Notching up your language by Sheena MacDonald, Emma Reid & Susanna Boytha

Aspire to lead graduates reflections (cohort 3)

Our words have power….our words have a profound effect on others.  Words can cause pain, words can cut, words can cause real wounds ……words can tear you down. Talking insensitively can leave other people feeling insecure or somehow diminished. Sarcastic jokes or comments, quotes and aphorisms that point out another’s deficiency, even certain gestures and facial expressions, can all serve as weapons… destroy others.

On the other hand kind words can build us up, they can release life…they can bring healing into our heart and mind…..they can bring healing and restoration into our relationships. They can alleviate loneliness, build self confidence, uplift and encourage. Kind and caring words spoken with sensitivity can strengthen the bond between us and help us to show love and respect towards one another.

It all depends on our attitude towards each other…. ultimately our attitude will shape our words!

By tuning into the needs of the people to whom one speaks, a person can generate immeasurable good into this world.

 The local ASPIRE to lead programme was the catalyst for this blog to share with colleagues across Dumfries and Galloway our learning about noticing and notching up language.  The focus of this programme has encouraged us to reflect on the language we use on a regular basis the top 2 being “deal with” and “so” and reflect on how respectful this sounds and lands with people.   We would like to share with you some of the resources from University of the West of Scotland by Professor Belinda Dewar – A Way with Words. 

Aspire 1We invite you to reflect on your own  “way with words” and use the poster to explore what you tend to say and what you could say to explore how changing our words can help inspire,  motivate and bring about positive provocations.

Aspire 2The seven C’s of Caring Conversations

A tool that we learnt at Aspire to Lead which helped us all to master our words in a
way that will always bring us closer to others, will always help others to
improve their self image, allow them to express who they really are and what they
really want. An integral part of developing and exploring our language to better fit a
positive culture is using the 7C’s of conversation.

Aspire 3Communication is key; how often do we hear this? The Senses framework is a useful tool to enhance communication and good relationships whether it is personally or professionally.

When having a conversation check to make sure all aspects of the Senses are being met. Be curious with each aspect of the Senses Framework and discover together what is helpful for goals and individual needs to be met.

If you are having a difficult conversation, which aspect of the senses framework is not being met for each of you?

We would like to share our reflections and what helped to empower patients and colleagues to express their ideas to co-create services

Emma Reid

Appreciative language and the 7C’s helped me build confidence to be curious and consider others perspectives more – staff and patients. I learnt to ask more open questions with people, and to feel more comfortable with pauses before jumping in with solutions myself.   As a result, people who came to the falls classes were empowered to ask for and suggest change.  My ASPIRE project started with co-creating the content of the falls classes. Since then we have used appreciative inquiry to redesign the Rehabilitation Day Unit into the Community Link Unit, and my colleagues are now taking this into the community on their own. For me this is really what ASPIRE is all about – it starts with a small drop of water and the ripples go further than you’d think.

Susanna Boytha

During the Project which I did with Aspire to Lead I have used 7 C’s to receive feedback from our patients about how they felt during the recent changes and developments at our Macula Service. Using the 7 C’s has helped us to really find out what matters to them the most.

Based on the information we received from our patients we managed then to further shape our services in a way that made them happier and more satisfied than before.

Sheena McDonald

Aspire 4During my Aspire to lead journey, I used image cards at the beginning and end of a Dafne Pump week long course to capture expectations and experiences of the course.  These sessions were always part of the course curriculum and delivered using verbal only methods.  I changed this session by inviting participants and facilitators to  choose an image that described how they felt about starting the course and how they felt after completion. It is worth noting that people are invited to only share what they feel comfortable with.  The sharing generated was much more detailed and allowed emotional connection within the group.  All of which influenced discussions and interactions throughout the week and at follow up appointments.

Since completing the Aspire to Lead programme we would like to share how changing our language and using appreciative inquiry has lead to successful projects and career progression

Emma Reid

Aspire 5Since ASPIRE, I have been able to use appreciative language to be courageous about how I feel in the moment. I have been able to communicate my goals in my career, and my needs as a person at home in a clearer way. I am now in a Trainee Improvement Advisor, undertaking the Scottish Improvement Leaders (ScIL) course. ASPIRE gave me the tools to compromise and collaborate with people in situations I previously would not have had the self confidence to try.

Sheena McDonald

Aspire 6Aspire to lead has provided me with many valuable tools that I use daily in my professional and personal life.   Using these skills I have been able to be more courageous.  I have recently started a secondment with the patient safety and improvement team out with my clinical speciality.   During this time I have been involved in several improvement projects all of which I have continued to notch up my skills from Aspire by working collaboratively with others and also celebrating achievements.   Probably the biggest challenge for me which I am still working on from the 7 C’s is sharing with people ‘how did that make me feel’, rather than what I think about the situation

Susanna Boytha

Aspire 7Since Aspire I have become more conscious of my language and using the different Aspire tools have made a significant difference both in my personal and professional life. It has enabled me to be more courageous and become the STL for Ophthalmology. It has helped me to connect emotionally to team members and consider other perspectives  while agreeing on different working arrangements. Following Aspire I have also completed the SIS Course at QI Hub and designed and led a major Service Development Project. Using appreciative inquiry has helped me to collaborate with all the major stakeholders. Using the 7 C’s of Caring Conversations has also helped me to enable the team to work together harmoniously towards achieving the aim of the project, which is ultimately to make our patients happier by seeing them closer to their home address in the West of D&G.  Finally I got accepted unto and started in September 2018 Cohort 11 of the Scottish Quality and Safety Fellowship! I am excited about this amazing opportunity and I am curious about the work of other fellows.  I feel the next step for me is to encourage the team(s) I am working with to celebrate more our successes and achievements!

Give it a go……. Consider notching up your language at your next handover, meeting or general conversation with colleagues, family and patients.

A ctivate knowledge

S killful Communication

P otential to Grow Leadership Skills

nnovate and improve

R esults that Make a Difference

E nergise self and Others

To Lead…………………………………………..

For further information on resources mentioned throughout the blog please see link below:


Useful link for Language matters in diabetes:  

Thank you to Alice Wilson, Deputy Nurse Director who was the inspiration behind the Aspire to lead programme and our programme facilitators Belinda Dewar and Fiona Cook from University of the West of Scotland, Karen Hills and Bill Irving from NHS Dumfries and Galloway.

Sheena MacDonald is a Specialist Dietitian and Trainee Improvement Advisor at the Diabetes Centre

Emma Reid is a Specialist Physiotherapist and Trainee Improvement Advisor

Susanna Boytha is a Consultant Ophthalmologist

All of the authors work at NHS Dumfries and Galloway

Welcome to Dumfries and Galloway by Heather Currie

Heath 6We have recently welcomed many new trainee doctors to our beloved Dumfries and Galloway. The first week in August always brings back memories of my own first job..known then as “house job”, when change-over day was 1st of August, whatever day of the week that may be. In 1982 that was a Sunday. I arrived eagerly to Heathfield Hospital, Ayr on the Saturday, expecting to be able to find my way around and meet the staff prior to fully starting on the Monday (no induction or shadowing), having been informed that the “local boy” who knew the hospital would cover Sunday. However a last minute change of plan and alarming phone call informed me that I was to start on Sunday morning, be on call for medicine and was the CCU team with 2nd on call at home a few miles away. Thankfully a Registrar who stayed in residencies helped on his day off and I will never forget his kindness to reduce my terror.

Heath 1Shadowing and induction programmes have improved the starting process hugely but do we do enough to welcome our new colleagues and do we all always remember how scarey this process is? Many of us have worked here for many years and it is easy to take for granted our familiarity with the place, people, who to ask, geography, processes but for our trainees everything and everyone is new.
Our trainees are our future. We really need to make sure that they have a wonderful educational and social experience and want to return to work here, and tell their friends how great Dumfries and Galloway is.
Trainees in Obstetrics and Gynaecology have been subjected to a couple of small ideas which we hope is enhancing their experience and can be adopted by others.

First is a weekly half hour chat time with whoever is available, led by myself. The rules are:

1. No clinical chat about diagnoses or conditions
2. Chat is confidential and not to be used for gossip
3. Only chat taken out of room is to facilitate a change in a process or system

Heath 2All sorts of issues are covered and many resolved; issues that are causing stress or reducing enjoyment of the job and many good ideas for improvement are implemented. We are all busy but half an hour per week that can make such a difference must be worth while!


Heath 3Second is a scavenger hunt, the brainwave of Dr Dutton. We live in a stunning, fascinating area yet we weren’t convinced that our trainees always got to explore and realise the beauty of the region. Our game enthusiastic trainees have gone out exploring following clues to places of interest. Selfies are required to confirm that they have successfully solved the clue.


Heath 4Of course this applies to all trainees and new starters, not just medical staff. The focus on trainee doctors is simply because August sees the biggest change in staff in the whole year, but whenever someone new joins us, we should welcome them, put ourselves in their shoes, be inclusive, be creative, and be kind!


Heath 5

Heath 7

Heather Currie is an Obstetrician and Gynaecologist and is Associate Medical Director for Women, Children and Sexual Health at NHS Dumfries and Galloway


It’s my life by Euan McLeod

In reading an article regarding co-production of services, it led me to consider co-production in the context of the therapeutic relationship in mental health nursing.

Recent personal experience with a patient who challenged the boundaries of that co-production and the meaning of that therapeutic relationship created opportunities in the team for reflection on how we participated in that relationship. It wasn’t a particularly easy journey I think for us or the patient. Personally I found it taxing and frustrating with moments of joy and sadness as we jostled and jogged our way along this road. “It’s my life” the patient would scream at us, obviously frustrated by our attempts to be therapeutic.

The text which follows is a brief summary of my research into that therapeutic relationship and how legislation both affects and enables it. 

The relationship between nurse and patient seeks to co-produce a plan of care and treatment that leads them back to “their life”. The context of this co-production is a continually shifting balance between autonomy that permits the patient to “travel their own path and make decisions and, paternalistic control that removes decision making from the patient until such times as they are able to retake control and have the capacity to make decisions.



Nurses working in mental health are often faced with working out the right thing to do, and when and in what context it is acceptable for us to limit someone’s freedom, or make choices for them. Sometimes these decisions are made easily because people are either a risk to themselves or others. But there are times when matters are less clear cut

Scotland has been seen as a beacon of good practice in the field of mental health care and has been proud of its legislative approaches in providing humane person centred care, however in the last few years there have been changes in international law that now finds Scottish legislation wanting.

Human rights legislation,  in particular aspects of legislation covering  care, treatment, capacity and consent within the Mental Health (Care and Treatment)(Scotland)Act 2003 and Adults with Incapacity (Scotland) Act 2000 and Adult Support and Protection (Scotland) Act 2007 now appear at variance with aspects of human rights legislation.  In particular the UN Committee on the Rights of Persons with Disabilities that oversees the United Nations Convention on the Rights of People with Disabilities (UNCRPD) has adopted a radical critique of mental health and capacity law. It argues that the justification for any form of non-consensual intervention based, even in part, on a diagnostic label such as ‘mental disorder’ and the use of capacity assessments is inherently discriminatory. 

Discrimination against those who are diagnosed as mentally ill has been a significant issue and has led to a focus on reducing that stigma through education and awareness programmes such as the “See Me “campaign but impact has been poorer than expected. Therefore a revised approach is now in place and is recognition of the substantial impact that stigma attached to mental illness has for people in society. Potentially this stigma has affected perceptions of how competent people with mental illness are to be involved in decisions around care and treatment.

A patient’s ability to contribute to the decision making around their care and treatment has been enhanced through the use of advocacy support and advanced statements.



The Scottish government is currently reviewing both mental health and capacity legislation to ensure it meets with the criteria stated above. There is some evidence from public responses that indicate the review does not go far enough (see SG)

“While the Mental Health Bill has provided an opportunity to revisit the Mental Health Act ten years on, it was felt that it did not appear to have fully explored the issue of how human rights can be further supported within law and practice.

‘I think there’s really interesting challenges ahead in terms of the noises the UN are making about the Convention on the Rights of Persons with Disabilities and what that means for compulsory treatment in mental health and suggesting that it’s discriminatory and that’s raised a lot of useful discussions which I think we should have been having a long time ago about the acceptability and prevalence of forced treatment.’

Expert Interview (A Review of Mental Health Services in Scotland: Perspectives and Experiences of Service Users,

Carers and Professionals-Report for Commitment One of the Mental Health Strategy for Scotland: 2012 – 2015)

However the UNCRPD believes that current legislation around detention and non consensual treatment needs to change in favour of a supported decision making model. It therefore seems likely that this will impact significantly on Mental Health professionals and will be a paradigm shift in how we relate to those entrusted to our care. Mental Health Nurses will need to consider how this impacts on their practice and how their fairly unique position as potential advocates might develop. Patillo (2011) notes that “Nurses seem better placed as advocates because they are constantly interacting with patients”. How then might this position develop in terms of a supported decision model? 

In considering this we can think about how relationships between mental health professional and patients have been described

Pelto-Piri, V. et al, talk about 3 styles of working with people who have a mental illness:

  1. Paternalism 
  2. Autonomy
  3. Reciprocity 

Sandhu. S et al (2015) suggest that “reciprocity may be conceptualized and incorporated as a component of mental health care, with recurrent and observable processes which may be harnessed to promote positive outcomes for service users.”


Positive outcomes thus may result from Mental Health nurses reflecting on their role as advocates and treatment partners in which reciprocity is the mode of interaction, enhancing the therapeutic relationship whilst discharging our professional responsibilities both as nurses and as members of the Multi-Disciplinary Team, and enabling consideration of changes to practice and education that would make this a reality of mental health care and treatment rather than a desired state.


Euan McLeod is a Mental Health Staff Nurse at Mid Park Hospital, NHS Dumfries and Galloway


Being Wrong by Jeff Ace

Being wrong is interesting isn’t it? When you get a call right, your view of the world is unchanged and things are happening much as you expect them to; all very unexciting. But when you’re wrong, there’s something off with your perspective, or lacking in your knowledge; very interesting indeed.

Luckily, I’m wrong particularly often and accumulate large numbers of these excellent opportunities for learning. I’ve been wrong on some big life stuff and on too many professional and work related decisions to keep track of. I was even wrong in recent attempts to help my daughter with her physics homework, leading to her claim that many of the elements hadn’t been discovered when I was in school.

There’s something in this unfunny and (mostly) untrue teenage sarcasm that I think explains one of the common causes of ‘wrongness’ in that people look to the past to explain the present and predict the future. This might be fine but most of us, including my daughter, have an absolutely lousy sense of historical perspective. Smart Alec history teachers will use any number of examples to highlight how poor this perspective can be. A couple of my favourites in this list of things that just don’t seem right are that Cleopatra lived closer in time to ‘Carry on Cleo’ than to the building of the Great Pyramid at Giza, or that Tyrannosaurus Rex was more a contemporary of Marc Bolan than it was to the Stegosaurus. Similarly, England’s 1966 world cup win is as close to the outbreak of WW1 as it is to the present day, despite it being mentioned every four flipping minutes over the summer.

Broad contemporaries: T-Rex and T-Rex



These examples show that people tend to distort historical perspective by magnifying the recent past and diminishing periods further back. So, to me, my schooldays of the 70s and 80s are useful reference points in understanding how the world works and will continue to work, whilst to my daughter it was when we learned to alloy copper and tin to make our swords. This phenomenon has big implications for how we get things wrong (or how we can avoid making mistakes).

Take climate change, for example. The scientific consensus is that we’re now heading for more than a 2 degree temperature rise on pre-industrial levels and likely implications include 3 metre plus increases in sea level rises. By all rational measures, this information should be dominating the political and economic agendas, with urgent risk management and mitigation measures everywhere we look. But 3 metres… that can’t happen, can it? That would swamp St Helen’s cricket ground in Swansea where Sir Garfield Sobers became the first human to hit six sixes in an over, where all great Welsh cricketers have strutted their stuff over the years (well yes I have played there, actually. Don’t like to go on about it. It’s not like there’s a framed picture in my house of me on the pitch or anything like that *). The scale of this change, that would flood Miami and make the Mumbles Road end at St Helen’s appear only at low tide, is way outside our historical reference points, our ability to visualise the world; so we sort of file it somewhere in our brains and get on with more everyday routine problems.  

St Helen’s Swansea – spiritual home of Welsh cricket


So I worry about how our tendency to rely too much on a poor and distorted understanding of the past can make us wrong and complacent over big changes. And I worry about it a lot in the context of health and social care provision. 

Our historical perspective here is dominated by the post war model of service provision. This model is an historic anomaly, of course, radically different from that which existed through the rest of human history, but is nonetheless now seen as an unchanging piece of how our bit of the world works. The difficulty is that if you start projecting the next 20 years of demographic change, workforce availability, technology driven cost increase and the amount of funding that an economy can generate for health and care… it’s really, really hard to see how it all holds together to provide the sort of health and care service that people of my age will by then be expecting. I think there’s a tendency to dismiss these forecasts because, well the Health Service has always been short of money hasn’t it, and winters are always a bit tight, but we always get through it in the end…. and basically because our perspective doesn’t help us to imagine a radically different future. 

This I think would be terribly complacent and would open up our largely wonderful but already creaking system to existential risk. But whilst I’m a bit of a worrier, I’m also a mostly optimistic type of bloke. There is now a lot of work ongoing on the sorts of disruptive changes that could help to address the apparent perfect storm of pressures building on health and care. Organisations like The Kings Fund have been busy in this field lately ( and are good examples) and show how we can move perspective from a future of tweaking our models of care to one where they are genuinely transformed. 

I’m wrong about loads of things but I’m pretty confident in predicting that, in order for us to continue to deliver the service our population deserves, we’re going to have to increase the pace of change to models radically different from those established. In D&G we have an outstanding track record of managing major change and this is one aspect of the past that I think is going to be extremely useful in preparing us for the future…

 (* ok there is)

Jeff Ace is Chief Executive Officer at NHS Dumfries and Galloway

Always look on the bright side of life by Ken Donaldson

I published this post on my own blogsite two years ago and, even though it is a little silly and dated, I thought I would share it with you again. Sadly things haven’t changed that much in the past two years.

“I don’t need to remind everyone that 2016 has been a particularly bad year. Who would have thought, 12 months ago, that we’d be leaving Europe, a complete Muppet (and that is an insult to Muppets to be honest) would’ve  been elected to the White House and far right, fascist, borderline Nazi rhetoric would suddenly become acceptable. Not me, that’s for sure, but here we are.

On top of all that we have daily news clips showing unimaginable suffering in Syria and other parts of the world whilst we sit watching helpless. And then there is all the celebrity deaths. It is as if the likes of Bowie, Rickman and Wogan knew it was all coming and thought “Stuff this, I’m out of here”.

So it is for that reason that I thought I would tell a wee story that may lift your spirits. Not much perhaps but hopefully, like me, you may have a smile on your face by the end of it.

A few weeks ago I had a bit of a crazy day trip down to London. Up at 4.30 to catch a train from Lockerbie to Euston, full day finishing at 9.30 (well, when I say ‘finishing’ that was the work bit, I then caught up with friends over some red wine until 1am…I never learn). I had to get up again at 4.30 to catch a return train to Glasgow. Forgive me a slight digression but the contrast between my two ‘walks to the station’ was quite stark. In Lockerbie it was a glorious, still, freezing morning with thousands of stars filling the jet black sky. In London it was slightly warmer walking down Tottenham Court road but there were no stars, just a plethora of homeless people shivering under blankets and, at one horrific moment, being investigated by the biggest rat I have ever seen. In fact the only rat I have ever seen outside of captivity. There was a somewhat Dickensian feel to it.

But back to my story. So I got on the 5.30 from Euston and promptly fell asleep. The next few hours were a bit of a blur but as we approached Preston the guard made his usual announcement – take care leaving the train and remember all your bags etc – but then he added “Ladies and Gentlemen I would like to take this opportunity to remind you that it is 36 days 15 hours and 43 minutes till Christmas. And with that happy thought here is a song” I must confess I was expecting a Christmas hit or carol but instead he played ‘Always look on the bright side of life’ by the Monty Python boys. I started to smile, I really had no choice, and as I looked up and down the carriage at my fellow passengers, folks who had spent the past 2 hours quietly reading the paper or tapping on their laptops and ignoring each other, I noticed that they were all smiling too. And some were staring to chat, probably about the song but who knows. The guard interjected a few times with “I want to hear you singing now” and before the chorus “Altogether now” which just added to the fun. And as the train slowed down and approached the platform the music stopped and he said “Ladies and Gentlemen, Preston” and that was that.

It made me realise the power of a small gesture, a simple thing which raised the spirits of a few hundred tired travellers. It also made me think that, sometimes, ‘Life is a piece of sh*t, when you look at it’ but Eric Idle was right, it helps to look on the bright side.”

KD 1

“Cheer up, Brian. You know what they say.
Some things in life are bad,
They can really make you mad.
Other things just make you swear and curse.
When you’re chewing on life’s gristle,
Don’t grumble, give a whistle!
And this’ll help things turn out for the best
Always look on the bright side of life!
Always look on the bright side of life
If life seems jolly rotten,
There’s something you’ve forgotten!
And that’s to laugh and smile and dance and sing,
When you’re feeling in the dumps,
Don’t be silly chumps,
Just purse your lips and whistle — that’s the thing!
And always look on the bright side of life
Come on!
Always look on the bright side of life
For life is quite absurd,
And death’s the final word.
You must always face the curtain with a bow!
Forget about your sin — give the audience a grin,
Enjoy it, it’s the last chance anyhow!
So always look on the bright side of death!
Just before you draw your terminal breath.
Life’s a piece of sh*t,
When you look at it.
Life’s a laugh and death’s a joke, it’s true,
You’ll see it’s all a show,
Keep ’em laughing as you go.
Just remember that the last laugh is on you!
And always look on the bright side of life

Always look on the bright side of life

Come on guys, cheer up

Always look on the bright side of life

Always look on the bright side of life

Worse things happen at sea you know

Always look on the bright side of life

I mean, what have you got to lose?
you know, you come from nothing
you’re going back to nothing
what have you lost? Nothing!

Always look on the bright side of life”

Lyrics copied from this site

Bully For You!! by Anonymous

image1I recently had the dubious honour of being at the receiving end of a bit of bullying behaviour at work.

It was not in my usual place of work, I hasten to add, and not by someone I normally work with. The details aren’t important, the issue was resolved as much as it could be but the after effects lingered.

It has caused me to reflect on the whole concept of what bullying is, who does it and how it affects not only the individual but the organisation as a whole.

Bullying behaviour does no one any favours. It demeans all those concerned and does nothing to resolve the issue.

My experience left me feeling initially shocked, then humiliated and embarrassed in front of my peers. As days went by I began to question my ability to do my job well. In the space of a few minutes I had gone from a fairly confident person to a bit of a wreck. So why do some people behave this way and what can we do about it?  I’m not sure to be totally honest, it’s a complex issue.

Within the NHS it is paramount that we work in a professional manner with patient safety at the heart of all we do, therefore constructive criticism is crucial. If something is not being done in the correct way then this should be challenged. This can be done without conflict in a non emergency situation. In an emergency however situation however, when the adrenaline kicks in for all involved, there may not be time to worry if someone has taken offence. There will be time for reflection later, when the event can be discussed in a calm manner, with all those involved, looking at what went well and what could have been done better. Any issues anyone has should be freely discussed, or if this is not possible then a one to one with the line manager may be helpful.

Abuse is not acceptable in any situation however, and we all have a duty of care towards each other to ensure this doesn’t happen. 

Bullying behaviour occurs for many reasons, often due to stress or fear, emotions are heightened and the definition of what unacceptable behaviour is can vary from person to person. That is why it is of such concern. There are guidelines in place highlighting what constitutes bullying and continued bullying needs to be reported and measures taken to resolve it as soon as possible.

Bullying takes many forms, not always overt, sidelining a person, rolling of eyes behind their backs, not giving a person equal opportunities with their peers to progress. We may have had this happen or even done it to others. Sometimes it’s so subtle that the person being bullied isn’t initially aware that they are the victim of ridicule. This is particularly cruel.

The cost to the NHS from stress related absence is enormous; there are recruitment issues in all areas, so let’s try to ensure that we are part of a welcoming, inclusive organisation that shows zero tolerance to bullying behaviour.

Now, don’t get me wrong, I’m not exactly a paragon of perfect behaviour myself and I’ve been sharper with folk than I should have been. You always know when you have done this… leaves a bad taste.  It’s certainly made me rethink my own behaviour, much to my husband’s delight!! 

With that in mind, I encourage everyone to think of someone in your own place of work that you don’t interact with much, they might even get right on your nerves, ask them about themselves, take a bit of time to find out who they are and listen. You might be surprised! One thing I can guarantee is that not only will they feel good, so will you.

For further information , I found the document on Bullying and Harassment in the Workplace at the Acas website very helpful. You can find it here.

If you feel you are being bullied or maybe complicit in bullying behaviour, now is the time to do something about it.

Kindness cost nothing.


Memories…of the way we were… by Elaine Ross

Readers of certain age will remember the Barbara Streisand song in the 1970’s with the line  ‘Could it be it was so simple then…’

The way we were

The NHS 70th anniversary is a reminder of the major progress made over the last 70 years.  The reduction in the spread of communicable diseases such as measles or whooping cough, which lead to significant numbers of deaths and long term incapacity in years gone by, is just one of them.

My own Uncle spent years in a mental health facility following encephalitis leading to learning disabilities having contracted whooping cough from my mother as a baby.

Hand hygiene and vaccinations are, in my opinion, the two most effective ways of preventing infections.  Yet we are now seeing measles outbreaks and increase in whooping cough across the UK due to a lack of uptake of the vaccine.


Whilst the essential elements of infection prevention and control have remained the same; preventing spread of microorganisms, advances in health care have led to increasingly complex procedures and equipment used on, often, more vulnerable patients.

Antibiotics were just available in 1948 but since then there has been an exponential rise in the number of antibiotics and the frequency with which they have been used, culminating now in a drive to reduce the number of antibiotics prescribed in a move to combat antimicrobial resistance, which is recognised as a global threat.



The first infection control nurse E.M Cottrell was appointed in 1959 in response to an increase in methicillin sensitive Staphylococcus aureus (MSSA) in Torbay hospital. It commonly causes skin infections and may lead to sepsis through blood stream infections (bacteraemia). The methicillin resistant version (MRSA) was first reported in 1961.  It wasn’t until the 1980’s that Infection Prevention and Control nurses began to be appointed more widely as part of the plan to tackle the expected AIDs epidemic. In reality MRSA probably killed more people in the UK than AIDs in the late eighties and reached a peak in the early 2000’s where 40%of all bacteraemia were caused by MRSA. 

Effective hand hygiene and ‘universal precautions’ as they were then known, helped to combat MRSA however screening has had the largest impact and nowadays it is rare to have an MRSA bacteraemia. This year in NHS D&G there has been only one. 

The advance of technology

There have been many advances in technology which changed the face of frontline infection prevention and control. The development of liquid soap improved compliance with hand hygiene and reduced occupational dermatitis that had been scourge of many a nurse in the days of carbolic soap.

The advent of alcohol hand rub in the late 1980s has reduced the spread of infection as it is so quick to apply; new formulas are actually kinder on the hands and more effective against the majority of organisms than soap.

Laboratory techniques have moved from manual to automatic systems utilising, in some cases, molecular microbiology. Test results are available rapidly, sometimes within in minutes and allow the swift isolation and treatment of patients. In the early days of the NHS tests would have taken several days and longer for organisms such as tuberculosis. Some tests would have used animals. There is no need for an animal house in any laboratory in the NHS these days!

In fact technological advances have affected everything from cleaning to patient records e.g. Clinical portal and TOPAS and IC net connecting lab results and patient journeys.

Sterilisation using high-pressure steam may not be an option for example with highly expensive and sensitive equipment such as endoscopes. Neither can we soak them in toxic chemicals such as Cidex as we did in my days in ENT! 

As healthcare has developed so has complexity of equipment and systems to support it. It is vital that infection prevention control is involved in the specification and purchase of equipment used in healthcare.

More recently, to further reduce the risk from an environment that may have been contaminated by a drug resistant organism, sophisticated machinery has been developed utilising hydrogen peroxide vapour or ultraviolet light which can enhance the level of disinfection achieved within a room. This is a far cry from the Dolly Mop and bucket that would have been in use at the dawn of the NHS though microfiber mops and bleach still have their place. 

The advent of automatic washing machines revolutionised hospital laundry. 

The move to predominately disposable gloves and aprons negated the need for regular washing of these items  and no nurse will be found in the sluice scrubbing ‘Macintoshes’ or draw sheets as they were known when I started. 

The need for adequate ventilation and supposed benefits of fresh air were recognised in the early days of sanatoriums. These days ventilation remains important in preventing the spread of infection but the engineering around this has become ever more complex.

Airborne  isolation rooms are a far cry from placing your patient in their bed on the veranda.


Lochmaben Hospital

What next?

We have reached a stage where there are organisms that are highly resistant to antibiotics and may find ourselves in a world where people are dying from common infections because the antibiotics we have won’t work. Prevention is better than cure, doing simple things like drinking more fluid to reduce urinary infections. 


In healthcare it’s what YOU can do to prevent infection that will make a difference to patients and as at the dawn of the NHS in 1948, the fundamental elements and messages remain the same, clean hands, clean rooms, clean equipment.

Keep up the great work.


Elaine Ross is Infection Control Manager at NHS Dumfries and Galloway