With occupational therapy you CAN… by Wendy Chambers

If I had a penny for each time during my career someone asked me “what is occupational therapy?” I wouldn’t need to be playing the lottery this weekend!

Next week is national occupational therapy week, November 7 – 13^th2016, #OTweek16 for those Tweeters out there.

So prior to its launch on Monday I’m offering you the opportunity to have an insight into this lesser understood, enigmatic profession. So pour yourself a contemplative cuppa and have a read.

Occupational therapy is a science degree-based health and social care profession, regulated by the Health Care Professions Council. It is one of the ten allied health professions. You can train to either degree or masters level, at any of three universities across Scotland.

Occupational therapy takes a whole-person approach to both mental and physical health and wellbeing, enabling individuals to achieve their full potential.

We work with children and adults across a variety of settings including health organizations, social care services, housing, education, re-employment schemes, occupational health, prisons, and voluntary organizations or as independent practitioners.

So what does that mean, what do occupational therapists actually do?

Well, as occupational therapists we think about “occupation” as any activity any of us does day to day, which is important, necessary or which we enjoy.

The range of “occupation” is endless. If I use myself as an example some of my daily “occupations” would be putting on my clothes in the morning, reading my emails at work, making a meal for my family, riding my bicycle.

The occupational therapists job is to consider how, if I was the service user, the changes in my mental or physical health are making it difficult for me to be able to do these “occupations”- the things I want or need to do day to day.

They need to understand what’s important to me in my life? What would allow me to stay in control and live my life my way?

Occupational therapists are adaptors; maybe that chameleon like ability is why people are often unsure what it is we do?

So for example in order to help me to keep riding my bike after an episode of depression the occupational therapist will problem solve and adapt either:

–the activity itself: maybe I should try going out for 10minutes, twice a week, with a close friend who also bikes, somewhere that’s easy to access and doesn’t take long to get there, with a nice coffee shop on the way back

–the surrounding environment and tools I use: maybe a tarmac cycle route would be easier, at a quiet time of day, and my bike could do with a service first so it’s working properly (they help me think through planning and organizing that)

–me: set SMART goals which I can achieve, to keep me motivated, help me think about what I value about biking and help me understand and make the link between doing an activity I enjoy and feeling better about and improving my mental health

So back to that question again “what do occupational therapists do?”

I guess the bottom line is it ends up looking different each time, as we are all different as people and what’s  an important “occupation” to me may not be important to you.

And we work in so many different settings, with different age groups of people, that that also makes what we “do” look different.

Ultimately it isn’t what the occupational therapist “does” that matters, rather what the person ends up being able to do that’s important.

So for occupational therapy week this year I’ll leave you with this thought,

“With occupational therapy you CAN….”

Wendy Chambers is Team Lead Occupational Therapist for Mental Health and Learning Disability Service at NHS Dumfries and Galloway

 

Gender Matters by Lynsey Fitzpatrick

 

 

 

 

 

 

On 6th September 2016 in Lockerbie Town Hall, NHS Dumfries and Galloway and Dumfries and Galloway Council, supported by the national feminist organisation ‘Engender’, jointly hosted ‘Gender Matters’ – an opportunity, in the form of a workshop, to explore the issues surrounding gender equality.

There were over 40 people from a range of organisations including NHS, Council, South West Rape Crisis and Sexual Abuse Centre, LGBT Plus, LGBT Youth Scotland, DG Mental Health Association, Support in Mind and Glasgow University, and also members of the public along with staff from other Health Board areas.
When I started to write this blog post, I was thinking back as to why the steering group behind the event decided to host this event in the first place. There is a plethora of evidence to back up why we need to support events of this nature, for example:

• Women are twice as dependant on social security than men
• In 2015 the gender pay gap in Scotland was 14.8% (comparing men’s full time average hourly earnings with women’s full time average hourly earnings)
• Also gender pay gap in Scotland when comparing men’s full time average hourly earnings with women’s part time hourly earnings was 33.5%
• This means, on average, women in Scotland earn £175.30 per week less than men.
• The objectification and sexualisation of women’s bodies across media platforms is so commonplace and widely accepted that it generally fails to resonate as an equality issue and contributes to the perception that women are somehow inferior to men.
• Femininity is often sexualised and passive whereas masculinity is defined by dominance and sometimes aggression and violence.
• At least 85,000 women are raped each year in the UK.
• 1 billion women in the world will experience physical or sexual violence in their lifetime.
• In 2014/15, there were 59,882 incidents of domestic abuse recorded by the Police in Scotland. 79% of these incidents involved a female ‘victim’ and male perpetrator.

 

So there are plenty of reasons as to why we held this event; to challenge social gender norms, to progress thinking around changing perceptions in our homes, at work and how we confront the media (not least our legal duty under the Equality Act 2010).

But what is it that made us so passionate about being part of this work?
A huge reason for me personally is that I have an (almost) 5 year old daughter. In my current post as Equality Lead for NHS D&G I have become much more aware of some of the research and facts around gender equality and often reflect on how her future is being shaped as we speak; because of the gender norms all around her, expectations from her family, her peers and her school.
I’m horrified to think that she is more likely in later life to be paid less than a male counterpart for doing the same level of work, or that her relationships and self esteem will be impacted by the stereotyping of her gender in the media.

A friend and I had a discussion at one of the film screenings for “16 days of action against Gender Based Violence” which focused on the sexualisation of children from an early age. We talked in particular detail following the film about the impact the internet might have on our daughters as they grow up – the availability of porn, more opportunity to be groomed, shifting expectations of how our bodies should look and what we should be doing with them – and decided that we really wanted to do something about this, to make a difference to our daughter’s lives, and hopefully many more at the same time.
As NHS employee’s we are legally obliged to consider gender issues in everything we do. The often dreaded impact assessment process is designed to help with this. Yet at times it is seems more of a burden than a way of informing services how best to prevent discrimination and advance equality for all.

I came across the following clip at a Close the Gap event which shows how gender mainstreaming is applicable in situations that many of us deal with on a daily basis and how this can impact on efficiency and quality of public services, benefitting not only the people who use our services, but also our key partners:

(Watch from the beginning to 3:18minutes in for a quick demonstration on how indirect gender approaches can change the way people live).
Back to the event in September: the day was split into two halves – the morning session focused on Culture and the afternoon session on Economy. The format for the day was Open Space Workshops, starting with a short presentation on each of the topics. Participants then identified topics that their group wanted to focus their discussions around. Participants were free to move around the room and join in or leave discussions as desired.
Some of the topics covered during the course of the day included:

• Gender in the Media
  Equal pay for equal work
  Rape Culture
  Part time Work
  ‘Hidden Care’ and the economic ‘value’ of care
  Societal Norms
  Women and Sport
  Success
  Cultural Expectations
  Being non-gender specific (e.g. clothes, toys, activities)
  Women’s Only Groups
  Gender Education
  Welfare Reform

Understanding ‘double standards’
There was a real buzz in the room as each of the groups discussed their topics of interest and it was clear that participants appreciated the opportunity to discuss the issues openly, an opportunity we don’t often get.
All of the event feedback was extremely positive, and there was a real interest from participants in taking this work forward, both in the workplace setting, and in their personal lives. Some of the suggestions included the creation of a Gender Equality Network for D&G, avoiding stereotyping, creating safe spaces for women to talk openly, promoting the White Ribbon Campaign, encouraging managers to see the benefits of a work/life balance, challenging the way gender is represented and considered across society, e.g. across social media, within policies and structures. This list is by no means exhaustive of everything that was covered on the day!
I hope that having a quick read of this sh

ort blog (and hopefully a watch of the gender mainstreaming clip) will be enough to convince a few more people that gender equality really does matter.
If you are interested in being part of future discussions on gender inequality and involved in a Women’s Network then please get in touch.

Lynsey Fitzpatrick is Equality and Diversity Lead at NHS Dumfries and Galloway

Celebrating Excellence Awards by Susan Coull

I was surprised and pleased to be nominated in the “Improvement to Care and Service” category and even more surprised to have been chosen as the winner. Sitting beside my fellow nominees on the night and hearing of their achievements, I wondered if they had sent the invitation to the wrong person. (Susan Coyle and I are often receive each other’s calls). Dr Ken Donaldson contacted the winners asking us to write a blog about our work and while I do not believe I have done any more than the other specialist nurses in our Health Board, I would like to use this opportunity to raise awareness of Parkinson’s disease and the difficulty people with this condition can face when admitted to hospital.

I began as Parkinson’s Nurse Specialist in May 2009. Dr Rhind (retired Care of Elderly Physician) proposed a business case for the post and with 2 years funding from Parkinson’s UK, the Health Board agreed. I had previously worked on ward 18, DGRI since 2002 and this was where my interest in this chronic neurological condition started. At the time of my starting, Parkinson’s UK (formerly Parkinson’s Disease Society) were working hard to promote their hospital “Get it on time!” campaign as they were consistently hearing of people being admitted to hospital and having their usual medication regimes not adhered to resulting in poor symptom control and prolonged in-patient stay as a result.

Parkinson’s medication is determined on an individualised basis and people with the condition are reviewed by Dr Shona Donaldson (Associate Specialist) and myself usually on a 3 to 6 monthly basis in order to customise their medication to their individual needs. The condition is progressive therefore review of medication is ongoing and as well as clinic review, people with Parkinson’s and their family/carers can access the Movement Disorder Service directly through telephone or email contact, usual working hours. We are in the very fortunate position whereby if I am out the office and not able to take a call, Angela Haining or Ann McCracken (secretaries) can speak to the person calling and very often help with their problem. Angela organises our out-patient clinic lists and this offers a patient-centred approach resulting in very few cancellations or non-attendance.

In an attempt to promote getting the correct medication at the correct time, I initially wrote to each Charge Nurse (including Community hospitals) to identify a Parkinson’s link-nurse and teaching sessions were held for them with the expectation that they would then raise awareness with their colleagues. This helped me to get to know ward staff and hopefully made staff aware there was a Parkinson’s nurse for our area.

The IT department was very helpful with installing an email alert system. This means I am contacted when a person with Parkinson’s is admitted to DGRI or a community hospital. This allows me to check their Parkinson’s regime and help staff to administer medication accurately. We have pill timers which can be helpful when times are out with usual drug rounds. I can also provide staff with information about social circumstances, multi-disciplinary input they made have had and what their usual presentation is. People with Parkinson’s can display considerable variation in their abilities dependent upon numerous factors including change of environment and routine, presence of infection, dehydration, constipation and of course, alteration to medication.

A Self-Administration of Medication policy for people with Parkinson’s was agreed with input from Gillian Burgess (Pharmacist ward 18) and Mrs Alice Wilson (Deputy Nurse Director). With the introduction of HEPMA this will need to be reviewed and updated.

Another area of concern is the issue of Nil By Mouth. Parkinson’s can affect the ability to swallow safely and it is not unusual if a simple swallow test has failed, for a person to be made NBM until their swallow has been assessed by a Speech & Language Therapist. Another scenario we see routinely, are people NBM because of bowel obstruction. If a person has their Parkinson’s medication stopped abruptly, they are at risk of Neuroleptic Malignant Syndrome (symptoms include altered conscious level, pyrexia, muscular rigidity, raised creatinine kinase, fluctuating BP, tachycardia). This condition is potentially fatal and the reason for my concern when a person’s medication is not given. If medication is not brought in to hospital by the patient, it must be sourced as a matter of urgency and cannot wait until delivered by pharmacy. If a person is unable to safely swallow oral medication for whatever reason, then a rotigotine (dopamine agonist) patch 4mg/24hr can be applied as per Clinical Handbook (see HIPPO). Please contact the Movement Disorder Service on 33909 to ensure we are aware the person is an in-patient (can be delay in email notification) and we will review the dose of rotigotine. Symptom control may require co-careldopa suspension via NG tube however the application of rotigotine in the short term, can prevent a serious deterioration in health.

Improvement to Care & Service Award – Sponsored by UNISON
Winner – Susan Coull

The evening of the award ceremony was very glamorous and a lot of fun. I feel very strongly that although I collected the award, it was only possible because of the amazing team of people I work with including Dr Donaldson, Angela, Ann and staff at Nithbank Rehabilitation Unit where our weekly out-patient clinics are held. Unfortunately, the others could not be with me on the night but I had support from colleagues from ward 18 who were nominees in another category.

 

 

World Parkinson’s Day is the 11^th April 2016 and Parkinson’s Awareness Week is from the 18^th – 24^th April. Look out for posters advertising our Cake, Candy and Book Sale on the 15^th April to support Parkinson’s UK and our endowment fund.  

And finally, thank you whoever you are who nominated me, still a mystery!

Susan Coull is a Parkinsons Nurse Specialist for NHS Dumfries and Galloway

Time to prepare for our new hospital by Chris Isles

This has been a busy month for the NHS. England has narrowly avoided a 24 hour strike by junior doctors, the difficulties experienced by the Queen Elizabeth Hospital in Glasgow have been laid bare on national television for all to see and Question Time debated passionately whether the NHS would fail this winter. Locally, Katy Lewis, our finance director, told a packed audience at our Wednesday Clinical Meeting of the financial difficulties faced by our Health Board while Ewan Bell, Associate Medical Director, wrote a blog about Prioritising Health Care and the chairman of our Medical Staff Committee drew our attention to Audit Scotland’s report on the state of the NHS in Scotland 2015.

Did I hear/listen to/read them all correctly? Can it really be true that the fifth largest economy in the world cannot afford to provide safe, high quality, emergency health care that is free at the point of delivery? 

Let’s start locally. Unless I am very much mistaken we have two major challenges in the run up to our new hospital opening in December 2017. We desperately need to avoid the scenes in Glasgow of ambulances queuing outside A&E and trolleys stacking inside A&E and equally we need to ensure that there is sufficient social care for our frail elderly patients when they go home from hospital. The challenge is likely to be greater for Dumfries and Galloway which has the second highest proportion of people in Scotland who are aged 75+ and living alone.

Katy Lewis spoke of the need for transformative change (aka doing things differently). Who could possibly disagree? If we carry on as we are doing now then the tidal wave of unscheduled medical admissions will cause our new hospital to silt up on the day it opens.  This is the conclusion I have drawn after analysing data provided by our own Health Intelligence Unit (the figure below shows the medical unit is sailing perilously close to 100% bed occupancy) and it is the nightmare scenario we must all be dreading. It should surely be concentrating everyone’s minds. If we get this wrong it won’t just be the local newspaper that will have a field day.

As it happens we have been working on ways of doing things differently and have identified two possible solutions: Ambulatory Emergency Care (which does what it says on the tin) and Comprehensive Geriatric Assessment (see below for definition). We must also ensure that we staff the new Combined Assessment Unit adequately. Both AEC and CGA will require investment if they are to be part of the organisation’s response to an impending beds crisis.     Other hospitals in Scotland have already embraced AEC and CGA and there is published evidence to support the view that these examples of transformative change will reduce bed occupancy. Has anyone come up with a better idea?

Equally if we are to keep that new hospital flowing we must invest in patient transport and community support services, particularly social care teams, providers of equipment, community nurses and carers.   The unintended consequence of preventive medicine is that we have more frail elderly people to look after than ever before. Their numbers appear to be increasing as the number of carers available to look after them decreases.  It can surely come as no surprise to learn that carers are in short supply when some are only paid £6.70 per hour (even less than this when we don’t pay mileage or travel time between visits). Compare this to a consultant physician on £36-44 per hour and the eye watering sums of up to £120 per hour we spend on some of our locums. The enormous difference between carer and locum salaries simply has to be addressed.  

Audit Scotland say that ‘significant pressures on the NHS are affecting its ability to make progress with long-term plans to change how services are delivered.’ The title of Katy Lewis’ presentation was ‘Austerity or Bust’.  Ewan Bell wants us to acknowledge that ‘we can’t continue to provide the current range of interventions and services, if we want a sustainable NHS for the future.’ I personally believe that the 5^th largest economy in the world could afford to provide high quality emergency care as well as batteries for hearing aids and palliative chemotherapy for the frail elderly (if that is what they really want), but if I am wrong then surely the batteries and the chemo must go.

Chris Isles is a ‘semi-retired’ Consultant Physician

Comprehensive Geriatric Assessment: ‘a multidimensional and usually interdisciplinary diagnostic process designed to determine a frail older person’s medical conditions, mental health, functional capacity and social circumstances. The purpose is to plan and carry out a holistic plan for treatment, rehabilitation support and long term follow up.’

There are only four types of people in the world….. by Lindsay Sim & Sharron McGonigle

‘There are only four types of people in the world…….those who have been Carers, those who are currently Carers, those who will be Carers and those who will need Carers.’

In this current climate of integration, it would bode us well to remember the above statement. Dumfries & Galloway Carers Centre has historically always promoted and encouraged partnership working but now it’s something that we have all been directed to achieve together under the Scottish Government Health & Social Care Integration Policy.

Are you letting your patients and their Carers know about the services that you yourself may need someday or are you assuming that someone else has done it? Don’t you want to be the person who lets a Carer know about the services they could access so that it can make a huge difference to their life? In order to give the Carer the smoothest journey throughout their caring role (which is likely to be us all at some point in our lives) we need to be aware of the issues Carers face and try and work together to make their journey have as smooth a road as possible.

If a referral is made to the Hospital Carers Support Project at the very beginning of a Carers journey, for example a stroke diagnosis, a cancer diagnosis, newborn baby with a disability, long term condition, brain haemorrhage (and the list goes on) it has been proven that the Carer feels supported, listened to and most importantly identified as a Carer who needs supported throughout their journey. Early intervention can mean a lesser impact of a caring role upon someone’s life with the correct support.

Carers have vital information to offer health professionals about the person they care for; they know the person inside out so this is more than beneficial to the professional involved as the Carer has firsthand knowledge on how the person they care for functions on a daily basis. Carers need advice on how to cope in the future, need help to access different services or simply want to know about progress and the outlook for the future. The advantage of sharing information with Carers is crucial in acknowledging the important role they carry out.

Carers have a large part to play in helping their cared for recover and ensuring their continued health. To do this, Carers need access to the right level of information. The Hospital Carers Support Project’s Coordinators frequently speak with Carers reporting that they feel cut off from the care of an individual to whom they have provided considerable support. The Carer is continuing to duplicate the care you administered once they get home after discharge. The Carer continuing what you have been doing in the hospital is vital in preventing re-admission. Many Carers also discover our Project for themselves by chance and tell us that no-one directed them to our service for support.

Why is it, when we have so much good policy and practice to help us support Carers through their journey, that some Carers still feel unrecognised and state that they feel they are not treated as partners? Identifying and referring a Carer to the Hospital Carers Support Project early on in their caring role means the Carer can access the following support….

• Instant access to support whilst their cared for person is still in hospital
• Information and advice
• A listening ear
• Assistance to have a voice in their cared for person’s discharge from hospital
• Advocacy
• Benefits advice
• Training and education
• Access to address their own health and wellbeing
• Accessing a Carers Support Plan which looks at their caring role now and plans for the future
• Funding and grants to access a break from their caring role
• Activities and groups where they can meet up with other Carers
• Access to counselling

If Carers and the people they support are informed, involved and supported throughout their caring journey, the likelihood of good outcomes rises, risk of re-admission falls and the financial and emotional costs this incurs can be avoided. Thinking about all the other services out there that are available to Carers is vital in giving the Carer the support they need. Don’t wait until you are a Carer yourself before realising that it can be a difficult, isolating, heavily impacting and frustrating role before remembering all the people you could have pointed in the right direction.

 

Did you know that the Hospital Carers Support Project, part of the wider Dumfries & Galloway Carers Centre has been based within Dumfries & Galloway Royal Infirmary for the last 14 years? We have supported over 1500 Carers with issues ranging from debt management, housing problems, applying for funding, arranging counselling; applying for benefits, accompanying a Carer to a hospice with their terminally ill child, liaising with ward staff, sorting out accommodation, listening when no-one else has, the list is endless. There is no problem that we won’t at least try and find out the answer to when trying to make the Carers journey more seamless but to achieve this we just need you to let us know who we can help……….

If we all work together – it will all come together.

 

Lindsay Sim & Sharron McGonigle

Hospital Carers Support Coordinators

Hospital Carers Support Project (part of the wider Dumfries & Galloway Carers Centre)

Support & Advice Centre

Dumfries & Galloway Royal Infirmary

Tel: 01387 241384 #33384

email: dgcarers@nhs.net

 

 

 

 

Dementia Champions in Dumfries and Galloway by @gbhaining

Who are we?

Across Dumfries and Galloway there are currently 116 dementia champions on our register. We come from a variety of professions and backgrounds including:-

• Nurses
• Allied Healthcare Professionals
• Social Work
• Care at Home
• Chief Executive Offices
• GP Medical Centres
• Community Nursing
• General Hospital
• Mental Health Hospital
• Community Hospitals

How do we become a dementia champion?

As dementia champions we have attended training either locally or nationally. The training provides us with knowledge of dementia, some of the complications and the impact a physical illness can have on a person living with dementia. Listed below are some of the topics included in the training:-

• Understanding dementia
• Communication
• Environment
• Promoting person and family centred care
• Community connections
• Working with families and friends
• Promoting health and well being
• Stress and distress
• Sexuality
• End of life care
• Supporting and protecting people’s rights

We are keen to stress that this training does not make us “experts” but gives us a greater understanding of dementia.

Our Charter.

As dementia champions we have developed and agreed a charter which outlines how we plan to promote our role and support people with dementia and their carers when we are delivering care.

How can you (our colleagues and teams) help us to help you?

If a person living with dementia or cognitive impairment is admitted to hospital or being seen by services check whether they have a copy of “This is Me”. This document can provide us all with very important information and can assist us to make sure we are supporting each person in the best way possible.

Effective use of “This is Me”

• If the person doesn’t have a copy of “This is Me” offer them one to complete along with their family and friends.
• “This is Me” can contain information which is not always readily available at first point of contact.
• Encourage all those working with the person to read “This is Me” and talk to them and their family about the person’s preferences.
• “This is Me” should be easily accessible and ideally left with the person to allow them to share with staff working with them.
• Sign the document after reading as this allows families and carers to see who is involved in the delivery of care.
• You must also make sure that “This is Me” goes back home on discharge as this document is very important to the person it belongs to.

You will see from our charter that we are striving to introduce ourselves to people with dementia, their families and carers during episodes of care. The ward or department may not always have a dementia champion on duty but you can assist us by making sure that everyone in the area knows who the dementia champions are and how to contact them.

We all wear badges as a means of identification so make sure you know who we are!

We will do our best to help, support and answer any queries you may have, however, as we’ve previously said, we are not experts! If we can’t advise you we know who to go to find out.

Development and Training.

We keep ourselves up to date by attending at least one of four development sessions organised for us each year. Our charter states we have to attend a minimum of one development session annually but we are encouraged to attend as many as possible.

These sessions cover a variety of topics but all help us to understand how we can best support people with dementia, their relatives and carers. The sessions are facilitated by Gladys Haining our Alzheimer Dementia Nurse Consultant and Alice Wilson Deputy Nurse Director. As dementia champions we are involved in decision making around specific topics we want to further our knowledge about. These sessions also give us an opportunity to discuss our role, share examples of good practice and discuss some of the challenges we face as dementia champions.

We rely on you as our colleagues and managers to facilitate out attendance at these sessions and your support is greatly appreciated.

To summarise:

• We, given the opportunity, can support and advise you on aspects of dementia and how to support people with dementia during episodes of care.
• We may not always be around, but, please make sure your department has up to date information about the dementia champions, who we are, when we’re on duty and how we can assist both staff and people with dementia.
• If we can’t assist you or answer queries we will seek help and support from some-one who can.
• We want to be able to help and support you as much as we can, so make sure you utilise the skills and knowledge we bring to the team.

If you require more information about dementia champions please contact:

Gladys Haining
Alzheimer Scotland Dementia Nurse Consultant

Tel: 01387 246981 Email: – ghaining@nhs.net Twitter @gbhaining

Just getting up and going to work by Phil Jones

My first memories of my younger brother Graham were bringing him and my mother home from the maternity clinic in August 1957. John Evans the Sunday school Superintendent and local shop owner, who had one of the few cars in the community, met us at the clinic and drove the two miles to our little cottage in Hawarden, Flintshire.
I was six years old and I carried Graham on my knee in a white shawl, I sort of looked after and looked out for him from then on as we were growing up.
Three brothers grew up together in a loving family home, we were an active, outdoor and sporting family and as I went on to play football in the local leagues Graham would come with me, that is until a new leisure centre was built down the road which included a full size ice rink, Graham suddenly disappeared into the world of ice hockey, training started at ten o’clock in the evening, and every evening, and he travelled all over the country, playing for the county and also achieving international call ups.
He left school to work in the nuclear industry, married, emigrated to Canada to work and play hockey and on returning to Wales a few years later had two children of his own.
Eventually Graham started to watch his son play football in the local leagues and his daughter compete in county and Welsh gymnastic events.
All was well until one day, at 40 years of age, running after a football that had gone out of play he stopped and thought to himself ‘ I don’t think I will ever run properly again’
After many tests and sleepless nights the symptoms, effects and consequences of multiple sclerosis were well known and much discussed in the Jones household.
Graham and his wife Barbara were soon to discover that Primary Progressive MS just gets worse and worse with no periods of remission. Barbara was soon to discover that becoming a carer was not a career or lifestyle choice, and it wasn’t much fun either.
One of their early decisions was to do every thing they could to give their young children as normal a life as possible and for Graham, who had a strong work ethic, this meant doing all the things that dads do including carrying on with his job, seventeen years later he is still doing it.
‘It’ being a job as a systems design engineer in a competitive market place. Graham had moved from a secure position in the nuclear industry to self employed status, firstly with Unilever research and then for the last 17 years in the petro chemical industry working for a company who are the world’s only manufacturer of lead additives for specialist fuels.

Nothing really remarkable so far? one of 100,000 sufferers of MS in the UK.
So its bed time Graham, you can’t stand, you can’t walk, you can’t take off your shoes, socks, and clothes. Well actually you can’t do pretty much anything at all.
So its Graham’s bed time Barbara, oh! in about 45 minutes so let’s get started right now, swing out the stair lift at the bottom of the stairs, move the cumbersome hoist out from the corner of the dining room, find the straps and body harness and using the hoist lift Graham from his chair and using all of your strength push the hoist with Graham into the hall and lower him onto the stair lift.
Power up the stair lift and off we go to the top floor, making sure you walk up first and are ready to manoeuver Graham onto the small wheelchair situated at the top and into the bedroom. Using the hoist in the bedroom, the one with the track in the ceiling, lift Graham from the chair and track the hoist into the bathroom. Undressed and bathroom stuff, that’s not as straightforward as it sounds, and then back into bedroom via the roof mounted hoist, carefully negotiating the contraption so that Graham is in bed, not just in bed but lying comfortably because he isn’t really able to move himself once lying down. ‘This isn’t what we planned our life out to be’ says Barbara. All the equipment around the house wasn’t how they wanted their home on the outskirts of Chester to look like either.
Before you know it, time to get up, same procedure in reverse, eventually Graham is downstairs eating the breakfast that Barbara prepared as well as the getting up, getting dressed and down the stairs stuff. Now he is sitting in his motorised wheelchair. Oh did I mention that he only has the use of one hand after slipping in work on washing liquid that had spilled out of a two-litre bottle that had been used to keep a bathroom door open. Health and safety at work, aye it’s got merit I suppose, especially if you use crutches to get around.
Until the accident at work Graham could just about get around using his crutches, but a broken shoulder and collar bone, followed by the insertion of a metal plate quite a long period of recovery and muscle wastage put paid to that.
At 0800, almost two hours after getting up, the doorbell rings and the driver of a converted taxi says ‘Hi Graham’ same routine five mornings a week and sometimes Saturday if there is an emergency call out from work. Graham drives his motorised chair out of the house, up the ramp and into the back of the taxi, a manoeuver that Lewis Hamilton would be proud of.
Off they go on the fifteen mile journey to the Merseyside chemical works, Oh lets not forget about Barbara, young wife and mother one day with her whole life ahead of her, the next and for the future, a carer. Barbara’s own day hasn’t started yet.
It’s Carers week in Dumfries and Galloway starting 8th June, might be worth calling in to get an insight, probably be quite surprised how good it would be for us to become a Carer Positive Employer.
Back to Graham, he is at the factory gate, reverses out of the taxi and down the steep ramp backwards, abseiling would hold no fears for him, no mean feat for anybody, and like the rest of the guys once in the plant he is just one of the boys, well not quite, he is the only senior systems engineer they have, responsible for the flow control systems that blend all of the different chemical compounds in the various batches.
I did mention that he could only use one hand didn’t I, ‘how many do you need to operate a keyboard’ he says.

So single-handed Graham has worked full time in a technically demanding environment on a self-employed basis, paid off his mortgage, put his kids through further education and into employment, topped up his own professional qualifications at night class, held down a top job for 17 years despite crippling MS and is the most positive and courageous person I know. I think I might just be quite proud of him.
Oh and how did this story start? ‘Just getting up and going to work’
Well that’s nothing at all, unless you’re the Carer of course.

Phil Jones is Chairman of the Board at NHS Dumfries and Galloway. 

Captains Blog Part 2 by Julie Robertson

Following on from the recent Captains Blog…Star date 26.09.14…..

“Compassion: that’s the one thing no machine ever had. Maybe it’s the one thing that keeps men ahead of them.” –DR. MCCOY, Star Trek

I’d like to tell you a little about my role as Community Link Worker.

This post was created as a direct result of the successful Community Engagement and Resilience and Health Service Development project, led by the Annandale & Eskdale Health Improvement Team.

My post gives me the opportunity to;

• Engage with people to identify what is important to them in life,
• Support them to achieve agreed outcomes and live their lives to the full.
• Link people with existing services, day centres, support groups, local activities, training or volunteering opportunities.
• Identify gaps in services and empower people to take an active role in the development and delivery of self help interventions (bringing groups of people together which was something requested in the community surveys).

Our team is part of the Safe and Healthy Action Partnership (SHAP), working with communities and other statutory and 3^rd sector organisations. This co-production has enabled us to create a calendar of activities and opportunities which we update quarterly

Activities have included

• Ipad training sessions (Silver Surfers) – supporting people to learn the basic functions of an Ipad/tablet – reducing social isolation, enabling people to access additional information
• Health Walks (Annan, Lockerbie, Langholm)
• Art Group (Annan)
• Craft Group (Annan)
• Living Life to the Full (Annan)
• Tea and Tennis (Annan)

During the short time the project has been running, we have received 158 referrals which has led to the expansion of the project and the creation of another Community Link Worker, Darren Bryan is now in post.

 

 

A significant part of our role is as part of the Forward Looking Care Team, focusing on preventative approaches to care. As well as Darren and myself

the FLC team is made up of:

Donna Wallace, Community Staff Nurse/PYF Community Staff Nurse supports people to identify and access alternatives to hospital admission and to plan their future care. 

 

 

Denise Fallon, Care Co-ordinator Social Services, Forward Looking Care Team works with people who currently have social service involvement or packages in place to ensure more joined up working avoiding duplication.

 

Dr’s Grecy Bell and Fiona O’Brien, General Practitioners support patient’s and their families to identify ways to improve their quality of life and self-management by encouraging patients to have a Forward Looking Care plan.

 

The changes that people have been supported to make have had a huge impact on those that have been involved. Some quotes from participants are shown below along with a poem written by Meg who goes to the Craft Group in Annan.

“Attending the group is one of the highlights of the week” Craft group participant

“I am able to live in my own home which means the world to me” FLC participant

“through this discussion my family are now aware of what I do and don’t want to happen to me” FLC participant

“I enjoy the company and learning new skills” Craft group participant

Do you sit all day just quiet and alone, no knock on the door, no voice on the phone?

Well we are here to talk to you; we will find you something you can do,

You can sew or knit, or sing a song,

If we know the words we’ll sing along,

Or you can just be quiet or free to have a chockie bickie and a nice cuppa tea,

Cardboard Jane she sorts us out, Gobby Meg just has to shout,

Christine is the quiet one, you hardly know she’s there,

Sandra gives us all a hug to show how much she cares,

Amanda had her hair cut it makes her face look round,

She loves to make her bracelets and sell them for a pound,

Julie and Heather are in charge, they make us tow the line, but they make a good cuppa tea so that’s all fine,

Sue is the clever one, she does sums in her head, she’ll sort out all your cash complaints especially if your dead,

Gillian too is quiet and a member of the clan, she really likes to crochet but does what she can,

Bridie’s thing is to crochet so if you don’t have a clue of how its skill is really done she’ll show you what to do,

Agnes our newest member doesn’t care for crafts, but she’ll join in all we do and join in all the laughs

By Meg Little  

As my manager Elaine ‘Captain Kirk’ Lamont says in the forward of the SHAP Annual Report – (she is) “beginning to wonder if there will ever be a time when…(sic)…we are not in a period of change”. Being involved in a ‘test of change’ our team feel that rather than shying away from the challenge of new ways of we are ready to…

“…boldly go where no ‘service’ has gone before!”

Julie Robertson is a Community Link Worker in Annandale and Eskdale Health Improvement Team

Three Little Words (Make a Difference) by @weemac63 & @gbhaining

Here’s a story about 3 people, 3 days, 3 towns, 333 miles, 3 words.

We recently had the great privilege of hosting a 3 day mini tour in Dumfries and Galloway with Tommy Whitelaw. Tommy spent many years touring the world running global merchandising operations for people such as The Spice Girls, U2 and Kylie Minogue, before giving it all up to look after his mum Joan, who had dementia. Sadly his mum passed away in 2012, and Tommy has tirelessly campaigned to raise awareness of dementia and the impact on carers.

Tommy’s inspirational talks encourage people to think about dementia and how it can affect each and every one of us, professionally and personally. You can watch some of his talks and videos here on his blog. The theme of Tommy’s tour for 2014 is “You Can Make a Difference”.

In April 2014, for the Dumfries and Galloway leg of his tour, Kylie and The Spice Girls were not available, so he was forced to go on the road with two new sidekicks.

(Us! – Linda and Gladys: @weemac63 and @gbhaining)

Here are the highlights of our tour with Tommy….

Tuesday 8^th April 2014.

We headed to our Transport Department to collect our “tour bus” for the 3 days.

“Oh no!” was our first reaction, It’s a Corsa! Never mind, there are only 3 of us and Tommy will just have a wee rucksack with the essentials. So off we went to pick Tommy up at Lockerbie station via a well known supermarket as we wanted to ensure a supply of sweeties, sandwiches and drinks to keep us well nourished and hydrated over the next 3 days.

We arrived at Lockerbie station just in time to see several bags, rucksacks and packages of many shapes and sizes advancing towards us at an alarming rate down the steps of the station platform. We soon discovered the smiley face of Tommy Whitelaw peeking out from beneath one of the bags!

After enthusiastic greetings all round, we made our way to the tour bus where the “roadies” ( us!) managed to squeeze all the gear into the boot of the aforementioned Corsa, and off we set to our first gig at Stranraer!

We arrived at Waverly Medical Centre and unloaded the “gear” to start the events. A quick sound check confirmed that the technology was going to play its usual tricks on us but we soon “made do” and the audiences at the two sessions were treated to emotional and inspiring talks from Tommy.

After a brief photo call, we were back on the road, heading for our next gig at Palmerston Football Ground.

We arrived at Palmerston with a little time to spare and again Tommy delivered a very emotive, inspiring and thought provoking talk to the invited guests. We had a wide range of people from our community at the event and it was a huge success. The football ground was an ideal location as Tommy during his tour has visited many other grounds across Scotland.

 

 

 

 

 

 

 

The lack of half time Bovril was made up for by a fantastic supper provided by the girls at Palmerston (including the customary pies and sausage rolls!)

Wednesday 9th April 2014

Another busy day ahead which kicked off with two very well attended open sessions in Crichton Hall.

After navigating the “tour bus” through all the interesting road works of Dumfries, we then arrived at Alzheimer Scotland’s resource centre in Gordon Street, where the three of us were very privileged to be invited to join some of the day care service users for lunch.

Tommy was then given a tour of the resource centre meeting staff and volunteers.

In the afternoon we popped back up to Crichton Hall where Tommy presented to members of our Person Centred Care Committee.

With a busy morning and afternoon there was a little time for Tommy to return to his hotel and relax before joining a few of us for dinner. (A welcome change from the sandwiches and junk food we had been consuming over the past two days!)

Thursday 10^th April 2014.

Our final day with Tommy and we’re not letting him slow down, so the tour bus was loaded up with a plentiful supply of Lucozade (the healthy version of course!)

The first session was held in Midpark Hospital. Word had obviously got round, as it was standing room only in the packed venue. Jeff Ace our CEO even had to give up his seat in the VIP area and move to the cheap seats. Despite technical problems which left us without sound and vision, the audience were moved to tears listening to Tommy. Afterwards, he had a short visit to the dementia assessment ward to see the wonderful facilities and meet with some of the staff.

 

No time to stop (even for another sandwich!) before rushing back over to Crichton Hall for a session with the dementia champions.

We were then back in the car heading to Annan for the last session of the tour, feeling sad as the tour is coming to an end, but so happy with the positive feedback we had received along the way.

As expected, this final session was inspirational and thanks to Brian Cluckie we had no hiccups with the I.T.!!!

The final leg of our tour was soon upon us, and we headed back to Lockerbie Station to bid farewell to Tommy, who had another talk with student nurses in Glasgow later that evening. As we left Tommy at the station platform, with slightly lighter luggage, and the last of the now stale sandwiches clutched in his hand, we felt exhausted, and sad to say goodbye, but with happy hearts that so many people had the opportunity to meet Tommy and hear his message. After 3 days, 3 towns, 333 miles, 33 sandwiches, the 3 of us hoped that everyone left thinking about 3 important words:-

WE can all “make a difference”.

Throughout the three days Tommy has engaged with and shared his story with people from our community including the public, health care, social care, third sector, police, clergy, carers, care providers ,footballers and many more.

Tommy has had lots of pledges from Dumfries and Galloway and it’s not too late… You can still pledge online at http://dementiacarervoices.wordpress.com/you-can-make-a-difference/

Here are some quotes from people who attended the sessions.

 

 

 

 

 

 

 

 

 

 

 

 

 

This blog has been compiled by:-

Gladys Haining (@gbhaining gbhaining@nhs.net) and Linda Mckechnie (@weemac63 linda.mckechnie@nhs.net). Gladys is our Alzheimer Scotland Dementia Nurse Consultant and Linda is a Service Development Manager at the Mental Health Directorate both at NHS Dumfries and Galloway.

 

 

 

 

IDEAS – A Project in Dementia Service Improvement by The IDEAS Team

The three members of the IDEAS team writing today are Fionnuala Edgar, Alison Groat and Lorraine Haining.

At the recent Mental Health Nursing Forum Scotland Awards, the IDEAS team were delighted to lift not only a practice excellence award in the dementia category but received ‘Practice of the Year’ as the overall winner This multidisciplinary team (Nursing, Psychology and Occupational Therapy) was formed in 2012 following a successful bid to the Putting You First fund to address non-pharmacological management of stress and distress in dementia, in line with Scotland’s National Dementia Strategy.

 

(L-R; F.Edgar, L.Haining, M.Born, W.Chambers, R.Warwick, missing from pic A Groat)

 Three members of the team write about their experience of the project to date:

 Lorraine Haining, Advanced Nurse Practitioner writes:

 As the nurse in the team I was extremely pleased to receive this accolade as it acknowledges and celebrates the work and efforts not only of the team but of the Care Homes and supporting services that have made it possible. In my career I have been lucky enough to have had several opportunities to make a positive contribution to changing the way we value and provide care for people with dementia and the IDEAS Project has been another of those vehicles for change.

This multidisciplinary approach lends itself well to holistic care, with each profession providing education and support from their clinical perspective. In terms of Nursing my aim is to promote the prevention of stress and distress symptoms by ensure screening for treatable physical or mental health conditions, ensuring regular reviews of antipsychotics and other psychoactive medications, addressing polypharmacy issues and ensuring effective care planning incorporating all health and medical needs.

A major personal driver for me is that my father has dementia. His experience on the journey has so far been positive and he is coping well with the diagnosis. We have had that difficult conversation about the future and not wanting to be a burden on his family he has opted that we should consider a care home if he is not coping at home so therefore I need to make sure that his positive journey continues if this turns out to be the case and there is no better driver for the best possible outcomes than your love for your family.

Quotes from Staff attending Nursing session:

 

 

 

 

Fionnuala Edgar Clinical Psychologist writes:

In Dumfries and Galloway Mental Health services have been at the forefront of reducing reliance on anti-psychotic medications for stress and distress/challenging behaviour in dementia since 2008. Through the IDEAS team we have been able to be more fully committed to the delivery of support and education to carers working in care homes across the region. This has allowed us to deliver a holistic, person-centred approach that has received overwhelmingly positive results across the region. Training has been based on current guidelines developed by the British Psychological Society (BPS) ‘Alternatives to antipsychotic medications: Psychological approaches in managing psychological and behavioural distress in people with dementia’ (BPS)

From a psychological perspective I have seen a positive shift in carer’s understanding and beliefs about dementia and this will, in no doubt, lead to better quality of life for residents. Staff morale has reportedly increased significantly as carers feel more valued and confident in their role and in their ability to successfully manage stress and distress without the need for psyco-active medication.            

Quotes from Staff attending the Psychology session:

 

 

 

 

Alison Groat, Mental Health Occupational Therapist writes:

As one of three Occupational Therapists involved in the IDEAS project (along with Wendy Chambers and Michelle Born) we feel this Team approach has worked very well. From an OT perspective, we wanted to focus on the Environment and creating opportunities for Meaningful Activity within it.

All Care Homes have been offered the opportunity to undergo a dementia design consultation with OT following completion of The Kings Fund Care Home Environmental Checklist (www.kingsfund.org.uk). Working in partnership with Care Home Staff, immediate environmental changes were identified such as improved signage, improved lighting, and contrast. Some areas have also able to include dementia friendly principles within longer term plans for refurbsihment.

Before and after photos                                                                                          

Change achieved by visually removing door by blending it into the wall has resulted in a marked reduction and on some days a complete removal of this stress for residents.

Staff were also provided with further information and tools on the implementation of meaningful activity tailored to the individual person. SMART Goals were developed with Staff around activities they planned to implement and follow up was offered. A main focus has been on creating the opportunity for normal everyday activity within the environment. We have been delighted to see Care Homes updating Interest Checklists, carrying out more Life Story work and adding everyday activities in to the environment e.g. dusters and sweepers.  We have witnessed excellent examples of meaningful activity already being implemented, which we have been able to share.      

Quotes from Staff attending the OT session: 

 

 

 

 

To date, the Foundation Level Training has been attended by over 600 care home staff and the Intermediate Level Training has been attended by 99 care home staff. We are in the planning stages for the Advanced Level training which will include a Train the Trainers element (for Foundation Level training) thus ensuring the long term sustainability of gains made as the project draws to a close in September.                           

For further information contact:

 Fedgar1@nhs.net; alison.groat@nhs.net; or lorrainehaining@nhs.net