The Pneumonia in Bed 5 by Sian Finlay

Although it is sometimes easy to forget it amongst the busyness of front line clinical duties, I am a person.  I suspect many of you are too.  Occasionally I am unwell, but I consistently find that I still remain a person during this period – I have never yet become a disease!  So why is it that when patients come into our care, we so often default to calling them by their diagnosis instead of their name?  Go onto any ward and I guarantee it will not be long before you hear someone described as ‘The Chest Pain’ or ‘The Pneumonia’.  Many handovers will include phrases such as ‘He’s a UTI’.

No, he isn’t! He’s a PERSON who has a UTI!

A common (and potentially even worse) variant of this is the ‘bed number’ name, exemplified by ‘Bed 3 needs the commode!’  Sometimes attempts are made to justify this practice with the excuse that it protects confidentiality, but let’s be honest here.  The truth is that it simply demands more mental effort to remember the patient’s name and we are taking a short cut.  All very understandable in a busy environment, and I really don’t blame anyone.  You might think it is just semantics anyway – what does it matter if we call someone ‘The GI bleeder’?  Well I argue that it does matter.   More than you think.  These patients are people, no less complex and emotional and fragile than you or me.  By depersonalising them, we are subtly starting down a path which allows us to forget this; which allows us to view them as tasks in our day rather than the individuals they are.  If you are unconvinced, try this little exercise; read these 2 sentences and see if they elicit the same emotional response in you:

Bed 5 is agitated.

Tommy is agitated.

Would you agree that the second sentence immediately makes us feel more empathy and compassion towards its subject?

Many people will be aware of the late Kate Granger, the inspirational doctor who responded to her diagnosis of terminal cancer by establishing the ‘Hello, my name is..’ campaign.  Sadly Kate died last year, but her campaign lives on and has touched many of us in the healthcare profession.  But Kate’s work didn’t begin and end with wearing a smiley badge with our name on it; it is in essence about remembering the humanity of our patients and treating them as fellow human beings.  And I can only imagine Kate’s fiery reaction if she ever overheard herself being referred to as ‘Bed 5’!!

But we are all under pressure.  What if we genuinely can’t remember the patient’s name and are just trying to communicate information quickly?  Surely that doesn’t make us uncaring?  Of course it doesn’t, but in times of acute amnesia, we could at least say ‘the man with pneumonia’ rather than ‘the pneumonia’.  And that should only be a holding measure until we can remember his actual name – surely essential for safe communication anyway!

I hope I have convinced you that words do matter.  The phrases we use set the whole tone for the level of kindness and empathy we expect in our clinical areas.  So if any of this resonates with you, I hope you will lead by example.  Look at your patients and remember they have hopes and fears and histories and personalities…and almost always names!!

Sian Finlay (aka ‘The Migraine on ward 7’) Acute Physician and Clinical Director for Medicine at NHS Dumfries and Galloway

 

 

Surviving and Thriving in a Time of Change by Dawn Allan

I have always been fascinated by human beings and why we are the way we are.

Does our cultural and family background influence us?

Why do some people believe in God and some don’t?

Why are some people able to talk about death and dying so easily?

Why do people focus on their weaknesses, what about their strengths?

How self aware are we?

Who are we when nobody is looking?

Having emigrated from Ayrshire to South Africa where I spent my childhood and early adult years, I discovered the down side of the school playground because I sounded different.  There were only so many times a 6 year old with an Ayrshire accent wanted to mandatory repeat the word ‘potato’ at the class bullies insistence, and then suffer his disparaging comments,

“…doesn’t she sound weird…say it [potato] again…oh, ja, you’re from ’SCOT-LAND’ hey…”!?!

I remember stifling back tears, wishing I sounded like my peers so he would leave me alone.  When I reflect on this childhood bullying memory, it is mainly laughable now and I quickly adapted by adopting a local accent to blend in.  Life nurtured resilience and I learned when it might be safe to confront a bully wisely, when to ignore them and when to ask for help.

This year I relocated from Shetland to live and work in a place, “Often described as “Scotland in Miniature,” South West Scotland’s Dumfries & Galloway region is characterised by its rich cultural heritage, stunning scenery, sweeping seascapes, towering cliffs, rolling agricultural land, and its wide, wild landscapes”.  Who wouldn’t want to live here?!?  So, what about the people?  I am pleased to say they too are fascinating, warm and welcoming.

The 2017 focus for NHS Dumfries & Galloway is the move for many staff from the current DGRI to the new hospital.  From what I am gathering, this process of change is daunting for some.  If communication is key to all that we offer and provide as health care professionals, part of the way we manage our expectations in preparing to move is to be aware of how we communicate with or about each other as individuals, departments and teams.  Having a person-centred approach should be our modus operandi – our behaviour and communication does not go un-noticed by patients and visitors.  Being a ‘relational person’, I believe our hospitality is as valuable as our clinical / social care, our administration skills or our financial targets.

If a holistic approach cares for the whole person, this includes acknowledging someone’s pain, providing them with pain relief and offering them a cup of tea – all spiritual ‘acts’.  We all deliver spiritual care, what I aim to define is that we as staff do not, ‘go Greek’ i.e. compartmentalise and separate a person into ‘bits’, i.e. age, gender, status, patient, service-user, client, spiritual, religious, physical, mental, psychological, emotional…When in physical pain, the whole of our being is affected.  Judeo-Christian views that –

  • every person is born with worth and dignity
  • every person has the ability to choose between doing good and doing wrong
  • every person has the responsibility to help others in need and the community

Whether the person we are caring for or working alongside has a belief / faith or not, they will have a ‘value system’.  I hope having a VBRP – Values Based Reflective Practice – approach will help all of us as we reflect and hopefully learn from the past in the present, to know how to continue or change best practice, including our communication.  Our motives are based on values we apply every day which will help or harm the people we care for, including ourselves.

To be a hopeful presence is how I sometimes describe my encounters with people.   When we are at our most fragile and vulnerable, we need others we can trust, who will listen with their eyes and ears, who can make us laugh, encourage us when we feel stressed, sick or lonely and offer compassion.  My confidential support includes staff – we are all at different stages in our professional roles and our personal lives.  Before anyone ever declares whether they have a belief / faith or not, it is what we have in common as human beings that is paramount.  Difference is a given, but negative overemphasis on difference marginalises people – companionship and inclusion build bridges.  Sometimes, ‘life happens’ and it is the sudden, unexpected occurrences that affect our health and relationships most.

One of my favourite authors C S Lewis reminds me that a man of such academic, creative gravitas was honestly transparent, he said, “I pray because I can’t help myself.  I pray because I’m helpless.  I pray because the need flows out of me all the time – waking and sleeping.  It doesn’t change God – it changes me.”

Rabbi Harold Kushner’s description speaks into my role, “When you cannot fix what is broken, you can help very profoundly by sitting down and helping someone cry.  A person who is suffering does not want explanation: the person wants consolation.  Not reasons, but reassurance.”

If we as individuals think we do not need each other, we are deluding ourselves.  My faith informs my professional practice, without imposing it on anyone.  If the Son of God relied on twelve disciples, who am I to say I can survive without the support and wise counsel of colleagues?  We are only human and we need each other to ensure NHS Dumfries & Galloway not only survives but thrives today and tomorrow.

Dawn Allan is Spiritual Care Lead Chaplain at NHS Dumfries and Galloway

Whistleblowing & Psychological safety by Gill Stanyard

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Three years ago, just before, I was appointed by the Cabinet Secretary to be a Non-Executive Director  , I became a whistleblower. I blew the whistle on an organisation I had previously worked at. The whole process felt like a mini earthquake happened inside of me – I felt physically shattered, on edge and at times, paranoid due to the fear of not knowing what was going to happen next. I was not kept informed and this was the most difficult thing to endure -I did not feel psychologically safe. However, this was bearable compared to the distress of keeping everything in, all the wrong doing I had witnessed and not knowing what to do or where to take it -this ate away at me until I took action to an external source. Despite the high reading on my internal Richter scale, I felt I had done the right thing.  Looking back, I know I did the right thing.

gill-3We have heard a lot lately about Whistleblowing in the press, from Julian Assange to the more recent Dr Jane Hamilton, who met with NHS Scotland Chief Executive and last week’s author of this D & G blog,  Paul Gray,  this month, about her concerns as a Psychiatrist working at NHS Lothian.

So, what does it mean when we talk about Whistleblowing? Public Concern at Work define Whistleblowing as:

A worker raising a concern about wrongdoing, risk or malpractice with someone in authority either internally and/or externally (i.e. regulators, media, MSPs/MPs)

In his Report on the Freedom to Speak Up review (“the Report”) published on 11 February 2015, Sir Robert Francis QC defines a whistleblower, in the context of the NHS, as: “a person who raises concerns in the public interest. An important distinction is to highlight the difference between grievances and concerns -the law around whistleblowing (Public Interest Disclosure Act)  responds to ‘concerns’.

 

Grievances                                Concerns

risk is to self                                  risk is to others

need to prove case                   tip off or witness

   rigid process                               pragmatic approach

legal determination                    accountability

private redress                           public interest

 

Fast forward to this present day, as Chair of Staff Governance, I was nominated last year to take on the role of Whistleblowing Champion for the Board -an assurance role created by Scottish Government for Non-Executive Members in November 2015. This was part of an on-going intention to raise the profile of Whistleblowing being safe to do and as part of a response to one of the recommendations from the Francis Report ‘Freedom to Speak Out’.

As Whistleblowing Champion I will look for assurance that investigations are being handled fairly and effectively including:

  • that reported cases are being investigated
  • that regular updates are provided on the progress of the investigations of reported cases
  • Ensure that staff members who report concerns are being treated and supported appropriately and not victimised
  • members of staff are regularly updated on the progress of the concern they reported and advised of investigation outcomes;
  • ensure that any resultant actions are progressed.
  • Ensure that relevant Governance Committees; HR; staff representatives and Whistleblowing policy contacts are being updated on the progress and outcomes of cases; and, recommended actions resulting from an investigation.
  • Publicise and champion positive outcomes and experiences.

 

Around the same time as this role was developed, also in response to the Freedom to Speak Up Review recommendations, the Cabinet Secretary for Health, Wellbeing and Sport announced the development and establishment of the role of an Independent National Officer. This is to provide an independent and external level of review on the handling of whistleblowing cases. This role is still being implemented and recent word from Scottish Government representatives last week, is that focus is on investigating the statutory powers that would need to sit alongside this role, so, it is hoped that the post will be live by 2018. A lot of learning has taken place from the established Guardian scheme in England.

Shona Robison has talked very recently about her desire for all NHS Staff to ‘have the confidence to speak up without fear about patient safety.’ Dame Janet Smith, back in 2004,  when she helped to develop proposals following the Shipman Enquiry wrote “I believe that the willingness of one healthcare professional to take responsibility for raising concerns about the conduct, performance or health of another could make a greater potential contribution to patient safety than any other single factor.”

The Right Honourable  Sir Anthony Hooper, in his report on the handling by the GMC to cases involving whistleblowing (2015) revealed an issue around bullying.  The GMC has recognised that the bullying of those who raise concerns may make persons reluctant to do so. A GMC survey (published in November 2014) of the 50,000 doctors in training found nearly one in ten reporting that they had been bullied, while nearly one in seven said they had witnessed it in the workplace. At the time of the publication Mr Niall Dickson said: “There is a need to create a culture where bullying of any kind is simply not tolerated. Apart from the damage it can do to individual self-confidence, it is likely to make these doctors much more reluctant to raise concerns. They need to feel able to raise the alarm and know that they will be listened to and action taken.’ What I see Dickson referring to is the creation of psychological safety,  defined as ‘…a belief that it is absolutely ok, expected even, that people will speak up with concerns, with questions, with ideas and mistakes…’  Amy Edmondson, Professor in Leadership , Harvard University

gill-1Recently I came across this painting by Gozzolli depicting the story of St Jerome and the Lion.  I had vague recollections of this story from one dusty morning spent at Sunday School, where I thought the golden motes falling in front of the window were a sign from God that it was ok to eat the mini eggs next to the toy donkey on the Easter shrine. Turns out it was just dusty sunshine and the ‘eggs’ were mint imperials in disguise. .   In the story, a lion approaches St Jerome and other monks whilst they were saying prayers in the monastery -whilst the other monks fled with fear out of the window, running for weapons and other ways to attack and scare the lion away, St Jerome sat quietly and looked into the lion’s eyes. He saw pain reflected back at him, and with pricked curiosity, he watched the lion limp up to him and hold out its heavy front paw.  Jerome took the paw and examined it.. He saw the limb was swollen, and with closer inspection saw there was a thorn embedded in the pad. He removed the thorn and bathed the area with healing herbs and water and placed a bandage of linen cloth around the paw.. Expecting the lion to leave, he sat back and waited. The lion looked at him, now with all  trace of pain gone and lay down on the floor and went to sleep. The lion was said to have never left Jerome’s side.

What strikes me about the lion is his courage and self-compassion to remove the source of his own pain and to take action to do so, despite the risks of being attacked by the monks. Whilst of course it was not in the public interest whether the thorn was removed or not from the lion’s paw in whistleblowing cases it is widely recognised that the whistleblower does suffer before, with the burden of needing to speak out and after, with the worry of the consequences of what may happen next. Robert Francis  acknowledged this in his report ‘Freedom to Speak Out’  ‘… that the stresses and strains of wanting to do the right thing can be immense’  Last September I attended a Whistleblowing event at the Royal College of Surgeons in Edinburgh. One of the speakers was  Dr Kim Holt, Consultant Paeditrician gill-4and founder of Patients First. She flagged up concerns to senior management in 2006 about understaffing and poor record keeping at St Ann’s clinic, part of Great Ormond Street Hospital. Sadly, her concerns were not acted upon and in 2007, Baby P died just three days after being seen by a locum doctor at the same clinic, who failed to spot that the toddler was the victim of serious physical abuse. Dr Holt, now recognised by the Health Service Journal as one of the most inspirational women in healthcare, spoke with calmness about the impact her experiences had on her well-being, including becoming severely depressed and unable to eat or sleep. She became a whistleblower, she says, because she feared something terrible would happen to a child and was devastated when her warnings were ignored.

I know it takes courage to speak up and share your concerns. I also know for a fact that we have quite a few St Jerome types here in NHS Dumfries and Galloway.

Our Whistleblowing Policy here at NHS D&G -take a look if you are not familiar :

http://www.nhsdg.scot.nhs.uk/Resources/Publications/Policies/Whistleblowing_Policy.pdf

The two people named in the policy are Deputy Nurse Director Alice Wilson – Tel. 01387 272789   and Deputy Finance Director Graham Stewart – Tel 01387 244033

These people have been given special responsibility and training in dealing with whistleblowing concerns. If the matter is to be raised in confidence, then the staff member should advise one of the designated officers at the outset so that appropriate arrangements can be made.

If these channels have been followed and the member of staff still has concerns, or if they feel that the matter is so serious that they cannot discuss it with any of the above, they should contact: Caroline Sharp, Workforce Director NHS Dumfries and Galloway (Tel : 01387 246246)

Also, the national helpline run by Public Concern at Work is called the National Confidential National Confidential Alert Line – 0800 008 6112

Gill Stanyard is a Non-executive member of NHS Dumfries and Galloway Health Board

 

 

Can I make a difference? by Paul Gray

It’s a big question – can I make a difference?  How does it feel to ask yourself that?  For some of us, the answer will be different on different days.  My experience suggests that your answer depends much less on what you do, than it does on how you feel.  In this blog, I’d like to offer some thoughts on making a difference.

However, some context first.  I fully recognise the challenges we face.  Health budgets are going up – but pressures on recruitment, and the demands of an aging population, are also very real.  There is also still much to do in tackling inequalities, and improving the health of the population, which NHS Scotland can’t do on its own.  And we do know that people have the best outcomes when they are treated and cared for at home, or in a homely setting.  So our current models of care are transforming to meet these demands, and to provide the most appropriate care and treatment for people, when they need it, and change brings its own challenges.

So my first suggestion is to turn the question, “Can I make a difference?” into a statement – I can make a difference.  If you start from that standpoint, you’re much more likely to succeed.  It’s easy to become pre-occupied with the things we can’t change, and the barriers and problems – I know that I fall into that trap from time to time.  But wherever I go, I see people throughout the NHS, and in our partner organisations, making a difference every day.  So ask yourself, what is the one thing I can do today that would make a difference?  And then do it!

paul-1Now, give yourself some credit – think of an example where you did something that was appreciated.  Write it down and remember it.  If you’re having a team meeting, take time to share examples of things that the team did, that were appreciated by others.  Sharing these examples will give you a bank of ideas about simple things that matter to other people.  And it also gives you something to fall back on, if times are tough.

Next – think of an example when someone did something for you, which you appreciated.  Find a way to share these examples too – if it worked for you, it might work for someone else as well.  Ask yourself when you last thanked someone for something they did well, or something you appreciated.  It’s easier to go on making a difference if others notice what you’re doing!

If you’re leading or managing a team, ask yourself how much time the team spends discussing what went well.  It’s essential to be open and transparent about problems and adverse events, but if that’s the whole focus of team discussions, we overlook a huge pool of learning, resources and ideas from all the positive actions and outcomes.  And we risk an atmosphere where making a difference is only about fixing problems, rather than about improvement.  So, as yourself and your team, what proportion of time should be spent on what went well?

Remember to ask “What Matters to You?”.  I know that the focus of this question is on patients, and that’s right because they are our priority, but it’s a good question to ask our colleagues and our teams as well.  Just asking the question makes a difference – it gives you access to someone else’s thoughts and perspectives, and is likely to lead to better outcomes.

paul-2Will any of this change the world?  Not on its own, of course.  But you could change one person’s world, by a simple act of kindness, or listening, or a word of thanks.  You can make difference!

Paul Gray is the Chief Executive Officer for NHS Scotland and the Director General for Health and Social Care at the Scottish Government

Improving Patient Flow by Chris Isles

Dave Pedley gave an excellent talk two Wednesdays ago on Tackling Crowding in Emergency Departments, triggered no doubt by the number of times recently we have been running at 100% bed occupancy with patients sitting in chairs in the Emergency Department because there were no free cubicles.

The nightmare scenario for us all as the clock ticks inexorably towards December 2017 is that the same thing happens when our fabulous new hospital opens and the TV cameras, newspapers and journalists begin to salivate at the prospect that something goes wrong (there will be no story to report if the transition to the new hospital goes smoothly and there are no corridor patients).

The chances that something could go wrong are actually quite high and the problem is almost entirely medical by which I mean the large number of frail older people living precariously in the community who fall, become immobile, incontinent or delirious and require at least some form of assessment but often admission to hospital.

The omens are not good.  Dumfries and Galloway has the second highest proportion of people in Scotland who are aged 75+ and living alone.  Our Health Intelligence Unit have shown that despite numerous initiatives and new ways of doing things the Medical Unit would be sailing perilously close to 100% bed occupancy if we moved into the new hospital today. (See me previous blog on the new hospital here)

During his talk Dr Pedley showed a powerful 5 minute video by Musgrove Park Hospital in Somerset entitled Tackling Exit Block ie their hospital’s inability to move patients through ED because of numerous interrelated system failures.  (https://youtube/WX1YwKIkWzA).  Musgrove Park ‘s Top Ten Reasons Why People Cant Leave Hospital were as follows:

  1. Discharge delayed so patient can have lunch
  2. Carer/relative can’t pick them up till after work
  3. Nurses too busy looking after other patients to arrange discharge
  4. Waiting for transport or refusing to leave without free transport
  5. Waiting for pharmacy
  6. Waiting for ward round
  7. Waiting for blood or scan results
  8. Waiting for discharge letters
  9. Packages of care planned for late afternoon/early evening
  10. Patient doesn’t want to go to the assigned bed in community hospital

During discussion a number of solutions to our own recurrent difficulties with patient flow were proposed.  These included tackling all of the above in addition to attempting to educate the public about when and when not to attend ED.  My own view is that this might be as fruitless as King Canute sitting in his throne on the beach and attempting to stop the incoming tide on the grounds that any patient who comes up to ED and is prepared to wait up to 4 hours and possibly more to see a doctor or a nurse must feel they have a very good reason to be there (one often quoted reason being that they could not get an appointment to see their GP).

There were some illuminating moments.  We asked Patsy Pattie whether Dynamic Daily Discharge was still as effective as it had been when it was first rolled out.  She replied that some wards needed support on embedding the process.  Dr Pedley praised staff for their firefighting skills on those occasions when patients were unable to access cubicles in ED which prompted Philip Jones, our chairman, to say that a corporate rather than firefighting response was needed.  Many heads nodded in agreement.

A corporate response might mean fixing lots of little things in order to make patients flow through the system more speedily.  Dynamic Daily Discharge could then become an established part of ward routine rather than an optional extra; the paperwork in the medical assessment area might need to be simplified to allow nurses to move patients into the body of the ward more quickly; a nurse on each ward might be designated to carry the ward phone rather than allow it to ring endlessly in the hope that someone else will pick it up; clinical teams would actively consider how patients might get home;  consider community detox for alcohol withdrawal; patients earmarked for discharge might move to the dayroom unless physically unable to do so; hospital taxis might take people home if relatives or patient transport cannot do so; patients could be issued with a prescription to take to their local pharmacy if new medications are required or go home with immediate discharge letter to follow if not.

To these solutions I would add fully funded Ambulatory Emergency Care and Comprehensive Geriatric Assessment services together with more and better social care and a commitment to fill the hospital with more staff on public holidays (of which there will be four within one month of the new hospital opening).

The Chief Executive of Musgrove Hospital finished her contribution to the Exit Block video by saying ‘we need every single member of staff to understand their responsibility in ensuring patients flow through our hospital so that we can discharge them home as quickly and as safely as possible’.  Who could disagree?

Professor Chris Isles is Sub-dean for Medical Education and is a Locum Acute Physician.

The Best Start in Life by Laura Gibson

  • Getting It Right For Every Child
  • Giving children the best start in life
  • Making Scotland the best place to grow up
  • Improving the life chances of children, young people and families at risk
  • Reducing health inequalities

These high level national aspirations underpin much of the work that we, as healthcare professionals, are involved in delivering on a day to day basis. And achieving them does not start with children, the early years, or even pregnancy. It begins before conception. And I thoroughly believe that we are missing an opportunity. An opportunity which is inexpensive, evidence based and highly effective. That opportunity is better promotion of preconception health and care.

What is preconception health?

image1-2There is a clear link between a mother’s health before pregnancy and her baby’s health. We know that healthy women and men are more likely to have healthy babies who grow into healthy children 1. Therefore, thinking about, and improving, your health and wellbeing before conception increases your chances of a safe pregnancy, a thriving baby and a rewarding parenthood. Preconception is the safest and most effective time to prevent harm, promote health and reduce inequalities (pregnancy and birth outcomes are not as good for people living in the highest deprivation).

 
Currently, most people only consider two stages: avoiding pregnancy or being pregnant. With around 40% of all pregnancies being unplanned, the middle stage of preparing for the best possible pregnancy continues to be overlooked; in terms of policy, professional practice and individual thinking across Scotland. Where delaying pregnancy is the norm in Scotland (the average age of giving birth is 29.5 years, and 28 years for first time mothers), taking action to avoid pregnancy is not the same as preparing well for pregnancy.
image2Preconception health is about preparing for pregnancy, whether for your first pregnancy or your next pregnancy. What you do, or don’t do, before the pregnancy test says ‘yes you’re pregnant’ really matters. The choices you make and the actions you take before conception can make a big difference to you and your baby. That is true even if you haven’t given much thought to when you’d like to become a parent.

 
However, preconception health is not just for women, it is important for men too. There are steps that future fathers could take before creating a baby, for the sake of his own health and for that of his partner and their baby.

 
The infographic below, developed by Dr Jonathan Sher, an independent consultant and respected author of numerous published reports and blogs 2, identifies the steps women (and men, where relevant) should take to improve their preconception health:

image3-copy

Why promote preconception health?

Many things that may put your baby’s health at risk, such as smoking, drinking alcohol, taking drugs (prescribed or not), being overweight, being very stressed and some medical conditions, can all make an impact before you even know you are pregnant. That is why planning and preparing for pregnancy are so important.

 
However, not all the negative possibilities of pregnancy are inevitable. Many miscarriages, stillbirths, too early or too small babies, birth defects and other problems may be prevented and the odds of a good outcome can be improved. Good outcomes should not be left to luck alone. Doing what you can to become as healthy and ready as possible, and getting help if required, is hugely beneficial for yourself, your partner and your baby.

 
Traditionally, health promotion for pregnancy begins in the antenatal period, most often from first contact with Maternity Services at around 8 to 12 weeks of pregnancy. Many women are not aware that they are pregnant during the early weeks and months, and unfortunately it is not uncommon for women and men to continue negative health behaviours such as smoking and drinking alcohol through this important stage of early foetal development. Getting ready for pregnancy is as important as getting medical attention once you know you are pregnant.

image4

The concept that “every contact is a health improvement opportunity” demonstrates that all health and social care service providers who have contact with women and men of reproductive age can make a significant impact on optimising the preconception health of their service users. By utilising every opportunity to promote preconception health and to support women and men to make healthy lifestyle choices, the health and wellbeing of women and men who plan a pregnancy, as well as those who find themselves with an unintended pregnancy, can be maximised.

 
How can we incorporate preconception health into our work?

A new Preconception Health Toolkit that has been designed, tested and refined using Early Years Improvement Methodology will soon be available to support staff across all agencies to raise the issue of preconception health with their service users. The Toolkit includes information on risk indicators for adverse pregnancy outcome, health enhancing behaviours, tips for raising the issue and other suggestions for raising awareness.

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The Preconception Health Toolkit will be launched next Friday 27th January at an event at the Garroch Training Centre near Dumfries, 10am-11.30am. Dr Jonathan Sher, independent consultant, will deliver an interactive key note address. There are still places available, please contact me at lauragibson1@nhs.net if you’d like to participate.
Following the formal launch, the Toolkit, which has been developed specifically for non-specialist staff, will be available electronically to all staff and volunteers in the statutory and third sectors. Please contact me to request a copy or download it from http://www.sexualhealthdg.co.uk.

Laura Gibson, Health and Wellbeing Specialist, DG Health and Wellbeing, Directorate of Public Health

References

Royal College of Obstetricians and Gynaecology (2008) Standards for Maternity Care Royal College of Obstetricians and Gynaecologists; London

J Sher (2016) Prepared for Pregnancy? NHS Greater Glasgow and Clyde (Public Health)

3 Woods, K (2008) CEL 14 Health Promoting Health Service: Action in Acute Care Settings The Scottish Government: Edinburgh

I am human by Dawn Renfrew

“I am human: I think nothing human alien to me”

dawn-1-terence-the-african

Terence the African

So wrote Terence the African, around 2000 years ago. He was a slave from Roman Africa, a dramatist, and an interpreter. He was quoted recently in the annual BBC Radio 4 Reith lectures, by Professor Kwame Anthony Appiah, professor of philosophy and law at New York University.

dawn-2-appiah-now

Appiah Now

Professor Appiah’s subject, “Mistaken Identities”, is one of the most defining issues of our age. We all have multiple identities which describe who we are. These include those suggested by our gender, age, occupation, political affiliation, nationality, race etc. The possibilities are endless when you think about it: parent, child, sibling, friend, Bake-off fan, or Queen of the South fan are just a few.

In a healthcare setting, we also have many identities, including being part of our own discipline, team, ward or service. Sometimes we are ourselves patients, and some of us are managers. Any health condition, whether physical or mental, can become part of our identity.

Appiah himself embodies many complex aspects of identity. Half-British, half-Ghanaian, he was brought up in Ghana and England, and has now adopted America as his homeland. He is the grandson of the Chancellor of the Exchequer, Sir Stafford Cripps. He is a crime novelist, and a fan of Japanese haiku. In addition, he was one of the first people to take advantage of the new gay marriage laws in New York State. He is probably ideally placed to set about unpicking assumptions which we all have about the “labels” associated with identity.

dawn-3-growing-up-in-england

Growing up in England

Appiah discusses 4 aspects of identity over 4 lectures: creed [religion], country [nationality], colour [race] and culture [Western identity vs non-Western]. These are delivered in 4 different locations: London, Glasgow, Accra [capital of Ghana] and New York. The lectures cover the great sweep of history, and examples from a range of countries across the globe. They argue that identities are more complex and fluid, than are commonly supposed. They are more a “narrative”, than an “essence”, and do not necessarily determine who we are. Everywhere you look, you can find exceptions in identities, which challenge our commonly-held assumptions about them.

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Growing up in Ghana

Identity is important for our survival. It helps give meaning to our lives, and helps us feel, and be, part of a community. Evolutionary psychologists would argue that it has been critical to our development as a species. All identities are constructed and evolve over time, but as soon as you construct an identity, you create potentially not only an “us” [those within the group], but also an “other” [those outside it]. When there is competition for resources, things can turn nasty, and the “others” may be persecuted or scapegoated. So it is important that we are relaxed and open about our identities, and that we recognise why that process of “othering” arises so easily within all of us. It’s a trap that is easy to fall into, and we need to resist it.

Appiah doesn’t mention healthcare in particular. But if we apply these ideas to the healthcare setting, we can see that a shared identity can help us pull together to meet our patient’s needs, in what are often increasingly challenging circumstances. Equally, there can be a process of “othering” which operates, whether it is towards our patients, our managers, our employees, or other agencies. Whilst understandable, “othering” can prevent us fully engaging with the “other” in a way that leads to the best outcome for all of us. This is relevant to our aims to provide person-centred care, and to integration with other agencies.

On the question of nationhood, Appiah isn’t against nationalism, so long as it is an “open, civic nationalism”. His favourite idea of nationhood, however, involves 2 concepts. The first is patriotism, defined as concern with the honour of your country [or countries]. This means feeling proud when your country does something good, and ashamed when it does something bad. The second concept is cosmopolitanism, which means being a citizen of the world. These can combine to form a “patriotic cosmopolitanism”. You can, and should, respect both “the local” and “the global”.

Identities connect the small scale, where we live our lives alongside our kith and kin [and healthcare colleagues], with larger movements, causes and concerns. Our lives must make sense at the largest of scales as well as at the smallest. We live in an era where our actions, both ideological and technological, have global effects. When it comes to the compass of our concern and compassion, humanity itself is not too broad a horizon. We live with 7 billion other humans, on a small, warming planet. The concept of cosmopolitanism has become a necessity.

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Appiah with Obama

Appiah argues for a tolerant, pluralistic, and diverse society. He says, failure to accept this is not just a failure to understand human identity, it is not in our collective self-interest. We do not need to abandon identities, but we don’t need to be divided by them either. Ultimately, the identity of “being human” ought to transcend all others.

As Scout, the young heroine in the novel about race and mental illness, To Kill a Mocking Bird, concludes: “I think there’s just one kind of folks. Folks”.

The Reith lectures are available to listen to on the Radio 4 website, indefinitely.

Dr Dawn Renfrew is a Consultant Child and Adolescent Psychiatrist for NHS Dumfries and Galloway