The Buzzzzing Fridge was Back! by Elaine Ferguson

 

 

 

 

 

Bzzzzzzzzzzzzzzzzz

 

How does being asked to do a blog remind me of a buzzing fridge? Well simply, a buzzing fridge was the image, along with the above facial expression, that came to my mind when Dr Ross Warwick, Lead for the Clinical Health Psychology Service, asked me to write a blog as part of our service promotion. His request provoked feelings of anxiety accompanied by forgotten memories of a much wanted, all singing, all dancing fridge purchased years earlier to make my life complete. Instead, it had left me feeling bewildered and anxious with all my attention and behaviours being taken up trying to fix the BUZZ that emanated from inside the fridge. Automatic thoughts predicting my imminent failure resurfaced: the BUZZ was back!

My initial catastrophic thoughts, images, feelings and behaviours reminded me of how uncomfortable it is when we are asked to do something that feels overwhelming or out of our comfort zone. Avoidance is often how I try to resolve these feelings of distress and discomfort but I can’t think of a time when that solution has actually helped! So with Ross’s words of encouragement ringing in my ears (“It’s good for your development”) and a reminder to myself that “avoidance doesn’t help” I decided to feel the fear and do it anyway. (Practise what you preach Elaine!).

For the past three years I have worked as a Psychological Therapist in the Clinical Health Psychology Team. Prior to this I worked as a Mental Health Nurse in busy wards and community settings. During my career I have not always been given the opportunity or support to look after my own psychological and emotional needs in the workplace. On reflection this impacted on the enjoyment and satisfaction I gained from my job. This affected my ability to live true to the values that had brought me into the field of mental health, i.e. helping and supporting the psychological wellbeing of my patients. From this experience grew a passion to look after not just my patients but also the emotional wellbeing of my fellow workers.

Part of the Clinical Health Psychology Team’s values and philosophy is the inclusion of colleagues in the work we do to develop and facilitate lasting psychological change in patients with long term health conditions. Crucially this includes helping staff think about their own emotional wellbeing and how we can do this in busy, chaotic and at times distressing working environments. In a nutshell if we look after ourselves, our patients get a better service.

This takes me back to my buzzing fridge. It too was meant to add something to my life but like some of my earlier working experience it became a source of annoyance, frustration and sadness with all my attention focused on the aspects I disliked about it. My attention drifted to the high pitch buzz and it started to taint my entire view of it. The pleasure and excitement began to be replaced by frustration that no matter what I did, I couldn’t stop the buzzing. Shaking it, turning it on and off, opening and closing the door, and finally shouting at it made no difference. Thoughts rushed in “I can’t even pick the right fridge!”, “The shop has sold me a broken fridge, I’ve been conned!”

 

    

It was at this point my friend popped in for a cuppa (too early for a cocktail). She admired the new fridge. How dare she!  I pointed out the buzzing and she said “Sounds fine to me; how are you?”  We got talking about family, friends, work, hobbies, and nights out and generally putting the world to rights. When she left I suddenly remembered the buzz from the fridge. I tuned in and yes it was still there. Curiously it didn’t seem so loud and it didn’t seem to annoy me as much as it had done earlier. What had changed? I realised that I had stopped focusing in on the buzzing because talking and sharing with my friend was of much more value and importance than listening to my new fridge. I had put my energy into doing what mattered. The more I had talked about what was important to me and my friend, the less I had noticed the buzzing.  I had enjoyed sitting in my kitchen with the fridge that buzzed. The buzz eventually became a low level necessity which assured me all was in working order with my new, shiny fridge.

My buzzing fridge has once again melted into the background. Why? Well simply because I have chosen to get on and write this blog and whilst doing so I have remembered why I enjoy coming to work every day. I get the opportunity to work with people like you who are passionate about their jobs but like me have buzzing fridges of their own which can leave them feeling distressed, disillusioned and unable to do more of what matters to them in their working days and home life. My job allows me to remind you that you are important.

If you and your team would like to know more about the training and consultation we offer, that may improve your own personal psychological wellbeing which in turn assists us to care for our patients and each other, please get in touch.

To quote my boss “you don’t need to be a psychologist to provide psychological care”. My friend wasn’t. So maybe I would add another question to Robert Barton’s list from his blog, the one that my friend asked me … How are you?

Elaine Ferguson is a Psychological therapist for the Clinical health Psychology Service at NHS Dumfries and Galloway

 

 

 

 

 

Questions Are the Answer by Robert Barton

Patients often feel overwhelmed and intimidated when they attend hospitals and clinics. These are busy places, time can be tight and, as professionals, we can unwittingly send out signals that might prevent patients from engaging. Unsurprising then that on many occasions patients say little and ask few questions. An unpublished American study showed that from the time they arrive until they leave, men ask an average 1.4 questions, including asking about parking!

 

This post is about questions, using them to encourage patient’s to actively engage in their healthcare and things we could ask to help shine a light on the complex mix of physical and psychological issues accompany illness.

 

This topic is particularly close to home for me.  My elderly mother has recently attended outpatient clinics in Edinburgh where she felt unable to ask questions during her appointments and was left no clearer about her condition. What’s more, because some questions were overlooked the professionals involved had a very sketchy picture of what was happening to her and this affected the success of treatment.

 

In Clinical Psychology we tend to start asking questions at the beginning of a consultation so the patient can understand why they are there and what to expect from the appointment.  This includes setting the agenda, a practice that could have value in other clinical settings as it ensures we have common goals for the available time and promotes collaboration (and involved patients tend to have better outcomes, Redding, 2017)

 

To set the set the agenda and make constructive use of time we might ask questions such as:

• What would you like to get from this appointment?
• Why have you come along today?
• What would be helpful to you today?
• This is why I think you are here and this is what we need to do, are there any questions before we begin?

I couldn’t attend appointments with my mother so we set her agenda by writing an outline statement of her problem giving clear information about her condition. This approach proved to be a great help to the outpatient clinic, helping them to understand her problem more clearly and how it manifested day to day, helping her achieve better outcomes.

 

Patients in clinics may have many questions about their treatment that are primarily used to gather information: what is this test for? When will I get the results? How do you spell the name of that drug? Can I park in the ambulance bays?  We may ask similar closed questions in the course of a consultation like “is this the worst it’s been in the past month?”  Using closed questions are useful when we want factual information and can create opportunities to ask open questions or invite a broader reply like “can you tell me a bit more about that?”

 

My mother was attending outpatient appointments to address poor mobility caused by an arthritic condition. During the appointments she was examined, her medication checked and the appointment would end with something they hoped was helpful. Questions about how she was feeling, what she thought and how her behaviour had changed were overlooked. If they had been asked they would have realised she felt a bit low and useless, had thoughts like “nothing is working so what’s the point” and her behaviour had changed; she went out less and stopped enjoying life. This all affected her condition which continued to deteriorate.

 

When patients are suffering from a health problem they can experience a whole range of unhelpful emotions that could affect their treatment. These emotions can be grouped under three headings.

• Loss: sadness, down, and depressed.
• Fear: anxiety, panic and terror.
• Anger: rage, frustration or irritation.

Emotions can lead to unhelpful thoughts about health that can often be untrue. Feelings and thoughts can lead to behaviour changes the patient makes often with the intent of helping matters but in reality can have the opposite effect.  So making small changes in our routine practice can help us become more familiar with our patient’s condition by understanding how it makes them think, feel, and act.

 

Involved patients have better outcomes. But if they are less likely to ask questions because of the environment, what open and psychologically-aware questions might we ask to help us have a better understanding of their problems?

Thoughts:
What does that make you think?
What runs through your mind when that happens?
When you feel like that what does it make you think?
What images come to mind when that happens?

Feelings:
How does that make you feel?
How do you feel when that happens?
When you think that how do you feel?

Behaviour:
What did you do when you thought that?
What did you do when that happened?
Is there anything you do that you find helpful / unhelpful?

Physical sensations:
When you feel that way do you notice any physical sensations?
Do you notice any physical changes when that happens?
Have you noticed any physical changes when you get those thoughts?

In psychological therapy it is important to invite people to make changes to their usual practice. So, with that in mind, which of the above questions will you commit to try at your next clinic?

References
Don Redding (2017) Patient engagement: A ‘win-win’ for people and services NHS England Publication.

Robert Barton is a Psychological Therapist with the Clinical Health Psychology service

Big brother is monitoring you by the Respiratory Team

Big brother is monitoring you – real time telemonitoring in CPAP and NIV therapy users
      with sleep disordered breathing

Introduction:
Obstructive Sleep Apnoea Hypopnoea syndrome (OSAHS) –It is more than just extreme snoring! It is a relatively common condition where there is repeated collapse /narrowing during sleep which interrupts normal breathing and can cause low oxygen levels as a consequence. Click here to see what happens during sleep in an individual with this condition.

The consequences of untreated OSAHS can have a significant impact on an individual’s quality of life, causing problems such as poor performance at work or at school and may also place a strain on relationship with others.

• The reported incidence of OSAHS is 3–7% of middle-aged men and 2–5% of women (ERS White book 2017)
• There is an estimated 25% prevalence in people who are overweight
• Other contributory factors are enlarged tonsils and tongue base and upper airway anatomical abnormalities such as a very narrow airway, short jaw or deviated nasal septum.
• There is increased risk of road traffic accidents from untreated Sleep breathing disorders. Current DVLA guidelines regarding sleep apnoea can be accessed here.

Poorly controlled OSAHS may also increase the risk of:

• developing high blood pressure
• having a stroke or a heart attack
• developing an irregular heartbeat such as atria fibrillation
• developing type II diabetes although it’s unclear if this is the direct result of an underlying cause such as being overweight

Our Sleep medicine service has in excess of 1000 clients living across 2,500 square miles of rural Southern Scotland. Considerable commuting distance and time are involved for service users to attend centralised clinics in Dumfries and also for clinicians attending peripheral clinics in the west of the region.
We have introduced real time telemonitoring over the last 24 months in some people who are using CPAP/NIV machines. These devices have an inbuilt sim card that have the capability to transmit treatment efficacy and adherence data to a secure web based platform combined with our usual clinical care. (See figure 1)

*not real patient names

Telemonitoring of CPAP and NIV potentially offers a convenient option for reviewing people at distance with OSAHS on treatment with Continuous Positive Airway Pressure (CPAP). It may have significant potential to deliver person centred, safe, and effective care that is closer to home (1). There may also be additional benefits for patients and clinicians in terms of reduced travel, fuel consumption and environmental impact in terms of reduced carbon emissions (2).

We have now evaluated this new technology and any future potential benefits it may have for service users and our clinical service delivery.

To date we have experience of introducing CPAP/NIV with telemonitoring in 116 patients.  There are currently 64 on active telemonitoring with 18 using CPAP, 14 APAP and 27 on NIV using the Resmed S10 Airview platform. No safety concerns or data transmission issues have been encountered.
The evidence for teleconsultation/telemonitoring in CPAP users is limited; however no safety concerns have been raised.  Adequately powered, well-designed trials are needed to establish whether real time telemonitoring and remote teleconsultation is a clinically and cost effective option for people using CPAP therapy. Further work will be conducted in our sleep medicine service over the course of 2018 in a Randomised controlled trial.

1.Isetta V et al, 2014. Telemedicine-Based Approach for Obstructive Sleep Apnoea Management: Building Evidence Interact J Med Res 2014; 3(1):e6) doi:10.2196/ijmr.3060
2. Murphie P, Clark L. Telemedicine – the Good, the Bad & the Future? by @murphieRNC & @Louisefclark. 2014.  Available from https://dghealth.wordpress.com/2014/…/telemedicine-the-good-the-bad-the-future-by-…
      (Accessed August 2017)

Phyllis Murphie, Robin Paton, Ross Paton, Musa Ali, Jane Gysin, Stuart Little

Respiratory Medicine Department,
 NHS Dumfries and Galloway
, Scotland

“Hello it’s me…why aren’t you there?” by Bob Heath

I am watching you from this field of grass

You can see me but you don’t hear me

I can see you talking but only hear myself

If you noticed me you’d run away

Theresa, Sobell House, 2012

When I received an invitation to speak at the last Medicine Unboxed event in Cheltenham, UK, I was immediately struck by the title for the weekend: voice. It’s a word that permeates throughout my work perhaps more than any other, and it’s a word that carries deep significance for many of the people I work with as a music therapist. Here’s an interesting exercise; try thinking of some of the words you might use to describe voice. How soon do you move on from descriptors such as “singing” and “speaking” and “quiet” or “loud” into “powerful” or “silent”, “lost” or “rediscovered”, “unheard”, “unwelcome”, “abandoned”? And, of course, this is just the tip of the iceberg. This word is impossible to disentangle from pretty much every human emotion and experience. Even in complete and perfect silence there is still a voice; and we’re listening to it.

At Medicine Unboxed I played the recording of a woman I had worked with, whom I’d called Eileen. I’d met her in a care home a few years ago and she’d been referred to me because, in the words of her referrer, “she’s driving us all mad”. Eileen was 90 years old and was, I was told, suffering from late stage dementia.  I  found  her  in one of the day rooms, rocking slowly back and forth in a wheelchair, eyes closed, mouth wide open saying “La, la, la” constantly in a voice that ached with loneliness and despair. They’d asked me to see her in the hope that a music therapist might help her find a way to be quiet. Her voice was too much for them to bear.

I took her to her room and for a while we sat opposite each other as I joined in the dialogue with Eileen, repeating her “La, la, la” at her pitch and at her pace. Eileen’s eyes were still tightly shut and I had no idea how she was responding to me; or, indeed, whether she could hear my voice at all. After a short time I moved a little closer to Eileen, played a simple open chord on my guitar and began to sing her words, “La, la, la” using a single note. The quality of my own engagement changed within seconds; I felt more open, a little revealed and as a result, perhaps, my willingness to be present and alongside Eileen became more apparent. Eileen responded almost immediately, her eyelids flickered. She cleared her throat and began to sing her own song with me, “La, la, la”. We met on five further occasions and we always sang together. Her repertoire expanded with each session as she explored her own vocal range and from time to time sang new words, almost always the names of other people. In our last session together, shortly before she died, Eileen sang uninterrupted for 40 minutes.

When I have shared the recording of this session with colleagues and health professionals, it has  provoked long debates about music and the brain, fuelled by evidence emerging from neuroscience about experiments with people engaged in active music making. It’s all fascinating stuff, of course, and helpful in many ways. But I have a much simpler way of explaining my experience with Eileen. By answering Eileen I could let her know that I could hear her and that I was listening; her voice moved from unwelcome and dismissed to heard and acknowledged. By singing her words I was able to communicate something more: the importance of her words, exactly as she was saying them. Eileen’s voice moved from heard and acknowledged on to welcomed and respected.

Today, perhaps more than ever before, there are loud voices all around us, angry voices demanding that we show our ability to care for vulnerable people with respect, integrity, and compassion. It’s our primary duty; nothing else works for the patient or the carer if we don’t practise in this way. And isn’t this exactly what Eileen was trying to tell everyone working at the care home where she spent the last 2 years of her life? “La, la, la…this is the voice I’m left with, why won’t you listen to me?”

When  working  in  palliative  care  environments with people who are dying, I have encountered an extraordinarily wide range of voices. I have become familiar with voices that are frightened, shocked, or angry, as well as those that are reconciled, peaceful, and hopeful; and my work involves listening to and hearing them all. It became apparent to me very early on in my work at the hospice that music therapy sessions would be an opportunity for people to talk as much as a chance to play music. I knew that creating music would provide a powerful channel for emotional expression and I sought to encourage my clients to stay in what we would frequently refer to as “The Musical Space”, where the rhythms, melodies, and harmonies we created could become a representation of the words themselves. Here, I would often meet the silenced voice, the frightened voice, and perhaps most frequently the lost voice.

The words that began this essay come from a song written by a client, Theresa, a woman in her late 50s who was finding the last few months of her life unbearable. In our first session she had said almost nothing at all, preferring instead to sit at the piano playing single, repeated notes with one finger as I supported her by providing a simple harmony. When I asked her how she was feeling she thought for a long time before replying, “invisible”. In our second session she had told me how much she wanted to die. I’d probed a little and she replied: “They think I’ve disappeared, I must be dead already.” By our third session a more creative dialogue had opened up between us and by placing some of her words into a musical framework Theresa was able to not only express but also to explore some of her more difficult feelings in a helpful way. “But I love you all”, she wrote in her second verse, “And I watch you all, I am always here, guarding you. You can call on me, you can call on me.” By reading the words back to Theresa I was able to help reinforce her sense of being acknowledged and listened to. But I believe the transformative moment in our brief time together came when we recorded the song with Theresa singing. This had taken a considerable amount of negotiation in supporting her to overcome some of the judgments she had been making about what she was saying and how she was going to say it. When Theresa finally listened to the recording of her song she cried, something she hadn’t been able to do for many months. Then she said: ”There, it’s done, it feels good to tell the truth”. For Theresa, finding her voice again had also revealed some of the reasons why she had come to believe that it had disappeared in the first place.

Helping patients to find their voice is not the exclusive preserve of those of us who work in palliative care environments. But perhaps the very nature of these environments does invite us to seek opportunities to model and develop approaches that are both creative and compassionate. Perhaps too it’s easier for us to place “the patient’s voice” a little closer to the top of the complete care package simply because we’re asking such big questions of patients, as they are of themselves. But even then it can still be one of the most difficult things to do. The Liverpool Care Pathway was, I believe, a well intentioned system designed to help give patients and their families their voices at a time when they most needed to be heard. Could the failure in the successful, long-term implementation of such a system have something to do with the way that we are listening? This may seem to be a simplistic view of a very complex system but the Liverpool Care Pathway, like all systems, can only provide the framework. The rest is down to us.

Looking through the list of the many hundreds of songs that have been created by my clients over the past 10 years or so, I begin to notice a striking feature. Almost all of these songs were created at a time when the writers were at some level experiencing discomfort and pain. And yet very few of the songs address these issues at all. Instead, the titles—often the first line of the songs—reveal patients reaching out to us, singing out in fact, and asking us to really listen to their voices. “Are you listening?”,

“Can you hear me when I call?”, “Is there anybody there?”, “Make a space for me”, “Stop, and hear me”, and the list goes on. Many of these songs are addressed to these patients’ own families and loved ones, but I do recall that during the writing process it felt as if these patients were talking to me too. A music therapy colleague recently shared a song that had been created by one of her clients whilst on the inpatient unit. The patient’s words are an invitation to us all:

It’s simple, so simple

Don’t tell me how I feel, ask me,

Don’t run off half way through, follow through Don’t think you know how I feel, Just ask, it’s simple

When we are responsible for the care of those who are suffering we have no choice if we want to do it well. We have to help our patients to find their own voices in whatever way we can. How we then listen and respond will have a profound impact; not only upon the important outcomes that we measure and monitor but also upon the very human experience of needing and receiving care. And, importantly too I would argue, upon ourselves and the quality and safety of the care that we all aspire to deliver.

Bob Heath has worked extensively as a music therapist in Palliative Care and Mental Health and is a lecturer and supervisor. He is published and has presented work at a range of events including The Hay Literature Festival and Medicine Unboxed. He works at Maggies Cancer Care Centre in Cheltenham and has a small private practice in Berkshire

Bob.heath.therapy@gmail.com

Patients’ names in this essay have been changed to protect patient confidentiality.

This article was originally published in the Lancet, Vol 384 September 13, 2014. It can be found here

 

 

A spoonful of sugar helps the medicine go down!

Since starting work I have been more aware of the tendency of the media to focus on the negatives. It is almost daily that we hear stories of how the NHS has failed a patient, waiting times are simply unacceptable or that hospitals are not clean enough.

 
I appreciate that it is this negativity that sells newspapers. There is nothing overly dramatic about the tale of a wonderful NHS experience. The patient came in as planned, the procedure was carried out without complication, they felt better and they went home. Not exactly something which can be spun into a gripping yarn.

 
While press sensationalism is not something new, it has surprised me that at times we struggle to focus on the positives at a local level. We are trained to learn from our mistakes. For the sake of patient safety, adverse incident reporting and critical incident analysis are now key parts in quality improvement. This is important. There are always lessons to learn when a mistake is made.

 
However, is it possible that we also learn from the things that we do well?
When teaching children in their early years parents are encouraged to use positive reinforcement. Just because we become older and supposedly wiser does not mean that positive encouragement loses its’ impact. While we strive to improve on the areas where we can make errors, it is important to also remember the things that we get right. We are always asked to reflect on what we could do differently, not to address the things that you would approach in exactly the same manner. Something which in some situations would be an interesting topic to broach.

 
From my own limited experience I know at times you can feel totally out of your depth. However, if someone takes two minutes to reassure you that you are on the right track it can make a world of difference.

 
So here is my positive feedback. I was told prior to starting work that FY1 would be the most horrendous year of my life. However, I enjoyed starting work. I have was well supported and for that I must thank you all. Everyone working within DGRI has made me feel well supported and at the same time given me room to grow and develop. It is as a result of this that I have continued to enjoy my work and develop as my career has progressed. You have created a supported learning environment for trainees which I hope is something that is recognised, as we all strive to achieve more.

 
So in attempt to round off this entry: if you notice a colleague, family member or a friend doing something well let them know. It takes no time at all and you never know what you might inspire someone to do.

 

Galloway Community Hospital: the Truth by Angus Cameron

Dear Colleagues,

Recent Concerns regarding the Galloway Community Hospital.

There are two issues that have attracted public concern:

1. The Emergency Department

The Emergency Department (ED) handles approximately 12,000 cases per year.  It is staffed by a suitably qualified doctor and experienced ED nurses.  In addition to that, the ED doctor can call on the services of an on-call anaesthetist if he is faced with a need to ventilate a severely ill or injured patient.  Alternatively, the ED doctor can seek help from the Emergency Medical Retrieval Service based in Paisley: This service is manned by consultant level staff 24 hours a day and has a helicopter on stand-by able to rapidly transfer medical staff to the Galloway and transport seriously ill patients to Glasgow Hospitals.

The Emergency Department has good working relationships with Scottish Ambulance Service paramedics based in Wigtownshire, who are often faced with critical decision making, deciding whether to transport patients to the Galloway Community Hospital for stabilisation, or to transport them direct to Dumfries & Galloway Royal Infirmary where definitive treatment is available.

Anaesthetic on-call cover used to be provided by two anaesthetists who lived in Stranraer.  One retired several years ago and the other last year, and it has not been possible to recruit replacement anaesthetists. As a result, the 12 hour shifts in the rota have been staffed by locum consultants and by consultant anaesthetists from Dumfries & Galloway Royal Infirmary.

We have had increased difficulty recruiting locum anaesthetists to the Galloway, which reflects a national shortage of locum consultants.  In addition, with 3 vacant posts in the anaesthetic department in Dumfries & Galloway Royal Infirmary we have had difficulty in rotating consultants out to the Galloway Community Hospital.  Obviously sending an anaesthetist out to the Galloway Community Hospital could result in theatre sessions in Dumfries & Galloway Royal Infirmary being cancelled – causing distress to a number of patients (some of whom could have come from Stranraer.)

In the last month there have been 3 occasions where an anaesthetic shift has not been covered as a result of failure to recruit locum doctors.  In these cases the impact has often been reduced by a doctor staying on longer after his shift ended, or a doctor agreeing to arrive earlier for the start of the next shift.  The dates when there was no anaesthetic cover were overnight were 4^th July, 5^th July, 6^th July and 11^th July 2017.

I would like to stress, however, that at no stage has the Emergency Department been closed.  It has not been “downgraded to a Minor Injuries Unit” – the usual doctors and nursing staff were present and seeing patients normally.  Children with asthma or patients with fractures for example could still be treated normally.  While we regret that we were not able to provide the fall-back cover of an anaesthetist it should not be concluded that this was from lack of trying – we have spent a total of £1.5million on providing medical locum cover for the hospital in the year to April 2017 and will continue to maintain a rota for the foreseeable future.

Being truthful, I cannot give an absolute guarantee that we will never have this situation again. We will, however, continue all efforts to recruit anaesthetists both to Dumfries & Galloway Royal Infirmary and to the Galloway Community Hospital and it is likely the situation will ease as locum availability improves after the holiday season.  However, we do face a very difficult medical workforce market.  I can confirm that we have a working group led by the Deputy Medical Director working on efforts to improve our recruitment and retention in a highly competitive market.

2. The In-Patient Wards

 You will be aware that there are two in-patient wards in the Galloway Community Hospital. One ward, the Garrick Ward, deals with more acute medical cases, whilst the other, the Dalrymple Ward, tends to deal with rehabilitation cases and care of the elderly.

Arranging a safe level of nurse staffing in the wards has been made difficult recently by 4 longer-term vacancies, and more recently by 3 nurses forced to take sick leave.  The nursing staff have worked exceptionally hard and flexibly providing extra shifts to help maintain the full service.  However, a decision was taken to move all patients into one ward (the Dalrymple Ward) for the period 5^th – 12^th July 2017, in order to allow for safe nursing levels to be maintained and for patients to be treated with dignity and compassion.  This was achieved by declining admissions to the Dalrymple ward for a week prior to this to allow the numbers of in-patients to decrease as patients were discharged.  During the period when the two wards were combined it was possible to admit acute patients to the ward from both ED and from GPs.

I am glad to say that following a very intensive weekend recruitment drive we have now managed to appoint to nursing posts and the new staff will start in September 2017, easing the pressure on ward staffing.

A statement from the General Manager was emailed to Councilors in Wigtownshire on Tuesday 4^th July 2017 informing them of the situation.

A Senior Manager is carrying out a review into the Galloway Community Hospital at the request of the Chief Executive.  The remit is to look at how services can be made more resilient and sustainable and to consider what services could be increased in the hospital, particularly out-patient appointments, diagnostic investigations and day-case surgery.  Increased services in the Galloway Community Hospital may, however, be delayed if we remain unable to recruit consultants to the region.

The Health Board is committed to the Galloway Community Hospital.  This is evidenced by the fact that we have budgeted for routine renovation and equipment upgrade of the theatres and a renovation of the dialysis unit later this financial year. In addition, further money will be spent in the Galloway Community Hospital on equipment for endoscopic examinations.

On a personal level, I feel that ultimately, the stability of services within the hospital relates directly to medical recruitment in a very difficult recruitment environment where we are forced to compete with hospitals across the UK.  The Board will continue to work hard to recruit to what are unfortunately

perceived as professionally isolated and clinically challenging posts.  I believe that there is a role for community leaders of all persuasions in helping to promote very positive messages about the hospital, the community and the environment to help us attract the best possible staff to the area.

Again on a personal, and professional, level I feel it is extremely important that none of us unnecessarily promote avoidable anxiety or confusion in patients and the public.  I think it is, therefore, important that the language we use in public fora is accurate at all times.  The Emergency Department has not been closed and patients should attend there as normal.  They will be treated by suitably qualified doctors and trained nurses. They should not be led to believe that they are required to travel to the Emergency Department in Dumfries & Galloway Royal Infirmary.  Patients who are mistakenly led to believe that may make seriously inappropriate decisions to delay seeking help or travelling to Dumfries – decisions that could have significant adverse effects on their health.

Dr Angus Cameron is Board Medical Director for NHS Dumfries and Galloway

The Doctor can see you virtually now by Chris Fyles

While Googling recently (for Technology Enabled Care related reasons!) I happened to come across PawSquad.  They provide “instant, qualified online vet advice” through the provision of video or text chat consultations to keep your pet “as happy and healthy as they can be”.

Amazing! Whatever will they think of next?

How about similar services for you, me and everyone else? Wouldn’t it be nice to be able to use these options to support you and your family’s health or to deliver services differently?  We can do that… can’t we?

YES WE CAN!

There are other health and social care partnerships in Scotland that support people to manage their health and wellbeing by video consultations and text message.  There is also demand from the public with the rise of commercial companies that offer GP appointment by video with the ability to deliver medication to your door the next day or email you a prescription.  Need a Physio? Initial and follow up consultations can be provided through video and exercise packages sent to your device for you to follow.

Now, some of you will be thinking “that’s all well and good but the internet connection at where I live and work is terrible!”  While that may be the case right now in some of the areas across our region, it is getting better.

Don’t just take my word for it – there is an ongoing programme of work being led by the Scottish Government and Dumfries & Galloway Council to support the roll out of superfast internet access and improve the speed of regular broadband.  It began in early 2014 and is planned to continue to the end of March 2018 enabling access to superfast broadband for 95% of premises in the region.  The Scottish Government have also committed to deliver 100% superfast broadband by 2021.  At the moment, our region looks like this:

Maybe you are thinking that the people that use your services don’t access the internet? It may surprise you to know that the internet was used daily or almost daily by 82% of adults (41.8 million) in Great Britain in 2016, compared with 78% (39.3 million) in 2015 and 35% (16.2 million) in 2006.

Or that during 2016, 70% of adults accessed the internet ‘on the go’ using a mobile phone or Smartphone, up from 66% in 2015 and nearly double the 2011 estimate of 36%.  It’s not only young people using the internet, recent internet use in the 65 to 74 age group has increased from 52% in 2011 to 78% in 2017, And finally, of those people using the internet, 51% of them were looking for health related information and 43% of people are using the internet to make telephone or video calls using applications such as Skype or Facetime.

If you wish to see some statistics on Internet users in the UK click here

If you wish to see some statistics on Internet access click here

So if we have connectivity, people are familiar with the internet, they are using it to access health information, and they are using it to make video calls why are we not offering our health and social care services via video?

In some places they already are. NHS Attend Anywhere was launched at the end of 2016 and has been developed by NHS24 in collaboration with Healthdirect Australia to enable video call access to Health services as part of normal day to day practices.  Instead of going to a health facility and physically sitting in a waiting room patients just use their device to access a virtual waiting area which the clinician comes and ‘collects’ them from to  begin the consultation. Services delivered elsewhere in Scotland include Pharmacy Reviews, Speech and Language Therapy, Dermatology, Endocrinology, GP appointments, Out of Hours care and more.

“What do I need to be able to do this?” I hear you ask.  For video consultations both the clinician and the person using the service need nothing more than a device (PC, laptop, Android or Apple tablet or Smartphone) that can access the internet with Google Chrome or an Attend Anywhere app installed and internet access of course.  NHS Attend Anywhere doesn’t need superfast internet access to work and generally speaking if you can watch a video on YouTube then you will be able to participate in a video consultation.

Curious to find out more and have a go?

https://nhsattend.direct/dandgtest

If you already have Google Chrome installed on your device just copy and paste the link above into your Chrome browser address bar, press the return/enter key on your keyboard and follow any onscreen instructions to take a seat in our Demo Waiting Area.

Once you are placed into the waiting area a notification will be sent to me and if I’m free I’ll come in and join you for a quick video call.  If I can’t make it you will at least have seen how easy the system is to use and begin to see opportunities to use it within your service. Preliminary results from a national survey in Scotland completed by people that have used NHS Attend Anywhere already indicate that 95% of them would use it again.

Video consultations give us options for flexible services going forward. It can help to reduce travel for people using our services and it could be a tool to help us to recruit to specialist posts from elsewhere to link in to Dumfries & Galloway. If we were offering video sessions into the home, it is possible to think that the person providing the service could also be at home and not in Dumfries & Galloway?

We expect to be able to use technology to buy shopping, make travel arrangements, manage our banking, communicate with our friends and to keep up to date with what’s happening in the world. Hopefully this blog post has made you think about new ways to use technology to deliver your service or to access a service. So what are you waiting for?

For more information or help with any of this, please contact Chris Fyles, Technology Enabled Care Project Lead for Dumfries & Galloway by email: chris.fyles1@nhs.net
LYNC:  cfyles@citrix.dghealth.scot.nhs.uk  or by phone:      07979357010 / 01387220006

Video consultation is one of four areas of focus for the Dumfries & Galloway Technology Enabled Care Programme. The others include Telecare, Digital Apps & Services and Home and Mobile Health Monitoring (HMHM).