‘Docere’ by Sonia Cherian

The word ‘Doctor’ is the agentive noun of the Latin verb Docere which means ‘to teach’. The title ‘Doctor’ refers to a person who is recognised to have acquired sufficient knowledge in a subject to be a teacher of that subject. The role of the doctor as a teacher helps educate patients about their condition. A well-informed patient is crucial to the success of any treatment plan. In an era of increasing demands on the healthcare system coupled with  changing patient expectations, the doctor’s role as a teacher has a unique significance.

The supreme court ruling in the Montgomery case (Montgomery v Lanarkshire Health Board, 2015) was a watershed moment from a medicolegal perspective. Mrs Montgomery, a small built diabetic patient had complications during a vaginal delivery which resulted in her son being born with severe disabilities. The case hinged on whether the health board had provided her with all the information which could have helped her make a decision between a normal delivery or a caesarean section. Her obstetrician felt that the risks of shoulder dystocia during normal labour was not significant enough to discuss with her thinking that this information may have resulted in the patient choosing a caesarean section which had its own risks. The supreme court felt that had the risks been explained fully to the patient, she would have opted for a caesarean section and the baby would have been born unharmed. This ruling established that a patient should be told whatever they want to know, not what the doctor thinks they should be told. Mrs Montgomery was awarded a compensation of £5.25 million and the ruling fundamentally changed the law on decision making with the transition from ‘medical paternalism’ to ‘patient autonomy’. The ruling makes it clear that any intervention must be based on a shared decision-making process ensuring the patient is aware of all options and supported in making an informed choice by their healthcare professional.

The General Medical Council (GMC) document on Good medical practice advises to work in partnership with patients:

  • You must listen to patients, take account of their views, and respond honestly to their questions.
  • You must give patients the information they want or need to know in a way they can understand. You should make sure that arrangements are made, wherever possible, to meet patients’ language and communication needs.
  • You must be considerate to those close to the patient and be sensitive and responsive in giving them information and support.

(https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/good-medical-practice/domain-3—communication-partnership-and-teamwork#paragraph-46)

The Realistic Medicine agenda led by the Chief Medical Officer (CMO) of Scotland makes shared decision making and a personalised approach to care its key themes. (https://www.gov.scot/publications/practising-realistic-medicine/)

‘The King’s Fund’ research recommends that patients should be given a chance to take an active role in decisions about their care and treatment by providing the right opportunities, information and support. Services should reflect the needs of patients by meaningfully involving patients and carers in service commissioning, planning, design and improvement. (https://www.kingsfund.org.uk/publications/shared-responsibility-health)

An informed patient can positively contribute to decision making regarding a personalised approach to his or her treatment. This would also mean that patients are more open to share the responsibility of these decisions and be prepared to live with the consequences of their choices thus reducing the risk of complaints and litigation. Patient decisions are not only influenced by medical considerations but also by non-clinical issues which are of relevance to that individual patient. Values, beliefs and life experiences that have a personal significance can influence choices. Our role as clinicians is to support the patient in the decision-making process by providing expert medical advice through a dialogue. Unlike emergency situations where decisions have to be made quickly to save the life or limb of a patient, the vast majority of treatment decisions are taken in primary care or in an elective setting in secondary care. Many conditions have a variety of treatment options, each with its own benefits and risks. In some situations, having ‘no treatment’ is also a reasonable option.

Many patients are well-researched about their condition having read various articles on ‘Google search’. However, for a non-medical lay person to comprehend the vast, often confusing and sometimes contradictory online information can be challenging. This may leave patients with incomplete and out of context information. Hence the information that the patient could assimilate online is quite different from the knowledge that he or she needs to make personalised treatment choices. The clinician has the unique role as a teacher to help transform the information the patient has into knowledge whereby safe personal choices on treatment could be made.

Discussion regarding the various methods of Patient education is a topic on its own and is beyond the scope of this blog. Though innovative ways to deliver succinct information using digital media seems to be the way forward, these would never replace the warmth and compassion of a caring competent clinician who would help patients make the right balanced choices. This would only be possible with the provision of time and resources to improve meaningful information sharing during consultations.

The CMO’s annual report (2016-17) acknowledges that the main barrier to healthcare professionals having more in-depth discussions with patients is the issue of time. “Simply offering the standard treatment or investigation may be quicker, but not necessarily what is in the patients’ individual best interests. It is essential that in order to provide high quality, personalised care clinicians are in a position to make the time to have these important discussions. If we are able to move towards engaging in these conversations as a part of routine practice, it is likely this will in some circumstances save time where patients decide against investigations or treatments that they do not feel are right for them.”

The second Citizens’ Panel Survey (August 2017) revealed that the behaviour/style of the doctor and how busy they are (or are perceived to be) had an impact on patients’ inclination to ask questions. The current legal and regulatory requirements make it the responsibility of the clinician to provide adequate time to the patient so that they are well informed prior to making a decision.  However, the Scottish Public Service Ombudsman (SPSO) has commented in the CMO’s Annual report (2016-17) that this responsibility is not that of the clinician alone. This process would require policy changes within the organisation and a change in culture that encourages and fosters patient centric multi-disciplinary team working.

The GMC guidance, the Supreme court ruling, the concepts of Shared decision-making, Patient centric care and Realistic medicine all point to the pivotal role of patient education  thus highlighting the importance of what it truly means to be a doctor : ‘A Teacher !’

Therefore, let us all remember to teach before we treat !’ and support each other in patient education with the ultimate aim of delivering holistic patient care.

 

Dr. Sonia Cherian is a GP at NHS Dumfries and Galloway as well as a GP Appraiser and CPD Adviser at NHS Education for Scotland

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“Undetectable=untransmittable….but only if people are diagnosed and treated” by Gwyneth Jones

As a trainee doctor I moved to Edinburgh in the late 1980’s to start a career in Infectious diseases. The wards were full of people my own age diagnosed with AIDs and given a life expectancy at best of a few years. Many had recurrent, difficult to treat opportunistic infections and suffered progressive decline with weight loss and dreadful skin conditions. Often siblings and close friends were also infected and dying.  As ID specialists we developed skills in breaking bad news; informing and testing terrified partners and supporting patients and families with both a terminal diagnosis and highly stigmatised condition. 

HIV testing was seen as a ‘special test’ and provided with wrap around counselling that benefitted those who tested positive but became a barrier to many clinicians who recognised the importance of testing beyond the initial ‘high risk groups’.  It took considerable campaigning by Lord Norman Fowler in 1987 to persuade Mrs Thatcher that informing the public would save lives.  The PM feared harm would come from discussing risky sexual behaviour but ultimately the hard hitting Tombstone campaign featured on bill boards, cinemas and leaflets to every household. Without effective treatment the only answer to the AIDS epidemic was ‘Don’t die of ignorance’ and protect yourself. The tone and message remained grim.

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Thankfully, much has changed but there have been no further government funded health campaigns and many clinicians remain unaware of the transformation in treatment and prognosis for HIV. I am delighted that my F1 colleagues Dr David Gibson, Dr Patsy Fingland and Dr Chryssa Neo have been exploring how we can better inform colleagues about the need for increased HIV testing and ensure that Dumfries and Galloway plays it part in reaching the end of the HIV epidemic.

December 1st 2018 celebrated the 30th Anniversary of World AIDS day. People diagnosed early with HIV can now expect to remain healthy with near, normal life expectancy. Treatment options include single tablet regimens of combination antiretrovirals started at diagnosis regardless of CD4+ cell count. Damage to the immune system is avoided and side effects are much reduced.  But it has been the findings of the PARTNER studies that provide an extra piece in the quest to eradicate HIV. Since patients receiving treatment that had undetectable viral load showed no ongoing transmission. UNDETCABLE=UNTRANSMITTABLE.

The challenge now is to ensure all those infected are tested and know their HIV status. This worldwide ambition is encompassed in the UNAIDS 90-90-90 campaign……

So how can we improve? 

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We want everyone to feel that they can prompt HIV testing. Doctors in training may feel uncertain as they rotate around new wards but we hope to encourage nursing, pharmacy and dietetic staff to recognise indicator conditions and suggest HIV testing. Our poster aims to increase awareness and we will follow up our recent survey with more ‘bite size’ HIV education.

The message is simple. You don’t need to worry about asking ‘risky questions’. You simply need to offer a test and very few patients decline.

HIV testing saves lives. 

Gwyneth Jones is a Consultant in Infectious Diseases and General Medicine and was helped in the writing of this blog by David Gibson, Patsy Finland and Chryssa Neo, all Foundation Year One Doctors currently working at NHS Dumfries and Galloway

Today is Carers Rights Day by Linda Owen

So what? some of you may ask, “that doesn’t matter to me.” Well for 6000 people in the UK who become a Carer each day it does matter. Today is about raising awareness of the rights that they, as Carers, have.

So who are Carers?

Carers are people of any age who provide unpaid help and support to a relative, friend or neighbour who cannot manage to live independently without the Carer’s help due to frailty, illness, disability or addiction.

So why does this matter?

You may or may not be a Carer, but more than likely in your daily working life you will meet Carers. Did you know 1 in 10 of all people in Dumfries and Galloway are Carers?

Carers in Dumfries and Galloway provide more care than the NHS, Council and the Third and Independent Sectors combined as shown below. Carers are a huge asset to our Health and Social Care Partnership and to the people of Dumfries and Galloway.

The Act aims to support Carers in Scotland to improve their health and wellbeing, so that they can continue to care, if they so wish, and have a life alongside caring.

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Some people are proud to be Carers but others don’t want to be identified as a Carer as they see that they are a husband, a daughter or a friend looking after someone important to them. It doesn’t matter if someone identifies as a Carer or not, they still have rights.

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So what rights do Carers have?

Carers having rights is not new. There have been specific Carers rights for more than 20 years, including the right to have an assessment of their needs.  Building on those rights The Carers Scotland) Act 2016 (the Act) took effect from 1 April 2018. The video below highlights they key elements of the Act

This blog focuses on the four of the new rights for Carers.

Right 1 – Adult Carer Support Plan or Young Carers Statement

Carers have the right to an Adult Carer Support Plan or a Young Carers Statement. This is a plan for Carers to identify their needs and their personal outcomes.  This is available to any Carer no matter how many hours of care they provide, no matter their circumstances. A plan can be downloaded here

Help and support to complete a plan or statement is available from Dumfries and Galloway Carers Centre.

Right 2 – Support for Carers

There is a duty for Local Authorities to provide support to Carers, based on the Carer’s identified needs through the support plan or statement which meet the local eligibility criteria. More information can be found here

Right 3 – Information and Advice

There is a requirement for Local Authorities to have an information and advice service for Carers which provides information and advice on, amongst other things, emergency and future care planning, advocacy, income maximisation and Carers’ rights.

We are lucky in Dumfries and Galloway to have a range of great third sector Carers Organisations who will provide information and advice to Carers, see links at the end of the blog for more details.

Right 4 – Involvement in Hospital Discharge

There is a duty on the NHS to inform and involve Carers if the person they care for is discharged from hospital.

It can be difficult to find time to have conversations with Carers. However there are real benefits to taking the time to have a good conversation.  This can lead to

  • Clinicians and others having a better understanding of the daily routine
  • Improved communication and trust with users and Carers
  • Shared decision making may assist in achieving clinically preferred goals more quickly
  • Increased patient satisfaction

So what can we do?

We as staff within the partnership can help

  • to identify people as Carers,
  • to support people who are Carers by listening,
  • offer signposting to Carers to access specialist Carer information and advice
  • take a moment of reflection and think about how your service interacts with Carers

If you are not sure that you know enough, don’t worry there are Carer Aware Training Modules on the electronic learning systems of both NHS Dumfries and Galloway and Dumfries and Galloway Council.

For more information on Carers Organisations see below:

Alzheimer Scotland, www.alzscot.org

Compass www.cbisl.org

Crossroads www.crossroads-scotland.co.uk/

Dumfries and Galloway Carers Centre www.dgalcarers.co.uk

PIN www.parentsinclusionnetwork.org.uk

Quarriers www.quarriers.org.uk

Support in Mind  www.supportinmindscotland.org.uk

User and Carer Involvement (UCI) www.userandcarer.co.uk

Linda Owen is a Strategic Planning and Commissioning Officer at NHS Dumfries and Galloway

In a heartbeat by Caroline Sharp

I have recently been very involved in all sorts of discussions relating to the move many of us will make in the coming months from Crichton Hall to Mountainhall Treatment Centre. Its a move which is going to affect many of us in a very personal way – just as the move to our new hospital last year affected the lives of all the staff based there, and also those who work in the wider system.

The impact of change – whether we choose it, or not, is profound and lasting on each one of us, and affects us all differently, because each one of us is different, and unique, and in our own way a special part of the best collective asset our organisation has –and that’s us….you and me ….the ‘Workforce’!

We are the heartbeat that keeps our organisation alive, working well and doing all the great stuff that our patients and clients need, and expect from us every day. We all have a part to play; we are all a piece of the organisational ‘jigsaw’ and connect with each other in so many different ways and levels, and without any one of us, we are collectively less resilient as a result. So what gets in the way of us being the best we can be every day – being the high performing, integrated and resilient teams we all aspire to be a part of?

Thats a really good question, and one I have been pondering on for quite a while now!

I believe there are 3 big issues that we all face, and which affect us as individuals, teams and as a whole organisation, affecting our ability to stay resilient, and cope each day with the complex and challenging work we do together and the changes that are an everyday feature of our work

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The first of our priorities is Workforce Sustainability. This is about our ability to have the right people, with the right skills and qualifications, in the right place at the right time. Fairly easy to type, very very challenging to maintain sometimes! I know how hard teams are working to attract new staff to NHS D&G, and our challenges are not just  inside our organisation, but also about the region we live in, and the ageing profile of our population and our workforce.

Having a sustainable workforce is about Supply, Attraction and Recruitment (are people with the right skills, knowledge and attitudes available to us here in D&G in the first place via great national and international education and training?),  do they want to work for us (or would they rather go to Glasgow, or Tescos?), and how do we make their connection and entry into our organisation sparkle so that they feel welcomed, valued and have direction and purpose?

Its also about Retention – how do we ensure that we, the staff, want to stay and develop? Its about Big Picture – national, regional, IJB and Board Workforce planning, and also about Every Day – having the team capacity and capability around us that we need to get the job done well, and feel OK at the end of our shift.

This leads me to my second big priority which is Staff health and wellbeing. Being well and at work is IMPORTANT. All of the evidence says that doing meaningful work is good for you and me, and that physical, mental and spiritual wellness are all equally important. When I am not well, I am definitely not at my best, and over the course of my career I have experienced periods of both physical ill health, and also mental distress, which have impacted on my ability and resilience, both at work and at home. At those times, it has been the team around me who have helped me to work through my challenges, and who have encouraged me to Get Well Soon and rebuild my resilience.

I know that the ultimate responsibility rests with me to do the right things to keep myself healthy (diet, activity, managing my work / life balance/ taking good care of myself as well as others at the times that others I care about need some extra support from me – you know the drill!) And yes, if I am Working Well, then I am a stronger member of the team, and that means others get the benefit too – my colleagues, and the staff, patients and clients I am here to support. So good staff health and wellbeing is actually good for everyone’s health!

And so to my third priority – Organisation culture.

Culture is about how we are, not what we do. (As Fun Boy 3 said, ‘It aint what you do its the way that you do it!’). Its about how it feels to be at work, and thats a rich and exotic cocktail of ingredients that sometimes is hard to put your finger on, but easy to identify when its not right (like adding salt instead of sugar to your favourite desert). Our Culture is created by us – you and me, and the other 4500 staff who are working with us in our organisation. And thats an important message I remind myself of each day – i’m a part of this, and I make a contribution to how things are around here, so I need to take my bit of responsibility for it, and help others do their bit well too.

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I remind myself that our CORE values (Compassion, Openness, Respect and Excellence) are a great guide light for us all to strive towards, which can help us towards a positive Culture in which we feel valued for what we bring to work each day (myself!), and feel safe to raise both concerns and ideas for improvement, so that we can all benefit from the talent and creativity that we have across the organisation, and see things afresh through the eyes of another colleague, someone who can help me to see into my own blind spots and help me change and improve.

The good news is – we are on the journey, and are changing things to help make improvements in each of these 3 priority areas. (I can perhaps come back with a Blog part 2 about that if Ken Donaldson will let me?!). But we all have more to do, and there is opportunity, and need for every one of us to contribute to our collective team health.

So lets stay focused on our opportunities and our good conversations this winter so that we support each other in our teams to be the resilient, integrated and high performing NHS D&G team we all want to be part of!

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Caroline Sharp is Workforce Director at NHS Dumfries and Galloway

 

 

 

Patient Safety Group and the Pressure Ulcer Collaborative by Alice Wilson

Over the last few months you will have seen information about the Patient Safety Group (PSG); this blog builds on one area of PSG work, using information and learning to address issues we see from reported incidents. 

More than likely anyone reading this blog will know something about pressure ulcers and, in PSG, we hear about the worst ones.  The grade 3 and grade 4 ulcers; based on the European Pressure Ulcers Advisory Panel (EPUAP) grading tool (there is a picture at the end just in case you’re reading this over breakfast and likely to be put off!)

Over the last couple of years we have seen a rise, not only in the number of pressure ulcers overall, but in the number of more severe healthcare acquired ulcers.  Pressure ulcers are painful, they slow recovery, cause anxiety to patients and their families and are largely preventable.  

What do we do?

It would be easy to get annoyed or despondent at this increase in harm to patients however there is a better way to improve and that is to work collaboratively with teams across NHS Dumfries and Galloway to test improvements at ward and community team level. 

Seven teams from across the Board volunteered to take part in a pressure ulcer collaborative; here are some examples of the projects being undertaken:

  • Area:  Castle Douglas Hospital

Project: Reducing the Pressure. 

The project team aim to reduce the incidence of acquired pressure ulcers in Castle Douglas Hospital by 50% by April 2018.  They aim to do this by increasing staff knowledge and understanding of the prevention and management of pressure ulcers.

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  • Area: Community Nursing, Rhins 

Project: Ensuring that Air Flow Mattress Users have knowledge of use and function.

They have completed an initial audit of 6 user groups both NHS and non NHS, and have evidence that little or no instruction on use of air flow mattresses has been received by the majority.  They have developed a teaching/information pack and Lynne McCourtney (Practise Education Facilitator) has nearly completed delivery of 20 minute information sessions for each of the user groups.  Karin Jack and Ann McCollum are involved and intend to re-audit personnel, hoping to evidence an increase in user knowledge by at least 50%.  They have also created a PPP and a Poster depicting the process followed. 

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  • Area:  Podiatry with DGRI wards

Project: CPR for Feet (Check Protect Refer) Implementation

CPR for feet is a national initiative developed with the Scottish foot action group following and audit in 2013 which showed 57% of patients with diabetes had not had their feet checked on admission to hospital and 60 % of people at increased risk of ulceration did not have pressure redistribution in place.

The project aims to ensure that all patients admitted to hospital have their bare their feet checked and this check recorded in the notes. As a result of this check anyone discovered to be at increased risk of developing a foot ulcer due to neuropathy, previous ulceration or previous amputation should have protection   with appropriate pressure redistribution put in place to reduce this risk of ulceration. Finally anyone with foot ulceration should be referred onward to Podiatry.  It is planned that roll out will commence in the pilot ward in January  2019 in conjunction with Podiatry, Clinical Educators and ward Link Nurse following initial data collection which is taking place at present .

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The other teams working on projects for the Pressure Ulcer Collaborative are;

  • DGRI B2 
  • DGRI B3 
  • DGRI C6 
  • Galloway Community Hospital, Dalyrmple and Garrick Wards 

 

Tissue Viability Nurse

It is also fantastic to take this opportunity to introduce Emma Whitby who has been appointed as the Tissue Viability Nurse Specialist and will join and support the collaborative. 

Emma says “I am delighted to become the new Tissue Viability Nurse Specialist for Dumfries and Galloway.  I am very much looking forward to getting out there and meeting all teams and departments and finding out what has been going on and where the learning needs are with an initial focus on pressure ulcers.  My role as the Tissue Viability nurse is not to be the “Dressing Nurse” but to support and educate all nurses on the management of wounds and pressure ulcers.  

I have joined the pressure ulcer collaborative group half way through but already I feel very motivated and enthused by the fantastic work that each group has achieved so far.  I will be on hand to support the groups involved and facilitate any learning needs that have been identified as well as supporting the Tissue Viability Link group.  I aim to mark the National Stop the Pressure day on November 15th with a challenge for all staff and I urge you all to get involved and generate discussions in your areas around pressure ulcers.  The purpose of this is to increase the awareness of pressure injury prevention and to educate staff as well as patients and their families” Emma Whitby, Tissue Viability Nurse Specialist emmawhitby@nhs.net

EPUAP Grading Tool,  available from http://www.tissueviabilityscotland.org/downloads/EPUAP%20Grading%20Tool.pdf

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Alice Wilson is Deputy Director of Nursing at NHS Dumfries and Galloway

Co-production – friend or foe? by Viv Gration

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Next week is Scotland’s Co-production Week (19 – 25 November). There is a lot going on across the country to share stories and experiences of co-production.

The word co-production is used regularly in conversations across health and social care in Dumfries and Galloway and in my experience generates a range of different reactions from people. I’ve seen people roll their eyes (in frustration?) “here is another buzz word or management term, ” others grimace (in confusion?) “what is it all about?” Some people shrug and are concerned that this will simply slow down progress and we shouldn’t have to bother, “we just need to get on with change” they say. For some people, myself included, there is a hope that this approach will genuinely make a difference to how we plan and deliver health and social care in the future.

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So, what is co-production? Are we doing it? And, does it work?

Co-production, according to the Governance International Co-production star toolkit, is when people with different interests come together as a group to:

  • Co-design
  • Co-deliver
  • Co-commission and
  • Co-evaluate

In health and social care, this means the people who use services, professionals, Carers, volunteers, providers and other stakeholders working together to consider how health and social care and support look and are delivered in the future.

Traditionally health and social care services have been designed and delivered by professionals working in partnership within the statutory, third and independent sectors.  With co-production the crucial difference is people in communities that receive care and support are involved in all aspects of their design and delivery.

We should already be consulting and engaging widely on any kind of service change. Co-production takes us to the next level of engagement. It’s crucially about doing with and not to people. It’s about recognising that people who use services and their communities know things that we, as professionals, don’t know.

Working in a co-productive way

  • can make a service more efficient and effective
  • can change peoples behaviours in how they use or deliver services
  • can place an emphasis on delivery of outcomes rather than just inputs and activity

100 days of co-production

In the USA there is a real emphasis on what Presidents can achieve in their first 100 days in office. It is amazing what can be achieved in a short period of time. For example, Franklin D. Roosevelt’s presidency began on March 4, 1933. During his first 100 days, a series of initiatives were developed that went on to successfully counter the effects of the Great Depression.

Perhaps a bit ambitious to think that we can counter all the challenges facing health and social care in Dumfries and Galloway in the same time period, however, using the 100 days to focus our efforts will be useful.

We have identified three topics to take into ‘100 day co-production labs.’ Co-production labs are essentially workshops to share experience, explore potential options for change, undertake tests of change, evaluate these and understand how and if they worked. This will help us to decide whether to embed these as part of routine service delivery or to try something else.

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Governance International Co-Design Toolkit © 2012

The topics for the labs have been identified by communities across Dumfries and Galloway. It is anticipated that a focus on these particular areas of care and support will bring some benefit to design and delivery of health and social care. They will also give us the opportunity to test out our co-production skills to understand what does and doesn’t work for us. The labs are part of a wider Co-production star training Programme, which is facilitated by Governance International in co-operation with the ALLIANCE.

 

This is an exciting time with an opportunity to try a different approach. It will require hard work and commitment over these 100 days. But we’re all set and raring to go! Watch this space – see you in 100 days!

Viv Gration, Strategic Planning and Commissioning Manager

 

For more information about the Dumfries and Galloway 100 days co-production labs contact Viv Gration on v.gration@nhs.net

For more information about co-production, including a range of case examples visit www.govint.org

For more information on Scotland’s co-production week visit http://coproductionscotland.org.uk/coproweekscot

 

 

Chairmans Farewell Message

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It’s been a pleasure

Serving as the Chairman of NHS Dumfries and Galloway, particularly during such a challenging and exciting time for our Region, has undoubtedly given me some of the most rewarding experiences of my career. I am deeply proud of what we have achieved together.

I am standing down after a four year term, and right since the start i’ve felt part of something very special. Despite the challenges that we face, this organisation has thrived and will continue to thrive, and that’s because of its people.

There’s a lot of pleasure to be had in public service and I have always regarded it a privilege to have an influence on people’s lives, to be responsible for such a wide range of services and to be able to do my very best to make sure those services have a positive impact. And that’s something we all do together at NHS Dumfries & Galloway regardless of our individual jobs. We pull in the same direction for the benefit of the residents of Dumfries & Galloway. The NHS does essential, critical work and it does it non-stop.

Day in day out, over the past four years, I’ve heard stories of our people doing extraordinary things. But it’s not only the extraordinary work that’s important in such a large organisation, it’s getting the routine stuff right. We’re responsible for so much – we build and operate hospitals and first class medical centres, we are responsible for community hospitals throughout the region. We maintain a massive records system and have just completed the digitisation of some 60 million paper based records. We have the best auxiliary staff in the business and with their crucial support our Health Associated Infection statistics are consistently amongst the best in Scotland. We help and support people at the most challenging times in their lives and our Spiritual Care Team provide care and support in one-to-one relationship which is completely person-centred and makes no assumptions about personal conviction or life orientation.

A measure of the regard in which we are held by the wider community is demonstrated by the significant number of people who volunteer to support the work we do. We currently have over 200 active volunteers who’s vital contribution has been recognised by Scotland’s Investing in Volunteers Award Programme and work is ongoing to develop the Volunteering Programme in our Rural Communities.

I don’t know of many organisations that could have delivered such a comprehensive and complicated programme of work as we have done, which included the unique challenges of the new Royal Infirmary project, Scotland’s largest NHS project at that time a project that required the skills of a whole range of people to bring to a successful conclusion. Our HR team achieved national recognition for the transitional arrangements they put in place securing a prestigious HR team of the Year award.   

The redesign project of the regional mental health clinical service including the development of one of the first home based treatment services in a rural setting in the UK was a groundbreaking initiative demonstrating the value of service provision close to the homes and communities of those who use the service and has paved the way for wider health and social care integration.

Despite all this change, teams across Dumfries and Galloway maintain an ongoing passion to continually improve care. As we mark the tenth anniversary of the Scottish Patient Safety Programme, we can reflect on the fantastic engagement and ownership seen from frontline teams who have shown a willingness to think differently and generate innovative ideas to deliver our shared vision for safe, quality and excellent care.

All of this change was done at the same time as doing the day (or night) job. The Scottish Government have confirmed, following our annual reviews, that NHS D & G  achieved continued excellence in the delivery of person centred care to the Dumfries and Galloway population. None of this is easy and I have been really impressed by the quality of our colleagues in all of the disciplines.

It is this commitment to patient safety, quality and patient experience that I’m most proud of and it’s something we should all take great pride in. I know that I’ll leave NHS Dumfries & Galloway safe in the knowledge that our facilities, our services and most importantly our patients and their families are in very safe, caring hands.

I’ve been pleased to see on a daily basis that Jeff Ace, our Chief Executive, fosters a modern management culture where there is trust and warmth. My non executive colleagues work hard not only to listen to things that reinforce our own views, but to take a broader view, based on advice and community engagement. Integrity of the Board has been important to us and we worked hard to make sure that our decisions have been based on sound judgement and evidence. I’ve always believed that if we are not a little bit scared then we have not been brave enough in our decisions, and I’m confident we’ve been bold in our approach.

Looking back over the past four years I am so proud to have played my part in supporting all of my colleagues in NHS Dumfries and Galloway in their significant achievements and I am particularly grateful to my Board colleagues for their support. The diversity and varied skill set of the non executive members has been a significant contributing factor to the effective running of the Board and will serve us well into the future.

It’s never easy to know when to leave but having considered the last four years and what I’ve been able to contribute, I feel that I leave NHS Dumfries & Galloway in good shape and in good hands for the challenges ahead.

I’m extremely grateful to you all for making me feel so welcome and making me feel part of our precious NHS from the very beginning.

Phil

Philip N Jones