Life changing events by Christiane Shrimpton

For those of us who have been working in healthcare for some time it can be difficult to remain aware of the patient perspective. For many patients what is part of everyday work for us is a significant change in their life. While I would not quite advocate the notion of medical students being forced to experience what life as a patient is like, this article really resonated with me. There still is a significant power difference between doctors and patients, something that Realistic Medicine is planning to reduce by promoting a shared decision making approach. And injuries or illnesses can lead to the traumatic disruption described, to the sudden loss of something you have taken for granted. A situation I am only too aware of at the moment.

I suddenly and rather unexpectedly found myself on the receiving end of healthcare following a cycling accident while on holiday in France. I seriously injured my arm and was stuck on the road until the ambulance arrived 30 minutes later. After several phone calls from the ambulance crew I was on a 60 minute journey to the nearest hospital with X-ray facilities. And unlike in the UK I was unable to get any pain killers until I got there as the ambulance did not have any paramedic. It rather brought it home how vulnerable you feel when you are in pain and don’t understand what people are trying to tell you – a situation our patients often find themselves in. While we don’t speak French it is very easy to use medical language because that is what we do with each other all the time. Are we always making sure patients understand? And how often do we really try to understand their perspectives and priorities, find out what the impact on them is? 

My experience of the doctors, nurses and other staff I have interacted with has mostly been good. They had sympathy for the loss I am so strongly experiencing and I have received a lot of excellent care and kindness. I have really appreciated what the NHS offers us here in the UK. And that has included the local hospital, my GP and the tertiary referral centre. Communication between all three has been good and the treatment I have and still do receive has made me feel very well cared for. There have also been aspects I have been less happy with. Overhearing that “bed 10” needed medication felt very impersonal and reminded me of Kate Granger’s # hello my name is campaign for more compassionate care. And there have been occasions when the information I was given by different members of the team seemed to be contradictory. That leads to an element of confusion and uncertainty.

All this has also led me to reflect on my role as an ophthalmologist. Have I been as understanding as I could have been when I had to tell people they will not get their sight back, they have to stop driving? I have always tried to understand the impact on them but I am not sure someone else can ever really understand what it is like. And I know that no matter how hard we try sometimes the message does not come across as we would wish. 


This was just one of the two very significant changes in my life last year and they could not have been more different. The other one was entirely planned, a career move I had been working towards for a while. After more than 18 years in my previous mainly clinical job as an ophthalmologist I moved to Dumfries to take up the post of Associate Medical Director in the Acute and Diagnostics team. And I could not have been made to feel more welcome. It is fantastic to work with so many people passionate about making a difference to patients. As the news headlines remind us regularly, the NHS is under increasing pressure. So it is really good to see teams come up with innovative ways to overcome challenges. And it is also very important to keep supporting each other in difficult circumstances. Not everyone finds it easy to consider or adjust to different ways of working. I really enjoy getting out and about, meeting patients and staff, listening to their stories and connecting with teams. 

What my experience “on the other side” has also made me very aware of is how easy it is to come across differently to how we intend. And this is much more likely to happen while we feel under pressure ourselves, a common occurrence in the NHS today. We are all aiming to provide the best care we can for our patients. Let us remind ourselves to treat each other with compassion, too, and make the most of working together as multidisciplinary teams. I look forward to joining all the different areas to review our services and consider what improvements we can make. In all of this good communication and an understanding of each other’s perspectives is so important. Change is ever present and in the increasingly fast pace of life and healthcare delivery today all of us need to work closely together to support each other and achieve the best outcomes for our patients.

We will all experience life changing events at times. Some of them will be welcome, exciting and motivating. Others will be difficult and challenge us. Those of us working in healthcare are in the privileged position to be able to make a positive difference to people who are struggling. And we can all look out for each other and help those of us who like me will have to adjust to a different way of life with unexpected restrictions. 


Christiane Shrimpton is a Consultant Ophthalmologist and Associate Medical Director for the Acute and Diagnostics Directorate at NHS Dumfries and Galloway

The Key is in the Room by Eddie Docherty

edLast year, Scotland’s ­population was estimated to be 5,424,800 – a record high and an increase of 6 per cent on 2017. The largest increase of 31 per cent was in the 75 and over age group. It is, of course, good news that we are all living longer. However that increase in older age groups is hugely significant for our health and social care system.

The likelihood of being admitted to hospital is, as expected, highly ­correlated with the age of the ­population. Around one person in three of the Scottish population aged over 75 was admitted at least once to hospital in 2016/17. By way of contrast, just under one in 11 people aged 25-44 were admitted. Dumfries and Galloway had some of the dynamics no doubt many boards and hospitals have: staff who were doing their utmost, in sometimes very difficult conditions, endeavouring to give the best care they ­possibly could.

At the same time as we have an increasing demand in our hospitals, we have other pressures to manage which can impact on care, for ­example ongoing difficulties in recruiting to a range of posts, and a perennially challenging financial context. So when Healthcare Improvement Scotland’s inspections on the care of older people in two of our hospitals highlighted a number of concerns and challenges, it was a very difficult message for staff to manage – even though we knew the findings were accurate. There is a natural emotional response that comes from staff who are working hard, doing their best and feeling like the criticism is unfair. After all, no one was ­coming to work to do a bad job. I have no doubt many who have received challenging inspection reports have felt the same. Yet, after that initial, understandable, emotional response, what has happened since those inspection reports were published has been hugely positive. That subsequent reaction has been down to the staff themselves, who chose to respond to the challenges in a way that that has empowered them and benefited patients.

The key to the positive response was in managers and staff using the feedback, taking stock and ‘owning’ the areas that needed improvement. There was no one silver bullet to the improvements taking place but a combination of factors which included an understanding that answers to improvements lay ‘in the room’; teams delivering care were empowered to make the changes they needed to make; we had a strong group of individuals who wanted to make the changes; and the key thing to change was creating a culture of person-centred care and it was staff who could shape this. So, having weathered the ­challenge, staff developed an action plan and used improvement methodology from Healthcare Improvement Scotland’s ihub to support the improvements, look at best practice from ­elsewhere to understand how to make change happen. It has taken at least 6-8 months for changes to feel tangible and there have also been some personnel changes which have added impetus to the cultural change. However, it is important to say that it is the teams themselves that have taken responsibility for change.

The latest inspection reports in to the two hospitals concerned are in stark contrast to the initial reports – inspectors positively commenting on team work, ethos and person-centred care.

It has been a major turning point for staff. It feels like there has been a clear psychological change – and a change to a more positive ­perception of inspections themselves. Staff will now welcome the inspectors and the inspection process, knowing that this is an opportunity to get better. They know that they can make the most of the improvement support that is available from Healthcare Improvement Scotland and feel they are able to embrace both aspects. One of the added benefits of the changes was that, across the service in Dumfries and Galloway there has been a less fragmented feeling, and more of a feeling of a team ethos. In addition, it also feels like there has been change in the working environment to one that is a more open, learning environment. However, there remains room for improvement and I’m not saying we have solved all issues.

But it feel like we are more confident and in a better place to use challenges from inspections, and the improvement support available, to improve care in a way that might not have happened before. For that, the staff in Dumfries and Galloway hospitals can take a huge amount of credit.

Eddie Docherty is Director of Nursing at NHS Dumfries and Galloway.

This article was originally published in the Scotsman online on the 15th January 2019 and can be found here.



“Undetectable=untransmittable….but only if people are diagnosed and treated” by Gwyneth Jones

As a trainee doctor I moved to Edinburgh in the late 1980’s to start a career in Infectious diseases. The wards were full of people my own age diagnosed with AIDs and given a life expectancy at best of a few years. Many had recurrent, difficult to treat opportunistic infections and suffered progressive decline with weight loss and dreadful skin conditions. Often siblings and close friends were also infected and dying.  As ID specialists we developed skills in breaking bad news; informing and testing terrified partners and supporting patients and families with both a terminal diagnosis and highly stigmatised condition. 

HIV testing was seen as a ‘special test’ and provided with wrap around counselling that benefitted those who tested positive but became a barrier to many clinicians who recognised the importance of testing beyond the initial ‘high risk groups’.  It took considerable campaigning by Lord Norman Fowler in 1987 to persuade Mrs Thatcher that informing the public would save lives.  The PM feared harm would come from discussing risky sexual behaviour but ultimately the hard hitting Tombstone campaign featured on bill boards, cinemas and leaflets to every household. Without effective treatment the only answer to the AIDS epidemic was ‘Don’t die of ignorance’ and protect yourself. The tone and message remained grim.



Thankfully, much has changed but there have been no further government funded health campaigns and many clinicians remain unaware of the transformation in treatment and prognosis for HIV. I am delighted that my F1 colleagues Dr David Gibson, Dr Patsy Fingland and Dr Chryssa Neo have been exploring how we can better inform colleagues about the need for increased HIV testing and ensure that Dumfries and Galloway plays it part in reaching the end of the HIV epidemic.

December 1st 2018 celebrated the 30th Anniversary of World AIDS day. People diagnosed early with HIV can now expect to remain healthy with near, normal life expectancy. Treatment options include single tablet regimens of combination antiretrovirals started at diagnosis regardless of CD4+ cell count. Damage to the immune system is avoided and side effects are much reduced.  But it has been the findings of the PARTNER studies that provide an extra piece in the quest to eradicate HIV. Since patients receiving treatment that had undetectable viral load showed no ongoing transmission. UNDETCABLE=UNTRANSMITTABLE.

The challenge now is to ensure all those infected are tested and know their HIV status. This worldwide ambition is encompassed in the UNAIDS 90-90-90 campaign……

So how can we improve? 


We want everyone to feel that they can prompt HIV testing. Doctors in training may feel uncertain as they rotate around new wards but we hope to encourage nursing, pharmacy and dietetic staff to recognise indicator conditions and suggest HIV testing. Our poster aims to increase awareness and we will follow up our recent survey with more ‘bite size’ HIV education.

The message is simple. You don’t need to worry about asking ‘risky questions’. You simply need to offer a test and very few patients decline.

HIV testing saves lives. 

Gwyneth Jones is a Consultant in Infectious Diseases and General Medicine and was helped in the writing of this blog by David Gibson, Patsy Finland and Chryssa Neo, all Foundation Year One Doctors currently working at NHS Dumfries and Galloway

Today is Carers Rights Day by Linda Owen

So what? some of you may ask, “that doesn’t matter to me.” Well for 6000 people in the UK who become a Carer each day it does matter. Today is about raising awareness of the rights that they, as Carers, have.

So who are Carers?

Carers are people of any age who provide unpaid help and support to a relative, friend or neighbour who cannot manage to live independently without the Carer’s help due to frailty, illness, disability or addiction.

So why does this matter?

You may or may not be a Carer, but more than likely in your daily working life you will meet Carers. Did you know 1 in 10 of all people in Dumfries and Galloway are Carers?

Carers in Dumfries and Galloway provide more care than the NHS, Council and the Third and Independent Sectors combined as shown below. Carers are a huge asset to our Health and Social Care Partnership and to the people of Dumfries and Galloway.

The Act aims to support Carers in Scotland to improve their health and wellbeing, so that they can continue to care, if they so wish, and have a life alongside caring.

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Some people are proud to be Carers but others don’t want to be identified as a Carer as they see that they are a husband, a daughter or a friend looking after someone important to them. It doesn’t matter if someone identifies as a Carer or not, they still have rights.

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So what rights do Carers have?

Carers having rights is not new. There have been specific Carers rights for more than 20 years, including the right to have an assessment of their needs.  Building on those rights The Carers Scotland) Act 2016 (the Act) took effect from 1 April 2018. The video below highlights they key elements of the Act

This blog focuses on the four of the new rights for Carers.

Right 1 – Adult Carer Support Plan or Young Carers Statement

Carers have the right to an Adult Carer Support Plan or a Young Carers Statement. This is a plan for Carers to identify their needs and their personal outcomes.  This is available to any Carer no matter how many hours of care they provide, no matter their circumstances. A plan can be downloaded here

Help and support to complete a plan or statement is available from Dumfries and Galloway Carers Centre.

Right 2 – Support for Carers

There is a duty for Local Authorities to provide support to Carers, based on the Carer’s identified needs through the support plan or statement which meet the local eligibility criteria. More information can be found here

Right 3 – Information and Advice

There is a requirement for Local Authorities to have an information and advice service for Carers which provides information and advice on, amongst other things, emergency and future care planning, advocacy, income maximisation and Carers’ rights.

We are lucky in Dumfries and Galloway to have a range of great third sector Carers Organisations who will provide information and advice to Carers, see links at the end of the blog for more details.

Right 4 – Involvement in Hospital Discharge

There is a duty on the NHS to inform and involve Carers if the person they care for is discharged from hospital.

It can be difficult to find time to have conversations with Carers. However there are real benefits to taking the time to have a good conversation.  This can lead to

  • Clinicians and others having a better understanding of the daily routine
  • Improved communication and trust with users and Carers
  • Shared decision making may assist in achieving clinically preferred goals more quickly
  • Increased patient satisfaction

So what can we do?

We as staff within the partnership can help

  • to identify people as Carers,
  • to support people who are Carers by listening,
  • offer signposting to Carers to access specialist Carer information and advice
  • take a moment of reflection and think about how your service interacts with Carers

If you are not sure that you know enough, don’t worry there are Carer Aware Training Modules on the electronic learning systems of both NHS Dumfries and Galloway and Dumfries and Galloway Council.

For more information on Carers Organisations see below:

Alzheimer Scotland,



Dumfries and Galloway Carers Centre



Support in Mind

User and Carer Involvement (UCI)

Linda Owen is a Strategic Planning and Commissioning Officer at NHS Dumfries and Galloway

In a heartbeat by Caroline Sharp

I have recently been very involved in all sorts of discussions relating to the move many of us will make in the coming months from Crichton Hall to Mountainhall Treatment Centre. Its a move which is going to affect many of us in a very personal way – just as the move to our new hospital last year affected the lives of all the staff based there, and also those who work in the wider system.

The impact of change – whether we choose it, or not, is profound and lasting on each one of us, and affects us all differently, because each one of us is different, and unique, and in our own way a special part of the best collective asset our organisation has –and that’s us….you and me ….the ‘Workforce’!

We are the heartbeat that keeps our organisation alive, working well and doing all the great stuff that our patients and clients need, and expect from us every day. We all have a part to play; we are all a piece of the organisational ‘jigsaw’ and connect with each other in so many different ways and levels, and without any one of us, we are collectively less resilient as a result. So what gets in the way of us being the best we can be every day – being the high performing, integrated and resilient teams we all aspire to be a part of?

Thats a really good question, and one I have been pondering on for quite a while now!

I believe there are 3 big issues that we all face, and which affect us as individuals, teams and as a whole organisation, affecting our ability to stay resilient, and cope each day with the complex and challenging work we do together and the changes that are an everyday feature of our work

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The first of our priorities is Workforce Sustainability. This is about our ability to have the right people, with the right skills and qualifications, in the right place at the right time. Fairly easy to type, very very challenging to maintain sometimes! I know how hard teams are working to attract new staff to NHS D&G, and our challenges are not just  inside our organisation, but also about the region we live in, and the ageing profile of our population and our workforce.

Having a sustainable workforce is about Supply, Attraction and Recruitment (are people with the right skills, knowledge and attitudes available to us here in D&G in the first place via great national and international education and training?),  do they want to work for us (or would they rather go to Glasgow, or Tescos?), and how do we make their connection and entry into our organisation sparkle so that they feel welcomed, valued and have direction and purpose?

Its also about Retention – how do we ensure that we, the staff, want to stay and develop? Its about Big Picture – national, regional, IJB and Board Workforce planning, and also about Every Day – having the team capacity and capability around us that we need to get the job done well, and feel OK at the end of our shift.

This leads me to my second big priority which is Staff health and wellbeing. Being well and at work is IMPORTANT. All of the evidence says that doing meaningful work is good for you and me, and that physical, mental and spiritual wellness are all equally important. When I am not well, I am definitely not at my best, and over the course of my career I have experienced periods of both physical ill health, and also mental distress, which have impacted on my ability and resilience, both at work and at home. At those times, it has been the team around me who have helped me to work through my challenges, and who have encouraged me to Get Well Soon and rebuild my resilience.

I know that the ultimate responsibility rests with me to do the right things to keep myself healthy (diet, activity, managing my work / life balance/ taking good care of myself as well as others at the times that others I care about need some extra support from me – you know the drill!) And yes, if I am Working Well, then I am a stronger member of the team, and that means others get the benefit too – my colleagues, and the staff, patients and clients I am here to support. So good staff health and wellbeing is actually good for everyone’s health!

And so to my third priority – Organisation culture.

Culture is about how we are, not what we do. (As Fun Boy 3 said, ‘It aint what you do its the way that you do it!’). Its about how it feels to be at work, and thats a rich and exotic cocktail of ingredients that sometimes is hard to put your finger on, but easy to identify when its not right (like adding salt instead of sugar to your favourite desert). Our Culture is created by us – you and me, and the other 4500 staff who are working with us in our organisation. And thats an important message I remind myself of each day – i’m a part of this, and I make a contribution to how things are around here, so I need to take my bit of responsibility for it, and help others do their bit well too.

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I remind myself that our CORE values (Compassion, Openness, Respect and Excellence) are a great guide light for us all to strive towards, which can help us towards a positive Culture in which we feel valued for what we bring to work each day (myself!), and feel safe to raise both concerns and ideas for improvement, so that we can all benefit from the talent and creativity that we have across the organisation, and see things afresh through the eyes of another colleague, someone who can help me to see into my own blind spots and help me change and improve.

The good news is – we are on the journey, and are changing things to help make improvements in each of these 3 priority areas. (I can perhaps come back with a Blog part 2 about that if Ken Donaldson will let me?!). But we all have more to do, and there is opportunity, and need for every one of us to contribute to our collective team health.

So lets stay focused on our opportunities and our good conversations this winter so that we support each other in our teams to be the resilient, integrated and high performing NHS D&G team we all want to be part of!

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Caroline Sharp is Workforce Director at NHS Dumfries and Galloway




Patient Safety Group and the Pressure Ulcer Collaborative by Alice Wilson

Over the last few months you will have seen information about the Patient Safety Group (PSG); this blog builds on one area of PSG work, using information and learning to address issues we see from reported incidents. 

More than likely anyone reading this blog will know something about pressure ulcers and, in PSG, we hear about the worst ones.  The grade 3 and grade 4 ulcers; based on the European Pressure Ulcers Advisory Panel (EPUAP) grading tool (there is a picture at the end just in case you’re reading this over breakfast and likely to be put off!)

Over the last couple of years we have seen a rise, not only in the number of pressure ulcers overall, but in the number of more severe healthcare acquired ulcers.  Pressure ulcers are painful, they slow recovery, cause anxiety to patients and their families and are largely preventable.  

What do we do?

It would be easy to get annoyed or despondent at this increase in harm to patients however there is a better way to improve and that is to work collaboratively with teams across NHS Dumfries and Galloway to test improvements at ward and community team level. 

Seven teams from across the Board volunteered to take part in a pressure ulcer collaborative; here are some examples of the projects being undertaken:

  • Area:  Castle Douglas Hospital

Project: Reducing the Pressure. 

The project team aim to reduce the incidence of acquired pressure ulcers in Castle Douglas Hospital by 50% by April 2018.  They aim to do this by increasing staff knowledge and understanding of the prevention and management of pressure ulcers.


  • Area: Community Nursing, Rhins 

Project: Ensuring that Air Flow Mattress Users have knowledge of use and function.

They have completed an initial audit of 6 user groups both NHS and non NHS, and have evidence that little or no instruction on use of air flow mattresses has been received by the majority.  They have developed a teaching/information pack and Lynne McCourtney (Practise Education Facilitator) has nearly completed delivery of 20 minute information sessions for each of the user groups.  Karin Jack and Ann McCollum are involved and intend to re-audit personnel, hoping to evidence an increase in user knowledge by at least 50%.  They have also created a PPP and a Poster depicting the process followed. 


  • Area:  Podiatry with DGRI wards

Project: CPR for Feet (Check Protect Refer) Implementation

CPR for feet is a national initiative developed with the Scottish foot action group following and audit in 2013 which showed 57% of patients with diabetes had not had their feet checked on admission to hospital and 60 % of people at increased risk of ulceration did not have pressure redistribution in place.

The project aims to ensure that all patients admitted to hospital have their bare their feet checked and this check recorded in the notes. As a result of this check anyone discovered to be at increased risk of developing a foot ulcer due to neuropathy, previous ulceration or previous amputation should have protection   with appropriate pressure redistribution put in place to reduce this risk of ulceration. Finally anyone with foot ulceration should be referred onward to Podiatry.  It is planned that roll out will commence in the pilot ward in January  2019 in conjunction with Podiatry, Clinical Educators and ward Link Nurse following initial data collection which is taking place at present .


The other teams working on projects for the Pressure Ulcer Collaborative are;

  • DGRI B2 
  • DGRI B3 
  • DGRI C6 
  • Galloway Community Hospital, Dalyrmple and Garrick Wards 


Tissue Viability Nurse

It is also fantastic to take this opportunity to introduce Emma Whitby who has been appointed as the Tissue Viability Nurse Specialist and will join and support the collaborative. 

Emma says “I am delighted to become the new Tissue Viability Nurse Specialist for Dumfries and Galloway.  I am very much looking forward to getting out there and meeting all teams and departments and finding out what has been going on and where the learning needs are with an initial focus on pressure ulcers.  My role as the Tissue Viability nurse is not to be the “Dressing Nurse” but to support and educate all nurses on the management of wounds and pressure ulcers.  

I have joined the pressure ulcer collaborative group half way through but already I feel very motivated and enthused by the fantastic work that each group has achieved so far.  I will be on hand to support the groups involved and facilitate any learning needs that have been identified as well as supporting the Tissue Viability Link group.  I aim to mark the National Stop the Pressure day on November 15th with a challenge for all staff and I urge you all to get involved and generate discussions in your areas around pressure ulcers.  The purpose of this is to increase the awareness of pressure injury prevention and to educate staff as well as patients and their families” Emma Whitby, Tissue Viability Nurse Specialist

EPUAP Grading Tool,  available from

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Alice Wilson is Deputy Director of Nursing at NHS Dumfries and Galloway

Co-production – friend or foe? by Viv Gration

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Next week is Scotland’s Co-production Week (19 – 25 November). There is a lot going on across the country to share stories and experiences of co-production.

The word co-production is used regularly in conversations across health and social care in Dumfries and Galloway and in my experience generates a range of different reactions from people. I’ve seen people roll their eyes (in frustration?) “here is another buzz word or management term, ” others grimace (in confusion?) “what is it all about?” Some people shrug and are concerned that this will simply slow down progress and we shouldn’t have to bother, “we just need to get on with change” they say. For some people, myself included, there is a hope that this approach will genuinely make a difference to how we plan and deliver health and social care in the future.

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So, what is co-production? Are we doing it? And, does it work?

Co-production, according to the Governance International Co-production star toolkit, is when people with different interests come together as a group to:

  • Co-design
  • Co-deliver
  • Co-commission and
  • Co-evaluate

In health and social care, this means the people who use services, professionals, Carers, volunteers, providers and other stakeholders working together to consider how health and social care and support look and are delivered in the future.

Traditionally health and social care services have been designed and delivered by professionals working in partnership within the statutory, third and independent sectors.  With co-production the crucial difference is people in communities that receive care and support are involved in all aspects of their design and delivery.

We should already be consulting and engaging widely on any kind of service change. Co-production takes us to the next level of engagement. It’s crucially about doing with and not to people. It’s about recognising that people who use services and their communities know things that we, as professionals, don’t know.

Working in a co-productive way

  • can make a service more efficient and effective
  • can change peoples behaviours in how they use or deliver services
  • can place an emphasis on delivery of outcomes rather than just inputs and activity

100 days of co-production

In the USA there is a real emphasis on what Presidents can achieve in their first 100 days in office. It is amazing what can be achieved in a short period of time. For example, Franklin D. Roosevelt’s presidency began on March 4, 1933. During his first 100 days, a series of initiatives were developed that went on to successfully counter the effects of the Great Depression.

Perhaps a bit ambitious to think that we can counter all the challenges facing health and social care in Dumfries and Galloway in the same time period, however, using the 100 days to focus our efforts will be useful.

We have identified three topics to take into ‘100 day co-production labs.’ Co-production labs are essentially workshops to share experience, explore potential options for change, undertake tests of change, evaluate these and understand how and if they worked. This will help us to decide whether to embed these as part of routine service delivery or to try something else.

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Governance International Co-Design Toolkit © 2012

The topics for the labs have been identified by communities across Dumfries and Galloway. It is anticipated that a focus on these particular areas of care and support will bring some benefit to design and delivery of health and social care. They will also give us the opportunity to test out our co-production skills to understand what does and doesn’t work for us. The labs are part of a wider Co-production star training Programme, which is facilitated by Governance International in co-operation with the ALLIANCE.


This is an exciting time with an opportunity to try a different approach. It will require hard work and commitment over these 100 days. But we’re all set and raring to go! Watch this space – see you in 100 days!

Viv Gration, Strategic Planning and Commissioning Manager


For more information about the Dumfries and Galloway 100 days co-production labs contact Viv Gration on

For more information about co-production, including a range of case examples visit

For more information on Scotland’s co-production week visit