Services … but not as we know them…. by Elaine Lamont

“Change is the essential process of all existence…to boldly go… to seek out new life and to explore strange new worlds… “ ( Captain Kirk and the Star Trek crew….)

Unless you’ve been lucky enough to have been hibernating for the past year or so I’m sure you’ll be well aware of the changing landscape and the need for dramatic change in the way we go about our business across the sectors so that the needs of our local population are met. Sadly I have heard so many people talk about the changing demographics and rise in our older population as a’ negative’ or as a ‘problem we face’… but I personally feel this is our opportunity to do things differently….

The facts….

• people are living for longer
• people want to live independently in their own homes and communities for as long as possible
• older people have so much to give in terms of creating vibrant supportive communities
• we need to think differently in relation to ‘service provision’ and the kinds of support that are key to maintaining good health and well-being

Actively engaging and involving people in identifying what enables them to keep and live well and to feel they are in control so that they can ‘live life to the full’ is absolutely essential and is key to the work being taken forward in Annan by the Health Improvement Team. The ‘Community Engagement, Resilience and Health Service Development Project is supported by the Putting You First Change Fund and is part of Dumfries & Galloways’ response to ‘Reshaping Care for Older People’

Engaging and involving Communities…

There has been some extensive work with older people to try to establish what matters to them and the kind of services and activities they need to enable them to live independently for longer with a good quality of life.

In Annan, for example, we went out into the town to speak to people. We did not organise a public meeting … we went to the Day Centre, visited people in sheltered housing, spoke to people in supermarkets and knocked on doors. We managed to speak to around 600 people.. We asked then to share their thoughts and they were happy to do this. We also found 175 people were in need of some kind of support or information and we were able to signpost or support them immediately (for some it was little things that were making them extremely anxious and for others it was more serious difficulties they were facing. In some cases I think we probably prevented crisis at a later date). Around 120 people gave us their details and said they would be keen to help us plan and develop… A really positive response..

A snapshot of people said…

What do you think would improve your health and well-being?

Recognising our assets… individual and community ..& Strengthening Resilience

“Communities and individuals harnessing local resources and expertise to help themselves (Civil Protection Lexicon 2010) In the ‘The Well-Connected Community’, Alison Gilchrist argues the importance and value of building networks within communities that results in individuals, families and the wider community building a ‘resilience’ leading to a sense of wellbeing and greater quality of life.…(SCDC.. Getting to Grips with the language)

We contacted the 120 people who said they wanted to get involved and invited them to work us by coming along to a ‘hands-on’ workshop type session where we spent time identifying local ‘assets’ in and around the town. ..we asked about places, people, services…things that they did or used to keep them well and we asked them to share their stories and experiences..….below are a couple of examples..

“ the hairdressers on the corner…my Mum has dementia and they are always so good with her.. even when she’s having a bad day..”

“ Skyline Guitars… it’s where I go when I need a bit of respite… I hear people practicing and often just spend quiet time looking at the guitars”

This information was used to populate the ALISS information engine which is a local national search tool that people will be able to use to find things to do or services that they need …

(This is still in development but you can have a look by going to www.aliss.org )

Co-productive approaches to developing ‘support and services’

“Co-production essentially describes a relationship between service provider and service user that draws on the knowledge, ability and resources of both to develop solutions to issues that are claimed to be successful, sustainable and cost-effective, changing the balance of power from the professional towards the service user. The approach is used in work with both individuals and communities.” Joint Improvement Team
Having information about how people kept themselves well and things they felt they needed to ‘do more of’ we invited people to come back together with some local Service Providers to start thinking about solutions and ways of meeting needs with the assets available. From these sessions came lots of creative ideas and we are currently working with local people to develop these… Some examples include Knit & Natter group who meet in a local Care Home, Arts & Crafts Groups, Walking groups for people with long term health conditions, creating Dementia Friendly Communities , informal Carer support, Ipad training, Confidence courses, Tea & Tennis… just to name a few. We are also working very closely with local third sector providers to help strengthen their capacity to offer more.

Changing behaviours and mindset..

Changing practice and ‘hearts and minds’ can be challenging to say the least, particularly in a short-life project or ‘test of change’. This work is part of the Putting You First Pathfinder Plan in Annan and we strive to ensure this ‘person and community focus’ is part of every project undertaken. As part of the work we have introduced the Community Link Worker role which is a resource to both individuals and practitioners. The Link Worker works with people to identify things that really matter to them and supports set personal goals and access what they need to achieve them. Practitioners across the sectors including GPs, Social Workers, District Nurses, Discharge Planners, are now realising the benefits for their client group of this real person centred approach focusing on outcomes rather than outputs and the use of existing assets that they may not have considered before. 

Linking people to these assets and the sources of support is crucial in ensuring good health, independent living and peace of mind as is trying to capture the benefits and outcomes (more about this in a later Blog,,,). The introduction of the Community Link Worker role means that people are introduced to the concept of recognising their potential and setting realistic goals to meet personal outcomes. Sometimes it’s simply about asking the right questions… as more often than not it’s something small, really simple and fairly easy to fix that’s having the biggest impact on peoples’ health and happiness and their ability to feel in control of their lives and health again..

This concept is one we are hoping to take forward as part of the integration of Health & Social Care as it clearly plays a big part of delivering the vision for the future…

Oh.. and the star trek theme… my name before I married was Kirk and I went through my School and University years known as ‘the Captain’.. so, without much choice Star Trek has always been part of my life..

Elaine Lamont is a Public Health Practitioner with Annandale and Eskdale Health Improvement Team.

 

 

Alcohol and Wellbeing by Andrew Carnon

A blog of two parts, first a glimpse into a common public health topic and then something I hope may be a bit different.

A retired doctor friend told me a story. He was invited to be on an interview panel for a consultant appointment in the 1980s. The interviews were held in the new Boardroom at Crichton Royal Hospital. After the candidates had been seen in the morning, a good lunch was provided and then a black-clad waiter with white gloves opened a wood cabinet from which he produced a silver tray with sherry and glasses which were offered around the panel and successful candidate for a celebratory drink. Different times now!

For years alcohol was one of the few causes of death that was increasing in Scotland. Completely opposite to the success stories in heart disease, stroke and cancers through better treatment and prevention, deaths from alcohol seemed to be going through the roof. Looking at the chart, you see that alcohol-specific death rates for females and males have been consistently higher in Scotland than in England & Wales. The female rates are lower than the male rates, and the female rate for Scotland is actually similar to the male rate in England & Wales. And as well as these very specific deaths, there are many more where alcohol is a contributing cause.

Death of course is the most severe outcome, but alcohol can also lead to a host of other problems impinging on the NHS, from long-term harm to health, falls and injuries, to domestic violence, unsafe sex, unwanted pregnancy, and problems at work or job loss.

Why are alcohol-related deaths so high in Scotland and what can be done about the problems?

Lots of things are tried or proposed, for example:

• Local or national awareness-raising campaigns
• Opportunistic advice when patients consult a health professional
• Brief interventions on alcohol in settings like Accident & Emergency
• Alcohol and drug treatment service
• Attempting to restrict availability of alcohol through the licensing system for off-licences (supermarkets, shops selling alcohol) and on-licences (hotels, pubs, clubs)
• Proposed minimum pricing of units of alcohol.

Do these work? Unfortunately there’s little evidence that campaigns make any more than a whit of difference. I suspect they’re more about salving consciences that something is being done, rather than actually doing it.

By far the most effective public health actions tend to be the big population measures, like tackling availability or price of alcohol, but these invariably run into strong opposition and can become mired down in commercial or contrary interests. The derogatory term ‘nannying’ is often used.

Are the opposite views unbridgeable, depending on whether we give more weight to preventing harm or to protecting individual autonomy for people to harm themselves if they choose? Are there any easy answers at all? At least there’s some comfort that rates seem to be falling in recent years.

Sometimes questions like these seem so difficult that I’m going to segue instead into another public health principle, increasing wellbeing. The Edinburgh book festival (https://www.edbookfest.co.uk/) is one of the highlights of my own year, a real heart-sing event. Last month at the festival my mind was stimulated by (amongst others) philosopher Roger Scruton, journo Jeremy Paxman and Rebecca Mead of the New Yorker magazine.

Rebecca Mead’s theme was that reading classic literature has lifelong benefits. That set me wondering what are possible benefits of reading to busy NHS staff? I’m talking here about reading fiction, rather than the day’s deluge of work emails or NHS D&G’s required reading sent out to all staff, as these are, of course, supposedly non-fiction!

What benefits might there be? I can think of:

1. Learning about how health professionals do their jobs, grapple with ethical questions or deal with lack of resources.
2. Learning about patients and how diseases or disabilities affect their lives.
3. Getting information about different lifestyles we might not have experience of ourselves.
4. Getting inside characters’ heads might help to develop the subtle trait of empathy.
5. May help improve communication skills (can develop our own vocabulary and range of expression and help us see different communication options and styles).
6. Possibly (if Rebecca Mead is right) may enhance our own wellbeing, personal growth and development of wisdom throughout life.

I’m sure book lovers amongst you will think of other benefits as well. And the best thing is that all of this learning can be achieved in comfortable home surroundings (with one small glass of favourite tipple if you must), and without having to attend the latest recommended professional development course.

And so, back to the beginning. One thing reading can do is give you wider perspectives and individual insights into alcohol use. Pharmacologist Ronald Siegel thinks it’s a universal human drive to want to get ‘out of one’s head’ with mind altering substances. It seems to be so persistent through history that he equates it with our drives for food, sleep and sex. Could that be right? If so, attempts to control or price alcohol to reduce problems might not work.

Getting out of one’s head to an extreme degree is portrayed by a number of authors. I can’t help drawing attention to a couple of books set in Russia, where protagonists become drawn into a culture of regularly drinking to oblivion – both are fantastic reads quite apart from their alcohol insights: Among the Russians by renowned travel writer Colin Thubron (a previous Edinburgh Book Festival speaker) and Consolations of the Forest by French author Sylvain Tesson.

And just to finish on getting out of one’s head through drugs rather than alcohol, there’s a stunning short story collection: Julia and the Bazooka by Anna Kavan, who was a heroin addict for much of her life. The bazooka is a euphemism that Kavan uses for her syringe which went with her everywhere. The stories give a powerful insight into what life must be like for a dependent opiate user.

Oh and if you’re already a bibliophile or any of this has whetted an interest, the Wigtown book festival is in a week’s time…

http://www.wigtownbookfestival.com/

Andrew Carnon is Joint Interim Director of Public Health at NHS Dumfries and Galloway

 

Thought provoking anniversaries by @HazelNMAHPDir

”Move him into the sun—
Gently its touch awoke him once,”

Wilfred Owen (1893-1918), British poet. Insensibility

The 100^th Anniversary of the start of World War One has stimulated a great deal of interest in seemingly forgotten history across the country. Families have been reconnecting with relatives who fought, died and survived using photographs, diaries and letters hunted down out of dusty boxes in the attic.

During the summer we visited a number of WW1 sites in northern France that were haunting in their atmosphere, magnitude and sense of sacrifice. The British monument at Thiepval near Albert and Arras (designed by Luytens; who also designed the Cenotaph) is an incredible place.

It caused me to feel thoughtful about nursing in that time – prior to any professional register, when it was viewed as ‘woman’s work’. In addition to recognised trained nurses, the VAD (Voluntary Aid Detachments) were crucial to supporting the war effort. In August 1914 there were thousands of them, whereas there were only a small number of military nurses by comparison (Queen Alexandra’s Imperial Military Nursing Services). In August 1914 they had no idea that every pair of hands was going to be needed over the next four years, as the common misconception was that the war would be over by Christmas.

The VAD system was founded in 1909 with the help of the Red Cross and Order of St John. By the summer of 1914 there were over 2,500 Voluntary Aid Detachments in Britain. Of the 74,000 VAD members in 1914, two-thirds were women and girls.

At the outbreak of the First World War VAD members eagerly offered their service to the war effort. The British Red Cross was reluctant to allow civilian women a role in overseas hospitals: most volunteers were of the middle and upper classes and unaccustomed to hardship and traditional hospital discipline. Military authorities would not accept VADs at the front line.

Katharine Furse took two VADs to France in October 1914, restricting them as canteen workers and cooks. Caught under fire in a sudden battle the VADs were pressed into emergency hospital service and acquitted themselves well. The growing shortage of trained nurses opened the door for VADs in overseas military service. Furse was appointed Commander-in-Chief of the detachments and restrictions were removed.

During four years of war 38,000 VADs worked in hospitals and served as ambulance drivers and cooks. VADs served near the Western Front and in Mesopotamia and Gallipoli. VAD hospitals were also opened in most large towns in Britain. ^]Later, VADs were also sent to the Eastern Front. They provided an invaluable source of bedside aid in the war effort. Many were decorated for distinguished service. Vera Brittain and Agatha Christie are two famous VADs; with the story of her experience captured by Vera in her book ‘Testament of Youth’.

“If the ghost that haunts the towns of Ypres and Arras and Albert is the statutory British Tommy, slogging with rifle and pack through its ruined streets to this well-documented destiny ‘up the line’, then the ghost of Boulogne and Etaples and Rouen ought to be a girl. She’s called Elsie or Gladys or Dorothy, her ankles are swollen, her feet are aching, her hands reddened and rough. She has little money, no vote, and has almost forgotten what it feels like to be really warm. She sleeps in a tent. Unless she has told a diplomatic lie about her age, she is twenty-three. She is the daughter of a clergyman, a lawyer or a prosperous businessman, and has been privately educated and groomed to be a ‘lady’. She wears the unbecoming outdoor uniform of a VAD or an army nurse. She is on active service, and as much a part of the war as Tommy Atkins.”

Lyn Macdonald, The Roses of No Man’s Land

 

 

 

Telemedicine – the Good, the Bad & the Future? by @murphieRNC & @Louisefclark

Phyllis Murphie

Louise Clark

This week’s blog is by Phyllis Murphie – Respiratory Nurse Consultant and Dr Louise Clark – Consultant Diabetologist and is intended to share the experiences and views of Clinicians and service users regarding Tele-clinic Consultation in NHS Dumfries and Galloway.

 

The term “telehealthcare” involves healthcare delivery at a distance, enabled by information and communication technology and driven by national and international trends in healthcare needs (an ageing global population, care closer to home, low carbon economy, etc). Telehealthcare incorporates telehealth, telecare, telemedicine, assisted living, remote clinical monitoring and supported self treatment. In remote and rural regions tele-clinic review can offer significant benefits for all those involved in this model of health service delivery.

Scotland’s 2011-17 eHealth Strategy advocates there is a clear role for telehealth and telecare technologies in delivering health care for the people of Scotland. When implemented appropriately as part of clinical service redesign, telehealthcare can:

• Afford people greater choice, control and confidence in their healthcare care;
• Enable safer, effective, timely and more person centred care and offer better outcomes for the people who use our healthcare and support services;
• Assist in delivering efficiencies with the added value of more flexible working and best utilisation of staff skill mix and by reducing wasteful processes, travel and minimising access delays.

The distance to travel to remote and rural clinics within NHS Dumfries and Galloway is considerable in terms of mileage and time spent for clinicians and service users if they have to travel to the main centre of Dumfries for review. A trip to Stranraer for clinicians or patients to the D&GRI is a 150 mile round journey that can take up to 4 hours of travelling time. NHS D&G Respiratory Sleep Medicine, Diabetes, Neurology and Weight management services have established tele-health clinics in the Galloway Community Hospital – Stranraer and Creebridge Medical Centre- Newton Stewart.

A review of the experiences and opinions of those using tele-clinic consultation using video conferencing technology and Office Communicator/Lync technology – clinicians, clinic staff and patients – was conducted and the outcomes are reported here.

 

 

Benefits of Teleclinic review for Patients/Service users:

• Formal patient feedback/surveys by participating clinical teams have demonstrated high levels of service user satisfaction with this model of health care review;
• Reduced waiting lists and a shorter waiting time for review are reported;
• Care is delivered closer to home and supported by local staff in line with the NHS Quality strategy;
• A reported clinicians concern was an initial scepticism about developing the clinician /patient relationship via a tele-clinic link. However, the tele-clinic model seemed to facilitate a more open, honest and transparent consultation that enhanced the clinician patient relationship.

Benefits of tele-clinic review to delivery of participating Clinical Health Services:

• All clinicians reported reduced travelling time and travel expense for people utilising this model of clinical service delivery;
• Timeous patient review that has enhanced patient experience and assisted in developing positive patient and clinician relationships;
• Reduced travelling for clinicians has freed up time in terms of clinical sessions to reinvest this in other aspects of service delivery;
• The number of clinical sessions freed up by delivery of teleclinic model for all specialties involved:
  • Consultant Diabetologist – 12 sessions;
  • Consultant Neurologist – 6 sessions;
  • Consultant Biochemist – 24 sessions;
  • Respiratory Nurse Consultant – 18 sessions;
  • Diabetes specialist Nurse – 12 sessions.
• Clinicians also reported that for return review patients this provides a very good quality equivalent service compared to face to face review;
• Having a prior face to face clinical relationship before the participating in tele-clinic review was also reported to be advantageous;

Benefits of tele-clinic review to the Healthcare organisation:

• Again clinicians reported a reduction in waiting times, reduced costs in terms of travel and fuel cost impacting positively on the environment;
• More patients can be seen in the tele-clinic model by reinvesting travelling time saved in delivering more telemedicine clinical sessions.

Environmental impact of delivering tele-clinic reviews with the participating specialities in the last year:

• Mileage saved by all clinicians is estimated at 9,300 miles;
• Travelling time saved for all clinicians is estimated at 244.5 hrs;
• Travel costs saved for all tele-clinics to date is estimated at £5,766;
• Carbon Car footprint impact is estimated at a reduction of 3.03 tonnes of Carbon dioxide emissions based on a standard 1.8 diesel engine car.

Negative aspects reported with tele-clinic review:

• The reliability of the broadband connection can be challenging with connectivity issues that can disrupt the flow of the consultation. The issues of communicating via this technology with service users with hearing difficulties were raised and this needs to be considered in future service planning to overcome this problem;
• There was agreement that the clinicians themselves should be the ones to decide if tele-clinic review is appropriate for their service delivery and not necessarily be driven primarily by the National telehealth agenda;
• A very small number of patients felt uncomfortable with teleconsultation and would prefer face to face review if offered.

Undertaking this review of current tele-clinic services offered in NHS Dumfries and Galloway has demonstrated many benefits to patients/service users, clinicians and the organisation. Telehealth technology and solutions are advancing and evolving at a rate that exceeds the current pace of change within the NHS and Scotland is recognised internationally as a leader in the development and deployment of telehealth and telecare. In undertaking this collective review of tele-clinic delivery in NHS Dumfries and Galloway we have demonstrated the real benefits of adopting this model of service in the Respiratory, Diabetes, Neurology and Weight management services and we are contributing to the delivery of the National Telehealth and Telecare Delivery Plan for Scotland 2015. Other clinical specialities and service users may benefit from this model of clinical care in the future and if delivered at scale the reduced travel costs, fuel consumption and impact on the environment are significant.

Thanks are extended to:

NHS Dumfries and Galloway IT department

Jill MacIvor – Diabetes Specialist Nurse

Karen MacKie – Health Care Support Worker – GCH

Dr Fiona Green – Consultant Diabetologist

Dr Ondrei Dolezal – Consultant Neurologist

Dr Ewan Bell – Consultant Biochemist/Associate Medical Director