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

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

Life after Life by Thalakunte Muniraju

Why should the good things in us stop after death when there is great opportunity for life to continue after life? It is impossible to describe in words the emotional and physical trauma individuals with chronic organ failure experience. I am sure most of you have seen or come across someone whose life has been transformed for the better after organ transplantation.

Kidney failure needing dialysis reduces quality of life and survival significantly. A patient in his/her 30s with kidney failure needing dialysis has a similar chance of having heart disease compared to someone in their 80s without kidney failure. Dialysis replaces some of the functions of kidneys, but not all. Receiving dialysis is almost like having a part-time job; sometimes it can be more than a full-time job if we take into account all the dialysis-associated complications and procedures. To make matters worse, dialysis patients must adhere to lots of dietary and fluid restrictions. A friend of mine once told me that he only started appreciating the taste of water after starting dialysis.

Kidney transplantation is the only treatment which can cure and improve the quality of life and survival in these patients. Yes, kidney transplantation is not without risks and patients have to take lifelong medications to suppress their immune system. But the overall benefits are far superior to being on dialysis. Survival of transplant patients and kidneys has improved significantly – half of the kidneys transplanted from living and deceased donors are still working at 15- and 10-years respectively. One of the immensely satisfying things to see for us as clinicians is to see patients leading a normal life following transplantation.

With the exception of living donation, organ donation is only possible following a sudden, unexpected and most often premature death. We should never lose sight of the families who go through this and should do everything to support them. One of the ways to salvage something positive out of these dreadful events is through organ donation.

Three patients die everyday in the UK waiting for an organ. Over the last 10-years, the number of transplants being performed has increased substantially. Still, a huge gap exists between the numbers of patients active on the list and the number of patients being transplanted (see graphs below). The current UK strategy for organ donation and transplantation, Taking Organ Transplantation to 2020, emphasises the pressing need to reduce family refusal rates. It is disappointing that there has been no improvement in the overall consent (or authorisation) rate in 2014-15. NHS Blood and Transplant continue to devote considerable attention to improving the support that it is giving to families when the possibility of donation is raised.

On 1^st December 2015, Wales became the first UK country to introduce a “soft opt-out” system for organ donation. It will be interesting to see what impact this will have on the number of transplants in Wales in specific and subsequently, the UK as a whole. Earlier this year Scottish government said it would consider bringing forward new legislation on an “opt-out” system for organ donation.

Hopefully one day in the near future we will see an “opt-out” system in whole of UK, for the benefit of our patients with organ failure.

 

 

 

 

 

 

Registering online takes less than two minutes. After registration make sure that your family and friends know about your wishes. This is the only way to continuously increase the transplant activity, and give someone gift of life. Please consider giving life after life…

https://www.organdonation.nhs.uk/register-to-donate/

http://nhsbtmediaservices.blob.core.windows.net/organ-donation-assets/pdfs/activity_report_2014_15.pdfb

http://www.bts.org.uk

Dr Thalakunte Muniraju is a Consultant Nephrologist at NHS Dumfries and Galloway

 

 

Boundaries . . . by @AnneMar43403619

“Freedom brings men rudely and directly face to face with their own personal responsibility for their own free actions. (Frank Meyr, 1962 in Defence of Freedom).

Do you ever get the feeling that the NHS is trying to run a five star service on a one star budget? Quite some time ago a motivation speaker came to talk to many of the senior managers within D&G NHS about the indisputable fact that demands on the NHS would continue to increase and resources would continue to decrease proportionately.  He asked them to think out of the box about how we could start to overcome this increasing discrepancy. So, here’s some thoughts…

 It is almost as though the welfare state (indisputably needed and a mark of a civilised and moral society) has created its own Catch 22 with so many people believing their right to a choice, their choice, is paramount regardless of the impact on anyone else either individually or corporately.

 This fundamental change in people’s expectations comes with an increasingly litigious mentality and is leading not only the NHS but all welfare provision to breaking point. The boundaries of personal and social responsibility seem to be getting dangerously blurred and I believe that it is time to start defining healthy and sustainable boundaries again. To start saying, dare I say it, ‘No’.

 Before you all shoot me down in flames please be aware that I am not decrying the drive to improve patient care or the patient experience – we all want the best treatment and care for our patients, but it has to be within reasonable and sustainable limits.

 It seems to me, and a lot of my colleagues that it should be possible to cut back without affecting front line services – but the cuts would affect at least two forbidden areas: the patient experience and those strategists who think that forty page documents talking about interface working and cross sectional content mean or change anything.

The latter is probably best summed up by a quote from an anonymous but very well known NHS source: “As is well reported the management and administrators within the health service could keep themselves busy in an empty hospital with paper exercises.”

 Maybe we could summarise the government’s strategic direction 2020LDP paper thus: “Continue to work together to provide the best patient care across all services within budget constraints.”  One person, two minutes, cost to the NHS about 20pence.

O.K tongue in cheek but you get my point.

Any measures that negatively affect the patient experience would be controversial but when you look at it in terms of managing your own home and how your budget affects the choices you make and are sometimes forced to make surely it becomes simpler. Running your own home involves setting limits and boundaries, it involves denial, taking second and third best or frequently going without at all and it is not just you, the adults, but your children that are affected by the choices you make. If you teach your children and help them understand why they cannot always have just what they want when they want they learn to value your family resources, understand why sometimes the answer is ‘No’,  maximise family resources and then take on their own responsibilities as they grow up.

 Perhaps it is time for the NHS to set some realistic boundaries of its own and make it clear that it simply cannot meet every demand or expectation, public or otherwise. Can we really expect to be able to continue paying for patients to occupy acute beds simply because they don’t want to go to a community hospital? Or let patient choice costs tens of thousands of unnecessary pounds when there is an alternative that costs so much less? Can we expect to continue to fund hundreds of unnecessary visits to A&E or GPs, to shell out blanket free prescriptions? Or, on the other hand, continue to allow employees to stick to procedures that not only cost more but have a negative impact on a patients physical, mental and social well-being – just because they have always done it that way? Or to recall patients repeatedly for hospital check ups when a telephone call would do? Or to take up an acute bed simply because a patient needs an urgent scan but is otherwise well. Or to …. the list is endless.

 Why is it so difficult for people to set sensible and realistic boundaries and stick to them? Why do we, as staff, so often capitulate to our patients every whim: “Not eating that sandwich I want grated cheese not slices!” and with each capitulation re-establish the boundary even further in the patient’s favour.

 How too is providing for every expressed patient need going to encourage the culture of self management that is being flagged up as an essential part of the NHS future? Granted there are a huge number of things that are crucial to improving the patient experience that should be a fundamental part of the treatment they receive anywhere in the NHS – respect, courtesy, clear information, empathy and openness – but maybe we need to remember that the original ethos of the NHS was treatment free at the point of delivery based on clinical need.

Clinical  need – not desire.

Anne Marshall is a Staff Nurse on the Renal Unit at NHS Dumfries and Galloway

 

All Men (& Women) are created equal? by @lynseyfitzy

Since taking up the post of Equality Lead at the end of October 2012, I’ve heard various comments such as “What does THAT involve?” and “Surely that’s a made up job?”.  If only.  If only it wasn’t the case in Scotland that only 0.3% of apprenticeships go to people with a disability or that women are paid 14% less than men in full time work.  But possibly the worst comment I have heard so far is “people need to have a sense of humour about some things”.  I’m sure those people that have suffered discrimination would be delighted to hear that all this could be resolved if they simply lightened up and learned to laugh about it….

With the ongoing work around person-centred care and  patient experience, equality and diversity couldn’t be more relevant, after all, each and every one of us has at least one ‘protected characteristic’ and we are all at risk of being discriminated against at one point in our lives.  Most of us will at some point have to engage with health services and I’m sure that none of us would like to be treated less favourably because of one of our protected characteristics.

After attending the Patient Experience event in September 2013, where I couldn’t help but think that equality and diversity is at the heart of so much of this work, I came across the following articles by columnist Ian Birrell who has a disabled daughter and writes passionately about discrimination. He cites an example of a patient with Downs Syndrome being made “not for resuscitation” without any discussion with loved ones as it was just assumed by medical staff that his life held no quality. He also quotes some frightening statistics about disabled patients being left to die as it was considered “the kind thing to do” by medical staff. Two of his articles can be read here and here.

It would be easy to think that we work in a place where discrimination like this doesn’t exist, and I often hear the words “I treat everyone the same” as if this excuses someone from needing any further training or development on equality issues.  One thing which is clear though is that treating everyone the same or basing decisions on our personal assumptions is not equality and, as these articles highlight, can be dangerous.  People (staff and services users) should be treated as individuals, with a range of different needs.  Some of the complaints which I have been involved in since October 2012 could easily have been avoided if those involved had taken the time to consider the needs of the individual rather than a ‘one size fits all’ response.

At the recent Big Burns Supper event held in Dumfries, I had the wonderful opportunity to see a one man show called “If These Spasms Could Speak” which was about the way in which disabled people experience the world and how they feel about their bodies.  The show is by Robert Gale, a disabled actor, and had rave reviews when it was shown at the Edinburgh festival (There are clips on You Tube for anyone that might be interested in finding out more, one of which can be viewed here).  Despite the spasms which are probably the first thing people notice, and are so very aware of, the first thing that Robert sees when he looks in the mirror is a “cute face” despite the attitudes of others to his own physicality.  However, one of the funniest, yet probably most worrying parts of the show is when he describes visiting his brother in hospital and a young doctor proceeds to ask him personal inappropriate questions, assuming that he “must be somebody’s patient”.  This highlighted the way in which non-disabled people often view those with disabilities, in this case Robert’s own cerebral palsy and speech impediment.

Not only is it good practice to consider equality from a moral viewpoint, but by law we have had to become more pro-active about eliminating discrimination, advancing equality of opportunity and fostering good relations.  One of the ways in which NHS Dumfries and Galloway have done this is to come up with a set of equality outcomes, which you can read more about here.  We are also in the process of reviewing our equality impact assessment policy and toolkit, again something which is required to be completed by law but something which is often seen as something which is a bit of a nuisance.   If the fear of being personally fined if there was ever a claim against us isn’t enough, then think of it this way.  You have gone to all the bother of writing a policy/coming up with a strategy/started the process of service change (delete as appropriate).  Surely it makes sense to ensure that you have considered and consulted as many different people and groups of people as possible.  This can only improve your service or your policy and make it better than it already is, and may save you having to go back and make changes at a later date.

This is not to say that there isn’t already lot of good work being done out there.  For example, we have several areas within our Board currently undertaking the LGBT Charter Mark.  As an employer we are signed up to the disability two ticks symbol and each of our directorates have developed their own action plans on how equality and diversity can be mainstreamed into day to day business.  There is a lot of good work being done out there and a lot of our staff willing to consider people as individuals with a range of needs and requirements which they are more than willing to try and accommodate.

But, for the time being anyway, it looks like I do have a ‘real’ job as equality and diversity is no laughing matter….

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

The Christmas Card by Mike McMahon

She wasn’t my Auntie, in case you wondered.

A little before Christmas a patient gave me a red envelope. She smiled as she handed it to me, her manner suggesting she was perhaps a little embarrassed. I can’t pretend to be Sherlock Holmes, but I was pretty sure it contained a Christmas card. I thanked her for it. I don’t remember if I mentioned to her that I presumed it to be a Christmas card, but I set it on the desk and said I would open it later if that was alright with her.

 A clinical consultation followed. Then she left the room leaving the envelope behind.

 That afternoon, in my office, which was quiet enough to bring my tinnitus to notice, I read then deleted several emails, each deletion a small victory swelling my soul, then corrected and verified some letters, a slow process of  removing or inserting apostrophes which sapped my soul back to normal size, all the while glancing occasionally at the envelope.

 I have always recognised that I have a slightly atrophied curiosity, but perhaps it is just slow to awaken, since eventually I found myself reaching for the envelope.

 A Christmas card. Just as I thought. A smiling snowman and a large star. “Merry Christmas”.  “Thank you for all your help” written inside. No “X”, thankfully, since that would be particularly awkward.

 But the card was not alone in the envelope. There was also a five pound note. Not a crisp new one, but a much folded one that had obviously had a story of its own.

 

 Perhaps you should know that she was not a wealthy woman by any stretch of the imagination.

 What should I do with the five pound note?

1. Give it back?
2. Write to ask what she would like me to do with it?
3. Write a letter of thanks?
4. Write a letter of thanks but hint that it was too much?
5. Write a letter of thanks and enclose the trust guidance on gratuities?
6. Donate it to charity?
7. Put it towards biscuits/chocolates for the clinic staff?
8. Place it in the endowment fund?
9. Have it framed and hung on my wall?
10. Disclose it, and my response, at my next appraisal?

Mike McMahon is a Consultant Physician and Rheumatologist for NHS Dumfries and Galloway