The Importance of Engagement by Rod Edgar

Good engagement is critical to the future of health and social care

It does feel that there’s an ever-growing emphasis on the importance of engagement when developing approaches to health and social care.

A number of very significant national documents produced in the last couple of years and directed at health and social care organisations have featured engagement prominently, or as their sole focus.

The 2021 Independent Review of Adult Social Care introduced the prospect of some very significant changes to organisational structures, heralding the introduction of a new national care system.

However, beyond that headline it also made sure to stress in no uncertain terms the importance of engagement when looking at how approaches to health and social care are developed.

A key recommendation to emerge from the independent review led by Derek Feely was that we need to listen to the views of people who use services and actively involve them throughout the process of planning care delivery.

It highlighted the importance of engagement taking place at the earliest stages of development and continuing throughout, with an expectation of being able to evidence how this collaboration with stakeholders informs and shapes what results.

The point was repeated in March 2021 when The Scottish Government and COSLA (The Convention of Scottish Local Authorities) published new long-awaited guidance explicitly intended for Integration Joint Boards, NHS Boards and Local Authorities on the engagement activity around service development and change.

The paper which introduced the report said, ‘Planning with People … sets out the responsibilities each organisation has to community engagement when services are being planned, or changes to services are being planned, and supports them to involve people meaningfully.

“Applying this guidance wholeheartedly will help to ensure these legal duties are met, and it will be used to inform assessment of organisational performance.”

‘Legal duties?’

Yes – this isn’t all just advice and guidance. It’s not something one can glance through and set aside to pick up later as a lesser priority.

There are very strong legal expectations underpinning the need to follow correct approaches to the most formal type of engagement – public consultation – either set out through legislation or established via common law.

For an example of this legislation, look to the NHS Reform (Scotland) Act 2004.

A section of that Act states, ‘It is the duty of every body to which this section applies to take action with a view to securing, as respects health services for which it is responsible, that persons to whom those services are being or may be provided are involved in and consulted on the planning and development, and decisions to be made by the body significantly affecting the operation of those services.’

So, lots of words, and warnings of legal implications, but what does all this mean in real world terms?

Well, there can be repercussions if consultation is judged not to have been carried out to the proper standards, just like in other aspects of work within health and social care.

In one instance, it can be a service which has been stood down through an operational decision having to be brought back as it was and staff reappointed – all because the outcome of a Judicial Review concludes that the correct process around consultation had not been observed.

Alternatively, it can be a multi-million pound flagship capital project placed on an awkward pause while the subject of an independent review.

No piece of engagement is ever going to be perfect, and we know that from our own past experiences. It can always be improved upon. What we always need to do is strive to approach our engagement activity diligently, with thought and care, to listen and learn, and to aim not just to meet the standards and expectations but surpass them.

It can all sound very daunting: the legislation, the legal complexities, the prospect of unhappy people challenging the approaches that have been taken….

It all sounds terrible, and this must be why good, properly planned engagement is being stressed as so important?

No.

Sure, things can go wrong with engagement activity, and as we’ve acknowledged it’s never going to be perfect.

But the real reason why organisations involved in the delivery of health and social care are increasingly encouraged and directed to undertake good, meaningful engagement activity is the very significant benefits that it brings.

No organisation can claim to know what might be best for an individual, a group or an entire region of people when developing approaches to treatment and care without actually working with the people experiencing them now, who might do in the future, or who have knowledge or perspective to lend to the question.

By working together with people across our communities, with stakeholders, staff and volunteers, we encourage and support everyone to play a role in the shaping of approaches. It should mean that whatever takes shape has the best chance of being fully informed and considered, truly workable, sustainable and best positioned to help meet people’s needs.

The result of regular meaningful engagement where we work with all these partners to cultivate and advance approaches to health and social care is that it develops relationships, it pools knowledge and experience, and it benefits everyone.

There’s more we can do around this. There’s more that needs to be done.

Work has been taking place recently to develop a Draft Participation and Engagement Strategy for Dumfries and Galloway Integration Joint Board.

This strategy is intended to set a course for how we gear ourselves over the next three years to undertake engagement activity within health and social care in the region. Building on work which has already taken place, in its present draft form it covers things like training for staff, so that they are better equipped to be able to support engagement activity, and how we ensure people know how they can participate.

It talks about the organisational changes which can help raise awareness of the benefits of good engagement and ensure that it’s a constant activity.

It can be surprising just how much engagement activity already takes place within the Partnership. It’s not all about heading out with a pen and clipboard to consult on a headline proposal.

In the Draft Participation and Engagement Strategy you will see 23 items of significant, structured, formal engagement which took place over the last three years, ranging from a cancer pathways and palliative care improvement project to meetings around the futures of GP practices.

Also, bear in mind that this list doesn’t account for all the daily informal encounters that are taking place, from volunteers greeting visitors at hospitals to care at home staff making regular visits into people’s homes, picking up feedback, thoughts and ideas around services.

We need to improve our approaches to engagement, and the draft Participation and Engagement Strategy aims to provide a three-year road map towards that goal.

It builds on elements such as the creation three years ago of the Participation and Engagement Working Group for the Health and Social Care Partnership.

The Working Group is the place where anyone should come in the first instance if they are proposing to undertake a significant piece of engagement or consultation work within the Partnership.

It’s a supportive group with membership from right across the Partnership of people who are trained or experienced within engagement, able to offer advice and support, and who help to co-ordinate and oversee these pieces of work. It also provides advice around the Consultation Framework which has been developed as a step-by-step guide for anyone undertaking formal public consultation on behalf of the Partnership.

If in a position where you might be undertaking some significant engagement work or a formal public consultation, please let me know.

As for the Draft Participation and Engagement Strategy that’s out to consultation?

Among the people it will impact on most of all is you – someone who is either working or volunteering within health and social care in Dumfries and Galloway.

Whatever your role, given the amount of engagement that already takes place, and the need to seek to improve our approaches as an organisation, there’s a very good chance that you may be affected by whatever actions are finally agreed.

So this is the Health and Social Care Partnership now calling on you, either as an individual or as a team, to play a role in shaping a strategy that will affect you.

The consultation is running until June 5 2022, and we’re here to support you to help shape the outcome.

A copy of the draft strategy is hosted here: www.dghscp.co.uk/consultations

There is also an Easy Read version of the strategy, a version translated into a British Sign Language video, and an animation explaining the process.

Included on the webpage is a survey looking to collect your views, and directions to contact the following email address if you want to offer your views as part of a relaxed online engagement session, where ideas and suggestions can be discussed. Email dg.engagement@nhs.scot to register to take part.

The key to shaping our approaches to engagement is by getting involved yourself. Please do take the opportunity visit the web address and get in touch with us.

Engaging with people can seem pretty daunting, but think about it and you may agree that it’s something we do on massive scale as an organisation every single day.

It’s about going out to talk with people, to hear what they have to say, and to work with them as partners to shape how we approach the future of our approach to health and social care.

Hopefully time will prove that the more we do engagement the easier, more mutually beneficial and productive it becomes.

Rod Edgar is Communications and Engagement Manager for Dumfries and Galloway Health and Social Care Partnership.

Put your own oxygen mask on first

I thought that hypnotherapy and mindfulness were for other folk and that relaxation and rest were things you did if you had time or nothing better to do. Until last year that is. Two family bereavements within three weeks of each other in 2019, followed by all the additional pressures due to the Covid pandemic meant I muddled through until finally asking for help from staff support in March 2021. I was stressed and over whelmed.

Whilst waiting for an appointment, in June I came across the Happiness Club, run by Jo Howarth, an advanced hypnotherapist and mindfulness practitioner. Working with Jo, my work overwhelm improved with simple things she showed and taught me. I plan my week in advance, which can be challenging in a clinical environment and needs flexibility to make it work. Proper breaks throughout the day are essential. I try to eat my lunch away from my desk or at least whilst not reading emails! One of the most liberating techniques Jo taught me was to only read my email once a day, scheduling time everyday specifically to read and action them. Honestly, try it. I didn’t believe her until I did. An automated response suggests if it’s urgent to phone me instead.

Despite Jo gently telling me and encouraging me to rest I didn’t truly get the importance of proper rest until more recently when physical health issues forced me to be signed off work. Even then my GP and Jo had to persuade me that I needed to be off. Suddenly I was aware of just how exhausted I really was, not just from poor physical ill health but mentally too. Working in the NHS in its self during a pandemic is reason enough to be stressed and overwhelmed. Re deployment of the team on several occasions due to Covid, unable to see family etc. are all reasons I would have given you as to why I was exhausted too.  But actually my exhaustion and over whelm was completely down to me. Learnt behaviour from my past meant I felt everything was my responsibility and everything that wasn’t right was my fault too. It was my job to sort everything and the guilt of that meant I had been at times working in excess of fifty hours a week, staying late, working at home in the evenings and weekends. I’m fairly sure there are many people reading this doing exactly that too.

But it’s not all my responsibility and in fairness no one ever told me it was, nor was I expected or asked to work those extra hours.  Using hypnotherapy to help me explore those behaviours and the emotions that go with it hasn’t been easy. Nine months ago, I wouldn’t even have considered hypnotherapy, but honestly, it’s magic. I cannot recommend it enough. I am so fortunate to have found a therapist who I trust 100%. It’s not been easy, there have been lots of emotions and difficult days, but it is so worth it.

I had also been using the mindfulness techniques Jo had taught me, along with meditation and relaxation techniques. But I know now I hadn’t truly learnt the importance of and how to properly rest and relax. Proper rest is not just about sleep. I read recently there are 7 types of rest.

In her book, Sacred Rest: Recover Your Life, Renew Your Energy, Restore Your Sanity, Dr Saundra Dalton-Smith suggests we all need seven different types of rest. The answer to overwhelm and burnout isn’t just taking a holiday. You need to identify what type of rest you need and adopt strategies to achieve this on a daily basis.

1. Physical Rest

Sleeping and napping are the passive component of this and the active part of physical rest include more active things like yoga and stretching

2. Mental Rest

Signs that you need mental rest include poor memory and not being able to settle to sleep at night without your mind racing

3. Social Rest

People pull from your social energy and you find yourself saying, “Can I just get a moment for me?” You feel like everybody’s taking, and you never feel like anybody’s ever contributing back into your life.

4. Spiritual Rest

Spiritual rest needs vary based on someone’s own belief system. At the very core of that is that need that we all have to feel like we belong, we need to feel our work and efforts contribute to the greater good.

5. Sensory Rest

You may not be consciously aware of the sensory input around you, but your body and your subconscious self respond to the sound of phones ringing in the background, the bright lights of your computer, the kids playing while you’re working at home, your notifications going off on your phone or your email.

From all of this you can develop sensory overload. The most common ways of responding to sensory overload are irritation, agitation, rage, or anger. So you may start the day calmly but by the end you are agitated and irritable.

6. Emotional Rest

Emotional rest specifically refers to the rest we experience when we feel we can truly share how we feel. Many of us keep our emotion to ourselves especially at work, we don’t share with people what we’re feeling. The automatic response to “How are you” is “Ok thanks”

Feeling that you always have to keep you emotions in check is an indication of emotional rest deficit.

7. Creative Rest

Creative rest is experienced when we allow ourselves to appreciate beauty. Whether this is natural beauty all around us or created beauty such as music or art.

She suggests a deficit in this type of rest can be seen if you struggle to be innovative.

So it’s not just about sleep! Whilst signed off work, I finally understood the importance of rest. Reflecting back I can see that I had a deficit in all types of rest. I was irritable, had no interest in anything much, my sleep was poor, the noise and inability to concentrate at work in the shared office meant I felt like I was achieving nothing. I had no time for me.

Proper rest has seen my appreciation of the world around me grow along with my mindfulness practice. I look at the sky driving to work instead of worrying about the day ahead; my new favourite place to be is sat by the river, listening to the water, appreciating so many things in my life and the world. Proper relaxation, doing nothing, absolutely nothing is something I want to do and I make time for everyday now. It’s essential for my mental health and well being. My love for things I enjoy like reading is back, along with my need to learn and understand. I try to exercise every day, walking for now but once I’m physically well enough I will get back to cycling. Now I have returned to work I know “the one minute of everything” I’ve learnt to use focuses my thoughts on my breathing and literally gives me a minute to re focus, and bring me back to the present moment. 

 Please don’t be like me and wait until you are not well enough to come to work before you take care of you. Just like with the in-flight safety briefing, we are no help to anyone unless we put our own oxygen mask on first. Self care enables good care.

I’ve written this simply to let you know it’s ok to say you’re not ok, and to try to highlight the importance of proper rest. 

Talk to someone, pick up the phone. There is so much help available through staff support or outside agencies, the Happiness Club being just one of the many out there.

On being a Trans Ally by Claire Alexander

Hi, I’m Claire (she/her) and work as a Psychological Therapist.  As we mark International Transgender Day of Visibility on 31^st March, I’m sharing some thoughts on how I try to be a Trans ally in my work with NHS Dumfries & Galloway.  

I try to visibly be an ally to the LGBTQIA+ community by wearing NHS Scotland’s Pride Badge on my lanyard. The Pride Badge has prompted discussions in sessions with a patient who was concerned that their therapist may not share their values on inclusion of the trans community. By showing them my badge and explaining that I’d signed a pledge to promote inclusion of all gender identities, sexual orientations and people from ethnic minorities, they felt reassured.

When beginning sessions with a new patient, I make the Pride Badge visible when I show them my NHS lanyard to confirm my identity. If a patient’s gender identity differs from what is reflected in their online medical records, I make sure to use their correct pronouns throughout my notes and clearly document their gender identity and pronouns at the top of each entry to help other staff use the correct pronouns when addressing the patient.

In my email signature, I have included my pronouns and a link to a document ‘A Short Guide to Sharing Pronouns for Trans Allies’ which explains the importance of using correct pronouns.  Unfortunately, I’m unsure of the document’s author, but it’s based on this article. Pronoun Round Etiquette (thebodyisnotanapology.com)

A book that I learned a lot from is called “Beyond the Gender Binary” by non-binary author Alok Vaid-Menon.  Some useful articles written by NHS colleagues include:
Why pronouns matter | NHS Confederation 

‘Hello, my name is… and my pronouns are…’ | NHS Confederation 

Transitioning Times – New Challenges to Face by Valerie White

My last blog was 30^th of March 2020. I re-read it to prepare for this one – if I had known then what the next 2 years had in store I think my resignation letter would have been in! The last two years for me, as they probably have been for many, is thinking about how I get to the end of the day, never mind the end of the week.

For someone who loves to plan the uncertainty has been at times overwhelming – but the truth is none of know what the future holds. It feels like over the last few years the world has become a very strange and unpredictable place – Brexit, a Pandemic, Russia invading Ukraine, a cost of living crisis – I’m not sure even Mystic Meg foresaw any of this.

We are entering a new phase in relation to the pandemic – thank goodness. Our ability to enter this is due to Vaccination.

Vaccination has been the game changer, we must never be complacent about this fact. Just look at what is happening in Hong Kong – low vaccination uptake there means Omicron is hospitalising and killing huge numbers of people. Ensuring you are as fully vaccinated as you can be and keeping up high vaccination uptake across our population is key to keep us moving forward.

We have not had a pandemic in the modern age, vaccine inequity is still an issue, the threat of new variants continues – they could be milder, they could be more severe, they could be less transmissible, they could be more transmissible – we just don’t know. So being prepared for these eventualities is key.

But at the moment we are moving towards COVID-19 being endemic but that will take time. During this time for the majority of the population COVID-19 will become another in the long list of respiratory illnesses that we get – sometimes we are mildly affected, other times we can feel really quite rubbish but for some COVID-19 is another respiratory disease that will continue to cause serious illness and even death– just as other respiratory illnesses do. Whilst we are all sick of COVID, and I include myself in this, there are some things that we need to embed as we move through into a new phase to protect those who could be more vulnerable.

• Good hand and respiratory hygiene – remember coughs and sneezes spread diseases – this has always been true and not just for COVID.
• At the end of April, the general public will no longer be advised to seek a PCR test if they are symptomatic for COVID-19. This will be replaced by guidance of what to do if we experience respiratory symptoms. So we will all need to think about our behaviours and interactions if we are feeling unwell, particularly in relation to those who might be vulnerable to COVID-19 or other respiratory diseases
• Improving ventilation in crowded indoor settings
• Mask wearing in certain indoor settings
• And you’ve guessed it keeping all our vaccinations up to date.

But as I write this blog – which I truly hope is the last one that is about the pandemic – it is not COVID-19 that worries me most. That dubious honour belongs to the challenges we face in relation to the rising cost of living, particularly for those most vulnerable in our society, often those who have been most badly affected by the Pandemic.

Poverty and income inadequacy is bad for your health, and poor health in turn can cause poverty and income inadequacy – it can become a vicious cycle incredibly quickly. The infographic below from the Health Foundation is a helpful summary of how poverty affects health.  

During this challenging time it is so important that those in need are able to maximise their income through the help and support available. With the unprecedented increases in the cost of living there will be many who are facing difficult financial decisions for the first time. Navigating the support that is available is complex but there is help out there. Our colleagues at Dumfries and Council’s Welfare and Benefits and Financial Assessment Team are on hand to help with dedicated support on what assistance you may be eligible for. More details are available on the following link:https://www.dumgal.gov.uk/article/15927/Benefit-advice-and-financial-assessments

Our local Dumfries and Galloway Citizen’s Advice Service is also on hand and eager to help and support everyone right across our region with a range of support on income maximisation advice and guidance and debt advice and support. https://www.dagcas.org/what-we-do/

Please if you are struggling, get in touch with these teams as soon as possible. It is probably one of the best things you can do to support your health and wellbeing – in both the short and long term.

Together we have ridden the ups and downs of a pandemic, and I know that we’ll continue to ride the difficult times ahead. Thank you Team D&G – you are just the best.

Valerie White is Director of Public Health NHS Dumfries and Galloway

Horizon Scanning by Jeff Ace

Well, this is all a bit rubbish, isn’t it? Two years on and still wave after wave of irritatingly more infectious variants, each one arriving just as we’re seeing light at the end of the tunnel from the last one. I must admit to never hearing of the Greek letter ‘Omicron’ before the pandemic; if we were using the more accessible Welsh alphabet, I think we’d be on letter ‘ff’ which much better represents my current feelings.

I liked Ken Donaldson’s blog a few weeks ago in which he wrote about the optimism of spring, and I have had real flashes of optimism throughout the pandemic. For example, I vividly remember our Pharmacy Director taking me to watch the first ever Covid vaccination in our region and thinking this was it, the beginning of the end, back to normal soon. Similarly, I got my first jab (it’s not ‘jag’, it just isn’t) on the morning of Wales’ Grand Slam game against France in March 2021, what an incredible start to a new era. But Wales lost and have kept losing, and we saw the Delta wave and then Omicron spikes push thoughts of recovery further and further away.

Omicron Arrives in Dumfries

We’ll get through the current surge of course, just as we have all the others (if we still have a dash of optimism left, it looks as though we could already be through the peak). But it’s a bit daunting to look at the scale of the rebuild that will be needed to deal both with the backlog in elective activity and with the new demands that will come from the wider impacts of the pandemic, the lockdowns, and the growing crisis of poverty in our population. It is so easy to lose confidence in our ability to build our services up to what our region needs. But we need to avoid falling into this pessimistic trap and start planning a future for our teams that is a whole lot better than the two years we’ve just endured.

The Board ran a planning exercise recently designed to kick off deciding priorities for this next phase. We used a three horizons model you might have come across that requires you to first describe a high performing system with the vast bulk of our problems behind us, say, 10 to 15 years in the future. You then look at a halfway point to this perfection and describe what progress and milestones you should reasonably expect to have achieved. Finally, you look at the next year or two and agree the short-term priorities needed to start this transformation. It’s sometimes quite a good tool to use when the scale of your immediate problems seems a bit overwhelming since you start from a point where they’ve all already been solved!

The only other framework we used was another simple tool, the balanced scorecard. The theory here is that a resilient, high performing system must be excellent in each of several areas.

• Quality and Safety

This is the most obvious for us. Services that we provide in the future have to be of a measurable high standard and pass that critical test that we would be utterly comfortable in relying on them for our loved ones.

• Workforce

Again, this one is self-evident. Our services, our facilities and our culture need to be such that we attract and retain the workforce we need to provide that high quality care. I think we can assume that we will be operating in a very competitive labour market and that to succeed in this area, our offer to current and prospective staff members has to be outstanding.

• Performance

The pandemic and its associated effects have smashed apart our operating model and we are really struggling to deliver consistently fast access to services, in either elective or emergency pathways. We have to rage against this and avoid any temptation to accept it as some new normal level of performance for our population.  I read this week that public satisfaction with the NHS had fallen to a level last seen before the 1997 general election and we need to regain that lost support for what we deliver.

• Finance & Sustainability

This may not be everyone’s favourite quadrant of our balanced scorecard but it’s absolutely critical to our success. We’re going to emerge from the pandemic in a very difficult financial place, close to £30M a year from a balanced position. Unless we turn that around, it will begin to dominate our agendas, to the detriment of all that’s set out above. Our income is pretty fixed, so these new service models that will deliver high quality, give fast access and be brilliant to work in… are also going to have to cost less. Sorry.

Oh, and we’re going to need to be carbon neutral by the 2040s.

Hopefully you can see now why it’s easier to start describing the system where all these problems have been fixed!

We’ll take a first cut of the three horizon plans to the Board meeting in April, but we’ve got a lot of work to do to refine our ambitions into something more concrete. Much of this is going to involve talking with our teams, our communities and our partner agencies, building on the huge number of Sustainability and Modernisation (remember SAM?) ideas that you provided before the pandemic changed the world.

So despite some bruises during the pandemic, I refuse to give up on my optimism (except maybe about Welsh rugby over the next couple of years, don’t get me started on our coaching team…). We’re a system with an incredible track-record of successful change and we’re going to plan our way out of this, one horizon at a time.

And finally, just because I can never say this enough times, please let me express my gratitude on behalf of the Board for all that you’ve done over the last couple of years. I’ve seen teams handle episodes of crisis before, but I’ve never witnessed that effort extended over such a time period, during which your own family lives were getting turned upside down by the pandemic and its lockdowns. Thank you.

Jeff Ace is Chief Executive Officer for NHS Dumfries and Galloway