Change Is Going To Come by Lisa McLachlan

Change has been the theme of the last 16 months for myself and many other colleagues across health and social care. Working in healthcare I’m very used to being flexible and having to adapt, but having been redeployed twice in the space of 10 months I struggled to return to my “own job”, a job that now shares little resemblance to the job I left in March 2020. This flexibility and adaptability no more obvious than the way our Pulmonary Rehabilitation service has continued to evolve since our first virtual class recommenced in June 2020.

“Pulmonary rehabilitation (PR) is a treatment programme that can help you to stay active if you have a lung condition” (BLF,2020). Knowing the difference a valuable service such as PR makes, not only to the physical fitness but also the mental well-being of our patients, it was a priority to me to provide a service to those helping fight our battle, by doing as they were asked and shielding at home. Group classes cancelled. Outpatient clinics cancelled. A change of venue was required. Cue several weeks of planning, countless risk assessments, some creative use of the technology available and our home PR programme was born. The model has provided a valuable service not only for those with chronic lung conditions, it allowed us to provide support to some of those most in need of rehab following admissions with covid-19. An MDT brought to the patient’s own home at a time when “stay home, save lives” was being ingrained into the minds of everyone across the nation.

Just as our first groups finished their 6 week programme, I successfully applied and was awarded an NES AHP Career Fellowship. Undertaking this project as an AHP Career Fellow has given me time and support to delve into personal and quality improvement, from my local mentor, NES and also the other AHP’s also completing this year’s Fellowship. It has allowed me to develop skills across the 4 pillars of practice all while bringing change to a service in a way that would never have come about but for a global pandemic calling a halt to life as we knew it. With dedicated sessions throughout the year and a forum for discussions it has given me confidence to undertake quality improvement but also in non clinical skills which are equally as valuable in any role in healthcare including research and leadership.

Skip forward to July 2021, Pulmonary rehab has returned to a face to face service although numbers in the room for group classes remain limited by ongoing Covid restrictions. However, the changes brought about by the pandemic have led to our service being able to offer greater patient choice. We have integrated our virtual services within a face to face class, allowing patients at home to take part from home while others are in the room. This gives our patients access to the same support and education if the distance is 5 metres or 100 miles. It also enables those taking part to learn from each other as well as healthcare professionals without the time and cost of travel, the anxiety regarding covid following shielding and for those who are unable to leave their home for any number of reasons. 

While this is still very much a test of change at present, we are learning and adapting every week, a number of staff have joined the class virtually to better understand from the perspective of our patients. Born from the ashes of the first wave of the pandemic, this project started as an idea when our hand was forced, but it has grown

wings and is now learning to fly. We have all been victims of Covid in one way or another but let us use that to make us stronger and better. Let us rise from the adversity Covid-19 brought upon us and make changes for the benefits of our patients, by constantly striving for better. Anyone can make a change and if at first you don’t succeed; reflect, evaluate, change and try again!

Twitter: @LisaMcLachlan

Lisa McLachlan is a Specialist Physiotherapist in Pulmonary Rehab & Community Respiratory for NHS D&G

More life changing events – a view from two perspectives by Christiane Shrimpton

After the challenging year we all had in 2020 most of us thought and hoped things would be easier in 2021, would slowly allow us to return to something that feels a little more normal. Vaccinations have helped us get back a bit more of our social lives and that is so welcome. And as we all know the challenges continued and will do so for a while yet. And I want to use this blog post to reflect a little on both the patient and leadership perspectives of this situation having been in a position to experience both once again.

In May 2021 I was diagnosed with breast cancer following a routine screening appointment. It was the start of another educational patient journey – and this time with the added Covid effect. I had delayed my screening appointment by a few months as I did not see it as a high priority in January when Covid numbers were very high. But I ensured it was on my agenda as soon as I felt comfortable to go and had an appointment in April. No concerns either from myself or the examination at the appointment for a biopsy and I expected it to come back with benign changes – as had happened before. Not this time. And suddenly I was so glad I had not delayed my appointment long, realised once again why regular self-checking (this links to a video how to do it) and attending for screening appointments is so important.

Overnight my whole world changed again. Lots of hospital appointments for tests and their discussion followed. And I had often been in meetings where we discussed cancer MDTs. These are an opportunity for a wide range of specialists to discuss the findings and suggest the most appropriate plan of action. Prior to my diagnosis and with my scientific approach to healthcare that seemed like the thing to do. From a patient perspective it suddenly did not seem so clear cut. As a patient you don’t feel like you have a voice – and it would clearly not be possible for all patients whose case is discussed to attend the MDT. And the surgeon discussed other possible courses of action with me. When this ends with: ‘This is the MDT recommendation are you going to accept that?’ I wonder how many patients really feel empowered to disagree with the experts.

In my case the recommendations made by various MDTs changed the plan of action several times, generally for good reason. It was unsettling as a patient getting your head round what to expect and then being told something else was going to happen. And on one occasion I could not at all understand why the plan had changed and felt very overwhelmed by it all. All of this has made me understand at quite a different level how powerless and vulnerable our patients so often feel – and how little it takes to be in a situation where you cannot fully take in what clinicians discuss with you. And as due to Covid patients generally had to attend appointments on their own without the support of a partner, relative or friend this became even more relevant.

I want to share a few things that really helped me in my journey. On some occasions I had a preliminary phone call from one of the specialist nurses before my clinic appointment. That allowed me to be much more prepared and made the appointment more effective – both for me and the consultant. Sometimes I took notes with me of questions I had and on one occasion gave this including a bit of my background relevant to that appointment from my point of view to the consultant to read at the beginning. I felt quite upset at the time and was sure I would forget about something I wanted to tell him or ask. Getting letter copies or having the letter mainly addressed to me also helped as a summary of the discussion and a reminder of the plan of action as it was at that time. And just being given a choice – no matter how small it might seem – feels so much better. I had a great example of that when I was phoned to be given one appointment and was asked how I would like it: as a phone, video or face-to-face consultation. My choice made no difference to the date and time of my appointment. And the video appointment I had worked so well for me.

Now that surgery is behind me and I am coming to the end of my treatment I want to use some of my experiences and look at what we can learn from it from a leadership perspective. Just as I reflected in a recent article relationships are all important and this is true within and between teams and with patients. At times when everyone is under so much pressure keeping up good communication is more difficult. As the challenges have been building up, I have been reminded of a pressure cooker analogy:

• At times everything is under pressure and under control
• There are situations where there is a constant emission of steam because the pressure has built up too much and things are increasingly fragile
• And on some occasions the lid has blown off the pressure-cooker and everything is starting to burn – while the heat is still being ramped up…

And there are so many situations nowadays where everyone at all levels feels disempowered and unable to influence, feels increasingly under pressure. And even more so when a lot of the national rhetoric is ‘life is getting back to normal’ leading to patients increasingly expecting what they see as normal services and wanting to see a quick catch up on everything that was halted or delayed over the last 1 ½ years. That is now putting even more pressure on exhausted staff who have worked so hard – and are now having to deal with complaints and aggression from disgruntled patients unhappy with a situation that is not of any of their making as well as still having to work hard just to keep going.

So I want to make a plea for all of us to be open with each other about what is achievable, treat each other with kindness and compassion and make more use of the patient voice. One of the things I realised is that as a patient it is very easy to give a compliment or make a complaint. We have far less opportunities to share experiences from a patient perspective that increase mutual understanding and it is less easy to input ideas how things could be done differently. Most of them are small changes that would make a significant difference. Being asked what is important to a cancer patient was a good opportunity to have an input locally and I hope many others will take this up. And I wonder if others would feel it worthwhile to work with the patient experience team to capture more holistic views of patient journeys and use these in staff meetings. Sometimes just doing something a little different can defuse tensions and help make life easier for all of us. And I am sure that is something all of us would value right now.

Christiane Shrimpton is a Consultant Ophthalmologist and National (& Local) Clinical Lead for Appraisal

‘When life gets difficult – keep turning the page…’ by Lucy MacLeod

During this time of profound national anxiety, there has understandably been an explosion of mental health issues, with specific groups particularly affected, such as young people and key workers. Lack of access to social opportunities, a reliance on remote forms of communication, caring duties, trauma, illness, and stressful working patterns all contribute to rising levels of stress, depression and feelings of loneliness/isolation, or a sense of being ‘disconnected’. The pandemic has undoubtedly exacerbated existing challenges – particularly for rural communities already cut off from accessing well-being, art, and cultural opportunities – AND created new ones.

During the first lockdown back in June 2020, a group of fifteen adults, of all ages and from all backgrounds, living in and around Langholm were given the opportunity by contemporary rural arts organisation OutPost Arts to take part in an art-for-wellbeing project which encouraged people to ‘connect with their creative self’ by developing their own personal art journal led by four D&G based artists.

Participants referred themselves into Art Journal Project, self-identifying as struggling with mental health issues, stress, or anxiety, either related to, or exacerbated by Covid-19 (isolation, struggling with caring duties and loneliness being the most common experiences). Participants had also experienced traumatic events including the loss of a loved one, chronic pain and illness, and the group included both key/frontline workers and furloughed staff.

Over twelve weeks the Art Journal Project artists delivered eight themed creative sessions with themes such as domestic life, landscape, portraiture and flora & fauna, and a bespoke materials kit was delivered to each participant, allowing them to take part more easily. Workshops focused on the expansion of existing understandings and the development of new skills; promoting experimentation to unlock creativity and maximise well-being. Participants were encouraged to link their learning to a larger cultural context, with optional bonus tasks set by the tutors; for example – visiting exhibitions online and accessing additional reading. The group used drawing, painting, collage, pattern, and mark-making techniques to have a ‘visual conversation’ with themselves, the people around them and their environment.

Over 12 weeks the group formed a tight-knit community, supporting each other in tandem with the tutor’s guidance. The project’s private Facebook group page created a safe environment for participants to share work, and receive advice, encouragement, and feedback. Zoom and email also allowed 1-2-1 interactions with tutors for those less comfortable sharing work with the group.

Participants quickly expanded their ability, which affected their confidence levels hugely and the process resulted in nine of the participants developing large-scale ‘final pieces’ for a celebratory public exhibition at OutPost Arts Langholm High Street space which linked to Upland’s annual Spring Fling event. The vibrant show communicated the group’s personal and creative journeys during lockdown, reinforced by extracts from their art journals in a stunning large-scale window display.

Understanding and appreciating the value and importance of creativity and artistic expression is one outcome from this project that everyone involved in this project feels strongly. As tutor Frank Hayes says:

‘Art journals are the perfect entry point – once that artistic spirit is sparked, it can open up a multitude of opportunities. We hope that by building strong networks, people are more likely to keep things going – supporting each other to take part in other creative activities available to them…’

Living and working in Eskdalemuir, a small and remote village outside of Langholm, developing an art journal has allowed carer June Adgo to find an escape from daily life:

‘My heart is so grateful to this project as it has allowed me to have the space for self-expression & exploration from the continuing caring for elders/adults during this lockdown. It has shown me that creativity is what keeps me moving forward from the stagnation of what became groundhog days. Its taught me that Art is as important in my life as eating, drinking & sleeping – supporting both my inner and outer well-being.’

Participant Diane Hay, who before lockdown worked in an administrative role at the local primary school explains:

‘I always enjoyed Art at school and whilst I have continued to enjoy calligraphy and recycling/making things, I lost my way with drawing. My husband suddenly passed away recently, and I wanted something where I could escape from the pain for a couple of hours. I wouldn’t have known where to begin without this project, in fact I know I would still be staring at the paper, but this is guiding me step by step. I’m trying watercolours and acrylics, which never interested me before and my love of art is returning. I will always be my own worst critic but I’m realising I don’t have to be so harsh.’

OutPost Arts were so pleased at the progress and impact of the project that they’ve embarked on a six-month research and development project to expand its reach in Phase 2 beyond Langholm, into Lockerbie and Annan.

In partnership with SOSE, NHS Endowment Fund and Holywood Trust, OPA aim to use the momentum gathered to widen access points for participation and form a strong and effective creative prescribing art-for-wellbeing model for their locality; building relationships with partner organisations to create clearer ‘next steps’ for people wanting to continue their creative well-being journeys. They also hope to target young people living in rural locations facing mental health issues and other difficulties, with a bespoke art journal project that allows them to take greater ownership of their wellbeing, recovery, and self-development journeys by identifying personal interests and pathways, connecting them to wider local, regional, and national cultural and educational opportunities and potentially work towards creative accreditation/qualifications.

To expand the impact the Art Journal Project and strengthen the capacity of rural organisations to facilitate art-for-wellbeing projects in our region, OPA also seeks to investigate well-being training opportunities for artists and engage a wide range of potential partners and client groups to co-design a larger, more meaningful, and sustainable model that users can be referred into.

The development project is also scoping the potential formation of a regional art-for-wellbeing alliance to champion and support art-for-wellbeing activity by creating a platform or network for organisations and individuals from the creative, health and social care sectors to communicate, connect, share, learn and work together more easily. A connected vision in D&G will truly enhance the lives of people and their communities, using art and culture as a catalyst for positive change in the way we support our region’s collective well-being.

OPA are interested in talking to anyone with an interest in the next phase of the Art Journal Project, art-for-wellbeing in D&G, or would like to contribute their thoughts/opinions to the research and development process in any way.

Please email OPA Director Lucy MacLeod via hello@outpostarts.co.uk to discuss.

www.outpostarts.co.uk

@outpostarts