It’s obvious…isn’t it? by @AliceWilson771

It seems pretty obvious to me that recognising and celebrating the achievements of staff is a good way to make them feel valued and to increase motivation at work. We know that people who feel valued deliver a high level of care to patients and clients and support their colleagues in the workplace; so why do we not do more of it?          

My mother always said “there’s more than one way to skin a cat”….the point is: recognising achievement and valuing people doesn’t have to be a big deal, it can done in different ways: a quiet thank you at the end of a shift or a hard week, a word to show you have recognised where someone handled a situation well or showed particular kindness to another person, a smile to acknowledge an individual or sharing some good feedback with a team….and including their boss so they have extra recognition!

In the heat of the busy day this recognition can be forgotten and no-one notices but when it is remembered everyone feels better for it and shares that feeling of being a bit lighter in their step; and therein lies my first challenge….every day for a week tell someone when they have done something well – and then just keep telling people!

Sometimes you just have to think BIG!

……… and that’s what happened on Friday 22^nd August when Dumfries and Galloway celebrated some of the things we do well and recognised the achievement of some of our staff. I personally must pay tribute to the hard work and effort that so many people put in to making a fantastic event and a special mention to Tracee and Nicola (pictured having a well deserved cuppa) who kept us all right on the day…THANK YOU ALL!

We celebrated:

Dementia Champions – not only the Champions themselves who presented and who received their awards but also the fantastic partnerships that make the programme possible and that was the forerunner for the national Dementia Champions programme – born in D&G, it has a ring to it! We are also able to celebrate the recruitment of 2 Doctors and 2 Non Executive Directors to our next cohort, not to mention 2 footballers…yes, you did hear right! We heard about a fantastic piece of work using football to help people with dementia and that led to 2 of our local Queen of the South football club members signing up to take part – this is going to be an interesting cohort!

Learning Disabilities Champions – again, we heard presentations from the achievers as well as reflecting a great training partnership and seeing the achievers receiving their awards

Mentors – celebrating the support that staff give to students whilst they are on placement and learning about the reality of the career they have chosen

Mentor of the year, May Houston and mentoring team of the year, ward 14, with Mike Sabin, Associate Nurse Director, NHS Education for Scotland

Flying Start – celebrating the achievements of newly qualified Nurses, Midwives and AHPs as they launch into their new careers

Care and Compassion – celebrating the work that individuals and groups did as a result of care and compassion workshops which had a huge impact on them

Releasing Time to Care – recognising all the work that teams have put in to complete modules of the programme and make improvements in the way in which they work

The achievers are all pictured with Ros Moore, Chief Nursing Officer for Scotland who spent all day at the event, talking to staff and hearing about their individual pieces of work – what a great opportunity for staff to be able to tell their story directly to the Chief Nurse

Ros was not the only dignitary at the event, we had our Chief Executive and Executive Nurse Director as well as many of the Non Executive Directors and representatives from Scottish Government, NHS Education for Scotland and our partner organisations and most importantly all the staff who attended and helped to make it a great day

Then we finished it off with cake, cut by representatives of all our achievers!

This day was not (just!) about showing off what fantastic work we do here but about sharing it so we can do more and about putting the people who have achieved things at the centre of our celebrations.

My second challenge is for you to share with me, preferably by commenting on the blog, some good work you know about or are involved in so others can read about it

As for celebrating…same time next year??……………..we’ve already started planning!

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

Keeping the lights on by @Shaun4Maher

Failure to recognise failure

Failure is an experience common to all human beings, its a fundamental part of our existence. Sometimes things go well and we experience success and sometimes the opposite occurs and we experience failure. If we are honest most of us probably don’t enjoy failure. Some of us might have developed the ability to learn from our failures so that failure is not an end in itself, but rather a means to end, helping us to continually learn and improve as we journey through life.

But what if we fail to learn from failure? Or even worse, we aren’t aware of failure at all? What if we just blundered on thinking that it was the norm?

Flicking switches and changing bulbs

The following is an imperfect analogy but it might help to emphasise the point. Imagine for a moment if every time you flicked a light switch in your house the bulb blew. As a result your daily routine involved walking to the cupboard to fetch a new bulb, fumbling around to find the right one, walking back to the room, standing on a chair and fitting the new bulb. Imagine if you just accepted this as your “normal work”? What a waste of time! What a waste of money!

After talking to a friend one day you suddenly become aware that this situation can be improved. She tells you how she has put a spare bulb in each room and has managed to save 8 minutes per bulb change per day. Wow! What an impressive improvement. You now set about improving and discover that by using a low energy bulb instead of an incandescent bulb it only blows every eighth flick of the switch, saving not only time but also money. A little later you discover that if you rotate the rooms you use during the hours of darkness you can generate further time and cost savings – brilliant! And so it goes on.

Clearly this is a ridiculous story. None of us would ever tolerate such inefficiency, such waste, such failure and poor quality. Its clear that a huge amount of effort is being wastefully directed to improve bits of a fundamentally flawed lighting system, using what amounts to a series of workarounds and streamlining the “fire fighting”. This situation occurred because you failed to recognise failure, and even when you did, you failed to look at the system as a whole. You focused on managing components for functional efficiency instead of looking at end to end flow.

But there is another critical factor that helped you to rapidly recognise the silliness of this story and spot where to make improvements?

Defining purpose

We all know and understand that the purpose of a lighting system in this context is to light a room. This understanding of core purpose and context gives us knowledge that helps us in two main ways:

1. properly understand what is real work that generates value
2. more accurately diagnose the probable location of the fault and deal with the root cause of the failure, instead of wasting resources “improving” our workarounds.

Once we have this knowledge we become aware that much of what we previously thought was “normal work” (i.e. changing the bulb every time we flicked the switch) was actually work to compensate for failure. Because we lost sight of (or never knew?) purpose we were blind to this fundamental truth. In our scenario we can imagine how a whole system of measures and methods could be developed that were of no real use.

This type of activity has been described as “failure demand” and you can read more about it here: www.wellbeing.vanguard-method.com. This type of demand is created by the failure of a service to deliver on its core purpose. Failure to get it right for the customer, and to get it right first time.

What is the purpose of the health and care system?

In the story above the system was not wired to achieve its purpose of lighting the room. This generated significant extra demand on resources, in fact most of the activity was failure demand. But what would this look like in the context of health and care services? What is the purpose of the health and care system? Is it “wired” to achieve its purpose? Do we have a lot of failure demand in the health and care system? To begin to answer these questions we need to start by identifying and understanding purpose.

The purpose of our health and care system should be to provide high quality service to the people it serves. This means we need to find out what really matters to the people who use the service. We then need to convert these “things that really matter” into simple measures in our system to be used where the work is done (at the frontline). Once we have done this we will have a better understanding of how we are doing and where we have opportunities to improve. This is the real work.

As time goes on and the relationship develops, we learn more about what provides value and the things that cause variation in the quality of the service. Why did Mrs Jones have a very good experience, but Mr Smith had a poor experience? Understanding the causes of this kind of variation enables us to continually improve and innovate. This is designing and improving against true demand rather than failure demand. When we organise our work in this way, with the people who use services, its described as collaborative customisation, or to use another word in vogue – coproduction.  

But this is also where service organisations need to turn the conventional improvement wisdom on its head! Its not about reducing variation in the conventional sense (usually achieved by standardising). If we think about care planning for example, standardisation would be counterproductive for the service user because it would reduce the system’s ability to flex around what really matters to them. In this context our aim should be to design a system that reliably identifies and responds to what really matters to each individual. When we design services built around this aim we are on the road to a truly person-centred health and care system.

How are we doing?

Do we have a health and care system that has a clearly defined purpose? Do we understand what really matters to those people we serve? Does our system value and respond to the natural variety that occurs in human beings? I’ll leave you to ponder these questions.

Lets imagine that the core purpose of our health and care system is to “support people to stay well and lead as good a life as they can defined by their own terms” (this might not be a perfect but you get the idea). Once we’ve established this as our purpose it becomes easier to identify what is real work – those things that generate real value for the people who use services. It also helps us to clearly identify failure demand – the catch-up work we have to do because we aren’t giving people what they want and need.

I’ve recently had the privilege of working with some frontline teams in a hospital setting supporting them to develop and test ways to reliably find out what really matters to the people who use their service. They are then using this information to collaboratively develop care plans focused on the things that the person identified as important. We have helped them to develop a few simple measures related to this purpose that build knowledge about what works well and what needs to be improved. The work is embryonic, but its been encouraging to see the enthusiasm of the frontline teams to work in this way, and also to hear the stories from people using the service who have had their needs met efficiently and effectively.

Contrast this “what matters to me?” approach to frontline work with one that is driven by top-down targets and standards. In most cases the latter distorts measurement, creates a de-facto purpose (i.e. meet the target) and stifles innovation making genuine improvement very very difficult to achieve. This unintended consequences of this approach have been widely described in a variety sources (you can read more by following up on the references below).

When measures are derived from purpose as defined by the user of the service (e.g. I want to live as good a life as I can as defined by me) things start to look different. These person-centred measures can then be used where the work is actually done – at the frontline by those who do the work. This in turn builds knowledge and creates the freedom and space to improve and innovate

An enormous opportunity

Having a clearly defined purpose and making sure we maintain its primacy over measures and method helps us to understand the nature and causes of demand. This is absolutely critical to our ambition to develop a health and care system centred on people. If we want to change the system we have to change the way we think. Designing against true demand (not failure demand) from the bottom up with a strong focus on the things that really matter, represents the single most important opportunity to transform our health and care system.

Is our system wired to support me to live as good a life as I can as defined by me? There’s certainly some movement in that direction but there is no time for complacency – there is still much work to be done! The question we need to keep asking is: “are we just flicking the switches and changing the bulbs or are we re-wiring the house?”

Refs

1. Miller and Grant (2013) Letting go: breathing new life into organisations. Argyll Publishing
2. Deming (1986) Out of the Crisis. Deming MIT Press Ed edition (2000)
3. Seddon (2003) Freedom from command and control: a better way to make work work. Vanguard Consulting Ltd
4. Caulkin (2006) Forget about targets and decide what really matters The Guardian (2006)http://www.theguardian.com/business/2006/may/21/theobserver.observerbusiness4
5. Guilfoyle (2012) On Target? Public sector performance management: recurrent themes, consequences and questions. Policing (2012) 6 (3): 250-260. Oxford Journals
6. Bevans; Hood (2006) What’s measured is what matters: targets and gaming in the English public healthcare system: Public Administration Vol. 84, No. 3, 2006 (517–538)
7. Ghobadian; Viney; Redwood (2009) Explaining the unintended consequences of public sector reform. Management Decision 47 (10); 1514-1535
8. http://gpaccess.uk/evidence/putting-targets-first/

Shaun Maher is an Improvement Advisor with the Person Centred Health and Care Collaborative at Healthcare Improvement Scotland

 

 

Climate Change – Can we make a Difference? by @DavidTheMains

INTRODUCTION

Having enjoyed a relatively warm and sunny summer for a change, there will inevitably be the usual speculation regarding possible climate change and the effect of human activity in warming the planet. Whether or not that is accepted depends on the individual’s point of view and most people are of the view that human activity can have some overall effect on the climate.

The difference between ‘climate’ and ‘weather’ of course is that ‘climate’ is the weather that you expect depending on long term averages, whereas ‘weather’ is what you actually get. What has this got to do with patient safety and patient safety in mental health specifically?

SAFETY CLIMATE

In the same way that the weather changes from day to day but follows an overall pattern consistent with the climate, how “safe” a ward or facility is can alter from hour to hour depending on the level of activity, the number of staff and the challenges that are being dealt with. The overall ‘safety climate’ ( on average how safe a ward or unit is in terms of the number of adverse events or the quality of care) is something which can be measured, and there is increasing evidence that it can be altered by interventions to change the safety culture, and therefore climate.

MEASURING THE SAFETY CLIMATE

Tools have existed for some time which gauge a staff group in an organisation’s assessment of how safe the facility feels. The sort of questions that staff are asked include whether or not they know who to report adverse events to, whether they would feel able to report such events, and how supported they feel by managers and others. Such tools have proven useful in identifying well functioning facilities across all industries including health, versus those where the climate does not support safe practices or encourage reporting of problems.

A search of the literature however revealed to us in the Scottish patient Safety Programme for mental Health (SPSP-MH) that no-one had previously developed a specific safety climate tool aimed at the users of services, specifically mental health services. 

The SPSP –MH programme has over the last eighteen months supported a group led by VOX (Voice of Experience) to develop and amend a patient safety climate tool for use by patients in mental health facilities. All Health Boards in Scotland have now used this tool to produce baseline information regarding how safe the participating wards feel to the patients within them. Again it asks similar questions to the staff climate tool about what they would do in the event of feeling unsafe, who they would report things to, whether they feel safe at different times of day or night, or in different locations, and how they feel when things are going wrong and if they are supported after upsetting events, such as witnessing an episode of restraint.

Already this has produced exciting insights into how variable this might be and the kind of things which seem to be important to patients using our services. For instance, a very small pilot here in Dumfries identified early on that patients did feel safe during the day when they had a named nurse who they could speak to but at night they didn’t have a specific named nurse and therefore this left them feeling more vulnerable in some instances. This led to a quick and simple change to address this. 

CAN WE CHANGE THE SAFETY CLIMATE?

Having identified that a climate of safety in a ward or unit can be measured usefully using such tools, including tools used by patients or service users themselves, the key question is can the climate or culture of a facility change and can that change result in improvement?. The answer seems to be a very definite yes.

One example is where colleagues in Greater Glasgow have been developing an amended patient safety walkround to include a more mental health specific slant and a specific’ safety conversation’ which aims to gauge the safety climate, and the level of any activity around the patient safety programme within that facility. Similar to feedback from the patient safety climate tool, early use of this approach has identified variation between units, with an apparent link to the units relative engagement in SPSP-MH work to address patient safety issues.

Essentially the more teams are committed to looking at their practice and processes and to making changes to try and improve safety, the safer the ward feels, both to staff and patients. 

CLIMATE CHANGE – FOR THE GOOD?

There is no doubt that the weather in Dumfries, as elsewhere, will continue to vary, and whether the climate alters such that we will have more of the pleasant summer weather that we enjoyed remains unclear. In terms of work around patient safety changing the safety climate and culture within our services, the Scottish Patient Safety Programme is producing increasing evidence that this is the case and that hopefully the climate change that we see will be one which we don’t need to worry about and which will be to the benefit of staff and patients. 

DR DAVID J HALL is Clinical Director & Consultant Psychiatrist at NHS D&G and National Clinical Lead for the Scottish Patient Safety Programme Mental Health

Exit Strategy by Jo Beecham

This weeks blog appeared in the Spectator (www.Spectator.co.uk) on May 10th 2014. It is by Jo Beecham who was diagnosed with advanced ovarian cancer in 2011. I would like to thank both Jo and The Spectator for allowing us to re-publish this artice on dghealth and also Andrew Turner (Head of Information Assurance and Security at NHS D&G) who sought their permission and submitted the article.

“I am ready to talk about my death. Is anybody else?”

It is October 2012 and my ovarian cancer is back. As we wait to see the consultant I say to my best friend, ‘We are going to Mexico this weekend to get that stuff so I can kill myself. We’ll probably get killed by drug barons.’ My consultant says I have three years. I agree to more chemo and ask: ‘Can I go to Mexico?’ She looks baffled.

It is February 2013 and the consultant is discussing hospices. She is eight months pregnant. I don’t tell her about the Mexican barbiturate in the fridge. I do tell the nice hospice counsellor, though. She goes white. ‘The drug dealers seem to have a good reputation. She isn’t reassured. ‘It works on large animals and I’m no bigger than a small donkey or a big dog.’

She tells me that I need to have a psychiatric assessment. Apparently it’s natural to think about dying but not to plan your own death. When I see my GP I tell her that I’m thinking about killing myself and want this recorded to protect my family and friends.

‘Oh, and I also need to be referred to a psychiatrist who’ll say I’m sane, or I won’t get therapy.’ ‘What do you think of that?’ she asks. ‘Ridiculous.’

The GP calls a psychiatrist and she says it’s ridiculous. Now that I’m officially not mad the counsellor will see me again, but only with her supervisor, who tells me that in 15 years at the hospice she has never encountered someone with a plan before.

How can you talk about a good life with- out talking about a good death? I get the feeling that the hospice isn’t the best place to talk about dying.

It is June 2013 and my friend suggests we go to a Death Café. About 40 people are there. The facilitator is asking people to imagine their deaths. People mention favourite cotton sheets and listening to Bach. I try to imagine the smell of baking but can’t stop wondering whether faecal matter will come through my mouth. So I tell them I have a terminal illness and an illegal drug in the fridge. ‘How many of the group are dying, like me?’ I ask. No one raises a hand.

Late June 2013. These are my people! A hundred of us gathered to learn about peaceful methods of dying at the Exit International Workshop. As we leave, however, there are protestors. My friend calls them cowards for hiding behind skeleton masks.

One takes hers off but looks so terrified I tell her to put it back on. Another says she’s a lawyer. I ask her: ‘What right do you have to tell me how I should die from ovarian can- cer?’ She answers that her sister died from ovarian cancer and fought for her very last breath. Her face is full of grief and I suddenly feel desperately sorry for her and want to hug her instead of punching her.

“Apparently it’s natural to think about dying but not

to plan your own death”

November 2013. Whenever I am in a clinic my blood pressure shoots up. I’m on a three-weekly intravenous drug called Avastin, which is the only thing keeping me alive, but my veins are getting thinner. Today my blood pressure’s higher than ever. Eventually I’m cannulated. A nurse tells me to relax, she’ll take my blood pressure later. I know I’m too anxious. I won’t get my drug.We wait for the doctor on call to give his permission. My BP goes through the roof.

I beg a nurse to turn on the machine. I could kiss him when he says ‘OK’, but later I look at the bag and the drug isn’t being fed into my arm. All the nurses have disappeared. I wander through the wards, wheeling my Avastin on its pole. I’m crying, pressing buttons on the machine, hoping I can turn it on myself.

Eventually a nurse tells me the doctor on call instructed them not to give me the drug.

I speak to him on the phone and demand my drug. He hangs up. Just as I think I’m about to have a stroke, the nurse tells me that my consultant has a clinic that day. I can’t stop babbling when I see her.‘Have a mince pie,’ she says, ‘I’m going to give you the Avastin.’

In January this year, the cancer spread to my glands and lungs. My consultant told me there was no further point in giving me the Avastin or in my undergoing any more chemotherapy. We talked about palliative care and pain relief. I asked her what her thoughts were on assisted dying. She said that no one had asked her this question before and she needed to think about it.

Many years ago I saw a Woody Allen film where he is considering suicide but he can’t do it without killing his parents first, as his death would be so devastating for them. I think killing my parents first is an excellent idea. I could check that the barbiturate works on them before I take it. My mother, who is 88, fell over at Christmas and broke her pelvis and is only just getting over it, and my father, 91, shuffles and lurches in a way that has us all running for cover. It can only get worse.

The three of us are sitting at home. At 51, I am aware that this is the first time I feel like an adult in the company of my parents, and being an adult means keeping it together in front of my mum and dad while knowing all our hearts are breaking.

‘I’m very sick. I don’t know how long I’ve got but I promise you that I will not suffer. I have the means so that I won’t let that happen. I promise you.’

They nod that they know and that they really don’t want me to suffer. My mum is looking at me very intensely and says that I am an angel — she has often thought so — and that there is some smoked salmon in the fridge. Would I like to take some home with me?

 

Jo Beecham

A longer version of this piece is online at www.spectator.co.uk/beecham

 

Land of our Fathers’ by @JeffAce3

One of the most striking features of this utterly brilliant Commonwealth Games has been the dominance of Welsh competitors. Very occasionally this has shown itself through the winning of medals but, most often, it has been through that most highly prized of awards – the moral victory. It is only fair to reflect, however, that Wales also provided one of the negative stories of the Games when the hurdler Rhys Williams, 30 year old son of legendary Welsh winger JJ Williams, failed a drug test. It’s fair to say that this shocked me to the core. How I asked myself could JJ, hero of the 1974 Lions, wing partner to the incomparable Gerald Davies, a man whom I vividly remember watching in his spring-heeled pomp, have a 30 year old child? The answer is devastating in its simplicity; the 70s were long ago and I’m getting a bit old.

I’m not alone. The ageing of our population seems sometimes to be talked of in the same tone as peak oil or an ice free arctic, something that should worry us certainly, but also an issue that will affect us sometime in the reassuringly distant future. But for Dumfries and Galloway, such complacency would be utterly misplaced. We are in the front line of the most profound demographic change that western society has ever experienced; it’s happening now, and it’s happening in Dumfries and Galloway more dramatically than in any other region in Scotland.

Here’s our population pyramid compared to that of Scotland as a whole.

 

It’s immediately clear that the term ‘pyramid’ is a misnomer. We have a bulge of population in the older age groups that overshadows the population of children and younger adults. Year by year this bulge is moving up through the age bands, causing a shrinkage of the working age population and an increase of those in the over 65, 75 and 85 age brackets. This is not a far future phenomenon; this is happening to us now and will be the dominant issue in determining the shape of health and social care provision until the population distribution broadly stabilises in the mid 2030s. Ken will do a blog to mark this event (probably beamed straight into your brains by the grandchild of Twitter).

At this point, I was going to start talking about the pressures on health and social care generated by this population shape. I will come to this, but first I think it’s important to say how truly wonderful it is that we’re able to present these figures. What we see here is an absolute triumph of post war healthcare in Britain that’s allowed people to live longer, healthier lives than ever before. We have made enormous progress in reducing mortality from big killers such as stroke, heart disease and cancer and this rate of improvement does not appear to be slowing. A population that’s older than ever before is an achievement to celebrate and something that our clinical and support teams should regard with a sense of pride.

Having said that… Here’s a diagram showing the relationship between age group and the usage of acute beds (expressed as proportion of total ‘bed-days’) at the moment. It’s very evident that age is currently a key driver in hospital occupancy, a fact that becomes somewhat uncomfortable if we think back to that population bulge moving inexorably upwards. And remember that over 80% of health contacts take place outside the acute sector so this profound shift in demand is affecting every aspect of our care.

Essentially, we have a health and social care system that is not designed for the unprecedented demographic change now underway. We will need to change and change both rapidly and radically. On the single issue of acute bed use, for example, we will need broadly to reduce that correlation between age and bed days by around 40% over the next 15 to 20 years. This is a scale of change similar to that undertaken by mental health services over the past decades, but is something never before evidenced in acute care.

There are good reasons to be optimistic about our capacity to deliver this change. One of the most important of these is the forthcoming integration of health and adult social care services. The model, already approved by Council and shortly to be presented to Health Board, will see all of health and adult social care brought under one management structure. This should create far greater flexibility for teams in addressing problems such as delayed discharges. Integration is not a cure-all solution but, if we get it right, it should enable a wider range of solutions to be identified and implemented within localities that will allow our older population to be cared for where safe and appropriate outside of an acute setting.

This is, however, an optimism based on a mechanistic modelling of the future numbers and patient flows. That’s all very well. But, whilst important, it’s not how our service will be assessed or how we should judge ourselves. Our success should instead be measured by the quality of care and support that we deliver to this changing population. I’ve recently completed the Dementia Champions training programme (a superb course which I’d recommend to anyone who has the chance to participate). The programme makes us confront areas where our service does not meet the needs of this vulnerable group or their carers. In one module, for example, we spend a day with current carers of people with dementia discussing their recent experiences and the difficulties they’ve faced in accessing properly coordinated and effectively tailored support. In others, clinical experts present latest thinking on issues such as the quality of pain management or the progress in improvements in end of life care.

There are some great local examples of outstanding person centred care for this patient group. But there is also overwhelming evidence that there is a long way to go to ensure that we reliably provide the level of support to individuals and their carers that maximises potential for independent living and tailor hospital experience to meet individual needs. Some of this we can address relatively easily (give or take £200M); the new acute hospital opening in just 3 years time is being designed using latest thinking on dementia friendly design and will provide a far more appropriate environment for the care of patients with degrees of confusion or dementia. But the much more significant change required is to shape the care provided by health, social care, independent and third sectors in a way that is most effective for that individual, their families and their carers. To do that, we will need to increase the depth of knowledge about our individual patients and their circumstances to a degree that feels daunting in a future of ever shorter hospital stays. It’s a future that will require far better information sharing between agencies and a level of coordination between care providers that is nowhere near reliable at the moment. The integration of health and adult social care gives us a great start on this journey, but there’s an awful lot of redesign still to be delivered.

I think this ambition to transform dementia care is important not only because it’s so plainly the right thing to do, but also because I believe that if we can get services and support right for this most vulnerable group of older adults, we’ll also transform it for the rest of the older population. The key principles of working with families and other carers, integrating our support across agencies and trying to enable as high a degree of independence as possible all apply to the wider population of older adults as well as to the cohort of patients diagnosed with dementia.

It is this approach that will see us succeed both in dealing with the numbers bulge and securing the far greater prize of providing coordinated person centred care and support for our older adult population. Then we’ll deserve the medal and have the moral victory!

Jeff Ace is Chief Executive Officer at NHS Dumfries and Galloway.