Hiding in Plain Sight by Laura Shanahan

Have you noticed that your mum’s wedding ring is looser? Has your father started using a tighter notch on his belt? Do your clothes feel baggy? Are your dentures rattling? Why doesn’t your sister have as much energy? Has granddad been sleeping more? Think… could it be malnutrition? It was my granny Eileen, could it be yours?

People develop malnutrition (undernutrition) as a consequence of various physiological, psychological, socioeconomic and institutional factors such as COPD, Dementia, IBD, Depression, substance abuse and poverty. Malnutrition has serious consequences for a person’s quality of life if unidentified and untreated.

As part of Dietitian’s Week 2019 we are hoping to raise awareness of malnutrition, an often hidden or forgotten problem. Remember an overweight patient can be at high risk of malnutrition too.

Surely malnutrition is not a big problem for the developed world?

It may surprise you to know that it is a major clinical, public health and economic problem in the UK which is estimated to cost us £23.5 billion annually in part related to frequent hospital admissions, increased dependency, longer hospital stays, more GP visits and increased prescription costs (BAPEN, 2015). Malnutrition is common in hospitals, care homes and the community. It is estimated there are about 3 million people who are malnourished in the UK at any time with about 1.3 million being over the age of 65.

Follow the hyperlink to Lyn’s story which shows how malnutrition can affect anyone and can often be missed in those of us who are lonely or socially isolated:

https://www.youtube.com/watch?reload=9&v=f1ERiWm5aBA

Messages from our dietetic teams across NHS Dumfries and Galloway

Community Nutrition Support Dietetic Team

Diabetes Dietitians

 

Stephen has type 1 diabetes and Gastroparesis, he describes how he feels living with these conditions using the UWS Image cards. Stephen picked the following cards and explained his reasons for these choices

Stephen reflected that what makes a difference to him is the information provided in our locally produced leaflet ‘Gastroparesis, Diet and Diabetes’ which outlines the above advice in an easy to follow format as unfortunately there is very little information available online. http://hippo.citrix.dghealth.scot.nhs.uk/sorce/beacon/singlepageview.aspx?pii=264&row=1023231&SPVPrimaryMenu=5&SPVReferrer=Sitesearch

 

Renal Dietitian

The malnourished person with kidney disease is at risk of weight loss, metabolic acidosis, muscle wasting, frailty, increased infections and recurrent hospital admissions. In particular protein energy wasting (PEW), a state of metabolic and nutritional derangement is a major concern in patients with Chronic Kidney Disease (CKD) undergoing dialysis. This results in muscle wasting, with increased morbidity and mortality. It has serious consequences for a patient’s quality of life.

Within NHS Dumfries and Galloway, a specialist Renal Dietitian carries out a nutritional assessment of CKD patients at least 6 monthly. This is critical for the identification and management of PEW and is considered an integral part of care for patients. The purpose being to obtain, verify and interpret data needed to identify nutrition related problems, their causes and significance.

Acute Dietetic Team

What is on the Catering Dietitian’s menu?

There are simple steps we can take to try and help maintain and improve nutritional status for those at risk in the hospital setting.

1. Add the ‘Fortified’ Catering flag on Cortix in DGRI or mark the menu Fortified in Community Hospitals.
2. Offer snacks between meals
3. Offer milk with meals
4. Provide the ‘Food First’ leaflet from Beacon.

The ‘little and often’ approach is an old one, but tried and tested and for those experiencing poor appetite and early satiety this can aid recovery.

 

We don’t and we can’t manage this alone! The Dietetic department work alongside Speech and Language Therapy, Occupational Therapy, other Allied Health Care Professionals, Doctors, Nursing staff, Support Services, Catering, Carers and Patients. It takes a team approach to provide gold standard care! There are also some great community initiatives too such as assisted shopping, meals on wheels, lunch clubs, food banks and many more…

 

What can you do to better tackle the issue?

Nutritional screening should be an integral, embedded part of assessments in our organisation. A MUST (Malnutrition Universal Screening Tool) for every patient!

For more information and useful resources visit Beacon; Teams; Food, Fluid and Nutritional Care. If you think that you or your staff would benefit from MUST training or further education on managing malnutrition please get in contact.

If you are concerned that you, or someone you are caring for may be malnourished speak with your GP or Healthcare Professional. BAPEN offers a free self screening tool you can use at home – https://www.malnutritionselfscreening.org/self-screening.html

Useful food first approach resources which can assist with the first line management of malnutrition:

https://www.malnutritionpathway.co.uk

https://www.bda.uk.com/foodfacts/MalnutritionFactSheet.pdf

If you’d like to know more, please do get in touch with us: laura.shanahan@nhs.net​

Laura Shanahan is an Acute Dietitian at Dumfries and Galloway Royal Infirmary

The Misfits by Murray Glaister

The incomplete unreliable yet occasionally accurate tale of The Misfits

Today.   Press ▶

As the sounds of “the liberty bell’ fade into the dark recesses of the mind.

At High Noon assorted willing volunteers will be lining up to face glory…

or doom.

Varied we are. Common in one purpose. Under the same banner. Ours is not the fight for freedom. Our team motto is” what the heck are we doing here”

And then it will start. Who knows what the next four hours will entail. What horrors and adversity, what drama and pain.

And I say yea hey what’s going on….

 

 

What’s going on is that an assembly of NHS workers (not officially representing the NHS to be clear), actually assembly is wrong, there is an expectation or order inherent in the term assembly.

What is the collective noun for a group of NHS workers? A swift google took me here

And it emerges there isn’t one, although I liked the flamboyance of flamingos.

So anyway, getting back on track, a flamboyance of friends of the NHS were assembling in a non-organised unstructured manner at Maryfield at the eleventh hour on the eleventh day of May to take part in “It’s a Knockout”

During our comprehensive briefing session, we had…

• Agreed where Maryfield was – apparently playing fields were behind Gilbrae and the new Baptist Church (but not accessed from there).
• Agreed on a range of appropriate themes for the team outfit – although left each individual member of the team to pick one of the varied selections offered.
• Agreed that the availability of alcohol at the event was something that, at a purely hypothetical level, may be considered.
• Agreed that the day wouldn’t end at the completion of the event.

It’s probably time to name, names, in alphabetical order, Alastair Murgatroyd, Gordon Loughran, Isla English, Jack Wilson-Green, Jemma Bowman, Ken Donaldson, Linda Bunney, Mark Young, Martin Conquer and Murray Glaister.

The first task was getting the gazebo up, this turned out to be the second, as the first was getting Alastair to tone down his enthusiasm and energy levels just a smidge. The gazebo was duly erected with minimal bits of plastic pinging off in random directions, and filled with out assorted “Stuff”.

The next challenge was registering, and coming up with a team name, somehow “The Misfits” seemed suitably appropriate.

Our tasks for the morning completed, at High Noon the event would start properly. We all choose our separate ways to relax and de-stress. You’ve seen the films where a group of people prepare for the off, possibly on a landing craft, or on an aeroplane to somewhere. The camera slowly pans across the various actors faces as they do things to fill the time before the oncoming onslaught. Although this time there was no adjusting parachute straps or sharpening knives. There was some writing letters home to loved ones, but todays’ text message equivalent was somehow less poignant.

The sounds of distant battle, as on stage the sound system is set-up. After the usual “testing, testing, one, one two, one two, routine” it started playing some ‘Motivational’ music. I can’t remember if they played ‘Eye of the Tiger’ but it was that sort of stuff.

Then we were called to the stage and lined up in teams, nerves flashing across everyone’s face, and nervous laughter fought a losing battle with the music.

Alastair was our team captain, by a ten vote to nil election result that shows a lever of confidence and support that few leaders have achieved since the Polit Bureau elections; well, he was Superman.

Introduction, briefing, motivational talk, reminder that we were there to raise money for cash for kids and most importantly to have fun. (We all said a silent prayer, adding survival).

There was a run through the six events, with a practised ease that speaks of trained athletes whose skills have been honed by years of training. And then it was out turn.

I’m sure that each event had a proper name, but they all involved a collection of inflatables, soapy water hula hoops and laughter.

Each team member was a star in their own right, and this is where I run the risk of upsetting everyone, these are my personal thoughts and no one else is to blame.

• Alastair – his role as captain meant he was first to try everything. He won key points in the boys dancing category. The photo of him celebrating a successful hula hoop throw was the image of the event.
• Gordon – missed the first few events but when he arrived he brought unique skills and distractional motivation to the team.
• Isla – falling off the space hopper was a ploy to show just how good a team we were as we finished the race far enough ahead to have another lap and still beat the rest of the field.
• Jack – belying his preparation being to buy some training shoes (deck shoes), and looking like he was just passing on the way to his yacht. Turned out to have some nifty hoop skills.
• Jemma – she was a star throughout and won points for the best girls dancing, admittedly with a very different dancing style from Alastair.
• Ken – made a point of losing some key tiebreaks to keep the other teams interested. His oft quoted line “am I really doing this” reflected the team’s motto well.*
• Linda – double ran in the Bounce jump race to demoralise the opposition.
• Mark – with previous experience showed he knew what was going on, his Synchronised swimming display at the end was the envy of other teams.
• Martin – another solid performance, scoring well in most events, bringing on his dig gave Alastair someone to burn his energy off with in the downtime between events.
• Murray – he was there too

*(I only lost one tiebreak, Ken)

And then it was over, the last race was run (or swum). The judges retired to assess the scores and we milled about drying off and thanking our deity of choice that we’d survived……..

They said prizes for top three, and we were confident that we were there or thereabouts, so we had a chance of a certificate at least.

It wasn’t to be third place as it happened, two second places were announced, so we were confident we were one of those (this wasn’t the time to discuss that with two second places, the third place was at least a fourth place). Sadly we were dashed there as well. Every failed hula hoop throw coming back to haunt us.

Being honest here, other team names were announced and if I was paying attention I would have told you who they were, but they hadn’t said Misfits and that was the only name I was waiting to hear.

To much jubilation, some shock and overwhelming hilarity, they mentioned the misfits next, after the words “And the winners are…”

I would like to say how calm and graceful we all were in accepting our certificates, winner’s medals, trophy and a dignified half smile betraying the modicum of pleasure we shared at this news. The scenes of dancing about in wild abandoned jubilation had no place at the end of a strange afternoon’s competition.

There’s a video somewhere of Alastair’s doing the basketball thing, he is last to leave the half way point and miles behind as they near the final challenge. In the last seconds, in one graceful movement, he throws, scores, catches, turns, plants the ball and raises arms aloft to claim victory before anyone else realised what had happened.

Nicely echoing Mo Salah’s T-Shirt “Never Give up”, which should have been out team motto.

Final words, we raised money for cash for kids, we survived, and we did kinda have fun.

 

The rest of the celebration, being last to leave the field and what happened next, are best left to another story

Murray Glaister is a Misfit

17 boxes of tea bags by Fionnuala Edgar

My mother died on the 4^th July 2014.  She was the matriarch of our family, the one who held us all together and within five short weeks she had been diagnosed with an aggressive, cancerous tumour which had metastasised  in her liver and she was gone.  There then followed the traditional Irish wake and funeral.  Three full days of everyone who had ever met ‘Mammy’ came to the house to pay their respects.  In Irish tradition, the coffin is returned to the family home and open for the duration of the wake.  My sisters, brother and Dad had a crash course in etiquette, including ensuring all the proper traditions were met –having people stay up all night with the body (a queue formed for this duty); having the ‘right’ candles (thank goodness for aunties in the know) and making all the decisions for the funeral which was held directly after the wake.  Food started to come in from everywhere; sandwiches were being made the length and breadth of the country and cousins and friends were jostling for tea-making duties in the kitchen.  A conveyor belt food preparation area was set up in the utility room and a make shift break out eating space was set up in my aunt’s house next door.

 

A recent episode of Derry Girls gives a good indication of this system with Da Gerry turning into a militant sandwich maker – not at all far from the truth, it has to be said. My (Scottish) husband spent most of the three days in utter bemusement and breaking with tradition by entering the female dominated kitchen space and daring to try to help! Alongside the tea making and the sandwich eating was the constant retelling of ‘what happened’ over and over the same story, how and when Mam was diagnosed, her rapid decline overnight and the frantic phonecalls to try to get my sister home from England in time – which she did, thankfully. After the funeral, I counted 17 boxes of tea-bags left over from the wake; an indication of the volume of people coming through the house and the fact that few attended empty handed.

Six months later, a close friend of mine in Dumfries sadly lost her father very suddenly.  In Ireland, I could have started the sandwich making or rolled up my sleeves and been on tea or dishes duty but I was at a loss.  I rang a mutual friend to ask, ‘what do I do?’; her reply ‘do what you normally would do’. So I went to the shop, bought milk and, yes, tea bags and made scones.  When I arrived at my friend’s mother’s house, her mother was there with just two other family members.  I took my bag of provisions into the kitchen, gave her a hug, had a brief chat and left.  The funeral was held two weeks later and I helped by looking after my friend’s baby twins whilst she went to the funeral.

The cultural differences between our experiences were stark but after the funerals one reality remained.  We had both lost a parent and now were left to grieve. On one hand, the Irish experience and the ‘re-telling’ may enable us to process the circumstances of the loss; particularly if sudden or traumatic , much in the same way as therapeutic re-processing; an integral process in Trauma Focused Cognitive Behavioural Therapy to treat PTSD or traumatic grief. On the other hand, the initial over whelming outpouring of support results in a, possible, assumption that people have ‘done their bit’ and subsequently, post the funeral, life goes on.  More than one person said to me after the funeral, ‘That’s the hard bit done’ but for me, I didn’t want everyone to leave because now we as a family had to face the reality of life without Mam.

 

What I thought I knew about bereavement, prior to my personal experience, has changed.  I recognise that our cultural expectation that we, ‘get over’ or, ‘come to terms with’ a loss is, ultimately, unhelpful.  More helpful is to consider that grief is akin to love.  We will grieve for as long as we have loved that person and for many of us that will be a lifetime.  That’s not to say that we will constantly experience those raw states of grief but that it will hit us, unexpectedly and we can be pulled from our normal state of functioning right back into the overwhelming sadness that we most likely experienced on a daily basis in the first days and weeks after a loss.  We should allow this to happen and as a society we should encourage expressions of grief and loss.  I often say to my patients, we could learn a thing or two from other cultures; the representation of grief with howling and sobbing and throwing hands in the air.  We, on the other hand, often talk about how ‘well’ someone is doing when they are not crying or upset.  ‘You are so strong’, one of my mam’s best friends said to me.  I wasn’t strong.  I was holding it together for the sake of my Dad and my siblings when all I wanted to do was howl and weep.

A recent Twitter post encapsulated grief as like a ball in a box with a pain button.  At the beginning, the ball is as big as the box and hits the pain button constantly.  As time goes by, the ball gets smaller but can still hit the pain button unexpectedly; but with the same ferocity.

 

This is one of the best analogies of grief that I have read and well worth a view:

 

https://www.boredpanda.com/ball-in-box-analogy-dealing-with-loss/

 

So as we come to the end of ‘Good Death Week’ it is important to be reminded that grief is not a mental health problem but a normal, human experience and the more we talk about it the more our society can begin to see it that way.  Let’s talk about death and dying and support one another in being open about our emotional responses to loss and recognising that the suppression of these normal responses is often what leads to the development of a chronic issue that can result in mental health difficulties.

And finally, remember that love and grief are partners, for if we have never loved we would never grieve. As Elisabeth Kubler-Ross so aptly puts it:

 

“The reality is that you will grieve forever. You will not ‘get over’ the loss of a loved one; you will learn to live with it. You will heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to.”

 

NES’ Supporting Scottish Grief & Bereavement Care Workstream has launched its first Annual Report which provides a summary of key achievements in 2018–19
Read the report to learn more about:

• The vision / mission of the workstream
• NES’ bereavement-related educational resources, produced with input from over 100 subject and clinical experts
• The number of learners who have accessed these training materials (on or via our website), e.g.
  • Suite of short animated films which has garnered > 27,000 views
  • Support around Death website which has attracted > 15,300 users across 100 countries
• Activities planned for 2019-20

Fionnuala Edgar is a Senior Clinical Psychologist for the Older Adults Psychology Service at NHS Dumfries and Galloway

Values Based Reflective Practice – VBRP® by Dawn Allan

Some staff may be familiar with the letters VBRP^® and some will have no idea what they mean.  I hope this blog will generate interest in Values Based Reflective Practice a tool owned by NHS National Education for Scotland, developed eight years ago to support health and social care staff to recognise and value their personal and professional value.  The VBRP^® national handbook states –

“Models of reflection abound within the caring professions but most value the work and the quality of the work over the worker.  One of the distinctive hallmarks of VBRP^® is that it values the worker who does the work and begins not by asking ‘what do you do?’ but rather ‘why do you do what you do?’ In other words, it takes as its starting point not what happened in the care setting in the recent past, but rather what motivates and drives the worker to come to work in the first place.’

VBRP^® is one of many helpful tools but the difference between other ways of reflecting either at work or about work that VBRP^® offers is the way it enables people to bridge their reflections back to actual practice.  In group reflection there is equity of learning in the listening and learning in the sharing of experiences of six or more trusted people who don’t have to work with each other to reflect safely and benefit together.

Health and social care staff are human, not-superhuman and we experience similar feelings and experiences during our working lives which may include self doubt, lack of trust, condemnation or harsh judgement from others that can cause us to feel our capabilities, competencies and skills are undermined or questioned.  Some staff may suggest, “if it ain’t broke, why fix it”?  I’d respond with, “ the risk of carrying on regardless without taking time out to reflect safely is not worth the risk when things DO go wrong, not only in the lives of patients and service users but staff lives can be affected, sometimes long term.  Prevention is the wisest approach to staff wellbeing, not waiting until something or someone is so broken they either leave their job or worse…”   VBRP^® can help provide a compassionate, safe, person centred, ‘belts and braces’ approach to caring and valuing each other enough to seek out regular moments and times to reflect about work which may help us become more resilient.  We’re human beings first and foremost – what our work identity badges describe is not a description of who we are.  What we do all have in common is our humanity.  What made you want to be whatever your identity badge describes as your job?

Have you ever wondered what makes you tick?  VBRP^® motivates staff by asking us to reflect on the ‘nugget of gold’ in the jobs that we do.  At root, these questions are all about the relationship between soul (motivation) and role (what we are required to do).

In a typical half hour VBRP^® group session, one person shares an event and the rest of the group listen and then, in an almost, rhetorical style, framed within the NAVVY explore the event with questions and comments to the person including the words, Notice/Needs, Abilities, Values,  Voices, YOU.  This is the chance for the group to explore the event from a values perspective which promotes a person centred approach.  A group need to make sense of how listening to an event may have made them feel as they listened and they gently, respectfully explore it by stating what they see and heard with noticing and wondering questions and comments.  i.e. “I noticed when you spoke, you looked troubled…”, “I’m wondering why you were on your own in the situation…”, “I wonder if another colleague’s voice had been heard how that might have changed things…” etc.  The person usually waits to respond until everyone has commented on the event.  A good facilitator will ensure any questions that need clarifying for the group are responded to by the person who shared the event.  VBRP^® is not an attempt ‘to fix’ or counsel a person or the historical event, the group will have all noticed different visible and audible things to comment on.  This works well within a group who may have reflected several times together and who trust each other.

The power of a multi-disciplinary group of people listening, noticing, wondering and responding to an event shared by one person acts as filtering process for the person to reflect on.  Sometimes there is an immediate, ‘light bulb’ moment via a comment or question offered that resonates and helps them through the responses of the group to recognise the ‘nugget of gold’ in their work or they may realise it later on after a VBRP^® session.  This ‘light bulb’ moment of realisation enables a person to ‘bridge back to practice’ i.e. take what they discover and learn in or after a VBRP^® session back to work, to imbed the present learning in their role/work/team/committee.  It is this outcome that benefits all staff who participates either as the person who shares an event or as one of the reflective, group members.

Some positive benefits and outcomes after a VBRP^® session expressed by staff are:

“It was cathartic”, “encouraging”, “enlightening”, “humbling”, “simply powerful”, “I don’t feel so guilty, I thought it was my fault…”, “It helped to hear everyone’s responses”, “I hadn’t thought about it that way,” “I didn’t realise I communicated so negatively…” it can help…

• as a sifting process for decision making
• reduce over-thinking
• reach acceptance nothing more could have been done and move on
• to start something fresh and new
• lower excess stress levels
• build trust in a department/team/ward rounds
• raise levels of transparency and honesty
• adapt/improve communication
• improve clinical practice with patients
• with general staff wellbeing and raise confidence at work
• know how best to respond to concerns/complaints and feedback
• encourage compassionate leadership
• share best practice in a safe space
• know how to plan training in education
• remind you that you are not alone
• as group clinical supervision for nurses and re-evaluation
• raise emotional intelligence and self awareness

 

VBRP^® is not the ‘holy grail’ but a safe and protected way for health and social care staff to reflect and it reminds us all to attend to our wellbeing more intentionally at work.  Sometimes just taking a few minutes after a meeting or a situation of bereavement, trauma, disappointment or shock to reflect using a pack of Envision cards can create a safe space e.g. each person picks a card to express how they feel about an event/situation and does not tell anyone why they chose their card.  Colleagues reflect in pairs by exploring, commenting and enquiring about what they notice and wonder about each other’s cards, without trying to interpret, work out why, fix or rescue.  These few minutes can encourage a ‘light bulb’ moment to support each other to breathe and bridge reflective learning in the present about an event/situation to effect positive change in future practice and wellbeing.

We don’t need the ‘wisdom of Solomon’ to recognise health and social care staff have a shared responsibility to help create safer working environments for each other, patients and service users.  An increase in the dosage of compassion and psychological safety at work also helps.  VBRP^® is a tool that can provide a regular safe space, to reflect on past events that may be about patient safety or our own safety or practice.  As the handbook states, “VBRP^® is about the re-humanising of health and social care through the recovery of, and dialogue between, personal and organisational vocation”.

You can learn more about VBRP^® here.

Dawn Allan is the Spiritual Care Lead for NHS Dumfries and Galloway

Sticks and Stones may break my bones: 40 years of Women’s Aid in Dumfries & Stewartry by Catherine Nesbitt

In 1979, a group of four women in Dumfries recognised the need for a local service to support women experiencing domestic abuse.  Determined to do something about it, they acquired a small room in Irish Street and paid from their own pockets to have a single phone line installed.  They manned this helpline between the four of them and began supporting women to leave abusive relationships by taking them into their own homes.  Two years later, in 1981, they received their first funding from the local Council and their first refuge opened.  It had eight beds, and all of them were filled by the end of the first week!  Since then, eight beds have multiplied into 17 flats and houses.  The staff team has expanded and now includes a team of workers supporting families in the refuges, a team of outreach workers supporting women in the community and a team of specialist children’s workers.

This year, Dumfries & Stewartry Women’s Aid will celebrate its 40th birthday!  They want to mark this milestone with a number of activities to raise awareness, to remember the families they have supported and to celebrate as a proud staff team.  Keep your eyes out for their events because I’ve heard those ladies can party with the best of them!

But this celebration also has a sombre side. Four decades on, their refuge beds are still as full as the first week they opened.  Their outreach services continue to be in such demand that there are often waiting lists to access their support.  The problem of domestic abuse is as prevalent as ever and shows little sign of reducing.  The support and awareness of the issue has improved over 40 years, but the problem hasn’t really changed at all.

‘Names CAN hurt me’

Women’s Aid is delighted that their 40^th birthday coincides with a change in domestic abuse legislation in Scotland.  From April 2019, the more subtle psychological side of domestic abuse (‘coercive control’) has finally been made a criminal offence by the Scottish Parliament.

The new legislation defines behaviour as abusive or coercive where it is intended to:

• Make a partner feel dependent on or subordinate to the abuser
• Isolate the partner from friends, relatives or other sources of support
• Control, regulate or monitor a partner’s day-to-day activities
• Deprive or restrict a partner in their freedom or choices
• Frighten, humiliate, degrade or punish a partner.

Services report that this kind of abuse is more common than physical violence.  Families report it is much harder to endure than physical abuse.  To really understand how dangerous it can be, you might be surprised to hear that perpetrators who show extreme forms of coercive control are more likely to eventually kill their partner than perpetrators with a history of physical abuse.  In 2017, the Suzy Lamplugh Trust reported that coercive control was a significant factor in 92% of domestic homicide cases in the UK.  The risk to the victim is especially high when they are trying to leave controlling relationships.  This is why security around the Women’s Aid buildings is so tight and why their support of families is so important.

Women’s Aid already support families who suffer this form of abuse and the new law is unlikely to change their work dramatically, but it does help them in raising awareness of this issue.  Many people continue to perceive domestic abuse as only being physical; believing that as long as partners aren’t “battered” it isn’t really abuse.  This new law at least gives a clearer legal message that this isn’t the case.  It continues to be a long road ahead to improve the number of relationships which feature these traits, but having it legally recognised is a step in the right direction.

Domestic Abuse and the NHS

Do you know how much domestic abuse costs the NHS? I didn’t until recently.

The official answer is that treating the physical injuries caused by domestic abuse is estimated as costing the NHS £1.2 billion every year.

But that doesn’t include the cost of treating the trauma and emotional difficulties, from current and historic abuse, for adults and children affected (including the impact of coercive control).

It also doesn’t include the cost of stress, absence and reduced productivity of NHS staff who experience domestic abuse in their personal lives.

Put simply, domestic abuse is a big problem for the NHS, not just in treating the victims but in supporting employees who are suffering from it too.

Most of us would assume that Women’s Aid, Social Work and the Police will come into the most contact with people affected by domestic abuse.  But that’s not strictly true.  Those organisations only really encounter them at times of crisis.  The NHS on the other hand supports them 24 hours a day, 365 days a year for their entire lives.  We support them with their coughs and colds, their vaccinations, their cancer screenings, the birth of their children, their dental check-ups, attend to their mental health and we treat them when they are injured or ill.  But on most of these occasions, we may be completely oblivious to what is happening to them when they leave us to go home.  And yet, what happens to them at home affects their health.

We also don’t tend to talk about the perpetrators, yet we treat and support them too.  This group of our patients worries me enormously, especially because I work with young people.  A number of the young people I work with who have experienced domestic abuse will go on to treat others the same way.  People who feel compelled to treat their nearest and dearest in ways which demean, humiliate, control or physically harm them are not happy or well people.  I often wonder how we might best help them too.  This is one of the reasons I am such an advocate of Women’s Aid and particularly the work they do with children.  Changing the lives of children who have witnessed and raising awareness in schools of what abuse is may prevent it happening for them as adults and is probably one of the best solutions to the problem.

Partnership with Agencies

So what are Women’s Aid’s hopes for the next 40 years?

The simple answer is, ‘Eradicating domestic abuse locally and acknowledging this can only be done in partnership with local agencies who have a stake in the problem.’

Their first steps towards this aim began in 2017 by recruiting new Directors to the Board of Women’s Aid.  Each Director was selected to represent a particular organisation which is central to the work of Women’s Aid.  I am the representative for Health.  Directors are tasked with trying to improve the partnership between their respective services and Women’s Aid and responding to issues that arise.  When things go wrong, the Board tries to understand how a particular issue might have happened using the knowledge Directors have of their own organisations. (You would be amazed how differently services do things and how complicated this can get!)  But we also take concerns back to our organisations with the hope of figuring out a solution.  This is slightly easier for some of our Directors than for others.  (For example, when concerns are shared with Police Scotland by their Retired Superintendant, he knows who to approach and they are usually eager to listen.  The same can’t always be said for the rest of us Directors.)

I get to hear about amazing practice by Health which we want to be able to share within the organisation.  But I also get to hear alarming things too.  After serious incidents, I have been struck by how intimately we NHS staff are involved in the dangerous lives of vulnerable people and how easily we put them at greater risk… but usually without knowing it.  This is something Women’s Aid hopes to improve if we are to change the face of domestic abuse.  If we can do this, we not only serve our patients better, but it also impacts positively on our services and our staff.

So this was my way of saying “Hello!  NHS Dumfries & Galloway has a representative on the Board of Women’s Aid, and it’s me!”  It may be that some of you have already heard from me.  It may be that some of you will in future.  I don’t always know how to find the right people so bear with me if I email you to ask where to go!  And I really want you to know that it’s not about me sharing information from Women’s Aid; my role is also to take information back from Health which might improve how we work together to solve this enormous issue.

Who knows what we might achieve in the next 40 years if we pull together?

Happy Birthday Women’s Aid!

Catherine Nesbitt is a Clinical Psychologist and Health Representative on the Board of Women’s Aid.