Dementia Champions: celebrating, connecting and chatting by Wendy Chambers

During Dementia Awareness week this year we have been celebrating, connecting and chatting with Dementia Champions across the region both digitally and in person. I’d like to take the opportunity to share some of what Champions have been doing in this Blog.

On Monday 30th we began by celebrating with an in-person Graduation ceremony for 28 new Dementia Champions who completed the local online digital course in 2021. That only a quarter of the graduates were able to join us in person is a reflection of the ongoing challenging and difficult times we are all working in.

In photo from left to right:Back row: Maureen Huggins (NDCAN), Dr Anna Jack-Waugh (UWS), Joan Pollard (AHP Director), Jeff Ace (Chief Exec), Mark Kelly (Interim Nurse Director), Wendy Chambers (AlzScot Dementia Consultant), Prof Debbie Tolson (UWS)Front row: Lee Brown, Alison Pringle, Joanne Helen Semp, Rachel Bickerton Notman , Libby Robinson, Barbara Robertson  

There was a strong presence from our NHS executive team including Jeff Ace (Chief Executive and Dementia Champion), Mark Kelly (Interim Nurse Director) and Joan Pollard (AHP Director) alongside Professor Tolson (Director Alzheimer Scotland Centre for Policy and Practice). Jeff provided a strong and clear message that we as an Integrated Joint Board remain committed to creating a culture of continued dementia learning and education to improve services and ensure our workforces are Skilled and confident to deliver safe, effective, evidence informed care for people who also have a diagnosis of dementia. Mindful that significant challenges remain, in a current climate of increasing co-morbidity and complex needs.

These new Champions join an established group of Dementia Champions across Health, Social care, Third and Independent Sector throughout the region – creating a network of over 120 active Dementia Champions staff. That’s certainly something to celebrate!

So what have these Dementia Champions been up to this week across the region? Have you noticed them each day on social media? NHS Dumfries & Galloway on Facebook? Or @DGHSCP and @DGNHS on Twitter?

As Dementia Champions we know that we need to share our knowledge and the skills we have in delivering effective dementia care, to inform and lead on changes to care and practice across workplaces and services. So we took a brave step forward and have gone digital, visible and public.

Every day this week a different Dementia Champion has recorded and posted a message; with a link to an online resource which can help support others to support people to live well with dementia. If you haven’t seen them, here they are along with the links to the resources.

Monday 30th May I started the week outlining that each day, during #DementiaAwareness week, Dementia Champions from across the region will share what matters to them & how they support people to live well with dementia; Wendy shares the importance & link for us all to become Dementia Friends in our communities   https://www.youtube.com/watch?v=24SMMuG14TE
Tuesday 31st May  Dementia Champion & occupational therapist Courtney sharing the importance of keeping our brains active and staying socially connected Click the links- useful resources & Print At home version #DementiaAwareness   https://www.youtube.com/watch?v=bTchEugxnrc

Wednesday 1st June

Dementia Champions Pauline & Katrina are both nurses, sharing the difference getting to know patients can have & something new in C4 DGRI called TIM (This Is Me) #DementiaAwareness  
https://www.youtube.com/watch?v=e2eD6QFtI1M
Thursday 2nd June Dementia Champion & district nurse Fiona sharing a link and information about why having a power of attorney in place is important #DementiaAwareness   https://www.youtube.com/watch?v=58SHxSv287w
Friday 3rd June Dementia Champion & physiotherapist Lauren sharing information about keeping physically active to live well with dementia and protect your brain health #DementiaAwareness     https://www.youtube.com/watch?v=rDSWUdKAekA
Saturday 4th June Dementia Champion & nurse Kimberly sharing information for those of us supporting people with more advanced dementia; here’s the link CEASE #DementiaAwareness   https://www.youtube.com/watch?v=Q1BNZ1z-7kY
Sunday 5th June Dementia Champion & nurse Sharon sharing how important is it we recognise pain and discomfort for people living with dementia; here’s the link Pain #DementiaAwareness   https://www.youtube.com/watch?v=M76EwknTv5A

As well as the recorded messages Champions in various settings have been putting up displays, having conversations and sharing information, skills and resources – from Care Homes to Social Work departments, ward settings and communal public areas. Here are some examples from a few places:

Cree Ward, Midpark
Thomas Hope Hospital, Langholm
Galloway Community Hospital, Stranraer A stall, a few skills sessions and many many blethers have been going on
Mountain Hall, IDEAS Team & Mental Health OT service
Atrium in DGRI, Dumfries

My hope for the Dementia Champions across the region, in all of our roles and settings, is that we remain visible, outspoken and proud throughout the year. Sharing what we have learned about best practice dementia care within our teams and workplaces, influencing and making positive change happen, so our services are inclusive of the needs of people who also have dementia.

So in your team and networks can you spot the Dementia Champions? Have you had a conversation with a Dementia Champion this week, either in person or digitally? I’d encourage us all to keep the conversation going, in person and also digitally; hit the like and share button, leave a comment – because when we get it right for people with a progressive brain disease like dementia we usually have also got it right for everyone.

Wendy Chambers

Alzheimer Scotland Dementia Consultant

Reflections on our contact tracing journey…. by Lesley Skilling on behalf of the Test & Protect team

Everyone will be aware that contact tracing ended on 30th April.  

3 days before, the Public Health Directorate held a Development Day where all teams took the time to pause and reflect on the Challenges & Successes of the last two years and what the future looks like.

For the Test & Protect Team it was particularly poignant as our work has now stopped and the team are returning to substantive roles or are looking for new opportunities.  

It’s fair to say it’s been very emotional and as I share our reflections with you I am sure much of this will resonate with many.

The unpredictability of the virus brought the biggest challenge – the pressure of keeping pace with the infection rate and the sheer number of cases meant that the team were not always able to contact all cases or close contacts despite their best efforts.

The unpredictability also brought ever changing guidance making it difficult for staff to keep up to speed. The changes came into effect immediately after a briefing by the First Minister, the next day or a date in the future. Juggling different guidance depending on infection dates became the norm and made it difficult for staff when case numbers were through the roof and so many calls were required.

Staff rotas where challenging when the crystal ball to see case numbers in the future was not working. On many occasions staff gave over and above what was asked working long hours when waves of cases hit.

Contact tracing became an ever changing landscape.

Having time off meant that quite often you came back to a different job.

The team grew and staff changed on regular basis. The growth of the team meant that existing staff became trainers while trying to do their day job. Training strategies had to be pulled together when time allowed.

The team even moved offices in the middle of the pandemic. Staff recall wheeling their chairs and computers along to the new office, plugging in their pc and making calls again!

As the team grew there was a move towards more people working from home and we now have team members who work remotely across the UK and Ireland. This brought the challenge of finding new methods of communication and team working. Our coffee catch up’s became a welcome break from constant calls.

Our recording systems also grew & developed. A local IT system soon became a national system know to us as CMS. CMS evolved daily and this lead to the development of online scripts and guidance on how conversations should be structured and what information we needed to gather.

What started as a local team helping to contain the virus in Dumfries & Galloway became part of a national army of Contact Tracers across Scotland. A representative from the team attended national meetings twice a day so we could highlight if we needed support or could offer support to other Boards through mutual aid.

Staff were expected to be an expert on everything!

Random queries became the norm and from all over. The team learned how to adapt and cope, learning as we went and seeking out answers.

When you made a call you had no idea of the personal circumstances of those you were calling. Staff were dealing with their own anxieties about the virus while managing the anxieties of those they were talking to. There were some very difficult conversations and emotions run high – anger, grief and tears. You could be speaking to someone who had just lost a spouse or someone sitting with a loved one in their dying days.

Staff had to deliver bad news too – talking people through the realisation of what that positive result meant – cancelling their wedding, not being able to meet up with extended family they hadn’t seen for 9 months or not being able to have the operation they had been waiting 18 months for.

The attitude of the people we called differed over the two years. The majority were very receptive to our calls but we could be seen as the bad guys working on behalf of the government and stopping their independence.

The public struggled to keep pace with the guidance so having to explain the rules had changed again was difficult at times. People were not behaving normally; it wasn’t just those who were positive, everyone was behaving out of character.

Despite the challenges there have also been many successes.

The team successfully carried out effective outbreak management and this was a critical tool in containing the virus. From interviews we were able to identify links and could report outbreaks to the Health Protection Team. Our processes moved from diagrams on flip charts to an electronic suite of reports allowing us to see patterns and numbers in a known outbreak setting. The team could draw on these reports when attending PAG’s & IMT’s. This couldn’t have been done without the use of very skilful interview techniques and staff honed these skills.

Staff came from all over to form the Test & Protect team – Environmental Health at the Council, Sexual Health and Public Health staff. As the team grew people who had vastly varied skill sets and different working backgrounds came together with one common goal. They wanted to protect the people of D&G from the Covid 19 virus and they wanted to do their bit for the cause. The team were truly passionate about the service, supporting and learning from each other.

Without a doubt the team can be proud that they have delivered a caring and helpful service for anyone who contacted us. It became much more than providing isolation advice – it was ensuring that people were able to cope with isolation mentally & physically, did they have family or friends to check in with them, were they able to access food and medication, was there money on their electric cards, if they were ill should we call 999 and a whole host of other welfare concerns.  The team became adept at finding solutions and regularly drew on the assistance of others.

So many people, teams and departments across the Health Board and other partners were always there to assist. Thank you to each and every one of you – we simply couldn’t have done this without you.

Lesley Skilling is the Service Manager for the test & Protect Team at NHS Dumfries and Galloway

Can you hear me? by Fran Milne

I was born profoundly deaf and have relied on lip-reading since the year dot. I was given my first hearing aids when I was 4.5 years old, and my Cochlear Implant in 2009. I now wear one hearing aid and a CI. As helpful as the listening aids are they, along with lip-reading, are not infallible. Let me explain why…..

My First Hearing Aid

It is estimated that only 30-35% of the English language is able to be lip-read, ie those words that are formed on the lips and/or the front of the mouth of a clear, articulate speaker – other sounds are made in the middle or back of the mouth, or even the throat.  Even for words that can be ‘read’ it is not infallible as many words have the same lip-pattern eg “Buy my pie” or “Shoots/shoes/chews/juice/June/Jews” – try it with your colleagues – no sound! I only have to laugh at some of the ‘misinterpretations’ I have made in the past….

As a result, a perfect lipreader would only be able to lipread about one third of what is said. So, what coping strategies can be used to aid communication for deaf people? We can add in the use of hearing devices, in my case a hearing aid and a Cochlear Implant (CI). If I were to listen only without lipreading, I can only hear approximately 60% of the conversation in a quiet environment and with full concentration (which is why I have difficulty using a telephone and can’t hear the radio), which drops to 53% or below with competing noise. Hearing aids are not like glasses which can aim for 20/20 vision. They are an electronic production of sound which, in the case of my cochlear implant, is transmitted directly to my cochlea. With both the Cochlear Implant and the hearing aid, all sounds are amplified with no ‘screening’ to focus on the sounds you want to hear.

Colleagues Chatting

 So, what of the remaining percentage of recognising words that make a conversation? This is guesswork plus taking in knowledge of the context, body language and any other visual cues. As you can imagine, to do this continuously for any length of time and with up to 1-2 people present, is very tiring! (and why I don’t ‘do’ social events – although I always appreciate being invited 😊. I often take off my ‘ears’ as soon as I get home from work and chill…). There are also other factors to take into account for example quality of lighting on the speaker’s face, clarity and speed of speech, accents, room acoustics, background noise, one person speaking at a time – even loose false teeth!

I thought that the following, thanks to Sensory Support Service UK, is a good illustration of what listening can be like for a deaf person. All this processing takes place within seconds – but is continual throughout the conversation. Thanks to my auditory aids (without aids I hear nothing!), my own experience isn’t ‘quite’ as extreme as this, but certainly gives the jist…..

In spite of the difficulties, my deafness has not held me back in my career. I haven’t known any different and have taken on the challenge of living in a ‘hearing world’. At my work with patients, which is currently mostly with older people, I can empathise with those who have developed hearing impairments and who often find it hard to learn to lip-read, so isolating them further.  Certainly, the onset of Covid and the need to wear masks have added to the challenge, but those staff who know me have been very supportive in taking a step back to socially distance and lowering their mask to enable me to converse with them. Most of my work is one-to-one with patients, who aren’t required to wear masks, thankfully. Teams chat is also another challenge, even with an audio link to my CI, as the quality of the video is paramount in my ability to lip-read. There ‘are’ subtitles in Group Chats in Teams (but not individual chat that I know of?) but this is based on speech recognition software which can produce some strange results! For face to face meetings, such as MDT and Discharge Planning meetings, I make sure that I am well prepared with knowledge of the context of the meeting, position myself so that I can see all those present, and take quick notes as a ‘aide memoire’ before going on to processing the next part of the discussion.

‘Selfie’

This is only MY experience of being deaf – everyone, as with anything, is an individual.  We are still not in the ideal world for Deaf people – I also would like to use British Sign Language which is so beneficial at training days and meetings but Interpreters are both so few and far between in Scotland/North England and expensive to hire for a day.

So, can you hear me – to help me to hear you?

Fran Milne, Specialist Community Physiotherapist at NHS Dumfries and Galloway

For more information – https://hearinglosshelp.com/blog/speechreading-lip-reading/

Two steps forward, one step back? by Gillian McNeil

When I trained to be a nurse, a few years ago now, I did not imagine for one second that home working would be a possibility. Yet here I am, as a Diabetes Specialist Nurse and, yes, there are occasions when I can work from home. If I am seeing my patients virtually or I am telephoning them then I do not need to drive 20 miles to work to see them then drive 20 miles home again.

There is much to say about the last 2 years, it changed many things and has been difficult for so many people for so many reasons. In my mind, one positive thing about the Covid 19 pandemic is that it made us grasp the modern technology that had been developed and was sitting waiting to be used. Before I was aware of Covid 19 I sat in meetings hearing about NHS Attend Anywhere, now renamed NHS Near Me. Like the dinosaur that I am, I could see the advantages but felt it was still a long way off being used routinely and I didn’t really engage with it. Fast forward a few months and I was embracing this new technology as it became the main way that I could see my patients. Telephone calls are all well and good but if I needed to demonstrate how to administer insulin or use one of the new injectable therapies then I had to be able to see my patient and my patient had to be able to see me. Something that felt alien at first very soon began to feel like the norm.

As a Diabetes Team we are going through a service redesign and have set up a triage service. Every weekday either a Diabetes Nurse or a Diabetes Dietitian takes their turn at returning all the calls and queries that come into the Diabetes Centre therefore freeing up other colleagues and allowing them to focus on work without being disturbed by calls. This is a system that is working well for us and patient feedback has been very positive so far. Delivering triage from home allows for a quiet environment with no distractions and no demands on time.

It is not just the clinical members of our team who have had to change their ways of working. At the start of the pandemic it was clear that we had no room for all our admin staff to safely maintain a social distance while working. Like any team, our admin staff is the glue that holds us all together, we rely on them for so many things and they are incredibly patient and supportive. They, too, were given the necessary equipment to allow them to work from home but with the advent of TEAMS this posed no communication problems whatsoever.

I keep trying to convince myself that the end of this pandemic is near and in the meantime I delight in the fact that I can occasionally work from home. Most of the time I am patient facing, either in DGRI or the Diabetes Centre at Mountainhall, clearly I am not able to work from home very often and I am very aware that a lot of NHS staff cannot work from home at all, this is in contrast to some members of staff who are able to work at home all the time.  Changes are afoot however and slowly but surely the staff members who were able to work from home for the past 2 years are being asked to come back in to work again. I keep asking myself why? The weekly Covid numbers are still a concern in D and G. We may be nearing the end of social distancing, isolating and routine testing but we are all aware that we should continue to minimise risk where we can.

I feel there is a common misconception that home working is a bit of a skive, that we are less productive at home, but let’s face it, we all have our workload to get through and I do not know many NHS workers who do not fill their working day. I find I am more productive; I can put my head down and concentrate without distraction. We had to find new ways of working when Covid hit, but do we have to revert back to our old ways?

Let’s consider a few of the positive aspects associated with home working:

We recently completed an audit within the Diabetes Team. I think we were all shocked to realise that, if all the team members were to come in to work on any given day, we would be covering 660 miles between us. We all know Dumfries and Galloway is a rural area, a lot of people have to travel to work. Public transport is scarce in a lot of places so people have no option but to use a car. Even in a relatively small health board like ours allowing people to continue to work from home would make a really positive contribution to the reduction of emissions.

We are all facing huge hikes in our cost of living. Fuel prices are at an all time high and Mr Sunak’s paltry 5p a litre reduction gave very little reassurance that maybe things won’t be as bad as feared. Surely it would make sense, and provide some support and comfort to our hard working NHS staff, to do all we can to keep fuel costs to a minimum. Workers who are less stressed are more productive. I don’t think I need to find a piece of research to back that statement up, it goes without saying.

There are perks to working from home. I would be lying if I said I never hang out a sneaky load of washing in between patients but I can easily balance that out with the time that I “waste” catching up with my colleagues when I am in work. (I use inverted commas because I do believe that interacting with my workmates, who are also my friends, is a very valuable part of the working day).It is a joy to be able to spend my lunch break walking my dog across fields instead of sitting in a crowded staff canteen or, worse, at my desk reading emails while I eat my obligatory cheese toastie. One of my colleagues, who shall remain nameless, recently said to me that one of the most wonderful things about working from home is that it gives her something that money cannot buy. It gives her time. Time that would normally be spent sitting in her car for an hour and a half every day. Time that she is not stressing about the cost of petrol or being stuck in slow moving traffic. Time that she is not spending worrying about everything that she has to do when she gets home because when she finishes work she is already there. And working from home is not all filled with perks. When I work from home I am alone in the house. It can get chilly just sitting at my laptop and I cannot justify heating the whole house just for me. We don’t think about the cost of heating when we are sitting in our cosy offices, because we are not paying that particular heating bill. We rely on heating oil in our house, the cost of a litre of this has more than doubled in the last few weeks. We hear a lot about electricity and gas prices shooting up but rarely is heating oil mentioned. I imagine in a rural area like ours there will be a high proportion of people who rely on heating oil. Electricity and gas prices can be capped, not so kerosene.

However; today the sun is shining, the birds are singing and I am working from home. I don’t have to drive home after work; I can go straight out into my garden and wind down after a busy working week. I feel very positive. I look forward to the whole NHS D and G team putting their best foot forward into restarting services.

Gill McNeil is an Associate Diabetes Specialist Nurse for NHS Dumfries and Galloway

“What are you going to do for me?” by Reave Brown

I am a fourth-year social work student and have just finished a 120-day placement. This was not only my first but last placement before I qualify. Due to the restrictions of COVID this meant that the initial plan of having two placements throughout my course, 85 days in third year then following with another 85 days in fourth year could not go ahead. I therefore found myself heading into my fourth and final year of studying social work and heading out on a 120-day placement with what I felt like was no hands-on experience.

I was fortunate to have a split placement, meaning I was allocated to two different learning opportunities. One as a student with the Care and Support at Home Tactical Team (CASHTT). The second working on a learning disability project, that was focusing on looking at what barriers people with a learning disability face when trying to access meaningful day opportunities such as further education, volunteering, and community activities.

It is understandable how social workers can often be seen as the people who put care in, as that is something we often do within our jobs but as social workers we aim to improve people’s lives by helping with social and interpersonal difficulties, promoting human rights and wellbeing. The following definition was approved by the International Federation of Social Workers in 2014 as the Global Definition of Social Work:  “Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work.  Underpinned by theories of social work, social sciences, humanities and indigenous knowledge, social work engages people and structures to address life challenges and enhance wellbeing.

I believe that taking a holistic approach to social work is important as it involves delving into all aspects of a person’s life rather than focusing on one issue. Combining our social work assessment with those of other professionals such as health, education, and housing. This takes everything into account and can encourage and enable people to make informed decisions for themselves with our support.

In CASHTT I am working alongside, a Lead Social Work Manager, Lead Allied Health Professional, Social Worker, Assistive and Inclusive Technology Programme Lead, Data Analyst and Admin Support. CASHTT offers support to care and support providers and ensures they have all required resources and aims to build strong working relationships with providers at an operational level. Through building collaborative relationships with the 29 different care and support providers across Dumfries & Galloway it will allow CASHTT to understand the key challenges in care and support at home and how to consider what changes and improvements can be made. Through working alongside this team, it was highlighted to me very early on about the challenges care and support at home are facing within Dumfries & Galloway right now, this impacted positively on the way I worked. As when doing assessments and thinking of ways a person can be supported without the use of ‘traditional’ care and instead thinking about different ways should that be the use of assistive technology or were there other services locally that could support a person in a different way that would still meet their needs. As well as working in collaboration with the person to identify their strengths and resilience within themselves, families, and groups. Then building on this as means to help resolve problems and deliver their own solutions. For example, I was working with an older lady who was relying on her family to support her with her personal care, the family had begun to find this increasingly challenging and felt they could not continue this level of support. The family thought she may need carers to assist her. Through Occupational Therapy and I undertaking an assessment it was found that the lady could manage her own personal care should she have the correct equipment and adaptations. She had a wet room installed and equipment such as a shower seat. To help building the lady’s confidence I discussed care call with her and the family, this put herself and the family at ease as the family would be her responders should she ever need help or assistance.

Through working alongside the care and support at home tactical team it has allowed me to see how integrated and collaborative working has such great benefits. This way of working produces benefits for individuals, professionals, and whole agencies as it includes offering and displaying broader perspectives and a wider range of knowledge of understanding surrounding an issue. It also allows for improved interactions between differing agencies and means for a better understanding of what the different agencies around us do, for example I had the opportunity to shadow a speech and language therapist for a day and it gave me great insight into that role and when would be appropriate to refer an individual to a speech and language therapist. Which overall helps provide an improved service and outcomes for people. It has also highlighted that within social work there are high demands for the combination of individual and group work techniques, therefore having the skills and ability to work within a team and communicate effectively is an essential skill. Having this ability means for greater knowledge, shared responsibility and allows for resources to be shared, which again results in better services and outcomes for people.

Now that I have finished my final placement, I am looking forward to starting my career and going forward working alongside other professionals with a holistic approach. To enable the people we support to achieve the best outcomes possible.

Reave Brown is a Student Social Worker

The Importance of Engagement by Rod Edgar

Good engagement is critical to the future of health and social care

It does feel that there’s an ever-growing emphasis on the importance of engagement when developing approaches to health and social care.

A number of very significant national documents produced in the last couple of years and directed at health and social care organisations have featured engagement prominently, or as their sole focus.

The 2021 Independent Review of Adult Social Care introduced the prospect of some very significant changes to organisational structures, heralding the introduction of a new national care system.

However, beyond that headline it also made sure to stress in no uncertain terms the importance of engagement when looking at how approaches to health and social care are developed.

A key recommendation to emerge from the independent review led by Derek Feely was that we need to listen to the views of people who use services and actively involve them throughout the process of planning care delivery.

It highlighted the importance of engagement taking place at the earliest stages of development and continuing throughout, with an expectation of being able to evidence how this collaboration with stakeholders informs and shapes what results.

The point was repeated in March 2021 when The Scottish Government and COSLA (The Convention of Scottish Local Authorities) published new long-awaited guidance explicitly intended for Integration Joint Boards, NHS Boards and Local Authorities on the engagement activity around service development and change.

The paper which introduced the report said, ‘Planning with People … sets out the responsibilities each organisation has to community engagement when services are being planned, or changes to services are being planned, and supports them to involve people meaningfully.

“Applying this guidance wholeheartedly will help to ensure these legal duties are met, and it will be used to inform assessment of organisational performance.”

‘Legal duties?’

Yes – this isn’t all just advice and guidance. It’s not something one can glance through and set aside to pick up later as a lesser priority.

There are very strong legal expectations underpinning the need to follow correct approaches to the most formal type of engagement – public consultation – either set out through legislation or established via common law.

For an example of this legislation, look to the NHS Reform (Scotland) Act 2004.

A section of that Act states, ‘It is the duty of every body to which this section applies to take action with a view to securing, as respects health services for which it is responsible, that persons to whom those services are being or may be provided are involved in and consulted on the planning and development, and decisions to be made by the body significantly affecting the operation of those services.’

So, lots of words, and warnings of legal implications, but what does all this mean in real world terms?

Well, there can be repercussions if consultation is judged not to have been carried out to the proper standards, just like in other aspects of work within health and social care.

In one instance, it can be a service which has been stood down through an operational decision having to be brought back as it was and staff reappointed – all because the outcome of a Judicial Review concludes that the correct process around consultation had not been observed.

Alternatively, it can be a multi-million pound flagship capital project placed on an awkward pause while the subject of an independent review.

No piece of engagement is ever going to be perfect, and we know that from our own past experiences. It can always be improved upon. What we always need to do is strive to approach our engagement activity diligently, with thought and care, to listen and learn, and to aim not just to meet the standards and expectations but surpass them.

It can all sound very daunting: the legislation, the legal complexities, the prospect of unhappy people challenging the approaches that have been taken….

It all sounds terrible, and this must be why good, properly planned engagement is being stressed as so important?

No.

Sure, things can go wrong with engagement activity, and as we’ve acknowledged it’s never going to be perfect.

But the real reason why organisations involved in the delivery of health and social care are increasingly encouraged and directed to undertake good, meaningful engagement activity is the very significant benefits that it brings.

No organisation can claim to know what might be best for an individual, a group or an entire region of people when developing approaches to treatment and care without actually working with the people experiencing them now, who might do in the future, or who have knowledge or perspective to lend to the question.

By working together with people across our communities, with stakeholders, staff and volunteers, we encourage and support everyone to play a role in the shaping of approaches. It should mean that whatever takes shape has the best chance of being fully informed and considered, truly workable, sustainable and best positioned to help meet people’s needs.

The result of regular meaningful engagement where we work with all these partners to cultivate and advance approaches to health and social care is that it develops relationships, it pools knowledge and experience, and it benefits everyone.

There’s more we can do around this. There’s more that needs to be done.

Work has been taking place recently to develop a Draft Participation and Engagement Strategy for Dumfries and Galloway Integration Joint Board.

This strategy is intended to set a course for how we gear ourselves over the next three years to undertake engagement activity within health and social care in the region. Building on work which has already taken place, in its present draft form it covers things like training for staff, so that they are better equipped to be able to support engagement activity, and how we ensure people know how they can participate.

It talks about the organisational changes which can help raise awareness of the benefits of good engagement and ensure that it’s a constant activity.

It can be surprising just how much engagement activity already takes place within the Partnership. It’s not all about heading out with a pen and clipboard to consult on a headline proposal.

In the Draft Participation and Engagement Strategy you will see 23 items of significant, structured, formal engagement which took place over the last three years, ranging from a cancer pathways and palliative care improvement project to meetings around the futures of GP practices.

Also, bear in mind that this list doesn’t account for all the daily informal encounters that are taking place, from volunteers greeting visitors at hospitals to care at home staff making regular visits into people’s homes, picking up feedback, thoughts and ideas around services.

We need to improve our approaches to engagement, and the draft Participation and Engagement Strategy aims to provide a three-year road map towards that goal.

It builds on elements such as the creation three years ago of the Participation and Engagement Working Group for the Health and Social Care Partnership.

The Working Group is the place where anyone should come in the first instance if they are proposing to undertake a significant piece of engagement or consultation work within the Partnership.

It’s a supportive group with membership from right across the Partnership of people who are trained or experienced within engagement, able to offer advice and support, and who help to co-ordinate and oversee these pieces of work. It also provides advice around the Consultation Framework which has been developed as a step-by-step guide for anyone undertaking formal public consultation on behalf of the Partnership.

If in a position where you might be undertaking some significant engagement work or a formal public consultation, please let me know.

As for the Draft Participation and Engagement Strategy that’s out to consultation?

Among the people it will impact on most of all is you – someone who is either working or volunteering within health and social care in Dumfries and Galloway.

Whatever your role, given the amount of engagement that already takes place, and the need to seek to improve our approaches as an organisation, there’s a very good chance that you may be affected by whatever actions are finally agreed.

So this is the Health and Social Care Partnership now calling on you, either as an individual or as a team, to play a role in shaping a strategy that will affect you.

The consultation is running until June 5 2022, and we’re here to support you to help shape the outcome.

A copy of the draft strategy is hosted here: www.dghscp.co.uk/consultations

There is also an Easy Read version of the strategy, a version translated into a British Sign Language video, and an animation explaining the process.

Included on the webpage is a survey looking to collect your views, and directions to contact the following email address if you want to offer your views as part of a relaxed online engagement session, where ideas and suggestions can be discussed. Email dg.engagement@nhs.scot to register to take part.

The key to shaping our approaches to engagement is by getting involved yourself. Please do take the opportunity visit the web address and get in touch with us.

Engaging with people can seem pretty daunting, but think about it and you may agree that it’s something we do on massive scale as an organisation every single day.

It’s about going out to talk with people, to hear what they have to say, and to work with them as partners to shape how we approach the future of our approach to health and social care.

Hopefully time will prove that the more we do engagement the easier, more mutually beneficial and productive it becomes.

Rod Edgar is Communications and Engagement Manager for Dumfries and Galloway Health and Social Care Partnership.

Put your own oxygen mask on first

I thought that hypnotherapy and mindfulness were for other folk and that relaxation and rest were things you did if you had time or nothing better to do. Until last year that is. Two family bereavements within three weeks of each other in 2019, followed by all the additional pressures due to the Covid pandemic meant I muddled through until finally asking for help from staff support in March 2021. I was stressed and over whelmed.

Whilst waiting for an appointment, in June I came across the Happiness Club, run by Jo Howarth, an advanced hypnotherapist and mindfulness practitioner. Working with Jo, my work overwhelm improved with simple things she showed and taught me. I plan my week in advance, which can be challenging in a clinical environment and needs flexibility to make it work. Proper breaks throughout the day are essential. I try to eat my lunch away from my desk or at least whilst not reading emails! One of the most liberating techniques Jo taught me was to only read my email once a day, scheduling time everyday specifically to read and action them. Honestly, try it. I didn’t believe her until I did. An automated response suggests if it’s urgent to phone me instead.

Despite Jo gently telling me and encouraging me to rest I didn’t truly get the importance of proper rest until more recently when physical health issues forced me to be signed off work. Even then my GP and Jo had to persuade me that I needed to be off. Suddenly I was aware of just how exhausted I really was, not just from poor physical ill health but mentally too. Working in the NHS in its self during a pandemic is reason enough to be stressed and overwhelmed. Re deployment of the team on several occasions due to Covid, unable to see family etc. are all reasons I would have given you as to why I was exhausted too.  But actually my exhaustion and over whelm was completely down to me. Learnt behaviour from my past meant I felt everything was my responsibility and everything that wasn’t right was my fault too. It was my job to sort everything and the guilt of that meant I had been at times working in excess of fifty hours a week, staying late, working at home in the evenings and weekends. I’m fairly sure there are many people reading this doing exactly that too.

But it’s not all my responsibility and in fairness no one ever told me it was, nor was I expected or asked to work those extra hours.  Using hypnotherapy to help me explore those behaviours and the emotions that go with it hasn’t been easy. Nine months ago, I wouldn’t even have considered hypnotherapy, but honestly, it’s magic. I cannot recommend it enough. I am so fortunate to have found a therapist who I trust 100%. It’s not been easy, there have been lots of emotions and difficult days, but it is so worth it.

I had also been using the mindfulness techniques Jo had taught me, along with meditation and relaxation techniques. But I know now I hadn’t truly learnt the importance of and how to properly rest and relax. Proper rest is not just about sleep. I read recently there are 7 types of rest.

In her book, Sacred Rest: Recover Your Life, Renew Your Energy, Restore Your Sanity, Dr Saundra Dalton-Smith suggests we all need seven different types of rest. The answer to overwhelm and burnout isn’t just taking a holiday. You need to identify what type of rest you need and adopt strategies to achieve this on a daily basis.

1. Physical Rest

Sleeping and napping are the passive component of this and the active part of physical rest include more active things like yoga and stretching

2. Mental Rest

Signs that you need mental rest include poor memory and not being able to settle to sleep at night without your mind racing

3. Social Rest

People pull from your social energy and you find yourself saying, “Can I just get a moment for me?” You feel like everybody’s taking, and you never feel like anybody’s ever contributing back into your life.

4. Spiritual Rest

Spiritual rest needs vary based on someone’s own belief system. At the very core of that is that need that we all have to feel like we belong, we need to feel our work and efforts contribute to the greater good.

5. Sensory Rest

You may not be consciously aware of the sensory input around you, but your body and your subconscious self respond to the sound of phones ringing in the background, the bright lights of your computer, the kids playing while you’re working at home, your notifications going off on your phone or your email.

From all of this you can develop sensory overload. The most common ways of responding to sensory overload are irritation, agitation, rage, or anger. So you may start the day calmly but by the end you are agitated and irritable.

6. Emotional Rest

Emotional rest specifically refers to the rest we experience when we feel we can truly share how we feel. Many of us keep our emotion to ourselves especially at work, we don’t share with people what we’re feeling. The automatic response to “How are you” is “Ok thanks”

Feeling that you always have to keep you emotions in check is an indication of emotional rest deficit.

7. Creative Rest

Creative rest is experienced when we allow ourselves to appreciate beauty. Whether this is natural beauty all around us or created beauty such as music or art.

She suggests a deficit in this type of rest can be seen if you struggle to be innovative.

So it’s not just about sleep! Whilst signed off work, I finally understood the importance of rest. Reflecting back I can see that I had a deficit in all types of rest. I was irritable, had no interest in anything much, my sleep was poor, the noise and inability to concentrate at work in the shared office meant I felt like I was achieving nothing. I had no time for me.

Proper rest has seen my appreciation of the world around me grow along with my mindfulness practice. I look at the sky driving to work instead of worrying about the day ahead; my new favourite place to be is sat by the river, listening to the water, appreciating so many things in my life and the world. Proper relaxation, doing nothing, absolutely nothing is something I want to do and I make time for everyday now. It’s essential for my mental health and well being. My love for things I enjoy like reading is back, along with my need to learn and understand. I try to exercise every day, walking for now but once I’m physically well enough I will get back to cycling. Now I have returned to work I know “the one minute of everything” I’ve learnt to use focuses my thoughts on my breathing and literally gives me a minute to re focus, and bring me back to the present moment. 

 Please don’t be like me and wait until you are not well enough to come to work before you take care of you. Just like with the in-flight safety briefing, we are no help to anyone unless we put our own oxygen mask on first. Self care enables good care.

I’ve written this simply to let you know it’s ok to say you’re not ok, and to try to highlight the importance of proper rest. 

Talk to someone, pick up the phone. There is so much help available through staff support or outside agencies, the Happiness Club being just one of the many out there.

On being a Trans Ally by Claire Alexander

Hi, I’m Claire (she/her) and work as a Psychological Therapist.  As we mark International Transgender Day of Visibility on 31st March, I’m sharing some thoughts on how I try to be a Trans ally in my work with NHS Dumfries & Galloway.  

I try to visibly be an ally to the LGBTQIA+ community by wearing NHS Scotland’s Pride Badge on my lanyard. The Pride Badge has prompted discussions in sessions with a patient who was concerned that their therapist may not share their values on inclusion of the trans community. By showing them my badge and explaining that I’d signed a pledge to promote inclusion of all gender identities, sexual orientations and people from ethnic minorities, they felt reassured.

When beginning sessions with a new patient, I make the Pride Badge visible when I show them my NHS lanyard to confirm my identity. If a patient’s gender identity differs from what is reflected in their online medical records, I make sure to use their correct pronouns throughout my notes and clearly document their gender identity and pronouns at the top of each entry to help other staff use the correct pronouns when addressing the patient.

In my email signature, I have included my pronouns and a link to a document ‘A Short Guide to Sharing Pronouns for Trans Allies’ which explains the importance of using correct pronouns.  Unfortunately, I’m unsure of the document’s author, but it’s based on this article. Pronoun Round Etiquette (thebodyisnotanapology.com)

A book that I learned a lot from is called “Beyond the Gender Binary” by non-binary author Alok Vaid-Menon.  Some useful articles written by NHS colleagues include:
Why pronouns matter | NHS Confederation
 

‘Hello, my name is… and my pronouns are…’ | NHS Confederation 

Transitioning Times – New Challenges to Face by Valerie White

My last blog was 30th of March 2020. I re-read it to prepare for this one – if I had known then what the next 2 years had in store I think my resignation letter would have been in! The last two years for me, as they probably have been for many, is thinking about how I get to the end of the day, never mind the end of the week.

For someone who loves to plan the uncertainty has been at times overwhelming – but the truth is none of know what the future holds. It feels like over the last few years the world has become a very strange and unpredictable place – Brexit, a Pandemic, Russia invading Ukraine, a cost of living crisis – I’m not sure even Mystic Meg foresaw any of this.

We are entering a new phase in relation to the pandemic – thank goodness. Our ability to enter this is due to Vaccination.

Vaccination has been the game changer, we must never be complacent about this fact. Just look at what is happening in Hong Kong – low vaccination uptake there means Omicron is hospitalising and killing huge numbers of people. Ensuring you are as fully vaccinated as you can be and keeping up high vaccination uptake across our population is key to keep us moving forward.

We have not had a pandemic in the modern age, vaccine inequity is still an issue, the threat of new variants continues – they could be milder, they could be more severe, they could be less transmissible, they could be more transmissible – we just don’t know. So being prepared for these eventualities is key.

But at the moment we are moving towards COVID-19 being endemic but that will take time. During this time for the majority of the population COVID-19 will become another in the long list of respiratory illnesses that we get – sometimes we are mildly affected, other times we can feel really quite rubbish but for some COVID-19 is another respiratory disease that will continue to cause serious illness and even death– just as other respiratory illnesses do. Whilst we are all sick of COVID, and I include myself in this, there are some things that we need to embed as we move through into a new phase to protect those who could be more vulnerable.

  • Good hand and respiratory hygiene – remember coughs and sneezes spread diseases – this has always been true and not just for COVID.
  • At the end of April, the general public will no longer be advised to seek a PCR test if they are symptomatic for COVID-19. This will be replaced by guidance of what to do if we experience respiratory symptoms. So we will all need to think about our behaviours and interactions if we are feeling unwell, particularly in relation to those who might be vulnerable to COVID-19 or other respiratory diseases
  • Improving ventilation in crowded indoor settings
  • Mask wearing in certain indoor settings
  • And you’ve guessed it keeping all our vaccinations up to date.

But as I write this blog – which I truly hope is the last one that is about the pandemic – it is not COVID-19 that worries me most. That dubious honour belongs to the challenges we face in relation to the rising cost of living, particularly for those most vulnerable in our society, often those who have been most badly affected by the Pandemic.

Poverty and income inadequacy is bad for your health, and poor health in turn can cause poverty and income inadequacy – it can become a vicious cycle incredibly quickly. The infographic below from the Health Foundation is a helpful summary of how poverty affects health.  

During this challenging time it is so important that those in need are able to maximise their income through the help and support available. With the unprecedented increases in the cost of living there will be many who are facing difficult financial decisions for the first time. Navigating the support that is available is complex but there is help out there. Our colleagues at Dumfries and Council’s Welfare and Benefits and Financial Assessment Team are on hand to help with dedicated support on what assistance you may be eligible for. More details are available on the following link:https://www.dumgal.gov.uk/article/15927/Benefit-advice-and-financial-assessments

Our local Dumfries and Galloway Citizen’s Advice Service is also on hand and eager to help and support everyone right across our region with a range of support on income maximisation advice and guidance and debt advice and support. https://www.dagcas.org/what-we-do/

Please if you are struggling, get in touch with these teams as soon as possible. It is probably one of the best things you can do to support your health and wellbeing – in both the short and long term.

Together we have ridden the ups and downs of a pandemic, and I know that we’ll continue to ride the difficult times ahead. Thank you Team D&G – you are just the best.

Valerie White is Director of Public Health NHS Dumfries and Galloway

Horizon Scanning by Jeff Ace

Well, this is all a bit rubbish, isn’t it? Two years on and still wave after wave of irritatingly more infectious variants, each one arriving just as we’re seeing light at the end of the tunnel from the last one. I must admit to never hearing of the Greek letter ‘Omicron’ before the pandemic; if we were using the more accessible Welsh alphabet, I think we’d be on letter ‘ff’ which much better represents my current feelings.

I liked Ken Donaldson’s blog a few weeks ago in which he wrote about the optimism of spring, and I have had real flashes of optimism throughout the pandemic. For example, I vividly remember our Pharmacy Director taking me to watch the first ever Covid vaccination in our region and thinking this was it, the beginning of the end, back to normal soon. Similarly, I got my first jab (it’s not ‘jag’, it just isn’t) on the morning of Wales’ Grand Slam game against France in March 2021, what an incredible start to a new era. But Wales lost and have kept losing, and we saw the Delta wave and then Omicron spikes push thoughts of recovery further and further away.

Omicron Arrives in Dumfries

We’ll get through the current surge of course, just as we have all the others (if we still have a dash of optimism left, it looks as though we could already be through the peak). But it’s a bit daunting to look at the scale of the rebuild that will be needed to deal both with the backlog in elective activity and with the new demands that will come from the wider impacts of the pandemic, the lockdowns, and the growing crisis of poverty in our population. It is so easy to lose confidence in our ability to build our services up to what our region needs. But we need to avoid falling into this pessimistic trap and start planning a future for our teams that is a whole lot better than the two years we’ve just endured.

The Board ran a planning exercise recently designed to kick off deciding priorities for this next phase. We used a three horizons model you might have come across that requires you to first describe a high performing system with the vast bulk of our problems behind us, say, 10 to 15 years in the future. You then look at a halfway point to this perfection and describe what progress and milestones you should reasonably expect to have achieved. Finally, you look at the next year or two and agree the short-term priorities needed to start this transformation. It’s sometimes quite a good tool to use when the scale of your immediate problems seems a bit overwhelming since you start from a point where they’ve all already been solved!

The only other framework we used was another simple tool, the balanced scorecard. The theory here is that a resilient, high performing system must be excellent in each of several areas.

  • Quality and Safety

This is the most obvious for us. Services that we provide in the future have to be of a measurable high standard and pass that critical test that we would be utterly comfortable in relying on them for our loved ones.

  • Workforce

Again, this one is self-evident. Our services, our facilities and our culture need to be such that we attract and retain the workforce we need to provide that high quality care. I think we can assume that we will be operating in a very competitive labour market and that to succeed in this area, our offer to current and prospective staff members has to be outstanding.

  • Performance

The pandemic and its associated effects have smashed apart our operating model and we are really struggling to deliver consistently fast access to services, in either elective or emergency pathways. We have to rage against this and avoid any temptation to accept it as some new normal level of performance for our population.  I read this week that public satisfaction with the NHS had fallen to a level last seen before the 1997 general election and we need to regain that lost support for what we deliver.

  • Finance & Sustainability

This may not be everyone’s favourite quadrant of our balanced scorecard but it’s absolutely critical to our success. We’re going to emerge from the pandemic in a very difficult financial place, close to £30M a year from a balanced position. Unless we turn that around, it will begin to dominate our agendas, to the detriment of all that’s set out above. Our income is pretty fixed, so these new service models that will deliver high quality, give fast access and be brilliant to work in… are also going to have to cost less. Sorry.

Oh, and we’re going to need to be carbon neutral by the 2040s.

Hopefully you can see now why it’s easier to start describing the system where all these problems have been fixed!

We’ll take a first cut of the three horizon plans to the Board meeting in April, but we’ve got a lot of work to do to refine our ambitions into something more concrete. Much of this is going to involve talking with our teams, our communities and our partner agencies, building on the huge number of Sustainability and Modernisation (remember SAM?) ideas that you provided before the pandemic changed the world.

So despite some bruises during the pandemic, I refuse to give up on my optimism (except maybe about Welsh rugby over the next couple of years, don’t get me started on our coaching team…). We’re a system with an incredible track-record of successful change and we’re going to plan our way out of this, one horizon at a time.

And finally, just because I can never say this enough times, please let me express my gratitude on behalf of the Board for all that you’ve done over the last couple of years. I’ve seen teams handle episodes of crisis before, but I’ve never witnessed that effort extended over such a time period, during which your own family lives were getting turned upside down by the pandemic and its lockdowns. Thank you.

Jeff Ace is Chief Executive Officer for NHS Dumfries and Galloway