Enough Love by Ken Donaldson

I was out for a run the other morning (yes, despite the physique I do run. I also eat) and was listening to a random music selection. An oldie by Genesis, Land of Confusion, came on. I smiled wryly as I listened to the lyrics. Lines such as ‘Too many problems’ and ‘losing control by the hour’ certainly resonated.

The past few weeks have been simply unbelievable. The initial adrenaline rush brought on by the Covid 19 crisis has started to dissipate and the realisation of what is coming and how this will affect us is sinking in. The purpose of this blog is not to discuss all the plans we are working through and what needs to happen over the next few days and weeks to make us as ready for this as we can be. The purpose of this blog is to talk about us. When I say us I was thinking NHS D&G but in reality I realise I mean everyone working together with the NHS through these difficult times; social workers, carers, police, council, fire and safety, third sector etc etc. Actually what I now realise is that I mean the People of Dumfries and Galloway. All of us.

What I have witnessed over the past few weeks has been a simply astonishing response to this impending crisis. Those in the critical areas; Primary and Community Care, Emergency Dept, Combined Assessment Unit, Critical Care Unit have stepped forward with plans to significantly alter services and ensure they can cope. Those in other areas less critical stepping forward to offer their skills and time to support services in any way they can.

All this is amazing and, I can’t deny, that when I have been feeling particularly stressed, it has made me feel emotional. But its the small things that have brought on the tears; the catering assistant when I was paying for my lunch who gently laid her hand on my arm and asked if I was ok (I know, she shouldn’t have, infection control etc but it was a lovely gesture), the colleague making a point of stopping me to ask if I was all right, another who offered a hug. I mention these for a specific reason.

Whilst I may be feeling a little stressed just now in a few weeks we are all going to be facing simply unprecedented pressures. Quite a few of us will be sick with this virus, we will have friends and family suffering and work will be relentless. We need to cling on to these small gestures. Simple acts of kindness are going to help keep us going through the dark times.

I was at a meeting with Valerie White, Interim Director of Public Health, and she said words to this effect “This is going to be really hard and we all need to work together but I can say without any shadow of a doubt that there is nowhere else I would rather face this than Dumfries and Galloway. The commitment I am seeing from everyone and the willingness to work together is amazing.” I can only echo Valerie.

Returning to that song, Land of Confusion, there was another line that stuck out; “There’s not enough love to go round”. Now this is one I totally disagree with, in Dumfries and Galloway I think there is enough love to go round, and then some.

Take care everyone. We can do this together.

Ken Donaldson is Medical Director at NHS Dumfries and Galloway

*Image taken from “The Boy, the mole, the fox and the horse” by Charlie Mackesy

Two tins of soup by Libby Johnston

When asked to submit something for the blog quite some time ago, the suggestion was that the subject be something that readers would find moving in some way. Recent press has been highlighting the degree of loneliness some are experiencing and how it can effect wellbeing physically, mentally and isn’t always visible to others.

In the run up to Christmas festivities I went to one of the so-called Pound shops. It leans towards my frugal nature and there is nothing like a bargain. However many use such shops to survive with a limited budget.

As I wandered down the first aisle a rather frail but spritely elderly woman moved to allow me to pass and I thanked her and we exchanged pleasantries. As I made my way through the aisles and shelves she seemed on the same route and I couldn’t help but overhear her saying ‘Merry Christmas’ to virtually every person she encountered. I made my way to the checkout and there she was again in front of me in the line. As I looked at her clothes, I could see that she had many layers of threadbare jumpers and no coat on what was a cold day.

She seemed to know the person at the checkout and was asking if they were ready for the holidays and he asked her the same to which she answered yes this was her last shopping trip. On the conveyor belt were 2 tins of soup. He commented, ‘No turkey’? She shook her head, saying nothing and placed the tins of soup in her shopping bag, continuing to wish everyone around her a Merry Christmas and the same to us as she trudged out of the shop, bag in hand. My heart was full as she had shared the joy of the season with everyone she encountered in the shop and yet there was a loneliness to her life.

As a nurse and midwife (retired), it’s always been in my nature to reach out and help others in need. I desperately wanted to ask this dear lady if she was having a Christmas meal with anyone and if not invite her to share ours. I feared she might only be facing a tin of soup. However, she had disappeared from sight and I will never know.

It left me feeling a touch of sadness for her. There is much awareness about people being lonely and particularly at this time of year. Many organisations, charities are endeavouring to help those who may be lonely. There will always be those who won’t want help and soldier on like this woman who found some company, even joy in sharing festive greetings in a shop. A lesson perhaps for the less lonely to be bolder in reaching out to others not only at Christmas but in everyday life.

The government is investing in ‘loneliness’ as it is felt it has been shown to impact health and wellbeing. This is highlighted in this article in The Guardian:“UK to tackle loneliness crisis with £11.5m cash injection”

The money will help establish projects that will bring people together and in so doing reduce elements of loneliness, improving health and wellbeing.

 

“Loneliness and the feeling of being unwanted

is the most terrible poverty.”

Mother Teresa

Sending love at Christmas…. by Mairi Small

Christmas is inextricably linked with love…..

Dean Martin sings about having his “love to keep him warm” – if you would like to spend a couple of minutes warming the cockles of your heart click here –

Smokey Robinson and his Miracles feel that if their baby loves them too, it would be Christmas every day and annually, in early December, we’re reminded that all Mariah wants for Christmas is youuuuuuu. (The remainder of the song choices in the collage are for you to ponder whilst digesting your turkey on Tuesday)

In Cardiac Rehab we love to sing and have a soundtrack to each of our weekly exercise sessions which are held in venues throughout D&G. Sometimes, the music choices are a little bit Homes under the Hammer-esque…. “Dont Go Breaking My Heart”, “Under Pressure”…..  And of course who could forget the dulcet tones of Billy Rae Cyrus belting out “Achy Breaky Heart” in years gone by (for those under 30 reading this, Billy is Miley Cyrus dad). But C/R isn’t “just an exercise class” as anyone who has ever had experience of our service will testify – so what do we actually do?!

Well, since “last Christmas”, the C/R service in D&G has supported over 500 individuals following a cardiac event. The British Association for Cardiovascular Prevention and Rehabilitation (BACPR) define priority groups for inclusion as post MI, coronary revascularisation (stents or bypass) and heart failure.  Locally, we also include those with a diagnosis of angina, post valve repair/replacement, post implantation of cardiac defibrillators and resynchronisation devices, post heart transplantation and ventricular assist devices and adult congenital heart disease.

The service was set up in D&G in 1990, with an extensive, worldwide evidence base being consolidated since – C/R reduces cardiac mortality by 26% and unplanned hospital admissions by 18%. Currently based in Cluden Cardiac Unit in Crichton Hall, we are set to move into Mountainhall in early 2019. We see inpatients in both DGRI and GCH and run out patient clinics regionwide. We are a small team of nurses and physios who work closely with a wide range of health care professionals, services and organisations.

Although C/R nationally is undergoing a programme of modernisation in line with Scottish Government priorities, it maintains its traditional “menu based approach” with patients choosing the components that matter to them.  So, whats on the C/R menu this Christmas, and beyond?!

To start

Identification, referral and recruitment of eligible patient populations – referrals tend to be picked up during in patient stay or from tertiary centres but we also accept referrals from other HCPs.  Referrals can be sent electronically to – dumf-uhb.CardiacCommunication@nhs.net

Early initial assessment of individual patient needs – including medical history (a significant proportion of patients will have one or more co-morbidites), relevant investigations, social determinants of health, lifestyle risk factors, psychosocial health and medical risk factor management.  This may take place in hospital, the patients home or out patient clinic and may be completed over more than one contact.

Agreed personalised goals – to be reviewed throughout the episode of care.  This really is the “what matters to you” bit of the programme.  Goals may range from “aim for 3000 steps a day” to “get back to work” to “get back to singing with the choir”.

To follow

Health behaviour change and education – this may include addressing cardiac (or other) misconceptions and illness perceptions that may lead to increased disability and distress, support of the patient’s significant other/s, goal setting and pacing skills, and facilitation of self management skills. Discussions may include – pathophysiology and symptoms, management of risk factors such as BP and lipids, occupational/vocational and driving advice, resumption of sexual relations and dealing with sexual dysfunction.

Lifestyle risk factor management – a trio of physical activity and exercise, healthy eating and body composition and tobacco cessation.

Individualised advice on ADLs and a tailored activity and exercise plan aims to increase physical fitness as well as reduce sedentary behaviour. Home based exercise plans are offered for those unable to uptake on traditional group exercise sessions and patients also get the opportunity to exercise within local authority leisure facilities. We are currently exploring the use of technology by way of short term loan of Fitbits to ascertain baseline activity levels and encourage an increase in an individuals “active minutes”.

Following baseline assessment of dietary habits, weight, BMI and waist circumference, a focus is on the adoption of a cardioprotective diet which encompasses healthier dietary choices, correcting misconceptions about diet and health, and body weight maintenance (or reduction if appropriate).

Patients who are smokers at the time of assessment are referred to the Quit Your Way service in addition to the C/R team providing education and support in the preparation and attempt at smoking cessation.

Psychosocial health – all patients are screened for psychological distress using validated tools and individual assessment allows for discussion regarding illness perceptions and self-efficacy for health behaviour change, and to determine levels of social support. Patients are encouraged to practice relaxation strategies or mindfulness exercises regularly and are offered taster sessions as part of the programme.

Medical risk management – optimisation of cardioprotective therapies is guided by regular measurement of BP, heart rate and rhythm, glucose and lipids. This provides an opportunity to discuss dosage and adherence with the patient and address their beliefs around their medication regime. It is hoped that some of the team can become independent prescribers to streamline the process of up titration of the secondary prevention medication in the longer term.

BHF Heartstart training – all patients and their family/friends are invited to attend this two-hour session to learn how to recognise an MI/cardiac arrest and deal with a life threatening emergency – perform CPR, access and use an AED, deal with choking and serious bleeding. This year 239 individuals across D&G have attended a Heartstart session run by the C/R team.

To finish

Final assessment of individual patient needs – to determine the effectiveness of our interventions, we are currently reorganising our service to create time for a more comprehensive final assessment to take place. To date this has been done quite informally but we feel it would enhance the patient experience to revisit baseline measures and formalise the ongoing management plan collaboratively. Patients are given details of local community based services and opportunities to support their self management moving forward.

Audit and evaluation – the uptake of C/R throughout the UK is variable but it is pleasing that locally we are supporting many more than the national average of around 50% of patients following a cardiac diagnosis. We have a robust audit process in place within D&G and are currently exploring how this may feed into a UK wide dataset to further strengthen the evidence base for C/R interventions.

Coffee and mints

In keeping with C/R tradition, on noteworthy occasions such as retirements and birthdays an after dinner ode to the recipient is dished out along with the coffee. With this in mind….

An ode to NHS D&G staff at Christmas

As Andy Williams famously sang, “it’s the most wonderful time of the year”

Perhaps you’ve spent the last few weeks thinking to where did 2018 disappear?

Now is the time for some fun, rest and reflection, hopefully in equal measure

To celebrate Christmas your own way and with love, kindness and pleasure

Although joyous for many, the festive season can be a sad and difficult time its true

Loneliness, loss, illness, expectation and pressure, maybe feeling more than just a bit blue

Christmas, like a heart attack, doesn’t always look like it does on the big screen

A time of remembrance and contemplation, hopes of what the year may have been

The pace of change in modern healthcare often goes at a rate of knots

Feels like there’s hardly time to do the job, let alone gather your thoughts

We all know too well of the “winter pressures” which don’t seem to relent much year long

Working difficult and unsocial hours, away from our loved ones, where we belong

It’s sometimes hard to remember that we all do a great job and are part of a fab wider team

It’s easy to criticise and get despondent when it doesn’t feel like you’re living the dream

But our local health services are truly amazing and star several thousand of a diverse cast

Staff who are caring, loyal, highly skilled and adaptable, genuine healthcare enthusiasts

So, take some time to enjoy your Christmas soundtrack and whatever is on your menu

The little things in life are often the best, regardless of the venue

Take some time to do “what matters to you” and enjoy some festive cheer

Wishing you and those special to you, health, happiness and peace throughout the New Year.

The cockles of the heart are its ventricles, named by some in Latin as “cochleae cordis”, from “cochlea” (snail), alluding to their shape. The saying means to warm and gratify one’s deepest feelings.

Mairi Small is a Senior Physiotherapist at Cardiac Rehabilitation for NHS Dumfries and Galloway

A Yellow Wood by Gill Stanyard

The 1st June 2018 was my  last day as a  Non-Executive Director for NHS Dumfries and Galloway.  After four years of a potential eight year appointment from Scottish Government, I decided to  leave. I felt I had reached a good and fulfilling end and to stay on for another four year term would have been signing up to endure.  I made a decision I wanted to enjoy. So, I felt happy with my decision to end my time, made when swimming in a shimmering blue sea one early morning, whilst in Greece.

I made a decision. ‘Decision.’ The Latin origin of this word  literally means, “to cut off.” Making a decision is about “cutting off” choices – cutting you off from some other course of action. Now that may sound a little severe and limiting, it’s not. It is liberating. Decisions, they take us onto the next stepping stone, sometimes called  ‘The End’  – two words which tell us a story is over.

My friend made the final and shocking decision to end his life at the weekend. A fact I am still struggling to comprehend. Our last communication was a fortnight ago, with me texting him about all the different gins (24 to be exact) that were on the menu at my leaving ‘do.’  He texted me back with a  joke about Rhubarb gin. Then nothing. I didn’t think too much of it, life gets in the way. And then I received ‘The News.’  Yet I have forgotten a couple of times since then, and have gone to text him. Then, with a strange physical ‘flipflop’ stomach feeling,  I have remembered ‘The End,’ which is accompanied by much hurt and sorrow and  strangely, lines from one of my favourite poem’s. – ‘ The Road Not Taken.’ by Robert Frost:

Two roads diverged in a yellow wood,

And sorry I could not travel both

And be one traveler, long I stood

And looked down one as far as I could

To where it bent in the undergrowth;

 

Then took the other, as just as fair,

And having perhaps the better claim,

Because it was grassy and wanted wear;

Though as for that the passing there

Had worn them really about the same,

 

And both that morning equally lay

In leaves no step had trodden black.

Oh, I kept the first for another day!

Yet knowing how way leads on to way,

I doubted if I should ever come back.

 

I shall be telling this with a sigh

Somewhere ages and ages hence:

Two roads diverged in a wood, and I—

I took the one less traveled by,

And that has made all the difference.

 A single decision can transform a life. I always assumed Frost wrote this poem about himself, yet I recently read Hollis’s  biography of Welsh poet Edward Thomas, and discovered that Frost and Thomas were ‘besties.’  Frost had written the lines as a joke about Thomas’s depression induced indecision, which showed up on their long ‘walk and talk’ days together, with Thomas never being able to decide whether to take the path on the right or the left. When Frost sent the poem to Thomas, Thomas initially failed to realize that the poem was (mockingly) about him. Instead, he believed it was a serious reflection on the need for decisive action. At the age of 36, after much wrestling, Thomas felt compelled to enlist as a soldier in the Great War.

He wrote of his decision to his friend Robert Frost  “Last week I had screwed myself up to the point of believing I should come out to America & lecture if anyone wanted me to. But I have altered my mind. I am going to enlist on Wednesday if the doctor will pass me.”  On the first day of the battle at Arras, Easter Monday, 9 April 1917, Thomas was killed by a shell blast.  His poem ‘Adlestrop’ was published in the New Statesman three weeks after his death and has since become a classical favourite of British poetry.

Adlestrop

Yes, I remember Adlestrop —

The name, because one afternoon

Of heat the express-train drew up there

Unwontedly. It was late June.

 

The steam hissed. Someone cleared his throat.

No one left and no one came

On the bare platform. What I saw

Was Adlestrop — only the name

 

And willows, willow-herb, and grass,

And meadowsweet, and haycocks dry,

No whit less still and lonely fair

Than the high cloudlets in the sky.

 

And for that minute a blackbird sang

Close by, and round him, mistier,

Farther and farther, all the birds

Of Oxfordshire and Gloucestershire

Life sometimes makes decisions for us. I don’t mean to get all Dead Poet’s Society here, yet I think T.S Eliot had something when he wrote “What we call the beginning is often the end. And to make an end is to make a beginning. The end is where we start from.” (Four Quarters) We get ill and have to take time to rest and get well, and sometimes we don’t always recover, we have accidents,  we don’t get chosen for that job or by that person and we lose people and animals we love and care for.

Where possible, make a decision and choose your ending and make a new beginning, whether it be the end of an unhappy relationship and the start of a happier one with yourself,  saying No to working for extra hours, when you could be saying Yes to spending more time with your family, or your dog or your garden, standing up to a bully and choosing to start being assertive and courageous, speaking out against something which you see is wrong and thus ending corruption or collusion, stopping trying to do everything by yourself and start asking for help -(getting a mentor through NES really helped me with this)  and putting a stop to being taken for granted and drawing new boundaries that put your needs first.

I have taken a Non-Executive decision to be more accountable to myself in my life, to spend more time outside, to stop watching tv and read more poetry,  to save up to live in a place where I can have two donkeys, chickens and  another rescue dog and to track down some Rhubarb gin.

Sorry if I did not see you to say Goodbye. I wish you well in your decision making and hope that your sigh is a happy and fulfilled one.

I

What Matters by Ken Donaldson & Alastair McAlpine

I recognise that it is a bit cheeky of me to put my name to this as I haven’t written any of it. A few months back I was scrolling through Twitter and came upon this thread that really moved me. The messages are simple yet immensely powerful. I have therefore simply taken some screenshots from Twitter and published them here. As you can see this is by a Doctor called Alastair McAlpine who is a Palliative Paediatrician in Cape Town, South Africa. Read on…..

Cant Thank Everyone Enough

You don’t have to look very far these days to realise that the NHS is under significant pressure; the local bulletins, national news and local papers are all talking about ‘Winter Pressures’ and ‘Flu Outbreaks.’ This, along with staff shortages and capacity issues, would make many of us dread going in to hospital or having a loved one admitted however I recently had to witness my husband spend the festive period in the new DGRI and I was so impressed by his, and my, care that I wanted to write about it.

On the 19th of December my husband was referred up to X-Ray for a CXR. This rapidly became a CT scan and then direct admission to the Combined Assessment Unit. This itself was a massive shock for all of us and a very scary time. However the staff in X-ray were amazing and made a frightening experience a tiny bit more acceptable by their kindness and attention. Thank you to all of them.

When we arrived on CAU it was obvious that it was a very busy place. For the staff to be working under this pressure in a new environment beggars belief but they did so with equanimity and charm. The care my husband got was excellent and I wish to thank Moira and all the other nurses who were fantastic as well as the Health Care Support Workers (many cups of tea which were never too much bother) and also Drs Ali and Oates. Dr Oates your visit on Christmas Day meant a great deal to us.

After CAU we moved up to Ward B2 and the outstanding care continued. I came in at 8.30am and left at 9pm and having a single room and open visiting meant I was able to stay with my Husband at all times which meant so much to us especially during this time of uncertainty. We could cry in private and talk in a way we could never have in a 4 bedded bay. Once again the staff were amazing – all the staff nurses, HCSWs and Domestics got used to seeing me around and, despite being extremely busy over Christmas and New Year, catered to our needs. They brought blankets and cups of tea – the small things which can mean so much – without us having to ask, in fact they were so busy we would not have asked for anything. Dr Gysin listened to our moans with patience and kindness and ensured that my husband got home as soon as possible, just after New Year.

We have just started a journey which will now mean trips to Edinburgh for more tests and possible treatment. This was always going to be a hard time but the caring and compassion we experienced whilst in DGRI over the festive period has made it that little more bearable.

Thank you

Love Wins by Euan McLeod

Having returned to clinical practice after a number of years away from the NHS (not saying what number) but nonetheless a significant period I attended the corporate inductions week to prepare me for my role in the organisation.

I had thought that much would have changed but although there were a lot of things different it seemed to me that the very essence of what we did as nurses, and indeed as anyone, employed in the NHS had not changed significantly in that we were all part of an organisation there to provide help and support to those in their time of need,

One thing that had developed was the formation of a set of values. The NHS Dumfries and Galloway CORE values

You may recall that the workshop to develop the CORE values was in response to the publication of the Francis enquiry into the Mid Staffs hospital, and that the aim like most health boards up and down the country was to try and create something that would help deliver higher standards of care and stop situations like Mid Staffs happening again.

What was it that went wrong? Did they not love (care/respect) the people they were looking after? Did nobody love their work enough to want to do things well? Were peoples regard for each other such that they became indifferent to their needs?

Love may apply to various kinds of regard towards other people or objects, and this aspect seemed to reflect what had happened at Mid Staffs, a lack of respect or due regard for the people entrusted to their care.

Love – it’s not a word we use often in healthcare but perhaps it’s central and underpins a lot of the other words or values we use to describe how we should be or act in the pursuit of caring for others.  In that sense I wanted to think about that word LOVE and what it might mean in the context of our main activity as deliverers of healthcare.

The title sat in my notes and in my mind for some weeks, I read the board paper on the development of the CORE values and wondered if it might mention love anywhere. Lots of care, compassion, empathy respect, dignity, etc in the body of the document, and hey right at the back in the summary of responses on positive experiences / feelings, there it was the word LOVE-maybe only 1 person had mentioned it but there it was.

Now all this talk of love may be getting some of you kinda twitched as if this was all some soppy, half baked romantic drivel, the kinda thing that people don’t talk openly about, but think just for a moment about how often you might use the word in the context of things, objects and places and not people

What do you mean when you say oh I just love going on holiday to France, Spain, The Bahamas etc or I just love Jaguar cars, or some designer shoes or handbags.

If someone asked you if you loved your job what would you say-Do you love making a difference to people’s lives?

I don’t think anyone would say no to that

I looked up the Francis report and here’s what it said was the MAIN message

The Francis report is a powerful reminder that we need a renewed focus on hearing and understanding what patients are saying Ruth Thorlby, Senior Fellow, Nuffield Trust

From <https://www.nuffieldtrust.org.uk/resource/the-francis-public-inquiry-report-a-response>

Hearing and understanding what patients say -no problem there then easy and straightforward

The importance of that hearing and understanding aspect was highlighted in the recently published kings fund report

https://www.kingsfund.org.uk/sites/default/files/2017-11/Embedding-culture-QI-Kings-Fund-November-2017.pdf

“Finally, participants noted that a focus on improving patient outcomes and experience was a way to further engage staff in improvement activities:

You have to build that coalition of people who want to make a difference and who want to change and at the centre of it all keep the focus absolutely on patients and never have a conversation that doesn’t involve a patient, because if you do you’re in the wrong place because that’s the only currency, the language, that staff understand. (NHS provider chief executive)”

How can we firstly HEAR what patients say and secondly how can we UNDERSTAND what they are telling us.

Into my in box comes an email from Gaping Void- Everbody’s a patient because evervbody’s a person

Here’s a link if you want to check further https://www.gapingvoid.com/

Gaping void exist to develop the use of culture and art in healthcare settings and the topic that caught my eye was entitled “Everybody’s a patient because everybody’s a person”

There are two underlying truths in patient care:

All patients are, foremost, humans, and one day, we will all be patients.

When designing healthcare experiences, from waiting rooms to waiting times, we have to remember that we’re building for humans — people in pain, people grieving, and people suffering who need to feel loved.

We have to create the experiences that we, as patients, would want to go through. Because, one day, we will.

From <http://mailchi.mp/gapingvoid/we-are-all-patients>

If we are able to love people we care for and hold them in a position of high regard then we will be able to hear what they say and perhaps understand, in turn Love may win over the tensions, frustrations and myriad difficulties that are part of delivering health care  and we can be part of creating experiences that are for  people knowing that perhaps one day we may be the patient

Euan McLeod is a Mental Health Staff Nurse for NHS Dumfries and Galloway