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.


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.


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:



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.


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 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.

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?


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

Getting Home for Christmas by @fanusdreyer

I was 19 and imbedded deep in the Angolan bush as part of an ideological war we did not understand. What we did know was that we were ragtag soldiers, paratroopers deployed in counter-insurgency, but dressed in a mixture of South African, Cuban and Angolan uniforms, unshaved and unwashed for weeks, carrying a plethora of weapons, living more off the land than off our rations; a few had been sent home for injuries or for smoking pot. A few weeks ago we had lost Simon and Anton when they stepped on a vehicle mine. We wrote the odd letter home and I had informed my parents that I would not be home until somewhere in January.

And then we were suddenly flown out from the north Namibian bush back to our base in Bloemfontein, a 1000 miles away, for a wash, a shave and change of gear. We handed in equipment and were given a five day pass, released onto the streets outside Tempe on the afternoon of 23 December. My parents were at their seaside holiday 600 miles away, I did not know the phone number and had little money. So I decided to ride with my thumb, although hitching was not allowed in uniform; you had to stand quietly on the roadside and hoped someone safe stopped to give you a lift.

So, as I stood outside the gate in my step-outs, red beret on and Brassoed wings on my chest, another soldier stopped. He was going to Despatch near Port Elizabeth, to see his fiancée and their son, and I was going in the same general direction. So I got a lift in his Datsun 1200, through the southern Free State and Colesberg down to Middelburg in the Karoo, and he dropped me off at a junction just outside town that felt like the middle of nowhere. Even in midsummer the Karoo night air was getting cool by 9. The first car came past after 30 minutes of waiting; it was a big old Ford pick-up truck holding a farmer, his wife and three kids and he immediately stopped; I was thankful to be bundled in the back with bicycles and sacks, and got dropped off in Cradock, with streets that were totally deserted by 11 pm, two nights before Christmas. I had made up my mind to walk to the Police station and ask if there was space in the holding cells for a place to sleep when another car stopped and the driver asked where I was going. He, his wife and daughter were returning home to their farm near Bedford after an early Christmas dinner with friends, 100 km from home. When I replied that I wanted to get to Grahamstown they told me to get in; I was grateful. Their car was an old Opel Rekord, and they took me down to Cookhouse, well beyond the Bedford turn-off, where they dropped me off on the main road south, before making a 180 degree turn and completing their 80km detour, all to help a lonely soldier trying to make it home for Christmas.

By now it was 1.30 am, Cookhouse was completely dark except for a few streetlights, but I noticed there was a train station. I walked the km or so into town and went to wait on the platform, hoping to find a railway bench that would be more comfortable to sleep on than the ground. And then a slow train came past, I explained my predicament to the conductor and he told me to hop on. I got to lie down in an empty compartment and paid nothing. At Alicedale the conductor woke me up and told me to change trains to get to Grahamstown. Again I flopped down in a compartment at no charge and can still remember how cold it became with no blanket and air leaking in somewhere. We arrived in Grahamstown at daybreak and I walked south to the road to Port Alfred. It was another hour away by car. Just before 7 a vegetable lorry stopped and the driver shouted “get in junior”; he had been in the para’s a few years earlier.

Senior dropped me off at 8 am on Wednesday 24 December in front of my parents’ beach house. Mum was alone in the kitchen, saw my face through the lorry window and started shouting “Fanus is here”. Poor Dad thought she had lost it, with me being away in the bush war, and came running out to help her, but found me standing at the door. Then everyone appeared, brothers, friends, neighbours, the children in swimming costumes and the old people in pyjamas, with me sticking out like a sore thumb, still with the red beret on my head. The vegetable lorry driver sat there watching the reunion, then gave me a crisp salute and drove off. I had no gifts, no other possessions, but it was probably our best family Christmas ever. Three days later I flew back to Bloemfontein, with the prospect of a traumatic week to secure my release from the army to get to university, and scars to carry forever.

Fanus Dreyer is a Consultant Surgeon at NHS Dumfries & Galloway.

Crabbit Old Woman by @gbhaining

This poem was written by Phyllis Mabel McCormack 30/06/1913–10/01/1994. Originally entitled “Look Closer” she wrote it in the early 1960s for publication in the Sunnyside Chronicle, which was a magazine produced by the staff of Sunnyside Royal Hospital for circulation within the hospital. She submitted it anonymously as she felt it was critical of some of her colleagues. A copy of the magazine was loaned to a patient in a nearby hospital, Ashludie near Dundee. Before returning the magazine, the old lady copied the poem out in her own handwriting and kept this copy in her bedside cabinet. When she died and the staff cleared her belongings, it was found and, as it was in her handwriting, it was assumed that she was the author.

POEM  Please take a little time to read this, also the nurses response!

I first learned of this poem whilst undertaking my mental health nurse training in the late 1980s.

Gladys 1

This poem resonated with me, and, has stuck with me throughout my career. This led me towards “care of the elderly mentally ill nursing” as it was then called, and, ultimately to strive for the delivery of the best possible care for people with dementia, their families and carers.

Why Dementia?

Traditionally dementia has been the “business” of mental health services but if we consider the statement below, this confirms that wherever we work, whoever we are, at some point we are going to come in contact with a person who has dementia.

“Dementia is one of the foremost public health challenges worldwide. As a consequence of improved healthcare and better standards of living more people are living for longer. This means in Scotland that the number of people with dementia is expected to double between 2011 and 2031. This presents a number of challenges, most directly for the people who develop dementia and their families and carers, but also for the statutory and voluntary sector services that provide care and support. Over time we expect that a greater proportion of health and social care expenditure will focus on dementia, and there is evidence of that change already. There are no easy solutions and transformation will take time. This document sets out what we will do in the next three years.”  Scotland’s National Dementia Strategy 2013 – 2016

What was it like away back then?

Gladys 2 Crichton Hospital (William Burns 1834)

Well…. whilst I was training in the 1980s I had various placements with the Crichton Royal Hospital that had wards for people with dementia.

These were large institutional wards with nooks and crannies all over the place, they had nightingale dormitories and from an observational point of view were a challenge.

The wards included acute assessment and long stay and it was dependent on the stage of your illness where you were placed. There was little evidence (in my opinion) at this time of person centred care. People were well cared for but personal choices were limited.

We had charts for bathing, toileting, weighing, to name but a few.

We dished out meals of limited choice and drinks based on what we knew, however, I mostly prefer to drink coffee BUT do like to be given the option of having a cup of tea!

We had large sitting rooms where everyone was expected to congregate between getting up, mealtimes, toileting times, bath times and going to bed. The telly or some Scottish music was generally going on in the background.  

I want to stress that we didn’t think we delivering poor care, we weren’t. We were delivering the care that met the physical needs of people with dementia and had to do this because of the numbers of people we were caring for. 

So have things changed?


We no longer have large institutional wards for people with dementia. People with dementia are cared for within their local community. Gladys 3

We have memory clinics where people are assessed and diagnosed early. People with dementia are supported to take control of their care and treatment including planning for their future and determining their wishes.

We have commitment from the Scottish Government to ensure that all people including people with dementia receive excellent person centred health and social care.

We have national programmes to support this including:-

  • Scotland’s National Dementia Strategy            
  • Older People in Acute Hospitals
  • Dementia Standards
  • Promoting Excellence
  • People at the Centre of Health and Care

So……………….back to my point about dementia touching each and every-one of us.

Yes it will:  be it personally or professionally, be it in the work place or at home. We will all have to be prepared to care for people with dementia as our aging population grows and we all live longer.

My current role as Alzheimer Scotland Dementia Nurse Consultant is as a result of the commitment from Alzheimer Scotland, the Scottish Government and a fundraising appeal by Kay the Dowager Duchess of Hamilton.

Gladys 4 I am a small cog in a big wheel but I am working with my colleagues across the region and striving to make sure “we get it right for every person every time” and particularly if that person has dementia.

Gladys Haining is an Alzheimer Scotland Nurse Consultant working at the Mental Health, Learning Disability and Psychology Directorate of NHS Dumfries and Galloway.

Telephone 01387 244007 (internal: 36606)


Dementia helpline: 0808 808 300

Leadership in a digital world by @dtbarron

Over the past few weeks, because of various activities I’ve been involved in, I have been considering leadership within a digital environment, specifically related to social media. derek1

Instantly two questions spring to mind 1) what do I mean by leadership? and 2) what is social media?


Malby in 1997 described leadership as “an interpersonal relationship of influence, the product of personal character rather than mere occupation of managerial positions”.   Bennis and Nanus add to this by described leadership as ‘influencing and guiding’ as having a ‘future focus’, a ‘vision for the future’ while remaining in the present.

The key aspects that interest me in relation to digital and social media leadership is the ‘interpersonal relationship’ and ‘influencing/guiding’ components of these descriptions.  To me they are key in my own engagement with social media, my own role as a leader.

Social Media

So, what is social media – it’s those FaceBook and Twitter things isn’t it, celebrity gossip and nonsense about what someone is having for their dinner?  Yes, these two systems are part of the social media landscape, and yes there are celebrities on them – however it’s so much more than that.  Perhaps you haven’t consider that the very act of reading this blog means you are engaged with social media albeit it in what can be described as a more traditional approach to it.

Social media is an overarching term describing a wide range of ‘platforms’ that enable people to interact with one another:

derek2  The infographic ( visually helps to describe the core aspects of social media.  NB the 2013 version of the infographic has been simplified into four categories, follow the link if you want to see the 2013 version.

The infographic shows clearly that social media has multiple uses and multiple systems to use depending on what it is you want to achieve, who you want to engage with and who you want to share your message with.

In this blog I only want to focus on one platform – Twitter and share why I use it.

Some stats

80% of the UK population access the internet on a regular basis

60% of the UK population have a smartphone

The sixth most used app on a smartphone is – the phone: behind SMS, camera, Twitter, Facebook and internet browsing.

These stats simply demonstrate we are living in a changing world, the landscape around us is a dynamic place where people are doing things differently, where engagement happens in ‘new’ ways.  We have a choice embrace these developing networks as leaders or be left behind.  To be honest, I know some people who are very happy to be left behind – is that you?  If it is, don’t worry social media isn’t for everyone, we went through the same ‘pain’ with email and some still don’t see the need for it – to be fair, why would they when we’ve still got pigeons?


derek3  From my personal perspective I use a variety of social media platforms to engage with a wider community – Twitter, Google+ (struggle to understand it), WordPress (use it frequently), (use it but not sure the point of it), Tumblr (just started to use it), LinkedIn (got it, but not sure why), Instagram (got it, seems pointless), Vine (too old to understand it or find a reason to use it) and even have a Facebook account (only post my blog to it – I’m not a fan!).  Some of them I don’t really understand and only have them because I’m curious what they do, others I use more frequently to share and shape opinion, to listen to the views of other healthcare professionals as well as people using our services.

My most used medium is Twitter which is a key engagement tool for me in sharing with a much wider community than I could every have hoped to do by ‘traditional’ means.  At an event I was at last week #techlearnscot @jonbolton used a quote from Douglas Adam’s  Hitchikers Guide to the Galaxy

 “I’ve come up with a set of rules that describe our reactions to technologies:

1. Anything that is in the world when you’re born is normal and ordinary and is just a natural part of the way the world works.

2. Anything that’s invented between when you’re fifteen and thirty-five is new and exciting and revolutionary and you can probably get a career in it.

3. Anything invented after you’re thirty-five is against the natural order of things.”

 We are all aware of the age profile of NHS Scotland (indeed Scotland as a whole) – perhaps Adam’s explanation helps us understand why I’m often told “I don’t do Twitter”  as it’s obviously against the natural order.  In fairness, since 35 was a long time ago for me, it might also explain why I don’t really understand some of the other social media systems I mentioned above.

I’ve been on Twitter for two years, the first six/eight months I didn’t tweet and only looked at it perhaps once a day or once every couple of days.  I now use it daily, I enjoy engaging with a wide network of people from across the world.  I get to share events as they occur and help to influence thinking of others, while also being influenced.

A key use for me is to access contemporary information, research and academic papers.  The fascinating thing for me is, as I now follow people who have similar interest e.g. mental health or leadership, I have information that is of interest ‘pushed’ to me, I don’t always need to go looking for it.  However it also widens my interests by having information ‘pushed’ to me that I ordinarily wouldn’t go looking for, simply being on Twitter has expanded my interests and knowledge.

Most of our conferences and events across NHS Scotland have twitter #tags, this allows me an insight into what is happening elsewhere when I am unable to attend.  I enjoy being influenced and challenged in my thinking, often tweets from conferences contain simple reminders of why I am a nurse – I never get tired of refreshing my commitment.


Traditional hierarchies do not exist in the same way within the social media environment, access to people who you would not ordinarily have contact with are open to anyone (I blogged previously on this topic).  We work in a system that aims to be more transparent, to be more approachable to ensure we have people at the very centre of care.  Twitter is one more medium through which we can listen to the views of others – those using services, colleagues and the wider healthcare world.  Our new Director General and Chief Executive of NHS Scotland is on Twitter (@pag1962) why not open an account and connect with him today?

Quick tips

Open an account (free) add a picture and a short biography (my advice for those who are professionals is to identify yourself as a professional).

Find someone you know is on Twitter and look through who they are following – if anyone they are following is of interest then you simply follow them as well.

Check it once a day, just have a look, no need to tweet anything.  Retweet something that interested you, only once you feel comfortable do you actually need to tweet something original.

Enjoy it – and if you find you are not enjoying the interaction and the engagement, then simply stop.  At the very least you’ll have empirical evidence of why its not for you and not simply because your over thirty five! (NB youngster <35yrs can ignore the last statement).

Some suggestions to get you started:

  •  @kendonaldson
  • @hazelNMAHPDir
  • @personcntrd_DG
  • @jeffAce3
  • @davidTheMains
  • @weemac63
  • @dghealth
  • @ayrshirehealth
  • and of course my own Twitter account @dtbarron

A final thought – does anyone know what the sixth most used app on a smartphone is?  Tweet me for the answer – hope to see you on Twitter in the near future.

Derek Barron is an Associate Nurse Director in Mental Health at NHS Ayrshire and Arran. he is also the Editor-in-Chief of our sister (?brother) blog @ayrshirehealth