Life in the NHS – A Personal View by Robert Allan

I have an admission to make.  Although a non executive member of NHS Dumfries and Galloway, I have never worked in the NHS at the coal face.   However, the NHS was involved at the start of my life, and I suspect the same will be true for the end.

The NHS was five years old when I was born in an NHS maternity home in Ayrshire. Within three days I was operated on for an intestinal problem, and when my mother got me home and I made my first visit to our GP, he detected a heart murmur.   So began my life and my NHS journey.

Frequent visits to Kilmarnock Infirmary and various Glasgow Hospitals became part of the pattern of my childhood.  Some appointments lasted an hour, some necessitated week long stays in hospital for more complicated tests.

In 1965 I had open heart surgery to repair an ASD (hole in the heart) and leaking mitral valve.  I made steady if slow recovery, and by the age of 17 was told I was as good as new and went off to live life.

There followed the healthiest twenty years of my life.  I got a career, I married and we started a family.  In 1984 we moved to London.

I‘d had a minor episode with a stone in the kidney in 1978, but in 1988 this returned with more serious consequences.  It dogged the next eleven years, with frequent visits and admissions to Northwick Park Hospital, and eventually successful removal of the stone in 1999 at West Middlesex Hospital.

Now that all was well, we moved back to Scotland although I continued to work in London.   Then in 2002, out of the blue, my heart problems came back to bite me.   I was hospitalised at Northwick Park, and back in Scotland sought out the expertise of the Arrythmia Team at Glasgow Royal Infirmary.   Unfortunately, after numerous tests and a third failed cardioversion, I realised I had to live with my new condition and carve out the best quality of life possible in the circumstances.  Over the next few years I collected several more LTC’s

So a lot of my time now is devoted to medical appointments and proactively managing my conditions.   It is a bit boring, but the rewards are a quality of life denied to many suffering from the same or similar LTC’s.

My journey so far has taught me many lessons, and I have seen the best and the worst of the NHS.   Here are some of the lessons.

The patient is not always right, but has the right to be wrong.   It is their life.

Only the patient experiences the patient journey from beginning to end.

No one cares more about my health than I do.

No hospital maintains the same quality throughout.  One hospital I attended had its maternity unit put into special measures and several other wards were a disgrace.   But End of Life Care and Cardiology were outstanding.   Another, an old crumbling Victorian edifice with poor facilities, gave some wonderful nursing and clinical care through dedicated teams. It has now been demolished and a new hospital built on the site.

Patient empowerment and patient self management see much better outcomes than leaving it all to the doctor. Taking responsibility for your health is a great way of ensuring the best quality of life possible, and the best from the NHS. Managing our health should be a partnership between patient and clinicians.

I now have multiple Long Term Conditions and mobility issues, but still maintain the best quality of life possible through self managing my health and proactively seeking information on my lifestyle and health conditions.

I became an elected non executive member of NHSDG in 2012 knowing that making even the slightest difference for the better was important. Drive for continuous improvement maintains my sense of purpose.  I bring to the table experience gained from a life in the NHS, and a career in public service spanning over 40 years.    In 2014 I was appointed as a non executive member..

I know the NHS is not perfect, and never will be, but it is a fine organisation staffed by many dedicated and highly skilled people who every day do their best.

The NHS today faces many challenges.  Staff will experience frequent changes and difficulties, but so will patients.   Both need to embrace change and accept that we must do things differently if the NHS is to face the future fit for purpose.  And key is for us the patients to take responsibility for managing our own health, and clinicians and health professionals empowering us to do so.

The future should be bright for the NHS, but success will require hard work, tough decisions, and the support of patients and staff alike.

I am looking forward to many more years of life in the NHS.

Robert Allan is a Non Executive Member of the NHS Dumfries and Galloway Health Board.

Speaking Up (or keep your head down and say nothing) by Alice Wilson and Graham Stewart

“Whistleblowing” :-

is the act of drawing public attention, or the attention of an authority figure, to perceived wrongdoing, misconduct, unethical activity within public, private or third-sector organisations. Corruption, fraud, bullying, health and safety violation, cover-ups and discrimination are common activities highlighted by whistleblowers.”

Whistleblowing has some negative connotations but what does it really mean: how safe would you feel to raise concerns or speak out about issues that worried you?

Why would you want to speak up? We’ve all seen the headlines about Whistleblowers feeling they have been treated badly by employers for speaking up about concerns or heard others suggesting it’s easier and better to keep your head down and not get involved.

What if you do that – keep your head down and not get involved? What would you say if something happened that you think or know could have been avoided – would you just say “I could have told you that was going to happen?”

If you could tell something was going to happen, why don’t you?

Don’t we all have a responsibility to get involved in the NHS to ensure patient safety and high quality care ?

There are reasons why people don’t speak up, mainly because they don’t feel safe to do it. NHS Dumfries and Galloway’s job is to make it safe… not just talk about it being safe but genuinely to make it ok, to make people feel glad they had the courage to speak and to hear and act on the message.

First of all it’s important to understand when a concern becomes Whistleblowing or – to use the legal speak a “qualifying disclosure”. Put simply a qualifying disclosure is a concern raised by a member of staff where they have a genuine and reasonable belief of wrongdoing in one the following categories:

• A criminal offence
• A miscarriage of justice
• An act creating risk to health and safety
• An act causing damage to the environment
• A breach of any other legal obligation or
• Concealment of any of the above

We have all heard examples of where things have gone badly wrong in health and social care, resulting in serious injury or death.

Whistleblowing is a means to reduce the chances of something like this going undetected.

In many cases staff knew there was a problem or had a concern about safety, however the culture of their organisation meant they didn’t speak up.

Whistleblowing provides a mechanism to allow individuals to speak up about something they know is wrong or dangerous

By having two independent whistleblowing “champions” at hand staff can be assured that they can raise their concerns in private (which can be over a cup of coffee and ‘off-site’) whilst knowing their anonymity is fully protected.

 It doesn’t happen everyday.

Whistleblowing issues are not a daily occurrence; often staff concerns can be raised with their manager and resolved however you can also speak to your trade union or professional organisation for advice.

Whisltblowing is not an avenue to take simply because you disagree with your manager or feel you haven’t been listened to (there are other formal HR policies that apply in these situations). Whislteblowing is there to allow staff to raise concerns as highlighted above in a confidential manner so that issues around safety and security can be looked at to assess whether there are real concerns.

NHS Dumfries & Galloway also has two members of staff who you can go to for advice, that’s us and our contact details are:

 

Graham Stewart                                                                               Alice Wilson

graham.stewart@nhs.net                                                               alice.wilson@nhs.net

01387 244033                                                                                  01387 272789

What would make it safe for you?

If you feel safe to speak up that is really positive; in the last staff survey 57% of the staff who responded said they felt safe to raise concerns but that leaves 43% of the staff who responded who didn’t say they felt safe (Staff Survey return rate for the Board was 41%)

Tell us:

• What makes speaking up safe?
• What prevents you from speaking up

We’d like to hear from you, either directly or through someone else, if there are things we could do to help staff speak up

Alice Wilson is Deputy Nurse Director and Graham Stewart is Deputy Director of Finance at NHS Dumfries and Galloway

The QI Hub by Wendy Chambers

 

 

 

Wednesday 19th of April – Marks the official launch of The Quality Improvement Hub for Dumfries and Galloway

Our vision: To support health and social care staff to design and deliver services that better meet the changing needs and aspirations of people, families and communities that access care.

The purpose: Quality is everyone’s responsibility. We aim to build a culture where continuous improvement is the norm and develop a network to share resources, learn and work together, to make it easier to do the right thing at the right time, every time.

The QI Hub is a creative space where you can connect with others throughout health & social care, people with a passion to make a difference. Thinking space, away from the hustle & bustle that is daily life!! Come and find a supportive network of colleagues, share experiences and learning. Choose from a library of resources and practical tools to help structure your improvement projects and explore development and coaching opportunities.

Building capability and capacity to lead improvement is vital, it empowers people and teams to own change; one resource available is a locally delivered Scottish Improvement Skills Programme. To illustrate how this is already having impact Wendy Chambers, who has recently graduated from Cohort 1, shares her reflections.

3 lessons from Scottish Improvement Skills (SIS) in D&G

Having recently completed cohort 1 of the SIS course in Dumfries, with a project that hasn’t gone quite according to plan, I thought I’d share 3 things I’ve learned along the way.

Lesson 1 – I’m not alone

I’ve always been comfortable questioning my own clinical practice; to be honest I ask “why” and “how” about most things in life; it drives my other half, and now as a parent I can appreciate must have driven my parents, mad! For me though questioning things is a reason why I get out of bed in the morning and keeps my job interesting and challenging. But in my 20 plus years of clinical practice, in many different settings, I’m acutely aware that not everyone thinks as I do…. then came SIS.

I walked into a room, filled with 30 other people, on the first day of the course and I felt like I had arrived, I’d come home! These were my people, this was my tribe – we spoke the same language, had the same fire in our bellies and were comfortable with the “what if …” questions!

Being surrounded by similar and like minded people; learning from each other, sharing ideas, both the things that go well and the things that fail – I’ve come to appreciate that this support is essential to the process of implementing and testing change ideas. Because when I go back out into the real world, with all its pressures and realities, the natives won’t necessarily be as welcoming or receptive to my “bright ideas” and things won’t feel as cosy.  So now I won’t be alone, I’ve found my tribe, I’ve found support.

Lesson 2 – “Whose project is it anyway?”

The SIS course has given me an opportunity to consider and reflect on the process of implementing a change idea from conception through, in theory, to completion. And one of the fundamental pieces of learning for me has been – it’s all about the relationships; the people who I need to work with and who need to work together cohesively, in order to try things out.

None of us like, or take kindly, to being told what to do, regardless of how much positive evidence there may be that it’s the right thing to do. We all like to feel and be in control of our own destiny and decisions, try things out and discover for ourselves – and I’m no different from anyone else, in fact I’m possibly worse!

A change project idea that one person has come up with is exactly that – it’s their idea, their project.  It doesn’t, at that point, belong to the team for whom it is intended will be the “willing” guinea pigs to trial and develop the ideas. At that point it is “my project, not yours” and “your project, not mine”.

I’ve had the opportunity to reflect on my current and also previous projects, consider and question when I’ve done this well and a team has taken on board an idea and really owned it and made it their own and when it has most definitely remained my idea and no one else has bought in.
And my reflections go back to the relationships and the time that I have spent in this part of the process as a whole. And I realise that the time spent in the planning, alongside and with the others who will be involved and affected by the change idea is essential to the process, not the icing on the cake.

This isn’t new, or rocket science, any leadership book or workshop will include this – but we rarely have the luxury of “thinking space” to reflect on our learning.  And having a space, such as the SIS course, where failure is seen as valuable a part of learning as success has been enlightening, reassuring – it feels like home.

Lesson 3 – Skills

Apart from the thinking and reflection space the SIS course has also given me an opportunity to learn some real, practical skills and to relearn some old ones. I feel as if I now have a working toolbox of things which I can use and try out next time around, and every time around, when my next bright idea pops up.  I also have access to a whole tribe of people who can help me when I get stuck – which I will.

Old dogs, New tricks, nothing new under the sun.

But in the current health and social care climate things have never felt so uncertain, it’s all about change and innovation. We are all being expected to get comfortable in a world which is full of discomfort and will be constantly shifting. In this world my learning and reflection would be – get skilled, take time building relationships, find your tribe!

 

Wendy Chambers is  a Mental Health Occupational Therapist and AHP Practice Education Lead at NHS Dumfries and Galloway

The QI Hub is for you and your team and you’re invited to actively contribute. Your ideas, knowledge and experiences are crucial to ensure the hub provides what you want!

Join us on Wednesday 19^th April 2017, Conference Room, Crichton Hall. Programme and registration available by contacting Stevie.johnstone@nhs.net

QI Hub Development Team