“I want to go home” by Wendy Chambers

 “I want to go home” – why people with dementia ask this & an expert opinion on how to respond

#WorldAlzheimersMonth


Isn’t why just a great question?

Possibly it’s more of a marmite question; one that we either love, hate or can tolerate but only in moderation. Certainly as a parent it can wear thin, after a busy day, when being asked why for the umpteenth time by a curious, insistent child.

September is World Alzheimer’s month, with national Alzheimer’s Day earlier this week, Tuesday the 21st.  Which brings me to why – why do we have awareness raising months and days? What’s the point? And when there seem to be so many of them, what difference can they make?

World Alzheimer’s Day is an international campaign to raise awareness and highlight issues faced by people affected by dementia, with Alzheimer’s being one of the most common types of dementia. It is an opportunity for people and organisations to demonstrate how we can overcome stigmatising and other challenging issues people with dementia face and help people live well with what is a long term and terminal condition.

The 5 Whys technique, developed in Japan in the 1930’s, recognises that sometimes the most effective answers come from people who have hands-on experience of the process or problem in question.

One such tricky question which staff and unpaid carers face frequently is when someone with dementia says “I want to go home”. What do we say? How should we respond? What is the person actually asking?

Recently I read a blog by Norman McNamara which provides an expert and insider view answering the Why of this tricky question. Norman lives with a diagnosis of Lewy Body dementia, and his reflection on why he asks and what he actually needs in response provides some very simple, useful advice to carers, nurses, AHPs and doctors alike. So in the spirit of Why and World Alzheimer’s month Norman has kindly agreed to share his thinking with us.

This is Normans blog.

“How many times have you heard someone with dementia say “I want to go home” It has to be one of the most common things that’s repeated many times by those with dementia when most of the time they are quite clearly still at home and have lived there for a very long time. And yet they still say it with that quizzical look in their eyes and a feeling of confusion. Those who are placed in care homes also say it, even when they have lived there for quite a while so the saying applies in many situations, but what does it mean?

As a person living with dementia and somebody who says the same thing (I am told by my wife) when I am “Sundowning” it’s something that’s puzzled me for a while and for what it’s worth, in my humble opinion, this is what I think it means. So when I say I want to go home? Does this mean my birth town of Bolton in Lancashire? Well, as much I am so very proud of my Northern roots, and rightly so, I fell in love with Torquay the moment I arrived here over 25 years ago and may I say wild horses would not get me back up north, I really do believe Torquay is the best place in the world to live, so no, it’s not that.

Do I mean my spiritual home? Well, I am a roman catholic but a much lapsed one and sorry to say lost my faith years ago because of world and personal events.

So, what do I mean when I look at my long suffering wife and say I want to go home?  After much discussion with my wife who was a carer for over 30 years before she had to stop to look after me we have come to this conclusion. “Home” is a place of safety, home is a place of reassurance and home is a peaceful place with no worries, no confusion and no troubles. When I ask to GO HOME Elaine always tells me all will be ok, holds my hand, reassures me that I am safe and makes me feel that all will be ok. I have always believed that no matter how poorly you are with dementia, no matter at what stages of it you are in with dementia, somewhere, deep down you know you are really ill, you know something is very very wrong and you know there is no cure. The worry of all that can become all too much at time, but can’t it for us all?

Doesn’t each one of us at some point feel like this, don’t we all need reassuring at times and be told that all will be ok, not to worry, or at least try not to. You see? People with dementia really are no different to anybody else, we really are all the same, and because someone put us into that “Box” this is what feeds the stigma around it. Now I am not saying this is the correct explanation, and it is as I said, just my humble opinion, but it’s got to be worth a shot don’t you think? Because even if I am wrong, what harm can it do to reassure those with dementia?, hold their hand and tell them try not to worry and they are loved so much by family and friends, I am sure it won’t do any harm and can only help them all.”

Norman is the founder of Global Purple Angel Awareness Campaign

You can follow him on social media @NamaraNorman or his blog on Linked in https://t.co/MT70CjdzDe?amp=1

Wendy Chambers

Alzheimer Scotland Dementia Consultant, NHS D&G  @wendyAHPDem

Let’s Enable not Disable by Sarah Geidesz

You might remember me as a self-care obsessed student harping on about ways to keep ourselves well over winter. Well, I’m back again, now as a qualified Occupational Therapist. I know can you believe!? I was very privileged to have been given a role within the children and young people’s service here in D&G. It’s been a busy few months since entering the post and although self-care remains just as important I wanted to share another subject that means a great deal to me and one that I hope after this blog may come to mean a great deal to you to.

That subject is enablement.

What is enablement? 

By dictionary definition enablement means ‘the action of giving someone the authority or means to do something’. As someone who has worked within a caring profession for most of their life this definition got me thinking, do we as healthcare professionals truly give people the authority to do something? I can only speak for myself yet I know that I have often been guilty of ‘doing to’: to dress, to wash, to feed. If we consider an enablement approach ‘doing to’ forces people to become passengers within their own lives. Even with the best intentions it can be disempowering, limit choice and control and be further disabling. 

Enablement accommodates individual need, challenge or disability and if embedded into practice can support children and young people’s development, learning and communication. By being enablers we can encourage children and young people to participate as fully as they can in their own lives and reach their full potential. The approach complements evidence that children’s health and wellbeing can impact their later life chances and experience. So if we enable from the get go we have the potential to broaden what opportunities they have access to across their lifetimes. To be able to influence better life outcomes is surely what it is all about!? I know for me being able to positively impact children and young people’s lives was the main reason I applied for this position and what better way to do this than through becoming an enabling practitioner.

Let’s talk real world

It may be evident through definition why enablement has become a passion of mine but if you’re anything like me you’ll prefer real world situations and this summer I got to experience just that.

As a student I had spent a placement within the service I currently work for. My placement educator was a very experienced therapist who had a real passion for enablement. She had done countless work to disseminate her knowledge across the region to empower parents and those in health and education to truly enable children and young people with disabilities. As part of this she had started an enablement group alongside a third sector organisation who run a cafe for young adults with disabilities. The group was created to give enablement opportunities to young people who were known to the service. As she left the service I was honoured yet daunted to have been trusted to carry this group forward.

This year’s enablement group ran for four sessions throughout the school summer holidays. Three children were identified to participate and were invited to attend. The sessions involved working in different parts of the cafe with some time for group reflection. Instantly within the first session the conversations they were having amongst each other were enough to warrant the group a success. One of the children who already attends high school was asked by another who was due to start about their experiences. This was a beautiful naturally occurring opportunity in which they were both able to explore their disabilities, share their anxieties and reassure each other.

By the second session, I quickly felt myself feeling a lesser need to be involved in the tasks required of them, to stand back and let them experience it for themselves. In doing so I could observe how they were truly participating, how they interacted with others and their true capabilities. As the third session came around their confidence and skill had notably grown. They were interacting well with other staff and customers; they were competent in the many tasks required of them and were able to reflect accurately on the skills they had acquired during each session. By the final group those who attended and their families were reporting significant changes in confidence, surprise at the true nature of the children’s abilities and were even requesting for further access to opportunities such as this. 

Family preparing lunch together at home

Despite being passionate about enablement from the get go even I was surprised by what they were capable of achieving. In every minute of each session I was blown away by their determination, their adaptability and their willingness to get stuck in to a wide range of tasks. Many of which they had never had opportunity to participate in before, that were therefore completely unfamiliar to them.  They were able to demonstrate an ability to overcome both physical and emotional hurdles and experience life as we all do. Through a web of trial and error, risk taking, exploration and mistake making. Experiences that we all encounter that enable us to learn, develop ourselves and find our place in the world.

A lifelong lesson

Running the enablement group was a significantly important learning curve for many, me being no exception. It taught me that even with the knowledge and passion in an approach that you can still hold assumptions and reservations about the capabilities of others and that often without knowing this can influence the decisions you make about what opportunities people have access to. It reiterated to me that you’ll never know until you try and that by not trying it may cause more harm than good. For these children not exposing them to such experiences is disabling, it denies them a wealth of opportunity, of discovery, of self-actualisation of a level of independence that will see them well into adulthood and enable them to live rewarding lives. This is why an enablement approach will fuel my way of working for the rest of my career and I hope that by reading this it too makes its way into your practice.

Sarah Geidesz, Occupational Therapist for Children and Young People at NHS Dumfries and Galloway

Effective Conversations by Lisa Muirhead

‘Never be afraid to ask questions’ is something I’ve found myself encouraging service users and my colleagues to do. Inadvertently I’ve realised by saying it I am reminding myself to do the same and make these enquiries however big or small and in whatever circumstance. When the opportunity to participate in further Effective Decision Making (EDM) training arose last year I was really interested but at the same time I had many many questions! What exactly did this involve? What would the expectation be at the end of it? Would I have capacity to build this into an already busy workload? … When I reflect back on the 12 week EDM journey I have just been on, I am convinced more than ever that sustaining enquiry and asking questions is imperative at all levels of interactions within our services. The ability to tolerate the uncertainty of not always having the answers and not feeling compelled to give an answer or solution to the questions is another challenge! 

The EDM training has been an enriching learning journey. It has challenged my thoughts on our current practices when interacting with our service users and each other. It has also opened my eyes to a very different style of learning and the benefits of coaching. There was not so much a ‘thing’ to learn and then teach the ‘thing’ to my colleagues which is the proforma for most learning opportunities I have undertaken. This was a very open journey of learning with direction which was facilitated well by Kate Malcolmess but ultimately no pre determined answers or plan of what the final outcome would be. To be on that journey with a mixture of Children’s AHP representatives from all over Scotland, of varying backgrounds but with no hierarchy or service bias was also enriching. For all the fears I had of taking on an unknown entity, by the end of the training I felt empowered that I was part of something bigger, something I believed in and something I could see making a positive difference to our service delivery and ultimately our service users.

Looking firstly at how it has changed my thoughts on current practice, one of the key elements I have recognised is my reliance on processes and systems. Yes, they are in place to ensure consistency and strive for effectiveness but I find myself questioning more who are they effective for? Considering the structured process of many referral management systems for example, referrals come into our services (mostly written with no prior discussion beforehand), decisions are made and this is communicated back in written format. I think our service has already taken great steps in increasing our telephone triage with prospective referrers. It is worth considering though if it could be enhanced further by having a conversation with who is most bothered before the point of request. The opportunity to discuss what the concern is, the context of this and what help (if any) is being asked for seems invaluable when striving for effectiveness and engagement. Agreeing the outcome of the request for help with the person concerned rather than perceiving the problem and deciding the outcome for them feels much more responsive and inclusive.

I recognise that there is a comfort following an established process and individuals can be at varying degrees accepting the uncertainty of change when these processes are questioned. Starting the conversation though seems the best place to start and that was key to the learning style of the EDM training. 

Moving on to reflect on the style of training delivered, I was aware that there was limited lecturing and instead we established smaller working groups to discuss key topics. There was a strong emphasis on having a shared vision and clarity of ground rules which are recognised as key principles to successful group working. There was also a strong emphasis to avoid suggesting solutions to problems or concerns and instead we were encouraged to ask questions and hence coach each other. I hadn’t realised how ingrained my practice was to default back to problem solving mode and it was a constant conscious effort at the start not to do so! As a health professional and a person I recognise that instinctively I want to help others however it was a challenge not to provide this ‘help’ in the way I am so accustomed to. There are times when my professional expertise and suggesting treatments is the right thing to do however having such a solution based approach to concerns can be restrictive rather than assistive. I realise facilitating someone to question their thoughts and actions about a concern is far more enlightening to both them and me than adding to the pool of ‘helpful’ suggestions. The skill of coaching is something I would really like to develop further and I have an even greater appreciation of the value of this now in peer supervision.

What I have also recognised as an outcome of the training is where I place value on the job I do. I appreciate that I cannot measure how good a job I have done or how effective I have been purely from the number of patients I have seen. Instead I place much greater value on the interactions and conversations I have and the immense impact this has on responding to concerns not just attempting to provide ‘treatment’.

I love what a good conversation can bring, you can feel inspired, enriched, enthusiastic, connected and informed. There is a greater chance of everyone feeling understood and ultimately this enhances our relationships with our service users and between services. This training feels like the start of a journey and while we do not have a definitive destination that feels ok. It actually feels more reflective of the training to shape this together as we move along and create a culture of practice we can all value and sustain.

Lisa Muirhead is a Children’s Physiotherapist for NHS Dumfries and Galloway

The language of vulnerability : a personal reflection by Donald Macaskill

In a recent video conference, I found myself gradually getting more and more uncomfortable when one of the participants continually referred to ‘vulnerable service users,’ ‘vulnerable old people’ and ‘vulnerable disabled people.’ I began to reflect on my discomfort and realised that in essence it has to do with the use of the term vulnerable. It is one which is increasingly being used by commentators in the media and in politics. In this brief blog I want to reflect on the way in which the word vulnerable can result in the ‘othering’ of a person or group and the damage which can arise from that, and secondly and not contradictorily why I believe we need to accentuate the positive in our understanding of vulnerability.

‘Vulnerable adult’ was a phrase that was much used in the context of adult protection and safeguarding and to a degree still is. However, when Scotland was developing its new Adult Support and Protection legislation – which came about in 2007- there was a lot of debate on the appropriateness or otherwise of the term ‘vulnerable’. Many self-advocacy groups from the disability and older people’s movements were rightly uncomfortable with the use of the term. The reason for the discomfort is that the term used as an adjective can have the effect of diminishing, limiting and categorising a group or individual. In adult protection terms, it can both lead to a situation where individuals are treated as a group -continually at risk – devoid of distinct identity and capacity, and at the same time can lead to situations where someone is not considered to be at risk of harm because they either do not see themselves, or other professionals do not define them, as ‘vulnerable.’ So it was that the Scottish legislation, not least after some robust judicial contribution, decided not to use the word ‘vulnerable, and in its accompanying Guidance and developments there has grown up an understanding that we are all of us vulnerable to harm from the malevolent actions of another. There is therefore nothing inherently ‘wrong’ about being vulnerable, rather it is an essential characteristic of our humanity. Being vulnerable is part and parcel of human relationship where we take of the masks of pretence and expose the nakedness of who we are to another. Harm can sometimes arise when someone uses our individual characteristics including our vulnerability to cause hurt to us, it is not inherent to vulnerability.

There is a related issue as to why the use of the term vulnerable is unhelpful and it is perhaps especially a development we have witnessed as the pandemic has advanced. There is a danger that the use of the word ‘vulnerable’ risks the ‘othering’ of a person or group. What do I mean by that? Othering treats a group as ‘them.’ To ‘other’ a group or person means to so categorise and distance them that they lose autonomy, individuality and control. They become the object of our concern or care, the centre of our action on their behalf – they lose their voice and agency – their ability to be autonomous and in control. We make the decisions and do so out of paternalistic regard. If we denote a group as being ‘vulnerable’ it seems to almost add justification to the way in which we diminish their autonomy and take actions ‘in their best interests.’ Thus, we have heard words such as ‘vulnerable old people’ throughout the pandemic – treating individuals as a collective with an increasingly diminished ability to see them as individuals and able to make decisions and exercise risk on their own terms.

I mentioned above that as well as a concern for the mis-use of the word vulnerable that I would also want us to embrace a positive dimension to vulnerability. Perhaps the person who has advanced this more than anyone else has been the researcher and speaker Brene Brown. She has in her writings and speeches cogently articulated the need to recognise vulnerability as intrinsic to our humanity.

Brene Brown argues that vulnerability is essential to enable us to live a life which is connected and authentic. She believes that it is those who live fully open to their vulnerability, who ‘spend their life showing up’, who are happiest in their own self and in relationship with others.

In our rush into situations of strength and protection, in our avoidance of risk and emotion, perhaps especially in pandemic times, we are in danger of on the one hand diminishing some people by labelling them as vulnerable and on the other hand totally falling to see that vulnerability is a real strength, and an  essential asset and characteristic of our humanity.

Throughout my working and personal life, I have continually discovered that it is those who are vulnerable, who are wounded, (the word ‘vulnerable’ indeed comes from the Latin word ‘to wound’),  those who live fully raw and honest lives, it is they that evidence to us a strength, reality and maturity which is beyond price and value.

To live a life open to the dynamic of change and circumstance, to be courageous to the point that we can allow others into the space which is our inner self, to be able to stand against easy stereotype and hatred, to speak against the noise of expectation, strikes me as a wound of vulnerability we should all be seeking.

The English poet David Whyte has written a beautiful narrative poem which captures the intrinsic value and necessity of vulnerability:

‘Vulnerability is not a weakness, a passing indisposition, or something we can arrange to do without, vulnerability is not a choice, vulnerability is the underlying, ever present and abiding undercurrent of our natural state. To run from vulnerability is to run from the essence of our nature, the attempt to be invulnerable is the vain attempt to become something we are not and most especially, to close off our understanding of the grief of others. More seriously, in refusing our vulnerability we refuse the help needed at every turn of our existence and immobilize the essential, tidal and conversational foundations of our identity.

To have a temporary, isolated sense of power over all events and circumstances, is a lovely illusionary privilege and perhaps the prime and most beautifully constructed conceit of being human and especially of being youthfully human, but it is a privilege that must be surrendered with that same youth, with ill health, with accident, with the loss of loved ones who do not share our untouchable powers; powers eventually and most emphatically given up, as we approach our last breath.

The only choice we have as we mature is how we inhabit our vulnerability, how we become larger and more courageous and more compassionate through our intimacy with disappearance, our choice is to inhabit vulnerability as generous citizens of loss, robustly and fully, or conversely, as misers and complainers, reluctant and fearful, always at the gates of existence, but never bravely and completely attempting to enter, never wanting to risk ourselves, never walking fully through the door.’

Donald Macaskill is Chief Executive Officer for Scottish Care

This blog was originally published on the Scottish Care website and can be found here

“E bikes: the power for change” by Rhian Davies

I began my role as Active Travel Officer for NHS Dumfries and Galloway in 2017. A lot has changed since then, but the project aim is still enabling Health and Social care staff across the NHS and Dumfries and Galloway Council, to travel more by foot and by bike.

Rhian Davies, Active Travel Officer, on an ebike.

I was recently invited to share some of the project work at a remembrance event for Michele McCoy. Michele was Interim Director of Public Health and was one of the people instrumental in bringing this project to D&G. I’d like to take the opportunity to share more widely the reflections, and in particular, one of the successes, which I shared as part of the evening for Michele.

There’s a lot of talk about electric bikes and maybe you’re wondering what all the hype is about.

Firstly, what is an ebike? The “e” stands for electric and in the UK we have what are technically called ‘electrically assisted pedal cycles’ (EAPCs). This refers to the fact that the rider has to be pedalling for the electric motor to kick in. You can get into the nitty gritty of the legislation at https://www.gov.uk/electric-bike-rules

I’m often asked;

Does it feel different from a normal bike?

Yes and no. It’s certainly easier! Ebikes are heavier, but the boost more than makes up for that. It feels like always having the wind behind you.

How far can I go?

As with your legs, it depends on factors like hills, wind and how hard you pedal. It also depends on the model of ebike. Typically, 40 – 50 miles from a full battery on low boost.

How fast can I go?

The point of an ebike is not a higher top speed, it’s a higher average speed. The boost cuts out at 15.5mph anyway (UK law), but you can cycle faster.

What if the battery goes flat?

Just pedal anyway, like a normal bike. But do be aware it will be harder work to cycle on the uphills.

Isn’t it cheating?

It’s a lot more exercise than driving a car! And you can choose the level of boost, or no boost, as suits your time and energy level.


A member of staff having a go on an ebike.

In 2018 we trialled the use of a couple of electric bikes at Crichton Hall and Mountainhall for staff taking short business trips. The bikes were used on around 50% days.

We also carried out a survey of around 200 staff and found all took between 1 and 2 business journeys of less than 10 miles each week. Of the staff who said they make business trips during the working day, 30% said they would be very likely or somewhat likely to use electric bikes for business trips. This would work out at around 120 trips a week where short business trips could be made by ebike rather than car.

After the success of the trial and based on the survey work, NHS Dumfries and Galloway bought 12 electric bikes using grant funding from Cycling Scotland. These bikes now form a fleet for use by staff.


ScotGem students enjoying their induction on using the ebikes.

One person using an electric bike twice a week can make a huge difference. At the last count in January 2021, over 6000 miles have been travelled by ebike, with 70% of journeys replacing car/van use, saving over 1 tonne of carbon. This has widespread positive impacts:

  • Physical activity is good for us! Colleagues replacing car journeys with ebiking are reducing sedentary behaviour which decreases risk of things like heart disease, stroke and diabetes.1
  • Across the NHS and social care system, patient, visitor and staff travel (including getting to and from work) accounts for 15.5 per cent of the total CO2 released from transport.2 
  • We know air pollution and injuries caused by people using fossil fuel vehicles disproportionately affects the most disadvantaged in society, so reducing car/van use also helps to reduce health inequalities.3
  • All these positive impacts help us to be a good neighbour to the communities we serve by improving health outcomes and reducing health inequalities.

But don’t just take my word for it – hear from Cher who had a loan of an ebike and Richard, who is a new cyclist, and what it means for them; https://youtu.be/ZI-80usQhdI

The recent publication of the IPCC report on Climate Change4 put into perspective the real and imminent threat humanity faces. It’s easy to feel overwhelmed by this. But the good news is you can take the first steps towards reducing your carbon footprint. Without reinventing the wheel.   

If you simply change some of your everyday journeys from car to walking and cycling – even for just one day per week, you can make a difference to the planet and to your own health.

The next decade needs to be a decade of action.  And the good news is you can take the first small steps now. 

If you’re interested in trialling an ebike on your commute, get in touch with your Active Travel Officer, Rhian Davies at rhian.davies@sustrans.org.uk or on 07788336211. You can also find loads of information on walking and cycling at https://activetraveldumfries.wordpress.com/

References

1 https://blogs.napier.ac.uk/tri/wp-content/uploads/sites/56/2020/03/Essential-Evidence-4-Scotland-No-25-Commuter-cycling-and-health-protection-1.pdf

2 https://www.scotsman.com/news/opinion/columnists/nhss-effect-climate-change-may-surprise-you-dr-catherine-calderwood-1395004

3 https://publichealthmatters.blog.gov.uk/2018/11/14/health-matters-air-pollution-sources-impacts-and-actions/

4 https://news.un.org/en/story/2021/08/1097362

“Protecting Breastfeeding: A Shared Responsibility” by Eithne Clarke

World Breastfeeding Week runs from the 1 -7 August 2021. The theme is “Protecting Breastfeeding: A Shared Responsibility”, but what does this mean and why does it matter?

Public health bodies are in agreement: Breastfeeding protects the health of babies and mothers and therefore breastfeeding should be encouraged. Yet breastfeeding rates in Scotland are amongst the lowest in the World, and in Dumfries and Galloway they are amongst the lowest in Scotland. Of course, every parent’s decision about how to feed their baby needs to be made freely and should always be fully respected. This is not about coercing mothers to breastfeed. However, it is about supporting the mothers who start off breastfeeding and stop long before they wanted to (Infant Feeding Survey 2010).  In the NHS we aim to promote breastfeeding, but messages urging mothers to breastfeed do nothing to enable them to do so. Too many women are forced to stop breastfeeding before they  want to, many in the first few days and weeks, through no fault of their own, potentially leaving with them with feelings of guilt and sadness, which may in turn increase their risk of postnatal depression. Too often, it seems, mothers are told “Breast is Best” before their baby is born, but once baby is here any problems they may have are “solved” with a bottle of formula milk. Where there is promotion of breastfeeding, but no real protection or support, mothers may end up feeling that they have “failed”. But this is not a failure of individual mothers it is a failure of the system and of our society as a whole.

Clearly this is an important public health issue. The Lancet (2021) published the most comprehensive review of all the evidence on breastfeeding to date. The article states:

 “Our systematic reviews emphasise how important breastfeeding is for all women and children, irrespective of where they live and of whether they are rich or poor. Appropriate breastfeeding practices prevent child morbidity due to diarrhoea, respiratory infections, and otitis media [ear infections]. Where infectious diseases are common causes of death, breastfeeding provides major protection, but even in high-income populations it lowers mortality from causes such as necrotising enterocolitis and sudden infant death syndrome. Available evidence shows that breastfeeding enhances human capital by increasing intelligence. It also helps nursing women by preventing breast cancer. Additionally, our review suggests likely effects on overweight and diabetes in breastfed children, and on ovarian cancer and diabetes in mothers.”

Breastfeeding needs to be nurtured and protected. Some might argue that there is “pressure” to breastfeed everywhere (including in this blog post). But if you look carefully, the subtle, and not so subtle, messages that surround us normalise bottle feeding and not human milk. There is copious advertising of breastmilk substitutes, and the normalisation of formula milk as a solution to all breastfeeding challenges. As a society, we often fail to understand infant behaviour. Well meaning friends, family, and even some health professionals, ask parents if the baby is “good” and does he/she “sleep through yet”, and suggest a bottle of formula to “fix” normal baby behaviours such as frequent feeding, night waking and wanting to be cuddled and carried. When mothers face breastfeeding challenges in the early days, they need encouragement from friends and family, and consistent advice and skilled support from knowledgeable health professionals and trained volunteers.

Many breastfeeding mothers feel uncomfortable to feed outside the home, despite the existence of law to protect the right of babies and mothers to breastfeed anywhere as and when they need to (The Breastfeeding etc. Act  2005).  Returning to work may present a challenge for some, and yet employers should be making reasonable adjustments to enable a mother to express milk or feed her baby.

So that’s the bad news. The good news is that what needs to be done to improve the situation for mothers and babies is well known. We just need to do it. A combination of peer support, third sector organisations, knowledgeable health professionals, the Unicef Baby Friendly Initiative and restriction of the advertising and marketing of formula milks has been proven to make a difference. In NHS Dumfries and Galloway we are fortunate that our Maternity and Health Visiting/Family Nurse services are Unicef Baby Friendly Initiative accredited, and our Neonatal Unit is working towards full accreditation. The Unicef Baby Friendly Initiative is an evidence based approach to improving the care of babies, mothers and families. It provides a structured framework of standards for each service. We need to work hard to continue to achieve and maintain these standards. Our Infant Feeding Policy requires all NHS Dumfries and Galloway premises and staff to adhere to the World Health Organisation (WHO) Code on the marketing of breastmilk substitutes.  We have three excellent Infant Feeding Team workers and a group of willing volunteers. We even have a Baby Friendly Guardian on our Board, and a Strategic Baby Friendly Initiative group made up of senior managers. What we still need is a shift in public attitudes to prevent breastfeeding mothers from feeling vulnerable when feeding in public, employment protection to support breastfeeding mothers returning to work, and ongoing investment from Government to provide NHS boards and third sector organisations with the staff and resources they need to offer optimal support to mothers. It costs relatively little to implement measures to protect breastfeeding, and, I would argue, the barriers are mainly about societal attitudes and how much value we place on the health and wellbeing of our infants and their mothers. As Keith Hansen of the World Bank said in 2015:

“In sheer, raw, bottom-line economic terms, breastfeeding may be the single best investment a country can make.”

Eithne Clarke

Infant Feeding Coordinator IBCLC

Women, Children and Sexual Health Directorate

NHS Dumfries and Galloway

Time is running out…. by Liz Forsyth

Consultation on the Integration Joint Board Draft Strategic Commissioning Plan for Health and Social Care 2022-2025 Click here to go to the plan and survey    

Time is running out for you to influence and shape the future of Health and Social Care in Dumfries and Galloway. We are now more than half way through the consultation period on the draft Strategic Commissioning Plan (SCP). If you haven’t already done so, please complete the survey or submit your comments to us by Sunday 29 August.

The draft SCP has been created by engaging with and involving as many local people as possible, including people who deliver and access health and social care and support across Dumfries and Galloway. Their input is shaping the document into the version that will be presented to the IJB for approval in spring 2022.

A short animation on the SCP is available to be viewed on https://www.youtube.com/watch?v=zF2KOOGmmds

Engaging during a pandemic has been challenging but it has also presented opportunities for us to find and use new ways of connecting with people. Some of these new ways of engaging have helped break down and address geographical, resource and transport barriers faced by people in the past and enabled them to be involved.

We have worked with partners from across all sectors to create and coproduce a range of resources that support people to access, and engage with the consultation to develop the SCP.

These resources include videos for the Easy Read SCP with British Sign Language translation, subtitles and voiceovers. These can be viewed on https://www.youtube.com/watch?v=SrSX-aBPel8

Other resources include

  • online engagement sessions and presentations – to groups and individuals (dates are still available)
  • the draft SCP produced in Plain English and Easy Read https://dghscp.co.uk/consultation/strategic-plan/
  • newspaper adverts and press releases
  • all documents available in Word or PDF to enable people with ‘Reader’ software to translate written word into audio or other languages
  • paper copy documents available on request
  • QR code on all posters and documents to take people straight to the Smart Survey via their mobile phone

To join the conversation and help shape the future of health and social care and support you can

Read the Draft SCP orEasy Read Draft SCP on https://dghscp.co.uk/consultation/strategic-plan/  

Share your thoughts and views with us through any of the ways shown below

2nd Floor, South Wing, Mountainhall Treatment Centre, Dumfries, DG1 4AP

  • Or Telephone: 01387 272734

Due to Covid-19 precautions, paper copies of the Draft SCP and Easy Read Draft SCP are only available on request and all engagement sessions are being undertaken online or by phone.

Engagement sessions are taking place on MSTeams on the dates shown below. Please contact us to register or request a presentation for your group about the draft SCP. If these dates are unsuitable, please contact the team and we will try to arrange an alternative date or time.

21/07/21        3 – 4pm

04/08/21        1 – 3pm

09/08/21        3 – 4pm

Please ‘keep the conversation going’

Double down on “double ups” –maximise choice, control and moving with dignity by Ritchie Maxwell

Double down on “double ups” –maximise choice, control and moving with dignity 

Ritchie Maxwell, Manual Handling Advisor 

Following on from the Delayed Discharge Performance (DDP) report from the IJB in May 2019 the impact of how we provide moving and handling support was a demonstrable delay factor. Waiting for ‘Double ups’ (2 staff to move and handle) generated delays for home care packages, placement or return to a care home and impacted on what mattered to people to live not exist.   Our beliefs, our historical practice, to default to requiring 2 people to safely move and handle a person were having a significant impact on NHS D&G’s ability to discharge people safely and efficiently. It was recognised from national publications that across Allied Health Professionals, Nursing and Carer workforce that staff felt ill equipped or trained to carry out assessments to reduce 2 carers to 1 or include informal carers in moving and handling (Harrison, 2020). The DDP report noted that delays were significantly higher for people requiring Care at Home ‘double up ‘packages. This prompted an idea for Sustainability and Modernisation programme (SAM).   

SAM idea94 – ‘FAIR’ Care 

To work with the integrated health and social care (H&SC) team and partner agencies/organisations to review the approach taken for people who currently require assistance involving 2 Carers. This would involve a change of mindset from the conventional starting point of 2 people through joint risk assessments.   The ‘default 2 staff approach’ requires change to assess if one Carer, and the appropriate equipment, could improve the person’s experience and meet their needs. This could support timely discharge, availability of carers and demonstrate best use of resources.  An approach already successfully tested in England. 

Why modernise? 

Moving and Handling equipment has continued to evolve with new ways of working through Assistive and Inclusive (AIT) practice.  Single Handed care involves the use of specific pieces of equipment to safely assist an individual to transfer with one person (following a robust risk assessment) rather than two.  Locally this is referred to as FAIR (flexible, achievable, individualised and risk assessed) care which: 

  • Enables and empowers a ‘Moving with Dignity’ approach and ethos to ensure safe moving and handling, comfort, dignity and respect. 
  • Supports increased flexibility with one person whilst improving staff resources to increase caring capacity 
  • Promotes positive experiences for people of inclusion, quality and confidence to maintain as much independence as possible, moving with dignity and participation  
  • Can identify where a safe reduction in care is possible whilst positively impacting on a person’s health and well-being outcomes and minimising costs 

How sustainable? 

In turn, staff providing care can support more people whilst assuring the quality of care they provide. Evidence shows, if single handed care is carried out in the right manner it can better meet 40% of people’s needs. Investing in the right equipment has been shown to be cost effective in the long run and can help moving with dignity less complicated and time consuming than double handed care.  FAIR care equipment includes but is not limited to: 

  • Stand Assist, Stand Aid Compact 
  • Positioning wedge  
  • Repositioning system  
  • Easy glide board   
  • Twin Turner(sling)  
  • Gantry portable hoist   
  • Comfort turn mattress  
  • in bed patient turning system   
  • RotoFlex Chair/Bed  

A FAIR Start 

A working group was formed in Jan 2020 involving members of the multi-disciplinary team including health and social care (H&SC) services.  This was underpinned by previous excellent evidence-based work across H&SC including partnership work across paediatric Occupational Therapy, Social Work Occupational Therapy and Social Workers.  This led to tests of change aiming to: 

  • Explain FAIR and undertake risk assessments for each client to ensure their safety, needs and choices as well as that of the family and carers were understood 
  • Underpin reviews with enablement approach to maximise participation and independence 
  • Improve the capacity of care providers to meet current demand 
  • Ensure staff understood and felt supported with robust training as part of mandatory updates and dispel the myth that ‘specialised’ courses were required 
  • Reduce patient waiting time for moving with dignity needs within their own homes 
  • Review current equipment provision to ensure it was appropriate and contemporary for patients needs 
  • Identify cost saving benefits 

FAIR Progress 

Since March 2021 we have started to roll out FAIR care training to all staff within NHS Dumfries and Galloway.  Integrated within our moving and handling training.  We are initially working with local authority in-house Care at Home (CASS), Care providers and Short Term Rehab (STARS) to ensure our shared aims are met across rehabilitation, support and care – to double down on double ups.  Let’s embrace flexible, achievable, individualised and risk assessed (FAIR) approaches to moving with dignity.  Lets support people to maximise their independence.  

Ritchie Maxwell is a Manual Handling Advisor for NHS Dumfries and Galloway and can be contacted at  Ritchie.Maxwell@nhs.scot  

CARERS WEEK 2021 – MAKING CARING VISIBLE AND VALUED by Clark Adams

This week is Carers Week (7th – 13th June 2021). Carers Week is an annual awareness campaign that celebrates and recognises the vital role of unpaid Carers across the UK.

The theme for Carers Week 2021 is ‘Making Caring Visible and Valued’.

You may have seen this film which was featured on BBC Breakfast earlier this week. It is a powerful illustration of the importance of Carers and highlights the particular challenges that they have faced during the pandemic: https://youtu.be/GOJligcFdEc

A Carer is someone who provides unpaid care and support to a family member or friend who has a disability, mental or physical illness, substance misuse issue, or who needs extra help as they grow older.

For some, taking on a caring role can be sudden: someone in your family has an accident or your child is born with a disability. For others, caring responsibilities can grow gradually over time: your parents can’t manage on their own any longer or your partner’s mental or physical health gradually worsens.

The amount and type of support that carers provide varies considerably. It can range from a few hours a week, such as picking up prescriptions and preparing meals, to providing emotional support or personal care day and night.

Caring will touch each and every one of us in our lifetime, whether we become a Carer or need care ourselves. Whilst caring can be a rewarding experience, it can also have a huge impact on a person’s health, finances and relationships.

Did you know that there are approximately 15,000 Carers in Dumfries and Galloway who provide at least 410,000 hours of care and support each week?  This is more than the care and support provided by the NHS and Council combined. Without this army of unpaid Carers the rest of the health and social care system would simply not be able to function.

We know that the Covid-19 pandemic has disproportionally affected Carers across the UK. Helen Walker, Chief Executive of Carers UK, has reflected:

“Throughout the COVID-19 pandemic unpaid Carers have played an essential role supporting older, disabled and seriously ill relatives and friends, doing so most of the year on their own behind closed doors. They have forgone breaks from caring and much of the support they would normally have relied on.

“As restrictions ease it is vital that we acknowledge the enormous contribution that unpaid carers continue to make day in day out. I am delighted that many individuals and organisations are getting involved with virtual activities, helping Carers to connect to others and access advice and information locally. 

“Looking after someone can be a hugely rewarding experience, but it sometimes comes with difficulties, including getting the right support. This Carers Week I hope all parts of the community – family and friends, employers, businesses, schools, health and care services – do their bit to make caring visible and show it is valued.”

Making unpaid Carers more visible and valued is something that we can all help to do something about.

The Independent Review of Adult Social Care in Scotland, published in February 2021, reflected the reality of the lived experience for many Carers in Scotland.

“Carers feel invisible, that they are just left to “get on with it” and that no one cares or appreciates them…. now is the time to act and make carers count, treated as equal partners in care with professionals.”

In our daily working lives, there are opportunities to recognise Carers as fellow Health and Social Care colleagues. Here are five easy things you can do to help make unpaid Carers more visible and valued.

  1. Ask someone if they are a Carer.
  2. Say ‘thank you’ for their hard work in their caring role.
  3. Ask some questions about their caring role – do they feel they have a good balance between their caring role and other things in their life? Do they feel supported to continue with their caring role?
  4. If you consider that they would benefit from some advice and support, signpost them to the Dumfries and Galloway Carers Centre.
  5. For more information on how best to support Carers, look at the Carer Awareness Training module called ‘Equal Partners in Care (EpiC) available on the TURAS e-learning site or contact me – Clark Adams, Carer Facilitator at Clark.Adams2@nhs.scot

The Dumfries and Galloway Carers Centre can be contacted in various ways. You can call 01387 248600 between 10.00am and 3.00pm or leave a message if outside these times. The Carers Centre can also be contacted by email at info@dgalcarers.org.

For more information you can visit their website at www.dgalcarers.org

This Carers Week, we should all take a moment to reflect on the significant contribution that Carers make across Dumfries and Galloway and how we can play a part in helping to make our unpaid Carer colleagues across Dumfries and Galloway feel more visible and valued.

If you are a Carer, thank you. Most of us will know someone who is a Carer. Please take a moment today to get in touch with them and thank them for all their hard work and dedication to their caring role. The change to make Carers more visible and valued starts with each and every one of us.

Clark Adams is a Carer Facilitator based at Dumfries and Galloway Royal Infirmary