Reflections on our contact tracing journey…. by Lesley Skilling on behalf of the Test & Protect team

Everyone will be aware that contact tracing ended on 30^th April.  

3 days before, the Public Health Directorate held a Development Day where all teams took the time to pause and reflect on the Challenges & Successes of the last two years and what the future looks like.

For the Test & Protect Team it was particularly poignant as our work has now stopped and the team are returning to substantive roles or are looking for new opportunities.  

It’s fair to say it’s been very emotional and as I share our reflections with you I am sure much of this will resonate with many.

The unpredictability of the virus brought the biggest challenge – the pressure of keeping pace with the infection rate and the sheer number of cases meant that the team were not always able to contact all cases or close contacts despite their best efforts.

The unpredictability also brought ever changing guidance making it difficult for staff to keep up to speed. The changes came into effect immediately after a briefing by the First Minister, the next day or a date in the future. Juggling different guidance depending on infection dates became the norm and made it difficult for staff when case numbers were through the roof and so many calls were required.

Staff rotas where challenging when the crystal ball to see case numbers in the future was not working. On many occasions staff gave over and above what was asked working long hours when waves of cases hit.

Contact tracing became an ever changing landscape.

Having time off meant that quite often you came back to a different job.

The team grew and staff changed on regular basis. The growth of the team meant that existing staff became trainers while trying to do their day job. Training strategies had to be pulled together when time allowed.

The team even moved offices in the middle of the pandemic. Staff recall wheeling their chairs and computers along to the new office, plugging in their pc and making calls again!

As the team grew there was a move towards more people working from home and we now have team members who work remotely across the UK and Ireland. This brought the challenge of finding new methods of communication and team working. Our coffee catch up’s became a welcome break from constant calls.

Our recording systems also grew & developed. A local IT system soon became a national system know to us as CMS. CMS evolved daily and this lead to the development of online scripts and guidance on how conversations should be structured and what information we needed to gather.

What started as a local team helping to contain the virus in Dumfries & Galloway became part of a national army of Contact Tracers across Scotland. A representative from the team attended national meetings twice a day so we could highlight if we needed support or could offer support to other Boards through mutual aid.

Staff were expected to be an expert on everything!

Random queries became the norm and from all over. The team learned how to adapt and cope, learning as we went and seeking out answers.

When you made a call you had no idea of the personal circumstances of those you were calling. Staff were dealing with their own anxieties about the virus while managing the anxieties of those they were talking to. There were some very difficult conversations and emotions run high – anger, grief and tears. You could be speaking to someone who had just lost a spouse or someone sitting with a loved one in their dying days.

Staff had to deliver bad news too – talking people through the realisation of what that positive result meant – cancelling their wedding, not being able to meet up with extended family they hadn’t seen for 9 months or not being able to have the operation they had been waiting 18 months for.

The attitude of the people we called differed over the two years. The majority were very receptive to our calls but we could be seen as the bad guys working on behalf of the government and stopping their independence.

The public struggled to keep pace with the guidance so having to explain the rules had changed again was difficult at times. People were not behaving normally; it wasn’t just those who were positive, everyone was behaving out of character.

Despite the challenges there have also been many successes.

The team successfully carried out effective outbreak management and this was a critical tool in containing the virus. From interviews we were able to identify links and could report outbreaks to the Health Protection Team. Our processes moved from diagrams on flip charts to an electronic suite of reports allowing us to see patterns and numbers in a known outbreak setting. The team could draw on these reports when attending PAG’s & IMT’s. This couldn’t have been done without the use of very skilful interview techniques and staff honed these skills.

Staff came from all over to form the Test & Protect team – Environmental Health at the Council, Sexual Health and Public Health staff. As the team grew people who had vastly varied skill sets and different working backgrounds came together with one common goal. They wanted to protect the people of D&G from the Covid 19 virus and they wanted to do their bit for the cause. The team were truly passionate about the service, supporting and learning from each other.

Without a doubt the team can be proud that they have delivered a caring and helpful service for anyone who contacted us. It became much more than providing isolation advice – it was ensuring that people were able to cope with isolation mentally & physically, did they have family or friends to check in with them, were they able to access food and medication, was there money on their electric cards, if they were ill should we call 999 and a whole host of other welfare concerns.  The team became adept at finding solutions and regularly drew on the assistance of others.

So many people, teams and departments across the Health Board and other partners were always there to assist. Thank you to each and every one of you – we simply couldn’t have done this without you.

Lesley Skilling is the Service Manager for the test & Protect Team at NHS Dumfries and Galloway

Can you hear me? by Fran Milne

I was born profoundly deaf and have relied on lip-reading since the year dot. I was given my first hearing aids when I was 4.5 years old, and my Cochlear Implant in 2009. I now wear one hearing aid and a CI. As helpful as the listening aids are they, along with lip-reading, are not infallible. Let me explain why…..

My First Hearing Aid

It is estimated that only 30-35% of the English language is able to be lip-read, ie those words that are formed on the lips and/or the front of the mouth of a clear, articulate speaker – other sounds are made in the middle or back of the mouth, or even the throat.  Even for words that can be ‘read’ it is not infallible as many words have the same lip-pattern eg “Buy my pie” or “Shoots/shoes/chews/juice/June/Jews” – try it with your colleagues – no sound! I only have to laugh at some of the ‘misinterpretations’ I have made in the past….

As a result, a perfect lipreader would only be able to lipread about one third of what is said. So, what coping strategies can be used to aid communication for deaf people? We can add in the use of hearing devices, in my case a hearing aid and a Cochlear Implant (CI). If I were to listen only without lipreading, I can only hear approximately 60% of the conversation in a quiet environment and with full concentration (which is why I have difficulty using a telephone and can’t hear the radio), which drops to 53% or below with competing noise. Hearing aids are not like glasses which can aim for 20/20 vision. They are an electronic production of sound which, in the case of my cochlear implant, is transmitted directly to my cochlea. With both the Cochlear Implant and the hearing aid, all sounds are amplified with no ‘screening’ to focus on the sounds you want to hear.

Colleagues Chatting

 So, what of the remaining percentage of recognising words that make a conversation? This is guesswork plus taking in knowledge of the context, body language and any other visual cues. As you can imagine, to do this continuously for any length of time and with up to 1-2 people present, is very tiring! (and why I don’t ‘do’ social events – although I always appreciate being invited 😊. I often take off my ‘ears’ as soon as I get home from work and chill…). There are also other factors to take into account for example quality of lighting on the speaker’s face, clarity and speed of speech, accents, room acoustics, background noise, one person speaking at a time – even loose false teeth!

I thought that the following, thanks to Sensory Support Service UK, is a good illustration of what listening can be like for a deaf person. All this processing takes place within seconds – but is continual throughout the conversation. Thanks to my auditory aids (without aids I hear nothing!), my own experience isn’t ‘quite’ as extreme as this, but certainly gives the jist…..

In spite of the difficulties, my deafness has not held me back in my career. I haven’t known any different and have taken on the challenge of living in a ‘hearing world’. At my work with patients, which is currently mostly with older people, I can empathise with those who have developed hearing impairments and who often find it hard to learn to lip-read, so isolating them further.  Certainly, the onset of Covid and the need to wear masks have added to the challenge, but those staff who know me have been very supportive in taking a step back to socially distance and lowering their mask to enable me to converse with them. Most of my work is one-to-one with patients, who aren’t required to wear masks, thankfully. Teams chat is also another challenge, even with an audio link to my CI, as the quality of the video is paramount in my ability to lip-read. There ‘are’ subtitles in Group Chats in Teams (but not individual chat that I know of?) but this is based on speech recognition software which can produce some strange results! For face to face meetings, such as MDT and Discharge Planning meetings, I make sure that I am well prepared with knowledge of the context of the meeting, position myself so that I can see all those present, and take quick notes as a ‘aide memoire’ before going on to processing the next part of the discussion.

‘Selfie’

This is only MY experience of being deaf – everyone, as with anything, is an individual.  We are still not in the ideal world for Deaf people – I also would like to use British Sign Language which is so beneficial at training days and meetings but Interpreters are both so few and far between in Scotland/North England and expensive to hire for a day.

So, can you hear me – to help me to hear you?

Fran Milne, Specialist Community Physiotherapist at NHS Dumfries and Galloway

For more information – https://hearinglosshelp.com/blog/speechreading-lip-reading/

Two steps forward, one step back? by Gillian McNeil

When I trained to be a nurse, a few years ago now, I did not imagine for one second that home working would be a possibility. Yet here I am, as a Diabetes Specialist Nurse and, yes, there are occasions when I can work from home. If I am seeing my patients virtually or I am telephoning them then I do not need to drive 20 miles to work to see them then drive 20 miles home again.

There is much to say about the last 2 years, it changed many things and has been difficult for so many people for so many reasons. In my mind, one positive thing about the Covid 19 pandemic is that it made us grasp the modern technology that had been developed and was sitting waiting to be used. Before I was aware of Covid 19 I sat in meetings hearing about NHS Attend Anywhere, now renamed NHS Near Me. Like the dinosaur that I am, I could see the advantages but felt it was still a long way off being used routinely and I didn’t really engage with it. Fast forward a few months and I was embracing this new technology as it became the main way that I could see my patients. Telephone calls are all well and good but if I needed to demonstrate how to administer insulin or use one of the new injectable therapies then I had to be able to see my patient and my patient had to be able to see me. Something that felt alien at first very soon began to feel like the norm.

As a Diabetes Team we are going through a service redesign and have set up a triage service. Every weekday either a Diabetes Nurse or a Diabetes Dietitian takes their turn at returning all the calls and queries that come into the Diabetes Centre therefore freeing up other colleagues and allowing them to focus on work without being disturbed by calls. This is a system that is working well for us and patient feedback has been very positive so far. Delivering triage from home allows for a quiet environment with no distractions and no demands on time.

It is not just the clinical members of our team who have had to change their ways of working. At the start of the pandemic it was clear that we had no room for all our admin staff to safely maintain a social distance while working. Like any team, our admin staff is the glue that holds us all together, we rely on them for so many things and they are incredibly patient and supportive. They, too, were given the necessary equipment to allow them to work from home but with the advent of TEAMS this posed no communication problems whatsoever.

I keep trying to convince myself that the end of this pandemic is near and in the meantime I delight in the fact that I can occasionally work from home. Most of the time I am patient facing, either in DGRI or the Diabetes Centre at Mountainhall, clearly I am not able to work from home very often and I am very aware that a lot of NHS staff cannot work from home at all, this is in contrast to some members of staff who are able to work at home all the time.  Changes are afoot however and slowly but surely the staff members who were able to work from home for the past 2 years are being asked to come back in to work again. I keep asking myself why? The weekly Covid numbers are still a concern in D and G. We may be nearing the end of social distancing, isolating and routine testing but we are all aware that we should continue to minimise risk where we can.

I feel there is a common misconception that home working is a bit of a skive, that we are less productive at home, but let’s face it, we all have our workload to get through and I do not know many NHS workers who do not fill their working day. I find I am more productive; I can put my head down and concentrate without distraction. We had to find new ways of working when Covid hit, but do we have to revert back to our old ways?

Let’s consider a few of the positive aspects associated with home working:

We recently completed an audit within the Diabetes Team. I think we were all shocked to realise that, if all the team members were to come in to work on any given day, we would be covering 660 miles between us. We all know Dumfries and Galloway is a rural area, a lot of people have to travel to work. Public transport is scarce in a lot of places so people have no option but to use a car. Even in a relatively small health board like ours allowing people to continue to work from home would make a really positive contribution to the reduction of emissions.

We are all facing huge hikes in our cost of living. Fuel prices are at an all time high and Mr Sunak’s paltry 5p a litre reduction gave very little reassurance that maybe things won’t be as bad as feared. Surely it would make sense, and provide some support and comfort to our hard working NHS staff, to do all we can to keep fuel costs to a minimum. Workers who are less stressed are more productive. I don’t think I need to find a piece of research to back that statement up, it goes without saying.

There are perks to working from home. I would be lying if I said I never hang out a sneaky load of washing in between patients but I can easily balance that out with the time that I “waste” catching up with my colleagues when I am in work. (I use inverted commas because I do believe that interacting with my workmates, who are also my friends, is a very valuable part of the working day).It is a joy to be able to spend my lunch break walking my dog across fields instead of sitting in a crowded staff canteen or, worse, at my desk reading emails while I eat my obligatory cheese toastie. One of my colleagues, who shall remain nameless, recently said to me that one of the most wonderful things about working from home is that it gives her something that money cannot buy. It gives her time. Time that would normally be spent sitting in her car for an hour and a half every day. Time that she is not stressing about the cost of petrol or being stuck in slow moving traffic. Time that she is not spending worrying about everything that she has to do when she gets home because when she finishes work she is already there. And working from home is not all filled with perks. When I work from home I am alone in the house. It can get chilly just sitting at my laptop and I cannot justify heating the whole house just for me. We don’t think about the cost of heating when we are sitting in our cosy offices, because we are not paying that particular heating bill. We rely on heating oil in our house, the cost of a litre of this has more than doubled in the last few weeks. We hear a lot about electricity and gas prices shooting up but rarely is heating oil mentioned. I imagine in a rural area like ours there will be a high proportion of people who rely on heating oil. Electricity and gas prices can be capped, not so kerosene.

However; today the sun is shining, the birds are singing and I am working from home. I don’t have to drive home after work; I can go straight out into my garden and wind down after a busy working week. I feel very positive. I look forward to the whole NHS D and G team putting their best foot forward into restarting services.

Gill McNeil is an Associate Diabetes Specialist Nurse for NHS Dumfries and Galloway

“What are you going to do for me?” by Reave Brown

I am a fourth-year social work student and have just finished a 120-day placement. This was not only my first but last placement before I qualify. Due to the restrictions of COVID this meant that the initial plan of having two placements throughout my course, 85 days in third year then following with another 85 days in fourth year could not go ahead. I therefore found myself heading into my fourth and final year of studying social work and heading out on a 120-day placement with what I felt like was no hands-on experience.

I was fortunate to have a split placement, meaning I was allocated to two different learning opportunities. One as a student with the Care and Support at Home Tactical Team (CASHTT). The second working on a learning disability project, that was focusing on looking at what barriers people with a learning disability face when trying to access meaningful day opportunities such as further education, volunteering, and community activities.

It is understandable how social workers can often be seen as the people who put care in, as that is something we often do within our jobs but as social workers we aim to improve people’s lives by helping with social and interpersonal difficulties, promoting human rights and wellbeing. The following definition was approved by the International Federation of Social Workers in 2014 as the Global Definition of Social Work:  “Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, and the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work.  Underpinned by theories of social work, social sciences, humanities and indigenous knowledge, social work engages people and structures to address life challenges and enhance wellbeing.

I believe that taking a holistic approach to social work is important as it involves delving into all aspects of a person’s life rather than focusing on one issue. Combining our social work assessment with those of other professionals such as health, education, and housing. This takes everything into account and can encourage and enable people to make informed decisions for themselves with our support.

In CASHTT I am working alongside, a Lead Social Work Manager, Lead Allied Health Professional, Social Worker, Assistive and Inclusive Technology Programme Lead, Data Analyst and Admin Support. CASHTT offers support to care and support providers and ensures they have all required resources and aims to build strong working relationships with providers at an operational level. Through building collaborative relationships with the 29 different care and support providers across Dumfries & Galloway it will allow CASHTT to understand the key challenges in care and support at home and how to consider what changes and improvements can be made. Through working alongside this team, it was highlighted to me very early on about the challenges care and support at home are facing within Dumfries & Galloway right now, this impacted positively on the way I worked. As when doing assessments and thinking of ways a person can be supported without the use of ‘traditional’ care and instead thinking about different ways should that be the use of assistive technology or were there other services locally that could support a person in a different way that would still meet their needs. As well as working in collaboration with the person to identify their strengths and resilience within themselves, families, and groups. Then building on this as means to help resolve problems and deliver their own solutions. For example, I was working with an older lady who was relying on her family to support her with her personal care, the family had begun to find this increasingly challenging and felt they could not continue this level of support. The family thought she may need carers to assist her. Through Occupational Therapy and I undertaking an assessment it was found that the lady could manage her own personal care should she have the correct equipment and adaptations. She had a wet room installed and equipment such as a shower seat. To help building the lady’s confidence I discussed care call with her and the family, this put herself and the family at ease as the family would be her responders should she ever need help or assistance.

Through working alongside the care and support at home tactical team it has allowed me to see how integrated and collaborative working has such great benefits. This way of working produces benefits for individuals, professionals, and whole agencies as it includes offering and displaying broader perspectives and a wider range of knowledge of understanding surrounding an issue. It also allows for improved interactions between differing agencies and means for a better understanding of what the different agencies around us do, for example I had the opportunity to shadow a speech and language therapist for a day and it gave me great insight into that role and when would be appropriate to refer an individual to a speech and language therapist. Which overall helps provide an improved service and outcomes for people. It has also highlighted that within social work there are high demands for the combination of individual and group work techniques, therefore having the skills and ability to work within a team and communicate effectively is an essential skill. Having this ability means for greater knowledge, shared responsibility and allows for resources to be shared, which again results in better services and outcomes for people.

Now that I have finished my final placement, I am looking forward to starting my career and going forward working alongside other professionals with a holistic approach. To enable the people we support to achieve the best outcomes possible.

Reave Brown is a Student Social Worker