doing to tackle the cost of living crisis?

Fun Friday by Adele Parker and Isabella Brown

How many times have you heard a colleague or even you say “Thank goodness it’s Friday”?

Another busy week done and the weekend in sight. For the stroke and rehab patients on D7, we, as a therapy team, have tried to make a new meaning behind the phrase.

The National Clinical Guidelines for Stroke were updated this year (2023) and now state “People should receive at least 3 hours a day of therapy (therapist delivered) and should be supported to remain active for up to 6 hours a day”.  This includes cardio-respiratory training once medically stable, for at least 30-40 minutes, 3-5 times a week for 10-20 weeks. Current research conducted by Chest Heart & Stroke Scotland (CHSS) has revealed a national crisis in rehabilitation, indicating that of the 1.1 million people in Scotland living with chest, heart, stroke and other long term conditions, less than half (45%) had accessed NHS rehabilitation services. CHSS is pushing the Scottish Government to improve services for people with long-term conditions and make sure they get the rehabilitation they are entitled to.

With this increased demand on acute AHP rehabilitation services within DGRI and only 8hours in a day, how do we as a team achieve this new guideline?

We as a therapy team put our heads together and this is where “Fun Friday” came into fruition.

Fun Friday is a small group session led by the OT’s, Physios and Rehab assistant practitioners and takes place on a Friday morning in D7’s therapy space. The session consists of a circuit style class which is created and individualised to maximise reaching the patient’s goals and aiding recovery. Person centred care is at the heart of the service. Patients who wish to take part in these sessions work on tasks that are important to them that include elements of both physiotherapy and occupational therapy.

The activities are varied depending on the patient’s ability and can range from seated activities to playing golf (in some sort of fashion).  With limited resources at present we have had to be creative and experimental. The Therapists are challenged to be innovative and think up a whole host of activities to allow focus on the patient’s deficits e.g. sitting balance, standing balance, coordination, fine finger dexterity, weight transference, proprioception, cognition, problem solving, cardiovascular fitness, overall activity tolerance as well as to make it FUN.

We as AHP’s look forward to fun Friday but it is not solely for the patient’s and our enjoyment – There is an abundance of evidence out there to support group therapy.

In DGRI the wards are made up of single rooms, and although there are benefits to this, we have found that our patients can be at risk of social isolation and decreased motivation. A study conducted in 2017 “The effect of Group – Based Occupational Therapy on Performance and Satisfaction of Stroke Survivors” concluded that doing daily, craft, and mobility activities in the groups can affect the ‘performance’ and ‘satisfaction’ levels in stroke patients. Another article by  Hillier, English et al (2017) stated by enabling individual’s to witness other stroke survivors rehab journey, in turn improved overall participation, motivation, level of activity and overall mobility outcomes and balance.  According to research (Hartford, Lear and Nimmon, 2019), social support and social groups have a large role in the recovery process of patients who have had a stroke. Participant feedback from Hartford, Lear and Nimmon (2019), describe these groups as “nurturing” with a non-judgemental environment that allowed them to feel more confident and provided emotional support. Our patient feedback has reflected this, it has been inspiring to see these patients empower each other and become more confident.

Don’t just take our word for it, here is what the patients have to say…

We asked the patients attending weekly to complete a feedback form and here is a snippet of how they have found the class:

Overall, patients have fed-back that it has been good to practice and complete tasks that are relevant to their life and are practical.

As a small therapy team and a ward of 28 patients or even sometimes more due to bed pressures and double up rooms, we have had to work more efficiently and consider sustainability of the workforce to be able to meet the demands of the stroke and rehab guidelines and take the pressure off ourselves. Joint working is paramount in allowing timely but effective rehab which also reduces duplication of work. 

Findings suggest recommendations for therapy frequency and intensity will remain unmet in many stroke units unless radical revision of therapist’s routine working practices are under taken. We may not be hitting the targets 100% but we as a therapy team are at least giving it our best go!

Written by Adele Parker (Specialist OT) and Isabella Bown (Specialist PT)

References:

Hartford, W., Lear, S. and Nimmon, L. (2019) ‘Stroke survivors’ experiences of team support along their recovery continuum’, BMC Health Services Research, 19(1). Available at: https://doi.org/10.1186/s12913-019-4533-z.

National Clinical Guideline for Stroke (2023) National Clinical Guideline for Stroke for the United Kingdom and Ireland, National Clinical Guideline for . Available at: https://www.strokeguideline.org/?_gl=1%2A1polfak%2A_up%2AMQ%2A_ga%2AMTg4NjE2MTY4My4xNjk4Njk1MTg5%2A_ga_EE3BZMVLRT%2AMTY5ODY5NTE4OC4xLjAuMTY5ODY5NTE4OC4wLjAuMA (Accessed: 28 October 2023)