Thank you to Ward 18 and DGRI by Kevin Irving

Dear Mr Ace,

I am writing to you to express my sincere gratitude and thanks to the staff in Ward 18 (Elderly Care) of the Dumfries and Galloway Royal Infirmary. Whilst I was visiting the UK my Mother took critically ill and was admitted to the hospital where she received excellent care from the doctors and staff on this particular ward. I spent nearly 4 to 5 hours a day in the hospital for over 15 days attending my mother’s bedside and could observe the highest quality of care. Having worked in health and safety in my career as a mining engineer, at the most senior executive level, for over 35 years I can honestly comment that the leadership and team work on Ward 18 was some of the best I have seen and is a credit to the staff.

The doctors on the ward, from the lead consultant caring for my mother to the rest of the team, showed enormous care and compassion to my mother’s needs and requests. My mother made what I think we all would agree was a remarkable recovery. During the difficult time of when my mother was very ill the doctors ensured that both my sister and I were well informed and we were able to have very open and honest discussions regarding my mother’s care. They also showed compassion towards my sister and my own feelings through what was a very stressful period.

I would like to give special thanks to Snr Charge Nurse Janice Cluckie who demonstrates incredible leadership to her staff and also discussed my mother’s needs with empathy and thoughtfulness. It was clear to see that she took time to see that all patients on her ward were well cared for. Janice is certainly a role model that your organisation should be proud of.

I have nothing but praise for the ward staff who showed consideration and care for all the patients. From a visitors point of view I saw total dedication to their duty for the well-being of their patients with humbleness and sincere kind heartedness.

Whilst spending time in the area I had the opportunity to look around the premises and surf the internet about the hospital. I see from your Board papers and Inspectors reports that you have some areas for improvement. I can only say from my observations that you certainly appear to be on a positive trend. I noted in your most recent Board papers that complaints about the hospital service are on the increase. I would recommend making a KPI of some of the positive comments you may be receiving, such as this letter, as they may show another side of the story or use information from the website www.patientopinion.org.uk or NHS Choices website.

As an aside I used the dining room daily at lunch times and the food served was of good healthy quality, a good price and presented by excellent welcoming staff. I feel the NHS food is sometimes often viewed negatively. I can only say that Dumfries and Galloway seem to be improving this aspect of patient and staff care.

I would be very grateful if you could ensure that the leadership team of Dumfries and Galloway Royal Infirmary give some recognition and positive feedback on my behalf to the doctors and staff on Ward 18.

With many thanks, yours sincerely

Kevin Irving

Kevin, who lives in Australia, added a handwritten post script which read “Wishing you all a Merry Christmas and a Happy New Year from the sunny side of Down Under.”

Sometimes you can’t see the wood for the trees… by Laura White

In September 2015 when my team and I were at the glittering Excellence in Care Awards ceremony at Easterbrook Hall after being nominated for not one, but two awards, I found myself pondering what it took for us to get from our lowest low to our highest high…

In early 2014 the Healthcare Environment Inspectorate walked into ICU unannounced and unearthed a catalogue of issues that turned our world upside down. In an instant our team went from a well-oiled machine to a rusty old tractor not knowing how to function.

The title of the blog sums up what we thought, as an organisation none of us could see what the Healthcare Inspectorate saw, we were in fact too close, too involved. For all our nursing care was never in question, we still doubted our abilities as nurses and wondered whether we were failing at the job we worked so hard at and got so much satisfaction from. The shame and embarrassment of having our place of work discussed in the newspapers and throughout the hospital, whilst trying to ‘keep it together’ still caring for critically ill patients and their families, was an overwhelmingly stressful time for all of us. The whole time we seemed to only have one question for each other…”How did this happen?” We put all our time and effort in to caring for our patients, did it matter that there wasn’t a record of the shelves being wiped down? Yes it did.

We listened to feedback, sought advice and did extensive research around the way we did things. We really dug deep and relearned our roles to include a vast new array of cleaning and infection control measures. It took months of liaising with the Infection Control Team, Domestic Services, Medics, Management, and Estates to name a few. There was clarification sought for EVERYTHING, from everyday things like bed bathing a patient to the fear of the effects of excessive Actichlor on our health.

The transition period between the inspection and the refurbishment of ICU put strain on everyone involved, however during this time it became apparent how well we pulled together, worked as a team and were committed to putting the broken pieces back together in order to be the best we could be. Staff came in to help in their own time, worked extra shifts and there was actually a lot of excitement about working in the newly refurbished unit, it was like a blank canvas. Don’t get me wrong, it wasn’t all plain sailing, the months following the inspection included periods of extremely low staff morale, increased sickness absence and an emotionally fragile workforce who at times found it difficult to talk about what happened to us. We eventually found that discussing the experience with colleagues and other professionals did help to rid us of some of the mixed emotions we were struggling with. Thankfully there did come a time when we realised we had to stop looking back and start looking forward and take the good from a bad situation.

We slowly began to regain confidence in ourselves and became very proud of our ‘new’ unit. During this time it became clear just how many of us had ‘a touch of OCD’! There were times when you could probably have eaten your dinner off the floor in ICU, and we just stopped short of putting Actichlor in our cereal! We now work relentlessly keeping our very extensive cleaning schedule up to date and everyone is involved in adhering to our philosophy of cleanliness, God help anyone who tries to put their gloves and aprons in a domestic stream waste bin! We really are acutely aware of everything now.

We knew that changing habits would be the hardest part but also that these changes had to be sustainable and over time these changes have become the new norm for us. These are the changes which are now the norm to the new staff that have joined us since the inspection and will undoubtedly evolve and develop in the future, as everything does in nursing.  The HEI inspectors have since returned to the unit and saw a drastic improvement in all aspects of cleanliness, which we knew they would.

Winning the Excellence in Care award for Infection Prevention in a way closed the chapter on the hard times we faced in 2014 and reinforced to us how we took the best from it and got to where we are today. We are dedicated, committed and knowledgeable in Infection Prevention and have regained the confidence we lost when our unit was put under the microscope.

As the saying goes “what doesn’t kill you makes you stronger”.

Laura White is the Senior Charge Nurse for ICU and Surgical HDU at DGRI

 

Time to prepare for our new hospital by Chris Isles

This has been a busy month for the NHS. England has narrowly avoided a 24 hour strike by junior doctors, the difficulties experienced by the Queen Elizabeth Hospital in Glasgow have been laid bare on national television for all to see and Question Time debated passionately whether the NHS would fail this winter. Locally, Katy Lewis, our finance director, told a packed audience at our Wednesday Clinical Meeting of the financial difficulties faced by our Health Board while Ewan Bell, Associate Medical Director, wrote a blog about Prioritising Health Care and the chairman of our Medical Staff Committee drew our attention to Audit Scotland’s report on the state of the NHS in Scotland 2015.

Did I hear/listen to/read them all correctly? Can it really be true that the fifth largest economy in the world cannot afford to provide safe, high quality, emergency health care that is free at the point of delivery? 

Let’s start locally. Unless I am very much mistaken we have two major challenges in the run up to our new hospital opening in December 2017. We desperately need to avoid the scenes in Glasgow of ambulances queuing outside A&E and trolleys stacking inside A&E and equally we need to ensure that there is sufficient social care for our frail elderly patients when they go home from hospital. The challenge is likely to be greater for Dumfries and Galloway which has the second highest proportion of people in Scotland who are aged 75+ and living alone.

Katy Lewis spoke of the need for transformative change (aka doing things differently). Who could possibly disagree? If we carry on as we are doing now then the tidal wave of unscheduled medical admissions will cause our new hospital to silt up on the day it opens.  This is the conclusion I have drawn after analysing data provided by our own Health Intelligence Unit (the figure below shows the medical unit is sailing perilously close to 100% bed occupancy) and it is the nightmare scenario we must all be dreading. It should surely be concentrating everyone’s minds. If we get this wrong it won’t just be the local newspaper that will have a field day.

As it happens we have been working on ways of doing things differently and have identified two possible solutions: Ambulatory Emergency Care (which does what it says on the tin) and Comprehensive Geriatric Assessment (see below for definition). We must also ensure that we staff the new Combined Assessment Unit adequately. Both AEC and CGA will require investment if they are to be part of the organisation’s response to an impending beds crisis.     Other hospitals in Scotland have already embraced AEC and CGA and there is published evidence to support the view that these examples of transformative change will reduce bed occupancy. Has anyone come up with a better idea?

Equally if we are to keep that new hospital flowing we must invest in patient transport and community support services, particularly social care teams, providers of equipment, community nurses and carers.   The unintended consequence of preventive medicine is that we have more frail elderly people to look after than ever before. Their numbers appear to be increasing as the number of carers available to look after them decreases.  It can surely come as no surprise to learn that carers are in short supply when some are only paid £6.70 per hour (even less than this when we don’t pay mileage or travel time between visits). Compare this to a consultant physician on £36-44 per hour and the eye watering sums of up to £120 per hour we spend on some of our locums. The enormous difference between carer and locum salaries simply has to be addressed.  

Audit Scotland say that ‘significant pressures on the NHS are affecting its ability to make progress with long-term plans to change how services are delivered.’ The title of Katy Lewis’ presentation was ‘Austerity or Bust’.  Ewan Bell wants us to acknowledge that ‘we can’t continue to provide the current range of interventions and services, if we want a sustainable NHS for the future.’ I personally believe that the 5^th largest economy in the world could afford to provide high quality emergency care as well as batteries for hearing aids and palliative chemotherapy for the frail elderly (if that is what they really want), but if I am wrong then surely the batteries and the chemo must go.

Chris Isles is a ‘semi-retired’ Consultant Physician

Comprehensive Geriatric Assessment: ‘a multidimensional and usually interdisciplinary diagnostic process designed to determine a frail older person’s medical conditions, mental health, functional capacity and social circumstances. The purpose is to plan and carry out a holistic plan for treatment, rehabilitation support and long term follow up.’

There are only four types of people in the world….. by Lindsay Sim & Sharron McGonigle

‘There are only four types of people in the world…….those who have been Carers, those who are currently Carers, those who will be Carers and those who will need Carers.’

In this current climate of integration, it would bode us well to remember the above statement. Dumfries & Galloway Carers Centre has historically always promoted and encouraged partnership working but now it’s something that we have all been directed to achieve together under the Scottish Government Health & Social Care Integration Policy.

Are you letting your patients and their Carers know about the services that you yourself may need someday or are you assuming that someone else has done it? Don’t you want to be the person who lets a Carer know about the services they could access so that it can make a huge difference to their life? In order to give the Carer the smoothest journey throughout their caring role (which is likely to be us all at some point in our lives) we need to be aware of the issues Carers face and try and work together to make their journey have as smooth a road as possible.

If a referral is made to the Hospital Carers Support Project at the very beginning of a Carers journey, for example a stroke diagnosis, a cancer diagnosis, newborn baby with a disability, long term condition, brain haemorrhage (and the list goes on) it has been proven that the Carer feels supported, listened to and most importantly identified as a Carer who needs supported throughout their journey. Early intervention can mean a lesser impact of a caring role upon someone’s life with the correct support.

Carers have vital information to offer health professionals about the person they care for; they know the person inside out so this is more than beneficial to the professional involved as the Carer has firsthand knowledge on how the person they care for functions on a daily basis. Carers need advice on how to cope in the future, need help to access different services or simply want to know about progress and the outlook for the future. The advantage of sharing information with Carers is crucial in acknowledging the important role they carry out.

Carers have a large part to play in helping their cared for recover and ensuring their continued health. To do this, Carers need access to the right level of information. The Hospital Carers Support Project’s Coordinators frequently speak with Carers reporting that they feel cut off from the care of an individual to whom they have provided considerable support. The Carer is continuing to duplicate the care you administered once they get home after discharge. The Carer continuing what you have been doing in the hospital is vital in preventing re-admission. Many Carers also discover our Project for themselves by chance and tell us that no-one directed them to our service for support.

Why is it, when we have so much good policy and practice to help us support Carers through their journey, that some Carers still feel unrecognised and state that they feel they are not treated as partners? Identifying and referring a Carer to the Hospital Carers Support Project early on in their caring role means the Carer can access the following support….

• Instant access to support whilst their cared for person is still in hospital
• Information and advice
• A listening ear
• Assistance to have a voice in their cared for person’s discharge from hospital
• Advocacy
• Benefits advice
• Training and education
• Access to address their own health and wellbeing
• Accessing a Carers Support Plan which looks at their caring role now and plans for the future
• Funding and grants to access a break from their caring role
• Activities and groups where they can meet up with other Carers
• Access to counselling

If Carers and the people they support are informed, involved and supported throughout their caring journey, the likelihood of good outcomes rises, risk of re-admission falls and the financial and emotional costs this incurs can be avoided. Thinking about all the other services out there that are available to Carers is vital in giving the Carer the support they need. Don’t wait until you are a Carer yourself before realising that it can be a difficult, isolating, heavily impacting and frustrating role before remembering all the people you could have pointed in the right direction.

 

Did you know that the Hospital Carers Support Project, part of the wider Dumfries & Galloway Carers Centre has been based within Dumfries & Galloway Royal Infirmary for the last 14 years? We have supported over 1500 Carers with issues ranging from debt management, housing problems, applying for funding, arranging counselling; applying for benefits, accompanying a Carer to a hospice with their terminally ill child, liaising with ward staff, sorting out accommodation, listening when no-one else has, the list is endless. There is no problem that we won’t at least try and find out the answer to when trying to make the Carers journey more seamless but to achieve this we just need you to let us know who we can help……….

If we all work together – it will all come together.

 

Lindsay Sim & Sharron McGonigle

Hospital Carers Support Coordinators

Hospital Carers Support Project (part of the wider Dumfries & Galloway Carers Centre)

Support & Advice Centre

Dumfries & Galloway Royal Infirmary

Tel: 01387 241384 #33384

email: dgcarers@nhs.net