“Ae Fond Adieu” by Alwayn Leacock

Recently the NHS Trust of Dumfries and Galloway saw the departure of its greatest ambassador ever.

When I first arrived in Dumfries in August 2000 I thought I was going to the end of the earth. I had driven through fields of greenery and seen more sheep, cows and land than my native country.   I was briefed on arrival by Colin Rodin and Fiona Patterson to report to Mrs Mcvittie the residences officer. Having lived in several NHS residences in England I was already in fear of the staunch matriarchal and regimented residences officers who were very territorial   and authoritarian and had very little conversation with anyone.  I shuddered once more at the thought that I was going to be housed in a military barrack and be greeted by yet another person of the same making who gave me the impression that they were merely facilitating my refuge in this country and that I ought to be on my best behavior and conform to UK norms and standards.

The Tobago keys a UN declared Marine Park just south of Mustique in the Archipelago state of St.Vincent and the Grenadines

The Tobago keys a UN declared Marine Park just south of Mustique in the Archipelago state of St.Vincent and the Grenadines

When I met Mrs Mcvittie for the first time that fear and reservation vanished immediately. Behind the desk sat a lady with a most welcoming smile. She greeted me in a most alluring and delightful way and informed me that she had already met my  country fellow Dr Camille Nicholls  who was another “cold tatty” like myself. Camille had to be provided with extra blankets to survive her winters. Her first concern then was whether I was managing in the cold. I could not be compared with Camille Nicholls, because apart from being an excellent physician, she was a   stunning five foot eight   beauty who made heads turn when she walked into a room.  All the men held their breath to the point of collapse not wishing to exhibit their customary abdominal protuberance.   She enquired about Camille’s’ well being.  From her conversation I could sense that she had a very good rapport with Camille as she appeared well versed about the geography of    Saint Vincent and the Grenadines, its  pristine  volcanic  black sand beaches,  the turquoise  blue Caribbean waters ideal for sailing and the splendid  golden sands   on which  Kiera Knightly was marooned with Johnny Depp on the Tobago keys in that ever so famous scene form  pirates of the Caribbean.

Mrs.  Mcvittie possesses a radiant personality which placed one immediately at ease and made a very cold September very warm. After I moved into the house at C3 Mayfield terrace there were several calls to find out if I was comfortable enough and if the accommodations had fallen short of anything I wished.   I had no complaints the residences despite not being plush and ultramodern were very clean and some of the best kept and habitable ones that I had lived in thus far in the UK.    I had very little need for further embellishments. The psychological and the emotional support and welcoming embrace made one forget about any adversity if there was any.  As a non EU resident as MTAS and the EWTD took effect   I went from being employable to non employable. Locum trainee to non trainee and therefore was set adrift. One day I was working in Dumfries doing a locum replacement for Heather Currie and the next day I had no job and could not be given a job. Over the subsequent years my sojourn took me to many hospitals and regions of the UK looking for work.   Strange but true despite having an excellent command of English and having worked in the system for your years I was no longer required. I almost fell victim to the massive Exodus of trained non European doctors who had to leave the NHS and the UK. I did eventually leave for a brief period and then was given employment in England when the job advertised for on several occasions was not taken up by a European. That short respite allowed me to gain indefinite leave to remain in the UK. My next step was to wind my way back to Dumfries and guess who was there to greet me as a prodigal son or sheep that had been lost?  The delightful Mrs. Mcvittie.

I was welcomed like a long lost friend who had returned home once more and the feeling was reciprocal  amongst the affable Scots. Mrs. Mcvittie is the “hands on” type of boss who looked after everyone and made sure they were well. If you infringed the residency rules you received a little note placed under the door asking you in a rather polite and diplomatic way to conform and be considerate to others. When you looked through the windows in the early morning you could see her approaching and before going to her office she would set about doing little errands around the compound. She was never afraid to muck in and get her hands dirty.  She was an ambassador extra ordinaire I am yet to meet anyone in her capacity that can fit in to her shoes. She it was that gave the trust in Dumfries a face and a persona that foreign doctors like me could hold on to as being welcomed and appreciated. I was delighted to nominate her for the excellence award a few years ago and was rather disappointed that her work and that of her staff were not recognised as being equally important to the function of the NHS as a heart bypass surgeon. I was devastated that she did not get that  award and even more so that someone revealed to her that I had nominated her and so my secret was blown and I embarrassingly and to admit to her rather coyly  that she was doing a herculean job that few could manage equally as well.

So it was that with much sadness and personal grief that I attended her small farewell gathering at the Margaret Barty room. I thought many more would have been there to give her the fond farewell she deserved.  I sincerely hope we can use her as an occasional resource person in teaching hands on human relations for which she has a natural knack.  I wish her well in her retirement and hope that she will be around for many years to come. She is a truly remarkable daughter of the soil of Dumfries.

 

Dr Alwayn Leacock is a Specialty Doctor Obstetrics and Gynaecology at NHS Dumfries and Galloway

 

 

 

Topping Out by Phil Jones

Reflections on the Topping Out Ceremony (held at the site of the new hospital on the 14th September 2016)

In June last year, just 15 months ago, I stood spade in hand alongside Cabinet Secretary, Shona Robison, in a big green field and said:

‘Today marks the start of one of the most significant periods in the history of public services in Dumfries and Galloway.’

We were marking a significant milestone, ‘breaking the ground’ for the start of construction of the new District General Hospital (ground works to prepare the site for construction had started in March, just days after Financial Close). I went on to say that we expected it to be delivered on time, on budget and built to the highest standards.

Decent progress on that front I think.

The decision to invest in a new hospital was taken well before that date, indeed before my time as Chairman, and a huge amount of work was put in examining different business and financial options before a final business case was approved in partnership with the Scottish Government in June 2013.

Our corporate team, under the leadership of Jeff Ace the Chief Executive, had complex overlapping work streams to manage, that I could simply categorise under technical, financial, legal and commercial, to get us up to and beyond financial close.

There was however nothing simple about it. I know from my own experience how professionally challenging all of this is.

I take this opportunity to say to Jeff that the leadership demonstrated in delivering on this vision through clear direction, the creation and motivation of a top team, and importantly the confidence to let them get on and do what they are best left to do is outstanding.

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Turning now to that top team, Chief Operating Officer, Julie White who is the Project Executive and Katy Lewis our Finance Director  have taken this project forward at the same time as doing their day jobs, and also in tandem with Executive roles on our newly established Health and Social Care Integrated Joint Board.  Both are held in the highest regard locally and nationally and we are rightly proud of them. 

It is also right I think to acknowledge the contributions made by the previous Board under the Chairmanship of my predecessor, Andrew Johnston, who I was delighted could join us at the Topping Out Ceremony.

We see so many examples, in all walks of life, of the negative effects of short termism, and it is really uplifting to see that in Dumfries and Galloway once again we can, and do make strategic decisions for the longer term benefit of the people of our region in the knowledge that these projects will probably be completed after our individual terms of office.

There were many important decisions to make and history will clearly show the foresight and resolve of the Board in providing this region with a health care service to be proud of, and one that stands comparison with best of the rest.

This 344 bed acute facility, which includes;  a combined assessment unit, theatres complex, critical care unit and out patients department has been designed, in collaboration with clinicians and patients, adopting new models of care and utilising cutting edge technologies.

All directed towards providing patients with the highest standards of care, and providing our staff with the highest quality working environment.

We required additional community benefits to be delivered through the project, and High Wood Health, in conjunction with construction partner Laing O’Rourke, have more than delivered on their commitment to provide opportunities for local people and businesses. They have exceeded targets set to employ local people, provide apprenticeships, graduate placements and opportunities for small and medium enterprises to tender for contracts.

I was an ex apprentice myself and really value that route through to a lifetimes work.

This project will deliver not only a first class health facility but also a lasting legacy through jobs creation and skills development.

It is also important that I acknowledge the small army of our own staff who, in addition to the day job, are working in 16 or more specialisms and in dynamic teams under the Change Programme that is being skilfully led by John Knox, which I must say impresses me greatly.

John and his team are working to ensure the high quality services delivered at DGRI migrate as seamlessly as possible to our new District General Hospital later in 2017, incorporating amongst other things the most modern technology solutions.

I understand that Graham Gault and his IT team have digitised some 50 million patient records, which if that was the only project we were taking forward would be a huge undertaking in itself.

We have grasped with both hands, the once in a generation opportunity, to examine every aspect of the way we organise our acute workload and our new approaches are being designed very much around our model of Health and Social Care Integration.

Our new hospital may be located in Dumfries but it is central to the decentralised and localised model of care that we are developing across the region.

So in closing, I am absolutely confident that by December 2017 we will have not only the finest District General Hospital imaginable but also a huge number of staff whose work experience has been enriched by their involvement in this project.

Philip N Jones is Chairman of the Board at NHS Dumfries and Galloway 

September 2016

Tour de Finance by Jeff Ace

This summer, unlike the many thousands of fellow Welsh folk heading south to France for one of our regular appearances in a major football tournament, I decided to head west, then east, then sort of north east. Together with our Finance Director, Katy Lewis, I recently undertook a tour of the region to try to talk directly to as many staff as possible about the challenges we were facing and to hear first hand their experiences and ideas for improvement.

In three days we travelled over 400 miles, met over 400 staff and heard from nurses, AHPs, domestics, GPs, consultants and others on issues ranging as wide as the region itself. At a number of the meetings, it was great to see social work staff in attendance, reflecting our ever closer working relationships.

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I asked Katy to open each session with a presentation on the financial situation – my thinking being that pretty much anything I then said would come as light relief. The 2016/17 numbers are grim and substantially worse than anything we’ve faced up until now. In summary, we estimate our costs will increase by around £16.5M in the year (largely driven by drug cost increases and pay / price inflation) whilst the increase in our allocation for health services is around £3.6M. The gap between these figures of about £13M (or 5%ish of our running costs) will have to be found from efficiency savings. This would be a tough ask at the best of times but, as most of you will be well aware, it comes after four years of delivering large annual efficiency savings targets.
And of course the financial problem does not sit in isolation. In each of the discussions across the region we heard of pressures caused by difficulties in attracting staff or by increased service demand driven by an ageing population. At times it felt as though we were describing a perfect storm of crises in money, recruitment and demography that threatened to overwhelm us as surely as Storm Frank had submerged parts of Dumfries.

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But just as the pub in this picture was open for business only two days later (it felt longer), things often brightened up pretty quickly in a lot of our discussions. The staff that we met were keen to highlight potential solutions, things that could change services for the better and stand up to our triple challenge.
We’re going to write up the key points raised and create a plan for delivery but some of the common themes were;

  • The right I.T. can transform the way teams work, but we need to make it connect faster and more reliably across the region.
  • We need to get far better at sharing appropriate information between health, social work and third sector colleagues.
  • We need to be quicker at admitting that some vacancies won’t be filled and to redesign and retrain teams to provide services differently.
  • Local teams need to be empowered to make locally appropriate decisions and as much resource as possible needs to be devolved to operational levels.
  • Coordinated support to teams around improvement techniques and methodologies would be helpful.
  • We need to work more closely with carers and families.
  • We need to celebrate team successes and better spread their ideas and learning.

It’s also important to remember that we’re not on our own in trying to work our way through the financial, demographic and recruitment problems. In our meetings we highlighted some of the huge amount of work ongoing at national and regional level at the moment to try to identify high quality and more sustainable models of service delivery across Scotland. Two particular strands of work have the potential to help us transform the landscape;

  • The National Clinical Strategy (written by Angus Cameron, our Medical Director) sets out a clear direction for closer working between Health Boards aimed at improving safety and effectiveness of care within their wider region.
  • The Chief Medical Officer’s work on ‘Realistic Medicine’ points to how genuinely person centred care can lead to better patent outcomes whilst reducing waste and unnecessary expenditure.

So, both locally and nationally, there are grounds for cautious optimism that we can come through these uniquely challenging times in a way that allows our teams to continue to deliver excellent health and care services for our population. It is clear though that to succeed in this, the pace of change around redesign of service models and ways of working will have to be dramatic. Whilst there’ll be a few giant leaps (it’s just over a year until we receive the keys to our new acute hospital…) most of this change will be smaller scale and driven by the local teams that we talked with on our regional tour. Our success will depend on how well we support these teams and ensure they have the skills and confidence to adapt their services in ways that allow us to deal with the financial, demographic and recruitment complexities.
Thanks to everyone who came along to speak to us on our tour.

Jeff Ace is the Chief Executive Officer for NHS Dumfries and Galloway

“This is doing my head in!” by Harriet Oxley

Harriet 1I wonder how often you’ve heard someone say these words. Every day perhaps? Depending on our circumstances the things that provoke each of us are different. As we become more stressed and pressurized it becomes harder to see the way forward clearly. If we go unsupported and problems start to pile up they can start to bring us down.

Staff listening offers one-to-one support that is confidential and non-judgmental. Each person is supported to talk about issues of concern, deepen his or her understanding and rediscover hope. As a result they are enabled to tap into personal strengths and find a way forward if that’s what they need to do. Staff listening is a service offered by the NHS Dumfries and Galloway’s Spiritual Care team.

I recognise that some people are not sure what spiritual care is or what we do. I notice that some people hear the word ‘spiritual’ and imagine everything from ‘religious nut’ to ‘bible basher’. Others wonder why we need spiritual care in the NHS nowadays.

I wonder if it would help to make the distinction between religious and spiritual care. Religious care is given in the context of the shared beliefs, values and rituals of faith communities. Spiritual care, on the other hand, makes no assumption about personal beliefs or lifestyle. In other words, spiritual care is not necessarily religious and many people with no religious beliefs recognise their own need for spiritual care.

Spiritual care recognises that everyone needs to have meaning and purpose in their lives and fostering this promotes resilience and wellbeing. Spiritual care enables people, whether they’re patients, carers, volunteers or staff, to cope with life transitions, such as illness, loss or bereavement, as well as ethical dilemmas and major life decisions.

The Spiritual Care team consists of self-aware and sensitive listeners who have time to be with each individual in their need. Staff listening promotes spiritual wellbeing by offering a safe space for people to explore their concerns and draw strength from their own inner resources and those of supportive people around them. It is available to any member of staff, volunteer or carer within Dumfries and Galloway Health and Social Care. Equality and diversity is important to us and we welcome everyone irrespective of personal beliefs or life circumstances.

Harriet 2So perhaps you’re wondering what happens in staff listening. Firstly I’d like to point out that our role is not to fix problems or give advice. Instead we listen as each person tells his or her story, ask the right questions and offer support and encouragement. For many people telling their story is all they need to do. To have someone listen to the issues they are struggling with is enough to leave them feeling heard and able to carry on.

Sometimes, in talking about the situation, the person hears themselves say what they need to hear and gains insight just from having put their story into words. At other times the person’s story may be very complex, with many different strands. In such situations our role is to help them disentangle some of these strands, to look at them in turn and perhaps identify what some of their options are.

‘I have just realised what I need to do – I have never thought about that before.’

‘I have just heard the answer to my problem in what I have said.’

‘Saying that made me hear and see my own story differently.’

Space to reflect and talk through issues with colleagues has become rare, yet it is often the very thing that makes a difference in how we cope. If something is troubling you or you’re struggling with a particularly difficult situation, maybe it would help to talk in confidence with someone outside your situation. If so, please drop us an email to: dg.stafflistening@nhs.net

Harriet Oxley

Spiritual Care team

Fire in your belly by Euan Macleod

Euan 1

What is the fire in your belly?

Euan 2When it comes to what you do? Do you feel passion for it and are you excited about the possibilities that could come your way, or is it a bit like the guys with the Gaviscon have just hosed you down and your fire is quelled?

 

 

Fire in your belly-you know when you’ve got it

You feel it

Euan 3Sometimes it is hard to find time to listen to our feelings in the midst of busy work schedules, the passion that you first felt when you entered a career in the NHS may have become blunted by the daily trudge-is it always going to be like that?

I recently mentioned in a blog the creation of the NHS and the welfare state.

Beveridge had a passion for that, but where did that passion come from?

Beveridge’ report might have been destined to be another dry and dusty Government document. What made it a huge public best seller was its breathtaking vision and passionate language. The fiery rhetoric largely came from Scotland after weekends spent with Jessy Mair in the spring and summer of 1942.

Jessy was Beveridge’s close confidante and companion for many years. His biographer, Jose Harris, highlights her influence on him during his visits north of the border:

“Much of his report was drafted after weekends with her in Edinburgh and it was she who urged him to imbue his proposals with a ‘Cromwellian spirit’ and messianic tone. ‘How I hope you are going to preach against all gangsters,’ she wrote. ‘who for their mutual gain support one another in upholding all the rest. For that is really what is happening still in England’. . . .”

Beveridge didn’t miss; the report sold 100,000 copies within a month. Special editions were printed for the forces.

The gangsters referred to by Jessy Mair were the deliverers of health care who profited from the sickness, squalor and disease prevalent at that time. Beveridge clarion call to a sense of community welfare based on need and not ability to pay heralded the start of the NHS.

No surprise that today many of us remain passionate about the values and aspirations of the health service, a service that many of us have experienced as employees, patients and carers of loved ones. There is still some fiery rhetoric and a will to retain and improve on the values and service which the NHS provides.

But it won’t be easy in this time of austerity.

Euan 4

It might need

Guts-More fight

Grit-More passion

Gumption-Being courageous

Euan 5

It means that you find a way to get better

It means that you’re putting in every ounce of extra effort you have

It means that you get pushed down but don’t stay there

Euan 6

Easy to say

Perhaps harder to achieve

But unstoppable when it starts

Euan 7

So what’s your passion and where is it taking you? Share the fire in your belly, it could start a bonfire

Euan McLeod is a Senior Project Officer for the National Bed Planning Toolkit

 

 

 

 

Stressed about Stress by Amanda Taka

Stress is one of those words that has become intrinsic in our everyday vocabulary: we’ve all heard ourselves moaning “I’m so stressed!” What is it and how can we manage it?

Stress is defined in different ways by different organisations, but the common thread seems to be that stress is “feeling under pressure”. A small amount of stress is good for us: it keeps us motivated and helps us to do our best. However, when we are living with stress all the time, it can lead to a myriad of unpleasant feelings and physical symptoms can follow.

A Taka 1

Often we are quick to identify stress in others, but would we recognise it in ourselves? Symptoms associated with stress are wide ranging and initially we might not associate the physical symptoms as related to our mental wellbeing. There has been a tradition to separate mental and physical health, but evidence shows the link is greater than we previously may have understood. The jury is still out as to whether stress itself causes disease, but there’s lots of evidence to show that the unhealthy habits we rely on when we’re stressed contribute to many conditions.

Physical symptoms can include:

  • Sleep problems
  • Dizziness
  • Chest pain, palpitations
  • Dry mouth, lump in the throat, shaky hands
  • Lack of appetite, or conversely, comfort eating
  • Repetitive tic
  • Headaches
  • Diarrhoea or constipation
  • Loss of libido
  • Tearfulness/depression/anxiety
  • Worsening symptoms of long term conditions

Additionally:

  • Poor concentration
  • Difficulty making decisions
  • Irritability
  • A feeling that things are hanging over you
  • Excessive intake of caffeine, cigarettes or alcohol
  • Low self esteem/lack of confidence

This list is not exhaustive!

A Taka 2

What causes stress?

Here’s the tricky bit. We’re all different, so we all have different triggers. For example, one nurse would struggle to cope with the incessant physical and emotional demands of working in the Emergency Department, whereas that environment is perfect for a different nurse.

Acknowledged triggers of stress are as follows:

  • Work pressures, job instability, fear of redundancy
  • Parenting, family and relationship difficulties
  • Financial pressures
  • Bullying and discrimination
  • Loneliness and isolation
  • Living with a long term condition
  • Caring responsibilities

And one more for us workaholics:

  • Taking on too much responsibility and feeling you don’t have enough time to do everything!

OK, so it looks like life itself is stressful.

If you’re feeling like stress is starting to impact on the quality of your life then the first thing would be to get it down on paper. Spotting stress in its early stages can help prevent things from getting worse. Things to include in your “stress diary”:

  • Date, time and place of the incident
  • What you were doing, before, during and after
  • Who you were with
  • What were your feelings, before, during and after
  • Any physical sensations
  • Give the event a “stress rating” e.g 0 = no stress, 10 = the most stressed you could possibly feel.

Making a stress diary is helpful because it aids our ability to make connections between the context and the symptoms. Ideally, a stress diary should be continued for at least 2 weeks. This helps us to see things in perspective. Additionally, this is a vital piece of evidence to discuss with your GP if you’re feeling overwhelmed and unable to cope.

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Quick Fix

When I searched ‘wellbeing’ in Amazon at the beginning of the year, I was astounded at the number of different products that claim to enhance one’s wellbeing: necklaces, crystals and orthotic sandals sat alongside the list of ‘new age’ literature that was available. I’m not sure it’s something that can be bought. There’s certainly no single ‘cure all’ solution. Therefore it’s worth trying, or combining, a number of different approaches until you succeed. Most research shows the following are a good place to start:

  • Physical activity – doesn’t need to be a gym membership, incorporating 30 minutes of activity can help boost mood and clear the mind (remember it can be in blocks of 10 minutes)

 

 

  • Relaxation techniques such as mindfulness and breathing exercises are evidence based ways of reducing stress. Courses are available across the region, check the local press or http://www.uws.ac.uk/wellnessandrecoverycollege for details.

Nursing is acknowledged to be a stressful profession. In our profession, we tend to put everyone before ourselves, but who looks after the caring professions? I passionately believe that we need to give ourselves the time and effort to look after our own mental wellbeing, and being aware of our stress levels is intrinsic to this.

Further self help resources to try:

  • Living Life telephone self help service and online programme for people with mild to moderate feelings of anxiety and depression using Cognitive Based Therapy. See http://www.llttf.com/ for more info

 

  • Breathing space – confidential helpline that describes itself as a ‘first stop’ service which aims to listen and provide emotional support. http://breathingspace.scot

 

 

  • Steps to Deal with Stress – you may have noticed the little square booklets floating around NHS D&G, pick one up, they have great common sense tips to help with stress busting. More info at http://www.stepsforstress.org/

A last word

If you or someone you know is struggling and self help techniques haven’t worked, you may need to seek expert help. For some people a combination of medication, talking therapy alongside some of the techniques outlined above are appropriate. Also, it’s worth remembering that the Samaritans have changed their number to 116 123. Further helplines can be found at http://www.nhs.uk/Conditions/stress-anxiety-depression/Pages/mental-health-helplines.aspx

And remember… “taking on too many commitments” may lead to feelings of stress!

Amanda Taka is a Keep Well Nurse at NHS Dumfries and Galloway

“Dear Ward 7” by Jackie Shrimpton

Dear Ward 7,

I would like to take the opportunity, afforded to me by this blog, to thank all of you on ward 7 for the care I received during my 14 day stay in June of this year. I have worked for 40 years in the NHS and all of them spent in DGRI so the thought of being an inpatient was not a terribly nice one. However there was something so special about the way I was cared for, the personal touches, the kindness, that I felt I had to put my gratitude into writing.

I became ill some years ago although at this time I did not know the severity of my illness. I had a painful right shoulder which nothing seemed to help. This got progressively worse and then about a year ago I had a brief stay in hospital with a DVT. Subsequent investigations revealed that I had breast cancer and that it had spread to my lungs and shoulder. I was devastated. Treatment commenced with radiotherapy and medications but I knew this was all ‘Palliative’. Earlier this year I became increasingly dizzy and sick and eventually had a brain scan which revealed the cancer had spread to my brain. It was now that I was admitted to ward 7.

From the moment I was admitted to ward 7 I realised I was somewhere special. The nursing staff seemed to go out of their way to make me feel comfortable, even when they were clearly busy. I have heard it said before but it can’t be said enough: at times like this it is the small things that really matter. Combing my hair to make me look nice for my family, knowing the right thing to say to cheer me up when I was down, a simple wee word here and there made all the difference. To feel that someone genuinely wants to help, to see joy in their faces when they know they have helped, means so much. One nurse said that helping me to the shower and making me feel better in myself helped her because she was not coming to me to inject something or do something to me.

I am particularly indebted to Dr Finlay. She was obviously busy and had many patients to care for but never made me feel this way. I was made to feel important and all decisions that had to be made were made with me, not for me. She went above and beyond and I viewed her as a person rather than a doctor. I didn’t feel silly when I struggled to understand, especially when my head was in a fug due to steroids. This was such a huge thing to me at the time. Thank you Dr Finlay.

It is sometimes easy to forget how being an inpatient with an illness like mine can affect your family. My two children and other family were clearly concerned but all said that seeing me in ward 7, speaking to the nurses looking after me, filled them with confidence and made the situation easier for them. My daughter said that she was overwhelmed with gratitude as she wasn’t spending time at work worrying that I wasn’t being cared for. This meant a lot to them and a lot to me.

To all the nurses, auxiliaries, therapists, domestics, doctors, porters, pharmacists, everyone on ward 7……Thank You. I am very proud to know you and have worked in the same hospital as you.

Yours,

Jackie

J Shrimpton