Be Prepared ….Have the Power by Graham Abrines

I think all of us would agree that making informed decisions for ourselves or others is one of the most responsible and indeed worthwhile things we do on a regular basis. It’s something we largely take for granted.

It’s only when matters begin to stray from the norm that we question our or others ability to make informed decisions. How many of us have parents, aunt’s uncle’s, partners even whose steady decline is becoming increasingly evident? Bring that same question into the professional arena; it will be more relevant for some than others, watching patients who you may have known for some time or perhaps only just met who are just struggling to make informed decisions.

Having conversations with people, whatever the context, about their wishes around how they want to be supported when they are not in a position to make informed decisions is important. It’s important for a whole raft of reason. The primary one for me; knowing how that person wants to be treated, cared for and supported  when they are unable to make informed decisions for themselves!

That’s why we all need to be better prepared

The message is quite simple if you have family members, patients or even yourself, who haven’t yet thought about how they would like to be supported if they lose the ability to make informed decisions for themselves then now is a good time to consider doing something about it.

Power of Attorney (POA) allows people, whilst they still have full decision making capacity, to state how they want to be treated and who and it can be more than one person, should be making decisions on their behalf when they are no longer able to do so. Quite simply it takes away many of the dilemmas that families and on occasion clinicians find themselves in when deciding what or what not to do in supporting the person.

There are some patients across our hospital settings, who with no POA  in place, require  an application by a family member or the local authority  for a Guardianship Order which is required to be heard in the Sheriff Court  to establish who should be making those informed decisions on their behalf. Take a moment; if that was you, or somebody you knew how does that make you feel? Particularly if you know there was an easier alternative where the person’s wishes were fully known?

POA is a legal process and the POA documents need to be very clear and detail the powers the adult proposes to grant to the prospective attorney/s.  As it’s a legal process involving a solicitor at an early point may be useful and most local solicitors should be able to assist in the drafting of a POA and can provide legal advice on this matter. A solicitor will charge a fee for this service.

Over the next number of weeks the Health & Social Care Partnership, via work within the Delayed Discharge Partnership, Local Authority Communications Unit & Local Authority legal services will be running a media campaign on local radio & TV supported via other methods, buses, bus shelters, flyers & local newspapers to encourage people to think about Power of Attorney.

Many of the local solicitors across our whole region, who are fully supportive of this approach will give a 10% discount to anyone wanting to progress with a POA until the end of June.

If you require further information, please contact Phyllis Wright, Regional  Statutory Mental Health Team Manager  on 03033333001 or Phyllis.wright@dumggal.gov.uk .  The Office of the Public Guardian in Scotland registers continuing and/or welfare powers of attorney under the terms of the Adults with Incapacity (Scotland) Act 2000, and their website offers full information on the POA process. www.publicguardian-scotland.gov.uk/power-of-attorney/power-of-attorney/the-power

So please, for everyone’s benefit   …. Be prepared and Have the Power of Attorney in place.

Graham Abrines is Interim General Manager Community Health and Social Care

Life in the NHS – A Personal View by Robert Allan

I have an admission to make.  Although a non executive member of NHS Dumfries and Galloway, I have never worked in the NHS at the coal face.   However, the NHS was involved at the start of my life, and I suspect the same will be true for the end.

The NHS was five years old when I was born in an NHS maternity home in Ayrshire. Within three days I was operated on for an intestinal problem, and when my mother got me home and I made my first visit to our GP, he detected a heart murmur.   So began my life and my NHS journey.

Frequent visits to Kilmarnock Infirmary and various Glasgow Hospitals became part of the pattern of my childhood.  Some appointments lasted an hour, some necessitated week long stays in hospital for more complicated tests.

In 1965 I had open heart surgery to repair an ASD (hole in the heart) and leaking mitral valve.  I made steady if slow recovery, and by the age of 17 was told I was as good as new and went off to live life.

There followed the healthiest twenty years of my life.  I got a career, I married and we started a family.  In 1984 we moved to London.

I‘d had a minor episode with a stone in the kidney in 1978, but in 1988 this returned with more serious consequences.  It dogged the next eleven years, with frequent visits and admissions to Northwick Park Hospital, and eventually successful removal of the stone in 1999 at West Middlesex Hospital.

Now that all was well, we moved back to Scotland although I continued to work in London.   Then in 2002, out of the blue, my heart problems came back to bite me.   I was hospitalised at Northwick Park, and back in Scotland sought out the expertise of the Arrythmia Team at Glasgow Royal Infirmary.   Unfortunately, after numerous tests and a third failed cardioversion, I realised I had to live with my new condition and carve out the best quality of life possible in the circumstances.  Over the next few years I collected several more LTC’s

So a lot of my time now is devoted to medical appointments and proactively managing my conditions.   It is a bit boring, but the rewards are a quality of life denied to many suffering from the same or similar LTC’s.

My journey so far has taught me many lessons, and I have seen the best and the worst of the NHS.   Here are some of the lessons.

The patient is not always right, but has the right to be wrong.   It is their life.

Only the patient experiences the patient journey from beginning to end.

No one cares more about my health than I do.

No hospital maintains the same quality throughout.  One hospital I attended had its maternity unit put into special measures and several other wards were a disgrace.   But End of Life Care and Cardiology were outstanding.   Another, an old crumbling Victorian edifice with poor facilities, gave some wonderful nursing and clinical care through dedicated teams. It has now been demolished and a new hospital built on the site.

Patient empowerment and patient self management see much better outcomes than leaving it all to the doctor. Taking responsibility for your health is a great way of ensuring the best quality of life possible, and the best from the NHS. Managing our health should be a partnership between patient and clinicians.

I now have multiple Long Term Conditions and mobility issues, but still maintain the best quality of life possible through self managing my health and proactively seeking information on my lifestyle and health conditions.

I became an elected non executive member of NHSDG in 2012 knowing that making even the slightest difference for the better was important. Drive for continuous improvement maintains my sense of purpose.  I bring to the table experience gained from a life in the NHS, and a career in public service spanning over 40 years.    In 2014 I was appointed as a non executive member..

I know the NHS is not perfect, and never will be, but it is a fine organisation staffed by many dedicated and highly skilled people who every day do their best.

The NHS today faces many challenges.  Staff will experience frequent changes and difficulties, but so will patients.   Both need to embrace change and accept that we must do things differently if the NHS is to face the future fit for purpose.  And key is for us the patients to take responsibility for managing our own health, and clinicians and health professionals empowering us to do so.

The future should be bright for the NHS, but success will require hard work, tough decisions, and the support of patients and staff alike.

I am looking forward to many more years of life in the NHS.

Robert Allan is a Non Executive Member of the NHS Dumfries and Galloway Health Board.

Speaking Up (or keep your head down and say nothing) by Alice Wilson and Graham Stewart

“Whistleblowing” :-

Alice W 1

is the act of drawing public attention, or the attention of an authority figure, to perceived wrongdoing, misconduct, unethical activity within public, private or third-sector organisations. Corruption, fraud, bullying, health and safety violation, cover-ups and discrimination are common activities highlighted by whistleblowers.”

Whistleblowing has some negative connotations but what does it really mean: how safe would you feel to raise concerns or speak out about issues that worried you?

Why would you want to speak up? We’ve all seen the headlines about Whistleblowers feeling they have been treated badly by employers for speaking up about concerns or heard others suggesting it’s easier and better to keep your head down and not get involved.

What if you do that – keep your head down and not get involved? What would you say if something happened that you think or know could have been avoided – would you just say “I could have told you that was going to happen?”

If you could tell something was going to happen, why don’t you?

Alice W 2Don’t we all have a responsibility to get involved in the NHS to ensure patient safety and high quality care ?

There are reasons why people don’t speak up, mainly because they don’t feel safe to do it. NHS Dumfries and Galloway’s job is to make it safe… not just talk about it being safe but genuinely to make it ok, to make people feel glad they had the courage to speak and to hear and act on the message.

First of all it’s important to understand when a concern becomes Whistleblowing or – to use the legal speak a “qualifying disclosure”. Put simply a qualifying disclosure is a concern raised by a member of staff where they have a genuine and reasonable belief of wrongdoing in one the following categories:

  • A criminal offence
  • A miscarriage of justice
  • An act creating risk to health and safety
  • An act causing damage to the environment
  • A breach of any other legal obligation or
  • Concealment of any of the above

We have all heard examples of where things have gone badly wrong in health and social care, resulting in serious injury or death.

Whistleblowing is a means to reduce the chances of something like this going undetected.

In many cases staff knew there was a problem or had a concern about safety, however the culture of their organisation meant they didn’t speak up.

Whistleblowing provides a mechanism to allow individuals to speak up about something they know is wrong or dangerous

Alice W 3By having two independent whistleblowing “champions” at hand staff can be assured that they can raise their concerns in private (which can be over a cup of coffee and ‘off-site’) whilst knowing their anonymity is fully protected.

 It doesn’t happen everyday.

Whistleblowing issues are not a daily occurrence; often staff concerns can be raised with their manager and resolved however you can also speak to your trade union or professional organisation for advice.

Whisltblowing is not an avenue to take simply because you disagree with your manager or feel you haven’t been listened to (there are other formal HR policies that apply in these situations). Whislteblowing is there to allow staff to raise concerns as highlighted above in a confidential manner so that issues around safety and security can be looked at to assess whether there are real concerns.

NHS Dumfries & Galloway also has two members of staff who you can go to for advice, that’s us and our contact details are:

 

Graham Stewart                                                                               Alice Wilson

graham.stewart@nhs.net                                                               alice.wilson@nhs.net

01387 244033                                                                                  01387 272789

What would make it safe for you?

If you feel safe to speak up that is really positive; in the last staff survey 57% of the staff who responded said they felt safe to raise concerns but that leaves 43% of the staff who responded who didn’t say they felt safe (Staff Survey return rate for the Board was 41%)

Tell us:

  • What makes speaking up safe?
  • What prevents you from speaking up

We’d like to hear from you, either directly or through someone else, if there are things we could do to help staff speak up

Alice Wilson is Deputy Nurse Director and Graham Stewart is Deputy Director of Finance at NHS Dumfries and Galloway

Some Personal Reflections by Jeff Ace

When TS Eliot wrote that “April is the cruellest month…” he ruled himself out of the running for patron poet of the NHS. April’s fine; the flu season is over, Norovirus is winding down and A&E attendances / acute admissions numbers are actually beginning to resemble Chief Exec planning assumptions. No, February and March are I think the trough of the cycle in the NHS year. This is when it can seem like winter’s been going on forever and people can feel just a little drained of optimism and bounce. Everyone will be different in how they react to this drop in bounciness of course; I definitely become more irritable and see a marked change in my threshold for when swearing is the appropriate response.

 
To be frank, I’ve been feeling a bit lower than the seasonal norm recently. This has nothing to do with work but all to do with the twists and turns of modern family life. My lovely old step dad died in February after a steep dementia driven decline. He’d spent his last couple of months in a care home in Swansea and whilst staff there were great, each visit re-emphasised the unfairness of a good life ending with multiple indignities. He was a man who’d fought (and survived blast injuries) in Burma, had a career and great family life and watching his last few weeks through the sort of time lapse lens of weekend visits was hard.

 
When I got the message that he’d died, I managed to take a few days off to help my mother with the various arrangements. She somewhat disrupted this plan by falling and breaking her femur on the first morning after I’d arrived. Fair play to the Welsh Ambulance Service and Morriston Hospital in Swansea, the transport, assessment, admission and timeliness of operation were all as you would wish it to be but I began to reflect, as I was supporting my mother through this whilst trying to arrange death certificate, funeral and various pension type things, that I was getting a touch stressed.

 
image1A day or two later when I was trying to return to Scotland, I was marooned for hours by Storm Doris in a Crewe station where the only remaining foodstuffs seemed to be Yorkie bars. By this point in the week I could imagine no circumstances in which swearing was not the appropriate response.

 
All of this was a bit sudden and unfortunately coincidental, but I think it’s important to recognise just how many of our 4,500 staff are going through this same juggling of work and family issues and the impact it can have on their resilience, particularly at the end of a long NHS winter. Our workforce is ageing along with the wider population and we now have substantial numbers of people who’ll be routinely dealing with issues of care and support for relatives whilst continuing to work in a health and care system that’s never been busier.

 
We desperately need our people to retain their resilience and their creativity both to continue delivering safe, person centred care and because of the need to reinvent our services to meet the extreme financial and recruitment challenges we’re now experiencing. Our population is relying on us and we simply can’t let them down so we have to find ways to get through the times when optimism feels hardest.

 
So this is my personal shortlist of techniques that seem to work for me in attempts to retain some bounciness in the face of difficult odds. It was compiled in a Yorkie fuelled sugar rush in beautiful Crewe so might lack the academic rigour of other approaches. As a result, I would guess its evidence base is only somewhere between homeopathy and wearing your lucky pants on rugby international days.

 
1. Avoid political debates or press coverage of the NHS...

 
You know this makes sense. There are decent, passionate politicians and superb investigative journalists but life’s too short to wade through the nonsense to get to them. This winter I’ve heard that the problems in the NHS are down to managers (naturally), the patients using services incorrectly (!), GPs (what? I mean, really?) and health tourism (I can’t comment politely on this innumerate gibberish because my swearing threshold has been breached).
If you stumble inadvertently onto some Question Time debate on the NHS, don’t despair. Reflect instead on this recent IPSOS Mori poll on the public’s confidence in the truthfulness of various professions.

image2Solid, mid – table respectability for NHS Managers there.

 
2.Exercise…

 
Our Public Health colleagues are right on this one. It doesn’t seem much to matter whether it’s walking, cycling, or hitting a ball of some sort, I am a calmer, nicer bloke after exercise than before it.

 
3.Family…

 
Tricky one this, as I’ve already highlighted the stresses that come with family life. But it’s also brilliant, life-enhancing stuff and if I start skimping on my input to making it all work as well as life in a household with a teenage child can ever work, I feel lousy.

 
4.A bit of escapism…

 
Now and then I need my mind occupied by something so engrossing that it just about drives every worry out to the edges. Books or films work reasonably well here, but for me this is best achieved by immersing myself in sport watching (ideally rugby or cricket). I think we can all agree that this has been an awful year for rugby with results so freakish that I wouldn’t be surprised if certain people had burned their lucky pants. But there’s always an Ospreys game coming up, or the Lions to look forward to, or the prospect that this summer will finally see Glamorgan triumphant. And to top it all, there are impassioned arguments with your mates over essentially pointless things. Unbeatable.

It’s a short list of feel-better approaches and I’d welcome suggested additions of what works well for you. Using these was also only partly successful recently so apologies to anyone who’s experienced a slightly more distracted or grumpier me. April’s almost here and things are definitely on the up again.

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

Why We Should Be Bold for Change by Luis Pombo

iwd2017bannerwvotesInternational Women’s Day (IWD) provides an opportunity to celebrate women, their achievements and their contribution to society.

IWD was first marked in the early 20th Century and was linked to the struggle of women (as a group) for equality on various aspects of their lives.

IWD is now an official holiday in several countries and it is marked on March 8th in lots of other countries around the globe.

Now, in the 21st Century Western World, we may tend to think of IWD as just an opportunity to celebrate women in a climate of total equality and fairness. However, this is not the case today as it was not 100 years ago; the reasons why will be addressed later on but briefly touching on gender and gender (in)equality is necessary before we move on.

Gender is definitely not sex!!

genderGender has to do with roles, personality traits, expectations, attitudes, behaviours, values, relative power and influence that are assigned to people by society on the basis of their sex, which is biological and has to do with our reproductive organs, physiology and genetics in general.

Gender, therefore, is a cultural product – a set of ideas, values and beliefs – that makes us define people (including ourselves) and that shapes our interaction with them. Gender is relative to any given culture in which it is expressed; if we pay attention, we can certainly see subtle differences in the expressions of gender in different cultures. However, gender stereotyping, gender subordination and various degrees of gender oppression seem to be constants across cultures. The millions of women and girls from all backgrounds who are currently affected by various forms of Gender Based Violence around the world and the fact that female representation in Parliaments in most countries around the world is under 50% – with the exception of Rwanda (61.3%) and Bolivia (53.1%) – are examples of this phenomenon.

Another crucial aspect to bear in mind about gender is that it is ‘learned’ from very early in our lives and it becomes part of who we are; we live and perform gender every moment; we constantly play by its rules. We start acquiring our gender at a very early age through exposure to the culture and people (performing their genders) around us. For example, since birth or even before, we are given a name, clothes, and toys in line with our assigned / perceived gender, our bedrooms are decorated accordingly, etc. By the age of 3 we already know whether we are ‘a boy’ or ‘a girl’ and by the age of 7 or 8 the gender stereotype is completely fixed in our brains; then the performance of our gender becomes a 24/7 activity.
What is interesting about gender is that despite us being in contact with it and it being around us all the time , it is somehow (as a notion) invisible to us due to its perceived ‘taken-for-grantedness’ and ‘naturalness’. In this respect we could compare gender to gravity which keeps us attached to the ground 24/7 but we do not necessarily think about it once throughout our day. In other words, gender works like a force that constantly shapes our thinking, decisions and actions but we very rarely or never question its workings.

Is there a problem, then?

In theory there should be no problem with gender and gendered differences between people but the reality is that these differences are not neutral. They have been influenced by different ideals about the roles, expectations and relative power that should be assigned to men and women through thousands of years. These ideals have shaped the notions of what it means to be a man or a woman / a boy or a girl, resulting in concrete inequalities between people of different genders; some of them are now historical but some are current. For example:

  • Lower social status was assigned to women in ancient Greece (c.283BC).
  • It was not possible for women in the UK to inherit property and accumulate capital until the 19th Century.
  • It was not possible for women in the UK to vote until the early 20th Century
  • Rape in marriage was not recognised as such in Scotland until 1989 and in the rest of the UK until 1991.
  • The policing of women’s bodies (virginity tests) (Egypt; 2011)
  • In general, all over the world, sex is considered to be a service that can be bought.
  • Currently, the majority of sex trafficking victims around the world are women and girls.
  • Women’s reproductive rights are currently being interfered with in Ireland, the USA, and other countries.
  • The domestic abuse law in the USA is currently being undermined through underfunding.
  • There is a nipple double standard – the female nipples being considered “obscene” if shown in public (with the exception of nude beaches, perhaps) –
  • Breastfeeding in public places is currently frowned upon by many people in the UK and other countries.
  • Russia has recently decriminalised some forms of domestic abuse – first violent attack that does not result in victim’s hospitalisation; etc.

Looking at it from another angle, we can see how in popular culture (and culture in general) masculinity equals leadership, strength, individualism, power, logic, decisiveness and other traits that convey a notion of ‘agency’ of ‘being in charge’. Interestingly, traits that usually define femininity in popular culture like submissiveness, perceived weakness, dependability, relative lack of power convey a notion of ‘non-agency’ or ‘passivity’. “Real women” and “real men” are defined according to these (artificial) standards that reinforce the subordination of one gender to the other.

Now, with greater status and power assigned to men (as a group) securing this way their superiority and influence in society and the consequent subordination of women (as a group) – by the way exceptional individuals like the Prime Minister or Her Majesty the Queen cannot be considered in this equation – gender based violence finds the ideal conditions to flourish. Domestic abuse, rape and sexual assault, sexual harassment, stalking, sex trafficking, prostitution, pornography, forced marriage, so-called “honour” crimes, female genital mutilation, continue affecting millions of women and girls all over the world regardless of their background, cultural or otherwise.

What has been done in terms of preventing gendered violence and gender inequality in D&G?

The Dumfries and Galloway Domestic Abuse and Violence Against Women Partnership (D&GDAVAWP) has been tackling and raising awareness of all forms of gender based violence in the region since 2006; promoting the support available for victims and
whiteribbonbringing information to the general public to help develop greater understanding of the causes, effects and subtleties of abusive behaviour and gender based violence in general. Also the White Ribbon Campaign that provides a space for men to take action against gender based violence has been promoted locally.

Recently D&GDAVAWP and Colleagues from NHS Dumfries and Galloway Equality and Wellbeing Teams (who a year ago formed the D&G Gender Equality Steering Group) have organised two Gender Equality events the most recent one in partnership with Engender. This event involved group discussions searching for ideas for action. People suggested ideas (amongst others) like public awareness campaigns on gender stereotyping; campaigns to encourage people to be good role models; challenging media messages; introducing gender education from primary school; and creating a Gender Equality Network for Dumfries and Galloway.

What else can we do about it?

As individuals we may feel that this is too big an issue to tackle but if we act collectively changes can be achieved. We just need to have a look at recent history for inspiration and take the Suffragette Movement as an example, or perhaps more recent examples that challenged extreme gender stereotyping in visual media like No More Page 3, and take action on gender (and other) inequalities that we can identify in society.

Now more than ever before we have the capacity to communicate instantly with thousands of people via social media; we can exchange and develop new ideas, plan and take action and – if we want to – we can start changing the gender rules and the ideas, values and beliefs that inform those rules.

changeChange can start with a critical examination of our own thinking, attitudes and prejudices followed by joining forces with other likeminded people who think that change is necessary and possible. Other strategies can involve engaging in a dialogue with other people and examine their own attitudes, behaviours, the language they use, and discuss examples of gender stereotyping we come across daily.

This personal + collective change process will in turn produce change at a cultural level and in the longer run help bring bigger changes in society.

Change – like gravity – is another constant in the universe and in our everyday lives; we only need to acknowledge this and start envisioning the possibility of managing and shaping change…

Change is possible; it can be done…if we want to…

On International Women’s Day let’s #BeBoldForChange !
networkIf you would like to join the D&G Gender Equality Network, please contact: domesticabuse@dumgal.gov.uk

 

 

Luis Pombo Is a Research and Information officer for the Domestic Abuse & Violence Against Women Partnership (DA&VAW) at Dumfries and Galloway Council.

 

Clinical Efficiency by Ewan Bell

In a previous blog (“Prioritisation in NHS Scotland” – November 2015), I opined that ‘we can’t continue to provide the current range of interventions and services, if we want a sustainable NHS for the future.’ In other words we really need ‘to start debating and defining the essentials of health-care and what can we pull back from’. I had numerous comments and emails from colleagues; the majority supportive of my view. Since then there have been several blogs, including Chris Isles (“Time to Prepare for our new Hospital” – December 2015), Catherine Calderwood (“A Message from the CMO” – February 2016) and Anne Marshall (“Rights without Responsibility – Where are we Going?” – August 2016). These, in some way, have all informed that debate.

Chris believes ‘that the 5th largest economy in the world could afford to provide high quality emergency care as well as batteries for hearing aids and palliative chemotherapy for the frail elderly (if that is what they really want), but if I am wrong then surely the batteries and the chemo must go’.

I think he is wrong and here’s why. Year on year from 1997 to 2013, the UK has spent more and more on healthcare. Below is the most up-to-date data I could find from the Office of National Statistics.

image1

Currently (2016-17) the UK spends approximately 18% of its overall budget on healthcare – about £143 billion (total UK expenditure is £784 billion). If our answer to the increasing demand on our current health service is to keep increasing the amount of money that we spend on it by the same factor (x2.97) every 16 years, then by 2033 we’ll be spending approximately 52% of our country’s overall budget on the NHS, squeezing out spending on education, pensions, social security and defence. Now I know that Economists will laugh at the simplicity of this argument (fair cop I say) as I haven’t taken into account rising GDP (if it does post-Brexit), but my point is that there is never going to be enough financial resource in the NHS to meet an ever increasing demand (and nor has there ever been).

The recent Chief Medical Officer’s Annual report ‘Realistic Medicine’ and the National Clinical Strategy (NCS) 2016 raise several fundamental questions, which include:

How can we further reduce the burden and harm that patient’s experience from over-investigation and over-treatment?
How can we reduce unwarranted variation in clinical practice to achieve optimal outcomes for patients?
How can we ensure value for public money and prevent waste?

The context to these questions is described in the NCS:

“Value-based healthcare is an established approach to improving healthcare systems across the world – the central argument is that higher value healthcare is not necessarily provided by higher inputs. What matters more is that care is provided early in disease to prevent progression (avoiding the added patient burden of more intensive interventions), it is provided safely to avoid harm, it is proportionate to the patient’s needs (avoiding the waste of providing outcomes that are not relevant to the patient), it is provided consistently and reliably (avoiding unwarranted variation).”

“Over-treatment, wasteful treatment and variation is a broad subject, and an important one. It is important that it is addressed in Scotland so that we can be more confident that the use of resources is targeted to producing outcomes that matter to patients.”

So the national conversation has started. How do we ensure value for public money? And how can we be more confident that the use of resources is targeted to producing outcomes that matter to patients?

Do we systematically, and with rigour, evaluate and rank the clinical value of new drugs, new devices, new clinical guidelines or new procedures? No we don’t, but we should and if we are going to invest in a new intervention with significant clinical value, how are we going to afford it?

Part of the solution might be for each of us to start looking at our own clinical practice in terms of over-treatment, wasteful treatment and variation. Does our rate of intervention vary significantly with the national mean, and if so, is this variation warranted or unwarranted? Is there any part of our clinical practice that we do, because it’s always been done this way, but actually it really doesn’t benefit the patient?

There is already a lot of good work going on in Dumfries and Galloway looking at waste and variation. The Surgical team, led by JK Apollos and Stuart Whitelaw have recently been looking at the clinical value (there’s very little) of routinely sending sebaceous cysts and lipomas to Pathology. What about gall bladders? Heather Currie, Ranjit Thomas and Kim Heathcote and other clinicians meet regularly (the lab demand-optimisation group) to put in place measures to reduce wasteful and thoughtless laboratory requesting (do you know that the blood sciences lab processed 40,000 thyroid function tests last year)? This is not just about money. Over-requesting of lab tests can often result in the clinical pursuit of minor, insignificant abnormalities, which can lead to over-investigation of patients and on occasions harm.

There are lots of opportunities here to improve patient care and start to tackle some of the issues raised by the CMO and NCS. I have been asked to start looking at waste and unwarranted variation here in Dumfries and Galloway and hope that you will help by considering the real clinical value of all that you do and identifying clinical waste.

Ewan Bell is a Consultant Biochemist and is AMD for Clinical Efficiency

The beat goes on by Julie Garton

Music has the power to help improve quality of life for people living with dementia and their families. It can bring back memories, open up conversation, improve mood, restore calm and strengthen the person’s sense of self and relationships
There are around 90, 000 people living with dementia in Scotland and we have a responsibility to find and employ strategies and interventions that help people to live well with dementia
A key part of my role is to encourage and support the use of strategies and interventions that can increase wellbeing for people with dementia. Dementia is characterised by progressive and irreversible memory loss, and often verbal communication and thought processes deteriorate to such an extent that it interferes with daily life and activities.
The charity, Playlist for Life, aims to spread the word about the benefits of music and to help families and carers build playlists of personally meaningful music for their loved one. Founded in June 2013 by journalist and broadcaster Sally Magnuson, after she saw the impact that music had on her mother who had dementia.
Sally researched the neurological effect familiar music had on the brain, and found a growing body of evidence to support the use of personal music for people with dementia, and an American organisation, Music and Memories, who had discovered the most amazing results after introducing personalised music on iPods for people with dementia.
So, while it was obvious that ‘live ‘music could bring bouts of joy and sudden flashes of memory to people, the effect on individuals was transient. But playlists on an iPod, this was personal. This could go through life with you.
Please check out the website Playlistforlife.org for more details, but already, people have been reconnected to their loved ones and that elusive thing, their ‘ selves’ through sharing their music from their past on an iPod.
Music is the first and last channel of communication. Our auditory system is the first to fully function, even at 16 weeks in the womb we can hear and respond to music. It’s recognised that babies as young as 5 months can distinguish between happy and sad songs.
This forms a soundtrack to our lives. We can remember words and tunes to music and songs that we may not have heard for a very long time, but often the first few notes are enough to prompt a flood of memories, emotions and/or bad dancing in the kitchen.
In dementia, musical communication remains strong while often other forms of communication fade. Music can help those living with dementia connect with their past and their present. The brain structures involved in processing musical information often remains intact

The Benefits of music in dementia
Speeds healing – early healers used incantation and the Egyptians used music to treat a range of disorders
Increase optimism
Decrease pain
Reduce isolation
Reduce stress and distress
Promote active engagement & communication
Increase affection, creativity and expression
Reduce anxiety and depression
Increases co-ordination of motor movement, especially if combined with dancing

There is growing evidence that listening to music can stimulate seemingly lost memories and may even help restore some cognitive function. Not to mention, music engages the areas of the brain involved with paying attention, making predictions and updating events into the memory. Research suggests that even as dementia progresses, the brain has the ability to make neural connections which allow the person to reconnect with memories and emotions and expression. This provides an opportunity for families to share experiences and maintain a relationship with their loved ones, and can make visits easier and more meaningful.

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This is simple, easy and cheap. Where we can use personalised music, why wouldn’t we? When it’s effective, there’s not a dry eye in the house. I’m not sure if the days of forced communal listening to Daniel O’Donnell /Val Doonican/Scottish Country Dancing music and the like are over- I am emotionally scarred by years of Jimmy Shand and his band, (apologies to fans of the above) played relentlessly in older people s wards over the course of my career, but iPods are the way to go folks! Other Mp3 players are available.
Working in dementia care is fascinating, motivating and can give those working in the field a huge sense of satisfaction, but we have a long way to go before we have really got to grips with how to prevent stress, manage distress and ensure people are receiving consistently high quality, person centred care. Using personalised music is just one small way to work towards those goals, but a good one.
We had a training day in June for 15 members of staff from across the region. Staff from community hospitals, Midpark Hospital, community hospitals and palliative care attended and the impact of the training was tangible.
Staff will work with families to create personalised playlists for their loved ones. Favourite songs of course (and make sure the artist is the identified, we all have a favourite tune that’s been ‘covered/ruined’ (delete as appropriate) ), but other favourite music such as, nursery rhymes, TV theme tunes, Christmas songs can all help build the music to that persons’ life .
It also allows staff to deepen their knowledge of the person, allowing developed and enhanced relationships between staff and families and helps promote the use of This is Me as yet another tool to really get to know the person we are caring for.
My gratitude to League of Friends for their generous donation to buy a number of starter kits (iPods/earphones/splitter cables) and also to the IT department who have been hugely supportive, overcoming the technical challenges (and technophobes!) Thanks also to the Mental Health, Psychology and Learning Disability Directorate for enabling the training.
‘It took a lost weekend in a hotel in Amsterdam ……..One of my top three tunes of all time, but the memory behind it is mine and not for sharing!
So, what’s on your playlist?

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Julie Garton is an Alzheimer Scotland Dementia Nurse Consultant for NHS Dumfries and Galloway