Busy by Laura Lennox

Our adult speech and language therapy team held a meeting on 27^th April. (Feels like a long time ago now!)  Amongst other things, we used it as an opportunity to reflect over the last few weeks and months.  Some of us were considered to be essential workers and maintained our job roles in hospital settings.  Others were deployed to familiar and some unfamiliar job roles within other parts of health and care.  We felt it important to have this moment of reflection in order to allow us to understand what we had learned over the last few weeks.  We wanted to make sure that when the surge that didn’t come as expected from COVID-19, but will now come when we gradually open up our services and become busy, that we consider how we hold on to the things that added value when we didn’t have the same number of face to face patient contacts in a day as pre pandemic times.  How can we use the learning from these experiences to shape a new and different type of busy?  Although this blog is based on our own reflections, we don’t think we are alone in considering this question: What is the definition of busy?

“I have one patient to see every day and my work around that is rammed…..there is always stuff to do whether that’s getting round to the same day things or thinking about how we work going forward, it’s all indirectly related to patient care.  I’ve been up to all sorts, measuring up hotels with the OT’s, Health Care Support Worker training to support the wards, helping patients connect with their families as they have no visitors, it’s all different stuff but still busy”.

“I’m very much enjoying working in new busy ways – I had always hoped that NHS Near Me (video consultations) would play more of a role in community to cut down on travel/time/expense/inconvenience and now we can add reducing exposure during a pandemic to that list.  I’m finding patients so much more open to this method now, and care homes, family members, staff…suddenly all that resistance is gone.  I’m not saying it can completely replace face to face contacts but we have come so far in such a short space of time.  I’m also very grateful for the opportunities to work from home and the technology that makes this possible.  Personally, it’s good for mental health and helps manage the anxiety I have about healthcare settings at this time.  Having a 1 year old, I get a better work life balance, true flexible working, and opportunity to still feel connected to family.  I’m also aware of the benefits to the environment, from society as a whole slowing down; climate crisis could also be described as a pandemic. 

(Thank you to our IM&T teams for being busy & making this all possible!)

“It’s lovely how connected the team feels with the opportunities for open honest discussions regularly.  So much support – we’re very lucky”

“For me it’s been fantastic that finally we have acknowledgement that staff need space to be and it’s okay and important to care for each other.  We’re all imperfect humans…not superhuman.   These gains are appreciated and MUST be maintained. Care for us so we can care for others”.

“For me the time to see and talk to patients and staff has been one of the “luxuries”.  Ward staff have been more available when you need them, its felt more like sharing the care for each patient and you can usually get hold of a relative as they are at home.  We won’t have seen so many people as not so many to see but it’s been a better more balanced pace of seeing them and having to keep up with other things like emails.  It’s just felt so nice not to be dealing with the demand by skimming the surface of care.  It’s given us a chance to think outside of the box and in doing so we’ve had a better view of colleagues’ job roles and their strengths.

At GCH we have started having our breaks around a big table which helps create the feeling of a team.  The whole AHP family thing is like a micro version in our office and I have loved the sharing of info, advice, practice and resources. I think it’s bound us together more tightly and the silos of old are well and truly gone now, and by that I mean proper integrated services.

“I’m working in a building I have never been in before.  Doing a job some of which I haven’t done for 4 years, some for 7 years but if I’m looking for the bright spots, I’ve had the chance to work alongside people I haven’t seen in years and see how much they have progressed and thrived within NHS D&G.  I’ve met so many new people and they have without fail been welcoming.  Improvise, adapt and overcome was always our SLT motto but never truer. 

We have changed in so many ways we never thought possible.  Possibly at a speed we never thought possible and whilst we would never have asked for it and it hasn’t all been easy, Winnie the Pooh sums it up”:-

Q. What is the definition of busy?

The oxford dictionary tells me that the word busy is a noun, a verb and an adjective so it’s not really surprising that its use in a sentence has many different connotations.  I do wonder though, if it now means something different to what we believed it to mean in the pre COVID-19 past when it comes to health and social care:

“The next challenge is how we go forward and in what direction….an unprecedented opportunity and we need to take it…the rush back to do and the numbers game can be false…let’s build the pillars of a better future”.

“I feel that this period of time has allowed me to prepare.  I have been ‘up skilling’ – learning about SLT in critical care in management of tracheostomy and laryngectomy.  I feel I have been ‘up skilling’ others.  Our team has been providing support for staff around communicating with patients in an effective and compassionate way whilst wearing PPE. I think that we are over this first wave and who knows if we will have a second wave and possibly more, but what I do know is that I’ll be less fearful because I’ve been busy getting prepared for if we do”.

Laura Lennox is a Speech and Language Therapist & Improvement Advisor for NHS Dumfries and Galloway.

Written on behalf of the adult Speech and Language Therapy team: NHS Dumfries and Galloway.   Twitter: @SLT_DG    #AHPDG     Email: dumf-uhb.adultslt@nhs.net

Working from home, home working, flexible working… navigating new waters…by Helen Moores-Poole

Are you working from home today? Statistically some of us will be. You have my sympathies. Sometimes portrayed as the easy option, those who have been doing this for the last 12 weeks will tell you that it’s not. It can be exhausting, frustrating and lonely.

This blog is about the space in between the policy and the guidelines… it’s about the personal experience… about making working from home work for you in the middle of a pandemic… the practicalities, the upsides, the downsides and some top tips donated by NHS colleagues and learned the hard way.

I’ll declare an immediate vested interest. Before corona gatecrashed our lives I was in discussion about the possibility of a Saturday study buddy club in the education centre at DGRI. I’m studying for my doctorate and have been on writing retreats – both in person and virtually and found them really productive. Having spoken to a couple of nurses and AHPs trying to get their Masters done at the kitchen table amidst cries of “Mum, Mum, where’s x,y,z?” or “Sorry love, what’s for tea?” the idea of a quiet place to write with great broadband, coffee and moral support was universally appealing and practical. That was 2020BC – Before Covid.

Right there however is the challenge of working from home. “We are all in the same storm but not the same boat” seems a recurrent theme of this pandemic. The resources we have at our disposal and challenges we face are not equal.

Initial population studies are showing that women still do longer hours of housework and childcare than men during this pandemic. We don’t all have a spare room, great broadband, laptop per person. Some of us can’t work from home even if we would want to, some absolutely don’t wish to. Who could and should? How do we stay connected, manage potential resentments, swap in and out so there’s parity? Can there be parity?

I have been working on adapting a protocol for Adult Speech & Language Therapy, looking at working from home and it’s raised interesting questions as we navigate this new world. What exactly constitutes working from home? I can see patients using Near Me from home but should I – ethically? Longer term, is flexible working the answer? Do I keep home for virtual in-house meetings, report writing, improvement project work and log on in my nearest community hospital for my outpatient work? So many questions, it will take us time to work through the answers.

Even with guidelines, policies and protocols to guide us, the personal experience is often far different. As I type out the words, “childcare arrangements should be in place” I can only imagine this is far easier to write than to do. I can only imagine the real heart wrenching situation of dropping your kids off at the key workers’ school then returning home to work; it shouldn’t be any different to leaving them to come to DGRI or GCH but somehow it is. Do you tell them?  I’m reminded of the scene in the Full Monty where the guy is made redundant and dresses for work every day and sits in his caravan so his family don’t find out. These things are our new everyday dilemmas.

I will confess right here that I am well set up. My eldest 2 are quarantined away at uni still, which I hate, but it does mean I have space. Even so Mr P and Little Miss P are working from home too.

In SLT we have implemented a rota so we get days on the wards and days off as a break from the donning and doffing. On the odd days I’ve worked from home so far, I’ve had to establish work rules that were learnt the hard way. Initially it’s been ‘First up Best room’ but we’ve now set up a house room booking system as Teams works better in some rooms than others. Mr P works European and USA hours so no loud music between 7 and 12, 2 – 4, 6-8; no flushing the loo when the ‘Do Not Disturb’ sign is on the door (we have another loo but this is currently full of the living room carpet which had an unfortunate encounter with a bottle of Cherry Sourz during said Miss P’s birthday party and was replaced the day before lockdown but at the time of writing still can’t be disposed of).

And this is the heart of the issue…

This is, as one colleague from NHS Grampian told me, “You’re not home working, you’re at home trying to work during a crisis” Nothing is normal, this is not the new normal, we are not there yet, but maybe we can start to reflect on what we can carry forward into the new world?

There are benefits of course, I don’t have the daily 50mile round trip. I save time, energy, petrol. I have peace and space to concentrate uninterrupted. On the downside, I miss my work family and some days my eyes are all screened out. One kind orthoptist colleague recommended drops called HyloTears in addition to the DSE guidelines.

Whilst we have the guidelines on ergonomic work assessments for your home station, the home working procedure and the and new working at home guidelines, I thought it would be interesting to collect some top tips from those working at home so that in NHS D&G we thrive and not just survive.

Below are some suggestions, take what you need and discard what you don’t and if you have any to add I’d be very interested.

 Top Tips for working from home during a global pandemic (in no particular order)

1. Walk or cycle to and from work. Literally walk round the block, down the lane and then arrive and crack on. It goes without saying you need to be up, dressed and showered – doesn’t it? Let’s say it anyway, “sloppy dress, sloppy mind” was one comment!

 

2. Noise cancelling headphones and a head mic – at this point you probably either have these or you don’t as they are currently like gold dust to order. Those who have them swear by them to make all the Teams calls easier and we know from evidence that their use helps protect your voice. Get them if you can. Digital natives are those born after 1980, the rest of us are digital immigrants – find a digital native in your life and see if you can borrow some.

 

3. Noise apps & concentration music – these are a quick and easy win. There are several free to download, have a browse and see what you think. Noisli, Forest (https://www.forestapp.cc/) Youtube were three recommended. These play background noises eg fan, fire, rain. There is evidence to show that certain low frequency noises can aid concentration and block out extraneous noise. Other people commented that they use them if they’re feeling low or cooped up eg the sounds of a coffee shop in the background as they work. Some more here: https://abilitynet.org.uk/news-blogs/top-three-ambient-apps-improve-focus-and-help-you-study

 

4. Make a Do Not Disturb sign and stick it up but remember to take it down at night or it will cease to work. Love this comment from a colleague: “Train your work mates aka family. This week husband decided using power tools in the garden was an acceptable way of keeping quiet whilst I was trying to record a podcast!”

 

5. Designate a work mug – delineate your workspace and personal space anyway you can, pack up at the end of the day or close the door. Having a work mug you just use during working hours is a visual cue that can help separate space physically and mentally. Similarly, one colleague has her work water bottle on the desk and finds that helps, another has a separate work profile on her computer so she can’t see it during non-working hours.

 

6. Adult SLT and ODL have created a ‘Logging Off’ checklist similar to the ‘Going Home’ checklist. You can find it under the staff support button on Beacon. One colleague wrote “Boundaries are important, I found myself noticing a work email and getting engrossed in work way after hours”. “Stick to your hours” said another.

7. Take your breaks – “My experience of home working is that it get’s to 3pm and I’ve still not had my lunch” “NHS D&G are getting far more from me at home than at work, but I’m so tired, I just don’t stop” were comments many could relate to. Use your calendar or phone to set alerts or book in diary space to take your breaks and eat. Particularly important if you’re at a screen. Stretch your legs, stroke the cat, remember your lessons from Occ Health on sitting in one position/ too much screen time for too long. Don’t feel guilty for taking your breaks.

 

8. Connect with work colleagues – comments included, “I’m an extrovert so I’m really struggling with this… trying to stay connected” “Working in complete isolation is so hard”. Perhaps the answer is looking to Sweden who have Fika, coffee and cake with colleagues for 10 mins just to connect. http://www.swedishfood.com/fika Can you link in with another person working from home and not talk about work, just how’s your day going, what are you having for tea type thing? You’re missing out on those water cooler conversations. Can you replace those this way? Answers on a postcard please.

 

9. Get organised said one “Do yourself a list, 3 key tasks and 3 extra bits, things I can focus on when my concentration’s strong and easier bits for when it starts to wander. Nice stationery helps too!”

 

10. Try the Pomodoro technique. One particularly well organised colleague wrote “I use an app to help manage my time and stay focused based on the Pomodoro technique. It keeps you on track and stops you segwaying off to do other things. It makes you take breaks to move, stretch etc. I use tasks in Outlook to manage my day and my emails open in the Outlook Today page not directly on emails so I can see what needs done and I don’t get sucked into spending time on reading/ checking emails.”

11. Random other things I love: Finding Your Campfire: A Remote Working Survival Guide, £10 paperback or free e-book download for a limited time (or was at time of writing) Eminently readable and very nicely laid out with practical advice.

https://seasaltlearning.com/finding-your-campfire-a-remote-working-survival-guide/

 

12. And finally, this was also a recurring theme… “Be kind to yourself, try to make a routine that works for you… know that you’re doing the best that you can do.” “Tomorrow is another day”.

And that is probably the best advice of all….

Helen Moores-Poole

Advanced Speech & Language Therapist with Adult SLT Service & Ideas Team, NHS D&G.

helenmoores-poole@nhs.net

 

Recharging our Inner Batteries by Ania Gut-Gofron

Let’s imagine we have internal batteries that can get drained, and that draining could happen without us noticing? Like there is no built in indicators showing us that we need to re-charge, certainly not obvious ones.

And what if up until now the internal system worked.  We somehow knew what to do and did all the things that helped us feel charged ; sleeping well, connecting with others, eating nutritious food, doing things that provide pleasure ( e.g. days out , trips, concerts , holidays, meals , walks) or achievement ( e.g. work, with known and predictable work roles, undertaking projects  and meeting challenges) .

Perhaps we feel that we are still doing all of the above, but things are not quite the same. It’s not possible to hug our friends or family members (when they do not live with us). Our work may have changed, we may now be working in a different setting or team or maybe the things we loved about our jobs (human contact, being on the go) have suddenly disappeared. We may worry more, not even about specifics. It can be harder to get to sleep at night, when we usually are able to let go and relax, we may start questioning ourselves “what’s wrong with me?”, “I should be able to cope?” or “will be able to cope with what might come?”

What if the feeling of being overwhelmed, tense, agitated or questioning oneself, which can sometimes come out as angry outbursts or tears, may be a  mere indication of our battery needing recharged?  Consider this is not a time to question oneself (we wouldn’t get angry with our phone running out of battery? ok if you are anything like me you could get annoyed at yourself for letting your phone go flat… However this never works; what works best for a phone out of charge is simply connecting it to the power source.

What are the sources that keep humans truly alive? There are the basic ones that we all need, nourishing food, sleep / rest, shelter/ sense of safety. There is also the sense of connection – with others, with nature – and now more than ever we need to rely on our inner capacity to plug into these sources, in order to charge. Modern psychology has taught us that planning and balancing daily activities those associated with either achievement, pleasure or connection can help restore our inner battery.

Gratitude, savouring and serving can help bring a magnifying glass to everyday moments that can also recharge and replenish our inner battery.  Taking the time to consider the things we are grateful for can significantly increase our sense of wellbeing, as shown in studies by the pioneer of Positive Psychology Dr Martin Seligman. And there are lots we can be grateful for,  small things like a cloudless sky ( Ok- we live in Scotland!) and for things that we still have today;  loved ones , food on the table , spring blossoming, kids getting along ( even if only for short periods of time) or the Wi-Fi working .

Connecting in the present moment and savouring any good moments is another powerful tool. It may be at work we experienced a really stressful period but we came out the other end (maybe not perfectly but good enough!). Savouring a moment means letting yourself feel it, acknowledging the sense of achievement and tiredness that comes with it, whilst also cultivating an inner voice recognising a job Well Done and allowing yourself to savour the sense of satisfaction.

Or savouring the pleasant moments during the day – a warm cup of tea, the yellow daffodils or freshly washed bed linen, when you allow yourself to be fully present and engage in the moment using all our senses. It may also be possible perhaps to allow our thinking mind to rest in this moment – letting our mind take a break from needing to sort, plan or deal with all the things on our to do list!

Serving means allowing ourselves to do something for others.  Reaching out and connecting with the world with a question “how can I help?”, it could be calling somebody and asking “how are you?” or doing something that may benefit someone else. This could include cooking a special meal, writing an email, chatting to a neighbour over the fence, spending time with your family member and really being interested in them. This may mean playing Lego with your child or listening to someone tell a detailed description of their gardening experience or smiling to the person that passes us in the street when we are out.  We can do all these things absent minded, already on to the next task and what is next on our list. However, if we try to bring a deliberate attention to these activities, whilst considering each one as a gift from us to the other, our experience might shift. We might notice feeling more energised and fulfilled by contributing to the better world.

And last but not least sometimes we all need a bit of a helping hand. Space where you can be reminded that we are all human, that it is ok not to feel ok, that we all need rest and that our batteries need recharged. Staff support service has been created with that purpose in mind. To be a safe space, and to be that reminder. Call us on 01387 241 303 or email dumf-uhb.mhstaffsupport@nhs.net

Service for GPs and Practice Staff: email dumf-uhb.gp-psychology-service@nhs.net

Ania Gut-Gofron is a Clinical Psychologist with the Adult Mental Health Team at NHS Dumfries and Galloway

 

Making Carers Visible by Clark Adams

Carers Week 2020

Monday 8th to Sunday 14th June

It is Carers Week from Monday 8^th June to Sunday 14^th June. It’s quite strange writing this blog when the whole country is in the middle of a Pandemic, so why write it? Why have a Carers Week? Why don’t they cancel it and reschedule it for next year?

Well, the theme of Carers Week is ‘Making Caring Visible’ so why?

If you describe something as visible, you are saying you can see it. Certain things are not visible to the naked eye, but that doesn’t mean they are invisible, you may just need a microscope or telescope to see them. The adjective visible also means obvious to the eye.

Unfortunately some Unpaid Carers don’t see themselves as Unpaid Carers or the work that they do goes unrecognised:

“The best way to describe the Unpaid Carer is like the mortar in the wall. It’s there, but it’s hidden.”

This is how a husband sees his job as full-time carer to his wife, who has dementia. “In the wall of the caring system, the Unpaid Carer is a very necessary and strong binding system to hold things together.” This husband is one of about 700,000 people in Scotland who have a voluntary caring role. While lockdown is on, many of their support systems are not in place, and life for Carers can be unrelenting, as he explained.

So what defines an Unpaid Carer?

A Carer is “a person of any age, adult or child, who provides unpaid support to a partner, child, relative or friend who couldn’t manage to live independently or whose health or wellbeing would deteriorate without this help. This could be due to frailty, disability or serious health condition, mental ill health or substance misuse. A lot of people who provide unpaid support do not see themselves as Carers as they may feel that is a normal part of life. This support might include:

• personal care such as assistance with bathing and dressing
• help with medication
• cooking, grocery shopping and domestic tasks
• accompanying to appointments
• transport
• help managing finances
• emotional support

The Silent Invisible Army… and the need to be seen!

Helen Walker, Chief Executive of Carers UK, said: “Unpaid Carers are fighting the same battle as care staff and many of our NHS workers: yet they do it behind closed doors and with far less recognition. “Unlike our fantastic frontline workers they are unable to clock off from their caring responsibilities. Many are overwhelmed and incredibly anxious about how they will manage in the weeks ahead.

“Unpaid Carers are just as vital in the national effort to keep vulnerable people safe yet many fear that continuing to care around the clock will lead to them burning out.“Carers tell us they feel ignored and invisible in this epidemic. The Government must ensure their physical and emotional well-being is supported at this challenging time and monitor the impact of the reduction in care services on carers.”

Before coronavirus, social care services were already in short supply and those families with support met a high threshold to get any form of care. Now, some of those services have disappeared and Unpaid Carers are having to cope alone.

 Covid-19 Pandemic and the Unpaid Carer.

• Having reduced or closed care services mean family members in Scotland are picking up even more care for older, disabled relatives and those with long-term conditions.
• Carers in Scotland are telling organisations that they feel ‘overwhelmed’ and are at risk of burning out
• A staggering 78% of Unpaid Carers in Scotland are having to provide more care for their loved ones during the coronavirus outbreak.
• 2 in 5 (39%) of them are providing more care because their local care and support services have been reduced or closed. Nearly a quarter (23%) are providing more care because they are worried about paid care staff having contact with the person they care for.
• A survey by Carers Scotland of 890 Unpaid Carers in Scotland showed that, on average, Unpaid Carers are picking up an additional 10 hours of unpaid care per week, helping loved ones with personal care, practical tasks and emotional support.
• Reduced care and support services, and paid care workers isolating or without personal protective equipment (PPE), mean many Unpaid Carers in Scotland have no choice but to care round the clock for loved ones with complex health conditions and disabilities – without any hope of a break.
• More than half (53%) of Unpaid Carers told the charity they feel overwhelmed managing their caring responsibilities during the outbreak and are worried about burning out in the coming weeks.
• 87% of Unpaid Carers in Scotland said they are worried about what will happen to the people they care for if they have to self-isolate or become ill.

Legislation and the need to adhere.

The Carers (Scotland) Act 2016: Part 4 Section 28, a statutory guidance brought out by the Scottish Government in April 2018, in relation to Unpaid Carers and the discharge process;

Section 28(1) and (2) requires each Health Board to involve the Carer before a cared-for person is discharged from hospital. It must do so by
(a) taking steps as it considers appropriate to: inform the Carer as soon as reasonably practicable of the intention to discharge the cared-for person; and invite the views of carers about the discharge; and
(b) taking account, ‘so far as it is reasonable and practicable to do so’, of any views given by the Carer in making decisions relating to discharge of the cared-for person.

Section 28(3) provides that this duty only applies where;

• The Unpaid Carer of the cared-for person can be identified ‘without delay’; and
• Where it appears to the health board that the cared-for person is likely to require care following discharge.

There is evidence to suggest that there has been a significant increase in recent years of post-discharge care being provided by Unpaid Carers. It is believed that if the hospital discharge is handled in a positive way and involves the Unpaid Carer, this can help with patient recovery and improve outcomes. Further evidence shows that involvement of Unpaid Carers in hospital discharge planning can reduce the risk of delayed discharge, readmission to hospital, therefore reducing cost implication and further required provision.

It is important that the Unpaid Carer feels prepared for the hospital discharge of the patient. Being informed and involved in the process can reduce the risk of negative impacts on both the Cared for person and the Unpaid Carer.

How many, How much?

There are actually 759,000 Adult Carers in Scotland, which makes up 17% of the Scottish population and 29,000 Young Carers, 4% of the under 16 population in Scotland.  Not only are more people caring, but they are caring for longer. Since 2001, the number of people providing 20-49 hours of care a week in Scotland has almost doubled (49%) and those providing 50 hours of care or more a week has increased by more than a fifth (21%). Every year over 160,000 people in Scotland take on a caring role and 3 in 5 of us will become Unpaid Carers at some point, while 250,000 people will juggle caring with holding down a job!

If the nation’s Unpaid Carers were unable to continue supporting their loved ones, it would leave the state with a £10.8 billion black hole. As if this wasn’t worrying enough, we believe there are far more Unpaid Carers in Scotland than estimated, meaning that the consequences for society of this support dropping off would be even more catastrophic.

Support Unpaid Carers, see what they are doing, vision what they are trying to achieve, look at the bigger picture!

References

Macaulay,J.(2020) The Hidden Role of Carers. [online] Available at https://www.bbc.co.uk/news/uk-scotland-52480568 [Accessed 5th May 2020].

Hodgson,S.(2020)  The forgotten families in lockdown: unpaid carers close to burnout during Covid-19 crisis [online] Available at https://www.carersuk.org/scotland/news/the-forgotten-families-in-lockdown-unpaid-carers-close-to-burnout-during-covid-19-crisis [Accessed 22 April 2020].

Scottish Government (2020) Social Care Policy: Unpaid Carers. [online] Available at  https://www.gov.scot/policies/social-care/unpaid-carers/ [Accessed 19^th March 2020].

Clark Adams is a Carer Facilitator at Dumfries and Galloway Royal Infirmary