An Uncertain Future by Ken Donaldson

Well, that’s been an interesting few months, hasn’t it!! We all watched with fascination as Covid spread across the Globe – China first then Italy and Spain – before it hit our shores and started creeping towards Dumfries and Galloway.  Everything changed. We were told to stay at home, avoid loved ones we didn’t live with, only go out if necessary and our work was transformed. Many people had to ‘Shield’ at home and could no longer work. Those still coming in found their working day turned on its head; perhaps completely new duties or sitting in front of a screen all day. But there was one thing I am pretty sure was felt by everyone; fear.

I was terrified. Terrified of how many people were going to get sick, terrified of how many may die, terrified for our frontline staff who were putting their lives at risk. I was also terrified for my own family and loved ones and, whilst this may sound selfish, I was terrified that I would fail in my job. This felt like a big test of leadership. Was I up to the task? Was D&G at risk because I was about to fail.  Many sleepless nights followed.

However it all looks different now. We have survived the first peak of Covid and, in general, we have gotten off fairly lightly. Our colleagues in the Critical Care Unit and Care Homes may disagree as those two areas have experienced a significant impact from the disease but, as a region, the numbers were nowhere near what we expected and whilst this may be down to our rurality it also reflects how all of us have adhered to social distancing and isolation and stopped the spread.

So what happens now? Lockdown restrictions will start to ease, people will be out an about and there is the strong possibility of a second wave. However there is no doubt that we are much more prepared for that and have systems in place to deal with it should it come. But social distancing is here for some time and we all need to think how we are going to deliver our services for the people of D&G in this uncertain future.

Things have changed and one message I would like to share today is that we cannot go back to what we had before. It quite simply wasn’t working and if we have demonstrated anything in the past 3 months it is that we can deliver healthcare in 2020 in a very different and more efficient way. We don’t need face to face consultations all the time, we don’t need to admit so many people to hospital, we don’t need lots of different steps before a patient interacts with the professional they need to.

There was one other noticeable change when all this kicked off; we all pulled together like never before. Many petty differences which had prevented progress vanished. People reached out to help each other (virtually or 2m apart, of course!) and it was obvious that we genuinely cared about our colleagues. There was really no need to use the phrase ‘We are all in this together’ because we all inherently knew that was the case.

So while the dust settles and we look around at the ‘New Normal’ let us not go back to what we did before. Let us embrace new ways of working and talk to our colleagues about how we do it together. Let us do the right thing for our population.

“A crisis can create an opportunity to learn and build a better way forward. The system that will emerge on the other side of the crisis is shaped by those leaders who are able to harness the potential in the moment and galvanise others to act.”

John Sturrock 2019

Ken Donaldson is Executive Board Medical Director for NHS Dumfries and Galloway

With thanks to Charles Mackesy for the image.

 

 

 

A Dance called America by Euan MacLeod

Those of you who are fans of Runrig will no doubt recognise the title, a song about leaving familiar places and being moved to new places with all that entails.

This is the story of the end of an era, the breaking up of a team, a family, a tribe

This is the story of the staff and patients who were Glencairn Intermediate Care Ward at  Midpark.

Glencairn wasn’t just a ward, for some it was family

It was life

Activity

Joy

And sorrow

It was a great gathering of many people

Of many skills and talents

Of people seeking to make a difference

Of hope

Of recovery

Of dignity

Along came COVID 19

Tuesday 31 March it began

The news that Glencairn would be no more

We had 3 days

18 members of staff

And the lives of 11 patients in our hands

“This will test the team more than it has ever been tested”

11 patients to find new homes

By Friday we would all be somewhere else

Our job was to let these patients (People) know where they would find a new home, a place to be, a place that would give them safety, care and support

We had a job to do, we needed to take great care to ensure their lives faced the least disruption in moving to their new homes

Of course we wondered if we could achieve that, how would they react to the news

The people we looked after had their own stories of their lives lived so far in Glencairn, some reacted, as you might expect with shock and expressed this in their own ways, ways we knew they would because we knew them

But them knowing us I think allowed them the space to react in their own ways safe in the knowledge that they were in safe hands, that we would do the best we could to get them to their new home

Ours was a strong team, like most teams we did not always agree , but we did always strive to deliver the care that people deserved, to work together to deliver outcomes that recognised patients as people and treated them with dignity, respect and an appreciation of our shared humanity.

Some staff have likened the experience of working in Glencairn as being akin to that of a family, families are places you are born into, places you have a blood bond with and a familiarity, I much prefer to think of it as belonging to a tribe.

Tribes are places where you work with like minded individuals with a purpose and a common goal, that raison d’etre was what carried us through those 3 days, the belief that we were being called to deliver an outcome without questioning the reasons why but merely to exercise our duty of care to the patients and our colleagues. Post mortem and why would all come later but for now we were on our game.

What follows is now a period of uncertainty and this is what COVID 19 has brought us, challenging  times where we are being called to join with others in continuing to deliver high quality person centred care whilst wrestling with the personal uncertainty that brings for the future.

Glencairn may rise again like the phoenix from the ashes and we may all re-join that tribe, we will be different individuals with more stories to bring to the tribe, more experiences.

It may be that we do not re-join that tribe but help to create other tribes in the places to which we have gone.

That story remains to be told……………..

Euan MacLeod is a Charge Nurse on Balcary (IPCU) at Midpark hospital, Dumfries.

NHS Near Me our new indispensable service by Ruth Griffith & Chris Fyles

As part of the Coronavirus resilience planning the Scottish Government has made the roll-out and use of NHS Near Me a national priority. To support this they have issued guidance for each the 3 key settings – primary care, outpatients and inpatients. NHS Near Me is a new service which uses the platform Attend Anywhere to facilitate video consultations

In December 2019 NHS Dumfries and Galloway launched NHS Near Me. NHS Near Me is a service that enables people to attend appointments by video from home or a location nearer home. Initially the service was for return outpatient appointments starting with clinics run by Diabetes, Rheumatology, Respiratory, Renal, Speech and Language Therapy and Psychological services. The plan was to over time increase this to include other clinical services.

Since mid March we have been working to rapidly expand NHS Near Me so that all services can offer video consultations. In just three weeks there was a 49% increase in the number of waiting areas set up.

Since this scale up work started there has been a significant upward trend in the number of video consultations that have taken place

Prior to the Covid-19 pandemic Dumfries and Galloway, like the majority of areas in Scotland were working to introduce the use of video consultations. Since the scale up started our numbers of appointments are now above the national average as the graph below shows.

We’ve gone from this…

to this…

and we have our own train (bear with us here) that anyone who wants to use NHS Near Me will need to take a short journey on… the Near Me Train(ing) page which is found at http://www.dghscp.co.uk/nearmetrain

Video consultations offer a number of benefits. They can make health and social care more accessible; reduce travel time for people who use and deliver care and support; reduce levels of inconvenience; reduce levels of anxiety; reduce the spread of infectious diseases; encourage self-management; and ensure resources are used more efficiently and effectively.

Video consultations are not intended to replace telephone or face to face appointments but to offer another way for people to access appointments.

During the Covid-19 pandemic appointments using NHS Near Me have proved to be invaluable. To reduce the spread of infection face to face appointments have obviously had to be significantly scaled back and being able to offer video consultations has meant that where the phone has not been sufficient essential health appointments can continue to be offered. Over the last number of weeks as the use of video consultations has increased it is becoming evident that this has helped to increase capacity in services.
One of the positives that has emerged from the Covid-19 pandemic is how beneficial technology can be to enable us to connect with family and friends, access information, support with education, provide entertainment, do shopping, and work remotely. On a daily basis the media are sharing stories of new and innovative ways that people are using digital technology to stay connected with family and friends.

In health and social care we have known for some time now that using digital technology has the potential to make the best possible use of our much stretched resources, ensure our services are sustainable for the future and, most important deliver better outcomes for people. But we have been slow to embrace technology into the way we do things probably if we are honest because we don’t like change and are very comfortable with the way we have always done things!

And yet during the Covid-19 pandemic we have been faced with unprecedented and rapid change. Changes have been occurring daily and sometimes even hourly and people delivering health and care services have risen to this and demonstrated that great things can come from moving outside our comfort zones. In a very short time we have demonstrated that NHS Near Me is an invaluable tool and the challenge for us now is continuing to use it after Covid-19 and recognise it as a new way of working, that can help sustain health and social care services.

As we emerge from the metaphorical tunnel of Covid-19 we need to reflect on the lessons we have learnt during this exceptional and challenging time as we approach the next leg of our journey. We have made a significant positive shift in our approach to using digital technology in health and social care and this needs to continue so that it becomes the new normal rather than us all returning to our previous ways of working. So book your seat and hop on board the TEC train while we lay down new track for the future.

“The secret of change is to focus all of your energy, not on fighting the old, but on building the new.” (Socrates)

Ruth Griffith is Strategic Planning and Commissioning Manager and Chris Fyles is Technology Enabled Care Lead for Dumfries and Galloway Health and Social Care Partnership.

 

Occupation During ‘Lockdown’ by Karen Robertson

I am a Community Occupational Therapist for children, young people and families and have been for nearly 18 years since qualifying.   I have the luxury of being part of a fantastic Occupational Therapy and wider AHP team.  In recent years I have focussed more on supporting the early intervention service, alongside brilliant AHP colleagues.  Due to working in rural D&G, I also retain a wide caseload, continuing to support children across our region with a range of challenges in achieving their occupational goals. 

‘Occupational goals’.  ‘What does that mean?’ you may well ask!  Over my career I have ebbed and flowed through a journey of becoming more comfortable with and concisely defining occupational therapy.  With ‘occupation’ being at the core of theoretical underpinnings of our profession, The Royal College of Occupational Therapy promotes the frequent use of the term.  This aims to help us as Occupational Therapists and therefore our colleagues and clients to become more familiar with it.  While society perhaps identifies with ‘occupation’ as being one’s livelihood, it is more widely understood as ‘how one occupies one’s time’.  This is in relation to our roles, routines and activities which make up and add meaning to our individual lives.  As an Occupational Therapist, my role is to ‘enable occupation’ for a person in a holistic client-centred sense taking into account what they need to be able to do, and what they would like to be able to do across their work, leisure and self care.  Occupational challenges can arise for many reasons; whether it be due to injury, poor health, neurological, cognitive, physical and/or sensory impairment(s).  This can result in a loss of, or difficulties in developing a skill to enable participation in and achievement in occupations.

During the last month at a time when our world is experiencing such disruption, I can honestly say, I have never related more to the importance of occupation and therefore the very underpinnings of my profession more!  Through posts on social media and from conversations (at a four-meter distance) I have noted common themes in peoples’ responses to their individual ‘Lockdown’ situations with its impact on daily lives and occupations.

Firstly came the significant impact on all of our work related occupations.  Whether on the frontline contributing to the stringent planning and preparation for ‘the surge’ of potential incoming patients; perhaps you have found yourself busier than ever.  Perhaps like myself and our team who have been busy adapting our working practice to ensure we can continue to provide the essential parts of our service safely.  For example, with the support of TEC and Patient Focussed Booking we can now offer therapeutic assessment and intervention using NHS Near Me for some of our most vulnerable children and families.  Our teams are again ready to demonstrate more flexibility and adaptation in the face of uncertainty as we ready for deployment to support other more in-need services.  Then there are those who are unable to engage with typical schooling or working if it is not considered ‘essential’ or possible to do while social distancing. People have understandably expressed concern about financial security.  As time progresses, it is clear that the changes to peoples working lives are impacting significantly on wider factors, such as our sense of meaning, achievement and contentment.  This can be understood as ‘occupational deprivation’ defined as ‘a state in which people are precluded from opportunities to engage in occupations of meaning due to factors outside their control’.  However, as humans we have used our flexibility, innovation and creativity, to think laterally and enable our own work occupations to move forward as best we can.  Some may have lost one role while taking on another such as ‘home schooling’ or caring for an older family member or neighbour or perhaps juggling both from home!

As people settle into their new (albeit temporary) routines and habits, many are looking to pass time, and/or relax and distract themselves from the enormity of the situation and are reconnecting with past or new leisure occupations.  The hoards of wonderful social media posts of reading, gardening, DIY, art, and music to name a few.  As an Occupational Therapist for Children, it would be remiss of me not to mention the several fantastic examples of parents/carers supporting children to accomplish new occupations such as tying their shoe-laces, making cardboard models and online science experiments.  Children are also building invaluable self-care skills while helping parents with cooking, baking and even delivering lambs on their farms!  This joy of sharing occupational knowledge and experience in my opinion is extremely valuable and will result in tremendous learning as well as bringing people together during this challenging time.

The therapeutic value of occupation and our human nature to turn to it to instil sense of purpose, accomplishment, relaxation and distraction is quite clear.  A question on my mind however, is that short of a pandemic, would we have made the time to revisit old or attempt new occupations which bring meaning to our lives?  It was just some 4 weeks or so ago, that I found myself with such limited time to play my guitar (or write a blog) by the time I had completed everything on my ‘to do list’!  So my final thought for everyone.  Whether you are on the front line and find yourself in the midst of what is the single most uncertain time of our generation to date and find yourself needing to relax and recuperate at home while off duty with the distraction of leisure occupations. Or whether you are spending most of your time at home in order to keep yourself and others safe at this time, and are find yourself with much more time to occupy.  Use this as a time to reflect, reconnect and to re-evaluate what is important to you.  Set yourself some new ‘occupational goals’?  Discover your ‘new normal’ and who knows, perhaps there will be some lasting changes to how you live and engage in occupations far beyond lockdown!  Stay safe everyone.

Karen Robertson is a Specialist Occupational Therapist for Children and Young People Dumfries & Galloway

Follow me on Twitter @Karen Robertson OT (@KarenRo93829292)

For information and guidance on tackling occupation during lockdown from The Royal College of Occupational Therapy, visit: rcot.co.uk/your-health-and-wellbeing-during-the-COVID-19-crisis

 

Two simple messages ……by Laura Nisbet

Looking back a few months, COVID-19 was happening to other people and for the vast majority of us, it was not having a noticeable impact.  The news was about a talented, beautiful and successful woman in the public eye who took her own life.  The mantra in the wake of Caroline Flack’s sad passing was #bekind.

Now at the beginning of April, COVID has taken over every part of our lives.  Or me kids are no longer in school, we cannot nip to the shop whenever we fancy.  We can’t meet family for pizza and a beer on Saturday night then (attempt to) run it off at Park Run on a Sunday morning.

And it is going to get tougher…..

As NHS key workers we are not able to stay home watching Netflix, learning from online tutorials & attempting Joe Wicks PE class every morning (maybe every cloud?).  We still come into work, whether that be physically or virtually.  Work under pressure and in emotionally charged situations will be common.  We will all be working out with our comfort zones and to the very niche of our specialism.  The pace is nothing like we have known before.  It is likely we will work with new faces without the usual opportunity to get to know others properly.

My first simple message is….. Lets not forget Caroline’s mantra now we have COVID. 

Lets remember to #BeKind to those around us at work.  In these unprecedented and challenging circumstances we can control something, our own actions towards each other.

Colleagues are scared of what is coming.  Whether they are already on the front line caring for patients but awaiting the ‘peak’ or preparing to join our front line colleagues through deployment.  These are scary times.    Lets #bekind and remember the circumstances colleagues are leaving at home to contribute to the cause.  Colleagues are rearranging the wedding of their dreams as their date has been cancelled, they are missing the birth of their first grandchild as they can’t travel to be with them, they’re cancelling the holiday they have longed and saved for all year, they are worried about their teenagers at home – are they studying enough?  They have just dropped off their young child at a different school with different teachers and none of their usual friends, before they even come through the door.   This is really tough.

#Bekind.   

                 

When the local schools closed amongst other things, but fairly early on I must admit, I looked to Amazon Prime for support.  It was maybe a coincidence or perhaps perfect marketing that Frozen 2 was released for download!  Regular evening viewing commenced in our household and I can now recite it word for word of course.   But it is a welcome change from the PawPatrol.   Any parents of young children reading this may agree it is a great film and well worth a watch, typical Disney just enough laughs to keep the adults entertained.

Little sister Princess Anna has always been my favourite sister.  Underrated, so open, so honest, loyal and loving.  She enjoys chocolate too so gets my vote.  The soundtrack of Frozen 2 in my opinion is great but will forever be associated with the COVID-19 situation for me.

Towards the end of this second film, poor Anna faces yet more adversity, she has lost her snowman, is lost in the caves hiding from the giants and thinks she has lost her beloved gorgeous sister Elsa forever.  But she focuses and remembers the wise words from the royal guard which is ‘just do the next right thing’.   When things get tough, overwhelming, it feels like everything is out with your control and you feel like you can’t go on ‘just do the next right thing’.   She picks herself up and carries on.

My second simple message is when things get tough and overwhelming deep breath and ‘just do the next right thing’. 

The community and the country are so proud of the NHS, even more so than ever.  I’m sure there were a few tears on a few doorsteps on Thursday evening as this appreciation was shown in our neighbourhoods.  Just Amazing.  We’ve got this.

#BeKind

#Justdothenextrightthing

 

Laura Nisbet, Senior Workforce Business Partner (written while self isolating)