About dghealth

dghealth has been established to provide an opportunity for all employees of NHS DG to blog and share ideas and opinions and start conversations. There will be a weekly post. All blogs will be the personal work of the contributor and NOT official NHSDG policy. NHSDG have an Information Policy doc available on the Hippo website under useful I.T. forms

Co-production – friend or foe? by Viv Gration

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Next week is Scotland’s Co-production Week (19 – 25 November). There is a lot going on across the country to share stories and experiences of co-production.

The word co-production is used regularly in conversations across health and social care in Dumfries and Galloway and in my experience generates a range of different reactions from people. I’ve seen people roll their eyes (in frustration?) “here is another buzz word or management term, ” others grimace (in confusion?) “what is it all about?” Some people shrug and are concerned that this will simply slow down progress and we shouldn’t have to bother, “we just need to get on with change” they say. For some people, myself included, there is a hope that this approach will genuinely make a difference to how we plan and deliver health and social care in the future.

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So, what is co-production? Are we doing it? And, does it work?

Co-production is when people with different interests come together as a group to:

  • Co-design
  • Co-deliver
  • Co-commission and
  • Co-evaluate

In health and social care, this means the people who use services, professionals, Carers, volunteers, providers and other stakeholders working together to consider how health and social care and support look and are delivered in the future.

Traditionally health and social care services have been designed and delivered by professionals working in partnership within the statutory, third and independent sectors.  With co-production the crucial difference is people in communities that receive care and support are involved in all aspects of their design and delivery.

We should already be consulting and engaging widely on any kind of service change. Co-production takes us to the next level of engagement. It’s crucially about doing with and not to people. It’s about recognising that people who use services and their communities know things that we, as professionals, don’t know.

Working in a co-productive way

  • can make a service more efficient and effective
  • can change peoples behaviours in how they use or deliver services
  • can place an emphasis on delivery of outcomes rather than just inputs and activity

100 days of co-production

In the USA there is a real emphasis on what Presidents can achieve in their first 100 days in office. It is amazing what can be achieved in a short period of time. For example, Franklin D. Roosevelt’s presidency began on March 4, 1933. During his first 100 days, a series of initiatives were developed that went on to successfully counter the effects of the Great Depression.

Perhaps a bit ambitious to think that we can counter all the challenges facing health and social care in Dumfries and Galloway in the same time period, however, using the 100 days to focus our efforts will be useful.

We have identified three topics to take into ‘100 day co-production labs.’ Co-production labs are essentially workshops to share experience, explore potential options for change, undertake tests of change, evaluate these and understand how and if they worked. This will help us to decide whether to embed these as part of routine service delivery or to try something else.

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The topics for the labs have been identified by communities across Dumfries and Galloway. It is anticipated that a focus on these particular areas of care and support will bring some benefit to design and delivery of health and social care. They will also give us the opportunity to test out our co-production skills to understand what does and doesn’t work for us.

This is an exciting time with an opportunity to try a different approach. It will require hard work and commitment over these 100 days. But we’re all set and raring to go! Watch this space – see you in 100 days!

Viv Gration, Strategic Planning and Commissioning Manager

 

For more information about the Dumfries and Galloway 100 days co-production labs contact Viv Gration on v.gration@nhs.net

For more information about co-production, including a range of case examples visit www.govint.org

For more information on Scotland’s co-production week visit http://coproductionscotland.org.uk/coproweekscot

 

 

Chairmans Farewell Message

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It’s been a pleasure

Serving as the Chairman of NHS Dumfries and Galloway, particularly during such a challenging and exciting time for our Region, has undoubtedly given me some of the most rewarding experiences of my career. I am deeply proud of what we have achieved together.

I am standing down after a four year term, and right since the start i’ve felt part of something very special. Despite the challenges that we face, this organisation has thrived and will continue to thrive, and that’s because of its people.

There’s a lot of pleasure to be had in public service and I have always regarded it a privilege to have an influence on people’s lives, to be responsible for such a wide range of services and to be able to do my very best to make sure those services have a positive impact. And that’s something we all do together at NHS Dumfries & Galloway regardless of our individual jobs. We pull in the same direction for the benefit of the residents of Dumfries & Galloway. The NHS does essential, critical work and it does it non-stop.

Day in day out, over the past four years, I’ve heard stories of our people doing extraordinary things. But it’s not only the extraordinary work that’s important in such a large organisation, it’s getting the routine stuff right. We’re responsible for so much – we build and operate hospitals and first class medical centres, we are responsible for community hospitals throughout the region. We maintain a massive records system and have just completed the digitisation of some 60 million paper based records. We have the best auxiliary staff in the business and with their crucial support our Health Associated Infection statistics are consistently amongst the best in Scotland. We help and support people at the most challenging times in their lives and our Spiritual Care Team provide care and support in one-to-one relationship which is completely person-centred and makes no assumptions about personal conviction or life orientation.

A measure of the regard in which we are held by the wider community is demonstrated by the significant number of people who volunteer to support the work we do. We currently have over 200 active volunteers who’s vital contribution has been recognised by Scotland’s Investing in Volunteers Award Programme and work is ongoing to develop the Volunteering Programme in our Rural Communities.

I don’t know of many organisations that could have delivered such a comprehensive and complicated programme of work as we have done, which included the unique challenges of the new Royal Infirmary project, Scotland’s largest NHS project at that time a project that required the skills of a whole range of people to bring to a successful conclusion. Our HR team achieved national recognition for the transitional arrangements they put in place securing a prestigious HR team of the Year award.   

The redesign project of the regional mental health clinical service including the development of one of the first home based treatment services in a rural setting in the UK was a groundbreaking initiative demonstrating the value of service provision close to the homes and communities of those who use the service and has paved the way for wider health and social care integration.

Despite all this change, teams across Dumfries and Galloway maintain an ongoing passion to continually improve care. As we mark the tenth anniversary of the Scottish Patient Safety Programme, we can reflect on the fantastic engagement and ownership seen from frontline teams who have shown a willingness to think differently and generate innovative ideas to deliver our shared vision for safe, quality and excellent care.

All of this change was done at the same time as doing the day (or night) job. The Scottish Government have confirmed, following our annual reviews, that NHS D & G  achieved continued excellence in the delivery of person centred care to the Dumfries and Galloway population. None of this is easy and I have been really impressed by the quality of our colleagues in all of the disciplines.

It is this commitment to patient safety, quality and patient experience that I’m most proud of and it’s something we should all take great pride in. I know that I’ll leave NHS Dumfries & Galloway safe in the knowledge that our facilities, our services and most importantly our patients and their families are in very safe, caring hands.

I’ve been pleased to see on a daily basis that Jeff Ace, our Chief Executive, fosters a modern management culture where there is trust and warmth. My non executive colleagues work hard not only to listen to things that reinforce our own views, but to take a broader view, based on advice and community engagement. Integrity of the Board has been important to us and we worked hard to make sure that our decisions have been based on sound judgement and evidence. I’ve always believed that if we are not a little bit scared then we have not been brave enough in our decisions, and I’m confident we’ve been bold in our approach.

Looking back over the past four years I am so proud to have played my part in supporting all of my colleagues in NHS Dumfries and Galloway in their significant achievements and I am particularly grateful to my Board colleagues for their support. The diversity and varied skill set of the non executive members has been a significant contributing factor to the effective running of the Board and will serve us well into the future.

It’s never easy to know when to leave but having considered the last four years and what I’ve been able to contribute, I feel that I leave NHS Dumfries & Galloway in good shape and in good hands for the challenges ahead.

I’m extremely grateful to you all for making me feel so welcome and making me feel part of our precious NHS from the very beginning.

Phil

Philip N Jones

Allied Health Professions day #AHPsday2018 by Wendy Chambers

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The first ever AHPs day is scheduled for October 15th 2018.

An opportunity for those working within allied health professions to showcase, celebrate and allow others to recognise the contributions made by AHPs across all sectors.

But frankly what is an Allied Health Profession (AHP)?

I thought I’d take the opportunity to let you know about the varied and eclectic family of AHPs working in Dumfries and Galloway.

AHP 2When I think about allied health professions it makes me think of an analogy I picked up when working in Vancouver. This visually described the multicultural society present in Canada as a “patchwork quilt”. Canadians aim to preserve their multicultural heritage by valuing the differences in being Chinese Canadian, Italian Canadian, British Canadian and so forth.  They become Canadian but keep their root heritage alive, contributing to a rich cultural diversity.

So when it comes to the term allied health professional this is a bit like becoming Canadian. We keep our individual professional identity while gaining from joining the allied health professions family. Across Scotland the number of AHPs employed is comparable to the number of doctors and dentists. There are 14 professions included in the AHP family, which makes it the 3rd largest workforce group within the NHS.

The potential contribution therefore to health and well being is significant, albeit varied.

As with the visual patchwork analogy the variety of skills and approaches available within the AHP family would suggest they are key players in creating a Healthier Scotland; where care can be delivered closer to home and people live longer and healthier lives. The Scottish government AHP policy document, “Active and Independent Living Program”,aims to focus the contribution AHPs can make, working with other professions and partners across agencies, to designing and delivering better health, better care and better value for people and communities.

Locally in D&G we have 8 of the 14 allied health professions currently employed in various settings across health and social care. In alphabetical order these include:

AHP 8

AHP 3

The AHP team in Galloway celebrating 70 years of the NHS 

How to become an AHP in D&G

We have both registered and unregistered jobs available within each of these professions locally.

The registered posts require people to study at university to either degree or masters level. Courses are available at various universities across Scotland. Information on where the courses are for each of the professions can be found using the following link I want to be an AHP

There are also very diverse support worker (unregistered) roles across the 8 professions. These posts require standard grade qualifications and usually provide ‘on-the-job’ training with access to further SVQ training as appropriate.

If you or someone you know might be interested in finding out more about allied health professional careers go to the following website link NHS Careers Scotland- AHPs

This site will also allow you to find out about current vacancies and job opportunities within the 8 professions across the region.

Meanwhile the AHP Therapies department staff (Speech & language therapy, Physiotherapy, Dietetic, Occupational therapy) and I would like to wish all allied health professionals in D&G and across the UK a happy first #AHPsDay, #AHPsDayScot.

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Wendy Chambers is an AHP Practice Education Lead and Occupational Therapist at NHS Dumfries and Galloway

Notching up your language by Sheena MacDonald, Emma Reid & Susanna Boytha

Aspire to lead graduates reflections (cohort 3)

Our words have power….our words have a profound effect on others.  Words can cause pain, words can cut, words can cause real wounds ……words can tear you down. Talking insensitively can leave other people feeling insecure or somehow diminished. Sarcastic jokes or comments, quotes and aphorisms that point out another’s deficiency, even certain gestures and facial expressions, can all serve as weapons…..to destroy others.

On the other hand kind words can build us up, they can release life…they can bring healing into our heart and mind…..they can bring healing and restoration into our relationships. They can alleviate loneliness, build self confidence, uplift and encourage. Kind and caring words spoken with sensitivity can strengthen the bond between us and help us to show love and respect towards one another.

It all depends on our attitude towards each other…. ultimately our attitude will shape our words!

By tuning into the needs of the people to whom one speaks, a person can generate immeasurable good into this world.

 The local ASPIRE to lead programme was the catalyst for this blog to share with colleagues across Dumfries and Galloway our learning about noticing and notching up language.  The focus of this programme has encouraged us to reflect on the language we use on a regular basis the top 2 being “deal with” and “so” and reflect on how respectful this sounds and lands with people.   We would like to share with you some of the resources from University of the West of Scotland by Professor Belinda Dewar – A Way with Words. 

Aspire 1We invite you to reflect on your own  “way with words” and use the poster to explore what you tend to say and what you could say to explore how changing our words can help inspire,  motivate and bring about positive provocations.

Aspire 2The seven C’s of Caring Conversations

A tool that we learnt at Aspire to Lead which helped us all to master our words in a
way that will always bring us closer to others, will always help others to
improve their self image, allow them to express who they really are and what they
really want. An integral part of developing and exploring our language to better fit a
positive culture is using the 7C’s of conversation.

Aspire 3Communication is key; how often do we hear this? The Senses framework is a useful tool to enhance communication and good relationships whether it is personally or professionally.

When having a conversation check to make sure all aspects of the Senses are being met. Be curious with each aspect of the Senses Framework and discover together what is helpful for goals and individual needs to be met.

If you are having a difficult conversation, which aspect of the senses framework is not being met for each of you?

We would like to share our reflections and what helped to empower patients and colleagues to express their ideas to co-create services

Emma Reid

Appreciative language and the 7C’s helped me build confidence to be curious and consider others perspectives more – staff and patients. I learnt to ask more open questions with people, and to feel more comfortable with pauses before jumping in with solutions myself.   As a result, people who came to the falls classes were empowered to ask for and suggest change.  My ASPIRE project started with co-creating the content of the falls classes. Since then we have used appreciative inquiry to redesign the Rehabilitation Day Unit into the Community Link Unit, and my colleagues are now taking this into the community on their own. For me this is really what ASPIRE is all about – it starts with a small drop of water and the ripples go further than you’d think.

Susanna Boytha

During the Project which I did with Aspire to Lead I have used 7 C’s to receive feedback from our patients about how they felt during the recent changes and developments at our Macula Service. Using the 7 C’s has helped us to really find out what matters to them the most.

Based on the information we received from our patients we managed then to further shape our services in a way that made them happier and more satisfied than before.

Sheena McDonald

Aspire 4During my Aspire to lead journey, I used image cards at the beginning and end of a Dafne Pump week long course to capture expectations and experiences of the course.  These sessions were always part of the course curriculum and delivered using verbal only methods.  I changed this session by inviting participants and facilitators to  choose an image that described how they felt about starting the course and how they felt after completion. It is worth noting that people are invited to only share what they feel comfortable with.  The sharing generated was much more detailed and allowed emotional connection within the group.  All of which influenced discussions and interactions throughout the week and at follow up appointments.

Since completing the Aspire to Lead programme we would like to share how changing our language and using appreciative inquiry has lead to successful projects and career progression

Emma Reid

Aspire 5Since ASPIRE, I have been able to use appreciative language to be courageous about how I feel in the moment. I have been able to communicate my goals in my career, and my needs as a person at home in a clearer way. I am now in a Trainee Improvement Advisor, undertaking the Scottish Improvement Leaders (ScIL) course. ASPIRE gave me the tools to compromise and collaborate with people in situations I previously would not have had the self confidence to try.

Sheena McDonald

Aspire 6Aspire to lead has provided me with many valuable tools that I use daily in my professional and personal life.   Using these skills I have been able to be more courageous.  I have recently started a secondment with the patient safety and improvement team out with my clinical speciality.   During this time I have been involved in several improvement projects all of which I have continued to notch up my skills from Aspire by working collaboratively with others and also celebrating achievements.   Probably the biggest challenge for me which I am still working on from the 7 C’s is sharing with people ‘how did that make me feel’, rather than what I think about the situation

Susanna Boytha

Aspire 7Since Aspire I have become more conscious of my language and using the different Aspire tools have made a significant difference both in my personal and professional life. It has enabled me to be more courageous and become the STL for Ophthalmology. It has helped me to connect emotionally to team members and consider other perspectives  while agreeing on different working arrangements. Following Aspire I have also completed the SIS Course at QI Hub and designed and led a major Service Development Project. Using appreciative inquiry has helped me to collaborate with all the major stakeholders. Using the 7 C’s of Caring Conversations has also helped me to enable the team to work together harmoniously towards achieving the aim of the project, which is ultimately to make our patients happier by seeing them closer to their home address in the West of D&G.  Finally I got accepted unto and started in September 2018 Cohort 11 of the Scottish Quality and Safety Fellowship! I am excited about this amazing opportunity and I am curious about the work of other fellows.  I feel the next step for me is to encourage the team(s) I am working with to celebrate more our successes and achievements!

Give it a go……. Consider notching up your language at your next handover, meeting or general conversation with colleagues, family and patients.

A ctivate knowledge

S killful Communication

P otential to Grow Leadership Skills

nnovate and improve

R esults that Make a Difference

E nergise self and Others

To Lead…………………………………………..

For further information on resources mentioned throughout the blog please see link below:

http://myhomelife.uws.ac.uk/scotland/resources/

 

Useful link for Language matters in diabetes:

https://www.england.nhs.uk/wp-content/uploads/2018/06/language-matters.pdf  

Thank you to Alice Wilson, Deputy Nurse Director who was the inspiration behind the Aspire to lead programme and our programme facilitators Belinda Dewar and Fiona Cook from University of the West of Scotland, Karen Hills and Bill Irving from NHS Dumfries and Galloway.

Sheena MacDonald is a Specialist Dietitian and Trainee Improvement Advisor at the Diabetes Centre

Emma Reid is a Specialist Physiotherapist and Trainee Improvement Advisor

Susanna Boytha is a Consultant Ophthalmologist

All of the authors work at NHS Dumfries and Galloway

Welcome to Dumfries and Galloway by Heather Currie

Heath 6We have recently welcomed many new trainee doctors to our beloved Dumfries and Galloway. The first week in August always brings back memories of my own first job..known then as “house job”, when change-over day was 1st of August, whatever day of the week that may be. In 1982 that was a Sunday. I arrived eagerly to Heathfield Hospital, Ayr on the Saturday, expecting to be able to find my way around and meet the staff prior to fully starting on the Monday (no induction or shadowing), having been informed that the “local boy” who knew the hospital would cover Sunday. However a last minute change of plan and alarming phone call informed me that I was to start on Sunday morning, be on call for medicine and was the CCU team with 2nd on call at home a few miles away. Thankfully a Registrar who stayed in residencies helped on his day off and I will never forget his kindness to reduce my terror.

Heath 1Shadowing and induction programmes have improved the starting process hugely but do we do enough to welcome our new colleagues and do we all always remember how scarey this process is? Many of us have worked here for many years and it is easy to take for granted our familiarity with the place, people, who to ask, geography, processes but for our trainees everything and everyone is new.
Our trainees are our future. We really need to make sure that they have a wonderful educational and social experience and want to return to work here, and tell their friends how great Dumfries and Galloway is.
Trainees in Obstetrics and Gynaecology have been subjected to a couple of small ideas which we hope is enhancing their experience and can be adopted by others.

First is a weekly half hour chat time with whoever is available, led by myself. The rules are:

1. No clinical chat about diagnoses or conditions
2. Chat is confidential and not to be used for gossip
3. Only chat taken out of room is to facilitate a change in a process or system

Heath 2All sorts of issues are covered and many resolved; issues that are causing stress or reducing enjoyment of the job and many good ideas for improvement are implemented. We are all busy but half an hour per week that can make such a difference must be worth while!

 

Heath 3Second is a scavenger hunt, the brainwave of Dr Dutton. We live in a stunning, fascinating area yet we weren’t convinced that our trainees always got to explore and realise the beauty of the region. Our game enthusiastic trainees have gone out exploring following clues to places of interest. Selfies are required to confirm that they have successfully solved the clue.

 

Heath 4Of course this applies to all trainees and new starters, not just medical staff. The focus on trainee doctors is simply because August sees the biggest change in staff in the whole year, but whenever someone new joins us, we should welcome them, put ourselves in their shoes, be inclusive, be creative, and be kind!

 

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Heather Currie is an Obstetrician and Gynaecologist and is Associate Medical Director for Women, Children and Sexual Health at NHS Dumfries and Galloway

 

It’s my life by Euan McLeod

In reading an article regarding co-production of services, it led me to consider co-production in the context of the therapeutic relationship in mental health nursing.

Recent personal experience with a patient who challenged the boundaries of that co-production and the meaning of that therapeutic relationship created opportunities in the team for reflection on how we participated in that relationship. It wasn’t a particularly easy journey I think for us or the patient. Personally I found it taxing and frustrating with moments of joy and sadness as we jostled and jogged our way along this road. “It’s my life” the patient would scream at us, obviously frustrated by our attempts to be therapeutic.

The text which follows is a brief summary of my research into that therapeutic relationship and how legislation both affects and enables it. 

The relationship between nurse and patient seeks to co-produce a plan of care and treatment that leads them back to “their life”. The context of this co-production is a continually shifting balance between autonomy that permits the patient to “travel their own path and make decisions and, paternalistic control that removes decision making from the patient until such times as they are able to retake control and have the capacity to make decisions.

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Nurses working in mental health are often faced with working out the right thing to do, and when and in what context it is acceptable for us to limit someone’s freedom, or make choices for them. Sometimes these decisions are made easily because people are either a risk to themselves or others. But there are times when matters are less clear cut

Scotland has been seen as a beacon of good practice in the field of mental health care and has been proud of its legislative approaches in providing humane person centred care, however in the last few years there have been changes in international law that now finds Scottish legislation wanting.

Human rights legislation,  in particular aspects of legislation covering  care, treatment, capacity and consent within the Mental Health (Care and Treatment)(Scotland)Act 2003 and Adults with Incapacity (Scotland) Act 2000 and Adult Support and Protection (Scotland) Act 2007 now appear at variance with aspects of human rights legislation.  In particular the UN Committee on the Rights of Persons with Disabilities that oversees the United Nations Convention on the Rights of People with Disabilities (UNCRPD) has adopted a radical critique of mental health and capacity law. It argues that the justification for any form of non-consensual intervention based, even in part, on a diagnostic label such as ‘mental disorder’ and the use of capacity assessments is inherently discriminatory. 

Discrimination against those who are diagnosed as mentally ill has been a significant issue and has led to a focus on reducing that stigma through education and awareness programmes such as the “See Me “campaign but impact has been poorer than expected. Therefore a revised approach is now in place and is recognition of the substantial impact that stigma attached to mental illness has for people in society. Potentially this stigma has affected perceptions of how competent people with mental illness are to be involved in decisions around care and treatment.

A patient’s ability to contribute to the decision making around their care and treatment has been enhanced through the use of advocacy support and advanced statements.

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The Scottish government is currently reviewing both mental health and capacity legislation to ensure it meets with the criteria stated above. There is some evidence from public responses that indicate the review does not go far enough (see SG)

“While the Mental Health Bill has provided an opportunity to revisit the Mental Health Act ten years on, it was felt that it did not appear to have fully explored the issue of how human rights can be further supported within law and practice.

‘I think there’s really interesting challenges ahead in terms of the noises the UN are making about the Convention on the Rights of Persons with Disabilities and what that means for compulsory treatment in mental health and suggesting that it’s discriminatory and that’s raised a lot of useful discussions which I think we should have been having a long time ago about the acceptability and prevalence of forced treatment.’

Expert Interview (A Review of Mental Health Services in Scotland: Perspectives and Experiences of Service Users,

Carers and Professionals-Report for Commitment One of the Mental Health Strategy for Scotland: 2012 – 2015)

However the UNCRPD believes that current legislation around detention and non consensual treatment needs to change in favour of a supported decision making model. It therefore seems likely that this will impact significantly on Mental Health professionals and will be a paradigm shift in how we relate to those entrusted to our care. Mental Health Nurses will need to consider how this impacts on their practice and how their fairly unique position as potential advocates might develop. Patillo (2011) notes that “Nurses seem better placed as advocates because they are constantly interacting with patients”. How then might this position develop in terms of a supported decision model? 

In considering this we can think about how relationships between mental health professional and patients have been described

Pelto-Piri, V. et al, talk about 3 styles of working with people who have a mental illness:

  1. Paternalism 
  2. Autonomy
  3. Reciprocity 

Sandhu. S et al (2015) suggest that “reciprocity may be conceptualized and incorporated as a component of mental health care, with recurrent and observable processes which may be harnessed to promote positive outcomes for service users.”

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Positive outcomes thus may result from Mental Health nurses reflecting on their role as advocates and treatment partners in which reciprocity is the mode of interaction, enhancing the therapeutic relationship whilst discharging our professional responsibilities both as nurses and as members of the Multi-Disciplinary Team, and enabling consideration of changes to practice and education that would make this a reality of mental health care and treatment rather than a desired state.

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Euan McLeod is a Mental Health Staff Nurse at Mid Park Hospital, NHS Dumfries and Galloway

 

Being Wrong by Jeff Ace

Being wrong is interesting isn’t it? When you get a call right, your view of the world is unchanged and things are happening much as you expect them to; all very unexciting. But when you’re wrong, there’s something off with your perspective, or lacking in your knowledge; very interesting indeed.

Luckily, I’m wrong particularly often and accumulate large numbers of these excellent opportunities for learning. I’ve been wrong on some big life stuff and on too many professional and work related decisions to keep track of. I was even wrong in recent attempts to help my daughter with her physics homework, leading to her claim that many of the elements hadn’t been discovered when I was in school.

There’s something in this unfunny and (mostly) untrue teenage sarcasm that I think explains one of the common causes of ‘wrongness’ in that people look to the past to explain the present and predict the future. This might be fine but most of us, including my daughter, have an absolutely lousy sense of historical perspective. Smart Alec history teachers will use any number of examples to highlight how poor this perspective can be. A couple of my favourites in this list of things that just don’t seem right are that Cleopatra lived closer in time to ‘Carry on Cleo’ than to the building of the Great Pyramid at Giza, or that Tyrannosaurus Rex was more a contemporary of Marc Bolan than it was to the Stegosaurus. Similarly, England’s 1966 world cup win is as close to the outbreak of WW1 as it is to the present day, despite it being mentioned every four flipping minutes over the summer.

Broad contemporaries: T-Rex and T-Rex

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These examples show that people tend to distort historical perspective by magnifying the recent past and diminishing periods further back. So, to me, my schooldays of the 70s and 80s are useful reference points in understanding how the world works and will continue to work, whilst to my daughter it was when we learned to alloy copper and tin to make our swords. This phenomenon has big implications for how we get things wrong (or how we can avoid making mistakes).

Take climate change, for example. The scientific consensus is that we’re now heading for more than a 2 degree temperature rise on pre-industrial levels and likely implications include 3 metre plus increases in sea level rises. By all rational measures, this information should be dominating the political and economic agendas, with urgent risk management and mitigation measures everywhere we look. But 3 metres… that can’t happen, can it? That would swamp St Helen’s cricket ground in Swansea where Sir Garfield Sobers became the first human to hit six sixes in an over, where all great Welsh cricketers have strutted their stuff over the years (well yes I have played there, actually. Don’t like to go on about it. It’s not like there’s a framed picture in my house of me on the pitch or anything like that *). The scale of this change, that would flood Miami and make the Mumbles Road end at St Helen’s appear only at low tide, is way outside our historical reference points, our ability to visualise the world; so we sort of file it somewhere in our brains and get on with more everyday routine problems.  

St Helen’s Swansea – spiritual home of Welsh cricket

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So I worry about how our tendency to rely too much on a poor and distorted understanding of the past can make us wrong and complacent over big changes. And I worry about it a lot in the context of health and social care provision. 

Our historical perspective here is dominated by the post war model of service provision. This model is an historic anomaly, of course, radically different from that which existed through the rest of human history, but is nonetheless now seen as an unchanging piece of how our bit of the world works. The difficulty is that if you start projecting the next 20 years of demographic change, workforce availability, technology driven cost increase and the amount of funding that an economy can generate for health and care… it’s really, really hard to see how it all holds together to provide the sort of health and care service that people of my age will by then be expecting. I think there’s a tendency to dismiss these forecasts because, well the Health Service has always been short of money hasn’t it, and winters are always a bit tight, but we always get through it in the end…. and basically because our perspective doesn’t help us to imagine a radically different future. 

This I think would be terribly complacent and would open up our largely wonderful but already creaking system to existential risk. But whilst I’m a bit of a worrier, I’m also a mostly optimistic type of bloke. There is now a lot of work ongoing on the sorts of disruptive changes that could help to address the apparent perfect storm of pressures building on health and care. Organisations like The Kings Fund have been busy in this field lately (https://www.kingsfund.org.uk/publications/eight-technologies-will-change-health-and-care and https://www.kingsfund.org.uk/publications/digital-change-priceless are good examples) and show how we can move perspective from a future of tweaking our models of care to one where they are genuinely transformed. 

I’m wrong about loads of things but I’m pretty confident in predicting that, in order for us to continue to deliver the service our population deserves, we’re going to have to increase the pace of change to models radically different from those established. In D&G we have an outstanding track record of managing major change and this is one aspect of the past that I think is going to be extremely useful in preparing us for the future…

 (* ok there is)

Jeff Ace is Chief Executive Officer at NHS Dumfries and Galloway