Honest Reflections by Barbara Tamburrini

As this is now the third blog I have written for DGHealth, either there is a shortage of ‘willing volunteers’ or others have found better ways to say “maybe, possibly, perhaps soon” to Ken Donaldson when his charming request drops in the email ‘in-box’. Whatever the reason, I find myself agreeing to contribute and construct another brief moment of interest in our increasingly busy days. Having written previously about handover processes and the importance of good communication, I thought I would flip this on its head for this blog and consider the ‘inward’ communication reaching our ears from eager and sometimes over-active media sources and outlets.

A scan of headlines published over recent times don’t make happy reading for hard-working and dedicated NHS employees trying their best to simply ‘stay afloat and fight the fire’. Over the last 4 days, a number of reports sum up the general gist of current NHS news:

  • 9th Feb 17 – “Worst A&E waits ever, leak suggests” – BBC News
  • 8th Feb 17 – “The NHS and its crisis: Myths and realities” – Sky News
  • 7th Feb 17 – “Scotland’s A&E departments miss key waiting time targets over festive period” – Daily Record
  • 7th Feb 17 – “Maternity services in Scotland ‘beginning to buckle’” – BBC News
  • 7th Feb 17 – “Ageing UK midwife workforce on ‘cliff edge’, warns RCM” – Nursing Times
  • 7th Feb 17 – “NHS [Scotland] cancels 7740 operations due to lack of resources” – STV News
  • 5th Feb 17 – “Scotland patients waited more than a year for hospital discharge” – Sky News
  • 5th Feb 17 – “Revealed: The hidden waiting list scandal for Scotland’s NHS” – Sunday Post
  • 5th Feb 17 – “Growing waiting times threat to NHS” – BBC News

The recent coverage by the BBC assessing the state of the NHS across the UK in their NHS Health Check Week raised issues including a perception of desperate times inside A&E departments, analysis of patient flow reducing to a halt and “clogging up” hospital wards and frontline services being radically changed in attempts to overhaul health provision in the wake of the publication of NHS England’s five-year plan for the NHS in 2014. Indeed, as recently as 15th January 2017, chair of the BMA, Dr Peter Bennie was quoted as stating the Scottish NHS was “stretched to pretty much breaking point” and “heading for a breakdown” unless the government acknowledge the disparity between the current comprehensive service provision and existing funding levels.

So what does all this mean for humble workers ‘at the coal face’ and patients who so desperately rely on the NHS and our contribution within it? Dr Bennie wisely points out that honesty is required when assessing all elements of our much loved but potentially deeply troubled NHS. Honest reflection on our actions and behaviours as NHS staff is required to ensure we are all maintaining a focus firmly centred on our patients and clients. In a profession which is becoming more and more challenging with morale which seems to be ebbing lower and lower, can I really state with certainty that my focus is always upon my patients?

If I am looking at my last shift on duty, as part of the DGRI capacity team, I know that the greatest majority of my time was spent considering patient care but, the complexities of the work involved in capacity management mean a constant ‘juggle struggle’ between complicated discharges, patients keenly attending for their long-awaited surgery and fast and furious emergency admission rates with significant staff shortages thrown in to make life really interesting. This is a really difficult environment to function effectively, positively and proactively.

Its exceptionally difficult to have to say “I’m really sorry but I don’t have anyone who can give you a hand at the moment” to hard-working and struggling colleagues whom you respect and want to help. This inevitably influences work-focus and morale, sometimes away from patients and onto less fruitful, less important areas – we’re only human after all! I’m sure many of you reading this blog can identify with this and acknowledge that there can be times when we recognise that our concentration has slipped away from the real reason we are all here. This honest reflection is being actively encouraged in nursing through the revalidation process which will positively impact the profession in the future with a similar process in place for medical staff.

Honesty is also required from patients and clients using NHS services with individual ownership of health and the impact of lifestyle choices upon this of fundamental importance. The vast majority of NHS patients freely and actively claim this responsibility but this is not always the case in some crucial clinical areas like Emergency Departments. For the headlines to stop, the public also need to do their part. In a recent article in Glasgow’s ‘Evening Times’ (9th January 2017), it was stated that around 1 in 6 Scottish ED attendances may be unnecessary at a potential cost of £33 million and whilst ministers have provided responses aimed at removing any punitive element and reassuring the public that they are right to be concerned about their health, this concern needs to be correctly channelled for current pressures on health services to be eased. Patients with 3-month history of injuries, minor ailments which could be assessed elsewhere and those telling us they didn’t bother trying their GP as “they wouldn’t get an appointment anyway” are all too frequent presentations in busy ED’s. In my ‘other role’ as an ANP in ED, every time a patient told me this, I called the surgery myself and was given an appointment that day for their patient so, as well as accepting ownership of their own health, patients and service-users also need to be well-informed, confident and comfortable about the health services they access and when they utilise these valuable resources.

My feeling is that an organisational honesty also exits within current healthcare with ‘the powers that be’ having a responsibility to consistently and carefully examine the healthcare delivered with rectitude and reliability. We are somewhat fortunate in that we have an organisation who actively engages with staff through measures such as #ontheground, weekly core briefings, active and lively facebook and twitter accounts and the informative and interesting DG Change website (http://www.dg-change.org.uk). Indeed, this weekly blog also serves as a useful interactive communication with reflections and comments on posts actively encouraged. But is this enough? I would argue that even though these proactive measures exist in NHSDG along with many other approaches, staff morale remains low in some clinical areas and sickness absence rates are running well above optimum levels in some departments. So, are the current measures of engagement between the organisation and its employees inaccessible, uninteresting or unimportant to some staff, not effective enough, not addressing the correct issues or simply not delivering the desired impact? Although impossible to answer within this blog, the significance of this question and the consequences associated with it, must remain high on the agenda if staff empowerment, engagement, motivation and morale are to be maximised as we hurtle head-long towards a new hospital and evolving chapter in our healthcare provision.

Every ward I go in to during my capacity shift has AHP’s, nursing and medical staff who look tired, strained and burdened by an ever-increasing workload with constant financial and resource pressures making the job all the more difficult. But, and this is crucial, staff continue to come to work to do the best job they can given these constraints. They continue to change rota’s to cover absences, work through breaks and past finishing times to help their colleagues and patients and they continue to ‘fight the fire’ with dedication, sometimes in the face of adversity. Healthcare staff MUST care about the service they provide, to deliver care which remains meaningful, appropriate, safe, effective and patient-centred.

Whilst we as staff have a responsibility to continually reflect on our own practice, this must be fully supported, actively encouraged and consistently underpinned by honest reflection at a strategic level on the current ‘state-of-affairs’ and how this can be promoted and enhanced within the existing inflexibility of financial austerity.

Therefore, returning to our news headlines, what does the future hold for the NHS locally and nationally? Locally, despite considerable challenges, there are exciting times ahead as we look to fully embed health and social care integration and also move our main hospital services into our new build. Nationally, the picture is less clear with ever-increasing financial pressures being placed on continually growing workloads in a society with greater demands in terms of health due to conditions such as obesity, diabetes, heart and respiratory diseases. This is compounded by an ageing population sometimes presenting with chronic conditions which one simply did not survive from a decade or two ago.

hould we as NHS employees, the general public, healthcare service providers and users be concerned about the growing tide of negative headlines? Perhaps. Maybe these give an insight into the ‘health of our NHS’ – gosh, that’s a worrying thought. Or maybe, we now live in an environment feeding off news negativity and scandal in which we have all become de-sensitised to minor challenges therefore pushing media providers to ‘raise-the-bar’ in their reactionary reporting of our beloved NHS which would have, until relatively recently, been ‘off-limits’ to the eager reporter looking for a scoop however vague, misleading or sensational.

Lets return to our honesty theme. Within this blog, I have suggested that some honesty is required in our NHS and this should also extend to the reporting of challenges and issues to a certain extent. The antonym to sensationalism, where bad, critical or damming NHS news is forbidden with offenders punished by a stint taking minutes for certain western hemisphere parliamentary press conferences, is also not good for contemporary healthcare since this stifles and prevents honest reflection from which, lessons can be learned and development thrives.

There is every likelihood that the headlines wont go away and they may even increase in frequency or adversity. Perhaps though, if we all contribute in our own way, positive, honest and transparent analysis at individual, peer, organisational and national level will drive, develop and sustain an NHS we are all proud of and which we want to protect, however difficult or complex the discussions and decisions.

Barbara Tamburrini is an Advanced Nurse Practitioner at NHS Dumfries and Galloway



One year on….by @kendonaldson


BlavatarIt was in November 2012 that a friend of mine, Ros Gray of the Early Years Collaborative, suggested that I start a blog for NHS D&G. I had become interested in Twitter and the power of linking to research articles, national documents and blogs and Ros knew that Derek Barron, Associate Nurse Director for Mental Health at NHS Ayrshire & Arran, had established his blog, www.ayrshirehealth.wordpress.com, earlier that year. She introduced me to Derek and from then on there was no going back.

Derek sent me a detailed email outlining how to set up and start a blog and tips on maximising readership. I must confess there then followed a few months of inactivity while I toyed with the idea before finally taking the plunge. After setting up the blog itself I had to ensure I would have some interesting blogs to publish. I also had to decide what sort of content NHS D&G desired and what the underlying ‘ethos’ would be.

Passing the buck

I therefore emailed a mixed bag of nurses, doctors, pharmacists, managers, therapists and Chief Execs asking if they wished to contribute. The remit would be “900 or so words, any topic you wish but related to healthcare and pictures if possible”. So basically the content and ethos would be decided by them, not me!

Ken 2By the time I had 14 willing bloggers I felt I could get started and set the date as March 22nd 2013. I had decided to emulate Ayrshirehealth and post once a week and as they posted on a Wednesday I decided to go for a Friday. I had booked a session on our Wednesday lunchtime meeting to discuss ‘Social Media in Healthcare’ but also launch the blog. This way I had no choice but to ensure everything was set to go.

Ready for launch

The final step was to obtain permission from senior managers and IT to use the DG2all email address so that I could email the link to all staff members of the health board weekly. @lauralougraham7 stepped up to the mark and agreed to provide me with our first blog, “Never underestimate the importance of safety briefs” and we were off.


In the past year we have had 50 blogs (2 weeks off for Christmas and New Year). 15 by doctors, 14 managers, 7 nurses and 6 Guest blogs. The rest are made up from IT, carers, AHPs etc. The most popular categories are person centred care, patient experience, communication, common sense and ethics.  We have had a total of 20,731 views and 263 comments.

If you access the blog from the email link then this is recorded as ‘Home page’ so, unsurprisingly, this is the biggest hit at 13,301. However if the blog is accessed via Twitter then that blog itself is recorded and the biggest has had 727 views with 474 second to it. This drops down to a few blogs in the 20s and 30s.

Ken 1We have had 19,365 views in the UK with 417 in the USA and 104 in Australia. New Zealand, India and Canada follow with 80, 65 and 59 respectively. There is a total of 87 countries worldwide where the blog has been viewed ranging from Tunisia to Trinidad and Tobago to Thailand. I am still impressed that we had a reader in the Philippines at the same time as Hurricane Haiyan was laying waste to the country. I would have imagined they had something better to do!

The year ahead….coffee

I think the list of categories above probably establishes what the ethos of the blog is but I have a slightly different take on things. Here in the Renal Unit in DGRI there is a longstanding tradition of starting the day with a cup of quality coffee. This involves general conversation that is extremely variable; the current headlines in the news, a new drug that’s been announced, the experience of a patient seen the previous day, an update from a meeting attended or just a funny story.

Ken 3I like to think of the blog as a similar experience for everyone in NHS D&G and beyond – have a cup of coffee (probably not as good as an ‘Isles Special’) and spend 5 minutes hearing the thoughts and opinions of a colleague. It will probably not change the World or indeed Dumfries and Galloway but it may make you think a little differently about your practice or realise what happens in different areas of the Health Board. Or it may just make you smile. Whatever, I intend to keep the blog going for at least another year and hope you will join me.

I would like to thank Derek Barron (@dtbarron) for all his help and support in setting up the blog. I would also like to thank Ros Gray (@rosgray) for the inspiration and encouragement. I am extremely grateful to all the bloggers to date and would be delighted if anyone reading this would be keen to contribute. Please email me on kdonaldson@nhs.net of you wish to have a go. Finally I would like to thank you Dear Reader for continuing to view the blog.

Ken Donaldson is a Nephrologist and Associate Medical Director at NHS Dumfries and Galloway