An Occasional Visitor to Dumfries & My ‘Scottish Heritage’ by Tarik Elhadd

(This article was written in Dumfries in August 2015)

I have always been fascinated by the Trust Weekly Blog and stemming out from my connection with Dumfries, I thought of posting this reflection, hopefully it will be deemed suitable for publication.

I first came to Dumfries in spring of 2011 several months after departure from my home country, Sudan. My re-traffic to Sudan in 2009, trying to re-uproot, make a living and help my own people, was very much dashed by several factors. Making a living there was second to impossible. Back in 2007/2008 I had an offer to join a thriving health service in the area beyond the far western Canadian prairies, in British Columbia, which encompassed both academic and service domains. Coming to Dumfries was the perfect choice as the job was still vacant. I went to British Columbia a few months earlier in a fact finding mission. Part of the Canadian recruitment process entails inviting prospective candidates and their families to come and see themselves, and then make an ‘informed decision’. Following a week in ‘Prince George’ in fall 2010 we got satisfied and decided to go for it, despite that it is in the ‘end of the world’, being 13 hours flight from UK. But for us, the Sudanese, it was ‘Safe Haven’. The prospect of working and living in the ‘New World’ proved exciting. I had just turned fifty by then, and the career prospect was still rife. I began the process of joining Prince George University Hospital of North British Columbia, but to fill the 9 month gap whilst this took place I came to Dumfries to take up a locum in Diabetes and Endocrinology. One place, one hospital and then off you go to Canada. That was the dream which proved to be elusive.

At Dumfries life was very smooth. I was embraced by everybody, from within the department and from without, as one of the team. I never felt, nor was given, the feeling of being the ‘bloody locum’, who is here to do little for ‘too much money’ and then vanishing away. I was always treated with dignity and respect and always given the feeling of being ‘one of the team’. Everyone expressed love and showed gratitude to the job I was doing. This culture you won’t see or feel in other places as a locum. At Dumfries your expertise and hard work would be appreciated and valued and, despite that I was well paid for the hours I was doing, I was never eyed as a locum and stranger by anyone save one or two people.  Weeks and months and the path to relocate to British Columbia became fraught with obstacle after obstacle. It proved to be a ‘bumpy road’, and my stay at Dumfries continued, not only for nine months but it went to one and half a years.

I left Dumfries in August 2012 pursuing the elusive Canadian dream only to come back again in December 2013 when change of heart and change of fortunes forced yet a move into the opposite direction, this time eastward. The Canadian dream been burned on the altar of destiny. I was heading towards the Arabian Gulf, another safe haven for us, the beleaguered Sudanese. I was again embraced by Dumfries with the same old love, dignity and respect. Despite that my second ‘tenure’ at Dumfries was in Acute Medicine but it was equally enjoyable and blissful. Again I was never been given the feeling of the ‘other’, or the ‘stranger’. Not only that, after over ten months, I left to Qatar with an open mandate to come back at any time if ‘things did not suit me!!! Is that not wonderful and special to be given the feeling of ‘being wanted’ and in demand? Needless to say I was even approached to consider a permanent position and a substantive post.

Back to UK after spending a full working year in Qatar, and having the demand of keeping my license and my GMC registration alive and staying close to my grownups, who were staying in Cheshire, who had all re-trafficked back to UK after completing their University education in Sudan. I was welcomed back to Dumfries. It was the same old fantastic feeling. As a trainee back in the mid and late 1990s, I began my training in diabetes in Edinburgh at the old Royal Infirmary near Edinburgh Castle & the Royal Mile, and returned to Scotland again as an MRC Research Fellow at Ninewells Hospital in Dundee. Not to miss out the two years spell I had in Ayrshire when the educational needs of my youngest son made a re-traffic to UK in 2007 a necessity. So out of over 20 years of my career I spend in UK, one third was in Scotland. I am proud to call it my ‘Scottish Heritage’. One third of this heritage belongs to Dumfries-shire.

Dr Tarik Elhadd is a Consultant in Diabetes and Endocrinology

Surviving and Thriving in a Time of Change by Dawn Allan

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

Does our cultural and family background influence us?

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

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

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

How self aware are we?

Who are we when nobody is looking?

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

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

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

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

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

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

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

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

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

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

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

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

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

Whistleblowing & Psychological safety by Gill Stanyard

gill-2

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

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

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

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

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

 

Grievances                                Concerns

risk is to self                                  risk is to others

need to prove case                   tip off or witness

   rigid process                               pragmatic approach

legal determination                    accountability

private redress                           public interest

 

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

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

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

“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.

phil-jones-1topping-out-2

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.

image1

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.

image2

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