Let us Begin by Ken Donaldson

I went for a walk with a friend of mine the other day. It was mid morning and, for once, there was little in the way of wind or rain and the sun was shining. We both commented that it felt a little like Spring and, along with that thought, came some hope; hope for better weather, longer evenings, holidays and all the other things that come with spring and summer.

This got me thinking about our current position with regards to Covid. Its been a tough two years for everyone, everywhere; no one has been unaffected by all the changes and regulations, especially those of us in Health and Social Care. However, and I say this with some caution, I think there are signs of Hope. A little like the appearance of Snowdrops I am seeing signs that we may be coming out the other end of this and I do feel that we should all have some cautious optimism.

The vaccine rollout has been phenomenal and is clearly working. Pandemics do come in waves but these waves tend to be of increasing transmissibility and decreasing virulence, which is exactly what we are seeing. The virus moves from being pandemic to endemic and we just learn to live with it. This doesn’t mean it is all over and there may be surprises ahead (although I really hope not) but we can start raising our heads a bit and looking to the future. Which is the purpose of this blog really, what does the future hold for us all?

The first thing to recognise is that it is a bit of a mess, isn’t it? Two years of rapid decision making and fire fighting have led to an increasing chaotic environment which means small changes in one area can have a significant impact in another that was completely unseen. Many, many small changes lead to a chaotic and complex environment where all the systems we relied upon pre pandemic seem to be failing or even broken. The majority of you reading this will be fed up and exhausted; staffing shortages, isolation rules, impact on family and loved ones etc. have worn us all down. So what can we do?

What we do know is that in a chaotic environment like we have been working in the most important thing is Relationships. That doesn’t imply that Relationships aren’t important at other times, they are, but when systems and processes are in balance we can deal with the small rift and carry on. However in chaotic systems these rifts lead to more complexity and breakdown and can be catastrophic. I will not labour this point but, in essence, we all need to be more understanding of each others experience and situation, we need to listen more, empathise, not jump to conclusions, and do what we can to help, not hinder, each other. I do not underestimate how hard this is when we all feel the way we do but it it is vital if we want to move forward together and get our precious services back on track.

We’ve seen massive changes in Primary Care leading to sustained and often intolerable pressure. We’ve seen our hospitals inundated with Covid and non Covid patients. We know there are countless patients waiting for operations that have been delayed time and time again. Our care at home sector is struggling and the mental health of the population in general has been affected leading to ongoing pressures across our mental health services. We can do something about this, maybe not overnight or even in the next few months but in time we can improve and support our teams to get services not just back to where they were but even better than what they were before. We can, and must, do this together. Let us begin.

Ken Donaldson is Board Medical Director at NHS Dumfries and Galloway

How did I not know about this? – Answers on a (digital) postcard by Susan Irving

Those of you interested in digital health may remember my last blog,   a summary of my experience about the journey of introducing digital technology in community children’s  AHPs.  Well……my journey has been on a very steep up hill direction over the last 4 months!

During one of my first sessions in the Digital health and leadership course back in 2018 we were advised – when you believe in something keep shouting, be (respectfully) disruptive and keep knocking on doors. Well after lots of talking (don’t think I shouted!)  I was fortunate to be given the opportunity to work alongside colleagues in IT on the expanded community rollout of Morse in the Womens and Children’s directorate. 4 months in and I thought I would gather my thoughts.

It has been a steep learning curve, but one which I am enjoying immensely. I have learnt about back ends/front ends (a vastly different definition to what it might mean clinically!), datasets, configurations, licenses, permissions and now have a better understanding why somethings that, as a clinician, we just think is easy to get – is not that simple! I still have lots to learn.

As a clinician I am always keen to embrace digital health to benefit my work and make life a little easier – whether that be in efficiency in record keeping, using data to evidence service need or using technology to to make sure we can see our patients safely; but what this last few months has really brought to the fore for me is equity vs equality. There is a tendency to treat everyone the same but we are not, neither in need or ability. The same equipment might work for one person/one team but not another.  What one term means to one team might not mean the same to another.  Clinic and caseload can mean different things to different clinical staff, never mind clinical staff and IT staff!  A community therapist working in schools/away from the office all day (will that ever be a thing again? – that’s a question for another day!) will have very different needs than a predominantly clinic based therapist who has access to a PC all day.

In order to ensure we can gather consistent and comparable workload data we do benefit from using the same systems, with a shared understanding of terminology, to gather workload information and record patient notes (and lets face it if we all use the same systems it is easier to navigate and support each other) As an organisation the direction is clear for community services – morse is the tool they want us to use. But we don’t all need to use the same technology/ equipment to do it and we don’t always need the same data!

If we are to avoid just giving out technology and devices that end up in a drawer or not used to its full capacity or rolling out systems that clinicians don’t utilise we need to spend time with teams asking and understanding what they need.

Having been part of the children’s physio team for 22 years, I have a good understanding of what my team needs, what the people in the team need and due to good working relationships have been able to expand that to other children’s AHP teams too. I am fortunate to have a good understanding of what technology is available to staff because I am not afraid to ask questions.  I enjoy spending time with people and understanding what they need, showing them how digital technology can help and supporting them to do use it, in way that is (hopefully) beneficial to them.

Over the last few months I have had to get to know other teams, other processes and understand what they need, not only to do their job, but what they need from me.

The project involves working alongside IT colleagues and clinical teams to introduce the product and sell its advantages, before teaching them to use it. To do that you need to spend time understanding the team – identifying the key players and understanding what the teams need and how they operate.  In the course of doing that, I have had many corridor conversations about technology and equipment; and achieved the ultimate sense of satisfaction when one person said, “that will make such a difference to me’.  Twice in one week the comment was made, ‘how did I not know that?’ – and for me that is the ultimate prize – we need to make this better.

The morse project currently also involves the development of additional functionality in the product in order to meet service needs, and being able to be part of discussions with the software developer is a great opportunity.  I recently attended a webinar on ‘what is a digital leader’ where there was a crystal clear example of the importance of co-production of systems with service users. As a service user I feel this is something I can bring to my role working between  IT and clinical teams.

As I said, this has been a steep learning curve, but spending time training and showing clinicians the potential of digital technology and how it can benefit their working life and then seeing the realisation of that makes it worthwhile.  As adult learning theory highlights – everyone learns differently and one size doesn’t fit all. I have been fortunate enough to be able to listen to people and ask the question, ‘what do you need’ and more importantly ‘ how can I help’ whilst recognising it’s not just about how technology can support what we currently do but challenging people – how can services evolve to utilise the opportunities that technology brings.

That for me is the true benefit of being a clinician with a role in IT.

Susan Irving is Team Lead Physiotherapy Children and Young People for NHS Dumfries and Galloway

LGBT History Month

This year’s LGBT History Month encourages us to ‘explore the waves of LGBT liberation and community around the globe’.

Perhaps, before looking further afield, we need to look at where we are, when it comes to LGBT+ rights here in Scotland in 2022.

It would be easy to be complacent, and to think ‘we don’t have an issue now, we have equality and all the benefits that brings’.  However, Scotland was very late when it came to decriminalizing homosexuality.  Many countries had already achieved that in the 18^th and 19^th centuries!

It took Scotland until 1981, 14 years after England and Wales. 

Since then, however, much has been achieved.  Equal age of consent, right to change legal gender, LGBT people allowed to serve openly in the military, civil partnerships, marriage equality, and sexual orientation and gender identity protected in discrimination law.

At a local level, we have the launch of our D&G LGBT+ Staff Network for NHS and council employees, and the NHS Scotland Pride badge.     

So, taking all that into consideration, how are we doing in comparison to global LGBT + communities?  

The good news is, Scotland is viewed internationally as a progressive nation when it comes to LGBT+ equality.  Although not quite making into the top 10 gay friendly countries in the world,  The 10 Most Gay Friendly Countries In The World, According To The Owner Of Out Adventures,  it’s certainly preferable to the 74 countries where it is still illegal to be gay, or the 8 where it is still punishable by death. 

Interestingly, some of the top holiday destinations in the world continue to be popular despite their horrendous LGBT civil rights – Dubai, Kenya, Barbados, Maldives to name but a few.

So why is this year’s theme of reaching out internationally so important?

Well, let’s look back in history 100 years ago, to 1920s Germany, a country recovering from the 1^st World War, where cultural freedom and LGBT tolerance were in abundance.  Yet, look at how quickly minority communities become the target of the masses, either through their actions or, just as concerningly, their inactions. 

We possibly sit somewhere similar to where they were back then. Economic anxieties and Far Right noises all around, blaming ‘them’ for society’s problems, whilst adding into the mix social media platforms which seem unable or unwilling to stem the flow of hate and lies.

So, as we champion this LGBT History Month, and remember the sacrifices of those who went before us, let’s all pledge, whether we are members of the LGBT+ community, or champions of it, to no longer be tolerant of intolerance.

Call it out in all its forms and counteract the misinformation it presents with facts, and by celebrating the differences  

This blog was written by members of the LGBT Staff Network