Dementia Awareness by Julie Garton

Dementia Awareness Week runs this year from 4 – 10 June. There are lots of events across the region supported by a wide range of individuals and organisations. This year, I’ll be promoting the use of a document called ‘This Is Me’ within acute hospitals and asking Dementia Champions and other colleagues across NHS Dumfries & Galloway settings to join in.

When someone with dementia comes into hospital, a care home or is receiving care at home, they and their family/friends may be asked if they have a ‘This is Me’ document.

What Is ‘This Is Me’?

‘This Is Me’ is intended for use by anybody with dementia, delirium or other communication impairment.

It aims to provide important personal information about the person from their perspective and those who know them best (family/caregiver) to help enhance the care and support given when the person is in an unfamiliar environment.  It’s crucial that we understand the person as an individual and take their personal history into account, helping us to communicate and engage with the person, which in turn can help us to prevent/alleviate stress and distress.

What are the benefits of ‘This Is Me’?

For the person, their families/caregivers – if the person with dementia has memory and/or communication problems, then a ‘This Is Me’ guides and supports staff to provide care in a way that respects the person’s choices, preferences and routines. ‘This Is Me’ can be a great opportunity to ask and find out information, that as family members we may not know – provoking good memories and conversation. In addition, a ‘This Is Me’ or similar may reassure people with dementia and their caregivers that we see behind the dementia and respect that person.

For staff – for professionals, it can help us deliver person centred care, and importantly, reduce the times we ask for the same information – the detective work has already been done.

Where can ‘This Is Me’ be used?

‘This Is Me’ can be used anywhere, in hospital, care homes, in primary care, respite care and is offered during Post Diagnostic Support.

When should it be completed?

‘This is Me’ always offered during Post Diagnostic Support but can be completed at any time.

Are there issues around confidentiality/sharing this document?

The document is the property of the person and/or their main care giver – it is not a clinical document and does not belong to any professional or service, the person/care giver decides what information is included and shared.

Once completed, the document should be kept in a place that is easily accessible for those providing care, for example, at the bedside, in a care plan. The information can help staff understand the persons’ baseline abilities, lifestyle, routines, likes/dislikes and gives great opportunities for conversation and engaging with the person.

What happens to the form if/when the person is discharged or transferred?

As it belongs to the person, it should go with them on discharge/transfer, and it’s also useful to check with the person and /or their main carer that the information remains up to date and relevant.

Living Well with Dementia

It’s important to understand that many people are able to live well with dementia, leading active and fulfilling lives for years after they first experience difficulties and receive a diagnosis, but coming into hospital can be daunting for all of us, and for people with dementia , this can be a frightening experience.

Whilst these days, a person with dementia may only be in hospital for a short time, how we communicate and support them will have an influence on the impact of the whole care experience and how quickly they can return home. We know that older people with dementia are more likely to be discharged to a care home than older people without dementia, have longer hospital stays and experience more falls and pressure ulcers.

We know that in Scotland around 93,000 people are living with dementia and we think around 25% of all acute hospital beds are occupied by people with dementia (Alzheimer’s Research UK, 2018), yet mostly, people arrive into our services without a document such as This is Me even if they have one at home.

“This is Me gives me golden information about an individual. The nuggets of information are priceless in helping to smooth the way to getting to know the person behind the dementia”

Gillian, Staff Nurse

‘This Is Me’ is just one of a range of tools that can support centred care, Getting to Know Me, Life Story work and a wide range of personal profile tools are available, many online, helping professionals to see the person, not just the patient.

I ‘m keen to hear about your experience/s of using This Is Me in your workplace – please contact me or, if  you would like more information about This is Me or would like a copy, please contact me at jgarton@nhs.net or 01387 246981.

Julie Garton, Alzheimer Scotland Dementia Nurse Consultant

“One Small Step for Dumfries and Galloway, one giant leap for Scotland” by Wendy Chambers

The occupational therapy mental health service is stepping forward this week and sharing their implementation of the Home Based Memory Rehabilitation (HBMR) programme for people with dementia at a National event in Edinburgh.

The event “Connecting People: Connecting Support” is showcasing occupational therapists contribution to dementia post diagnostic support, with the Home Based Memory Rehab programme centre stage, primed for a roll out across 5 other Health Boards in Scotland in the coming months.

Local occupational therapy staff Wendy Chambers and Alison McKean will be presenting during the morning live link session, and also leading along with Lynda Forrest in the afternoon workshop with the 5 Health Boards. The aim is for consistency of delivery for this evidence based occupational therapy intervention across Scotland, contributing to the developing evidence base and promoting best practice in post diagnostic dementia care

The event is being live-streamed and can be watched again at the following link

• video3uk.com/actionondementia
• Click on the EventCast Tab and follow the link called “Connecting People: Connecting Support. Home Based Memory Rehabilitation”

Speakers in the morning also include Mary McGrath, Advanced Clinical Specialist Occupational Therapist from Belfast; current work in Scotland with HBMR is firmly based on Mary’s original research (McGrath and Passmore 2009)

A video of servicer user feedback and opinion of the HBMR programme is also being shown on this day and a link to this can be found at

• https://www.youtube.com/watch?v=VNg5HrFi4_M

This work is also being showcased on the ‘Let’s Talk About Dementia’ Blog:

• www.alzscot.org/talking_dementia

Wendy Chambers is an Occupational Therapy Team Lead at NHS Dumfries and Galloway

 

 

 

 

 

Changes in place of death in Dumfries and Galloway By Prof David Clark

When I first came to work in Dumfries and Galloway, a rural area in the south west of Scotland, I began to explore the local healthcare scene and was told by several people that our region had a high rate of home deaths. Some reported that everyone wishing to die at home was able to do so. One person told me with confidence that the rates of home death were increasing here, against the general pattern elsewhere.

Of course, the researcher in me was interested in such claims and in due course it proved possible, with colleagues,  to conduct a study to shed more light on where people die in south west Scotland. The results of that work have just been published in the journal Palliative Medicine and can be read in full on open access to anyone.

The paper contains a lot of detail and some of it may be open to differing interpretations. But it sheds some light on the various statements made by my informants and is a warning to those who play fast and loose with their claims.

What we found

We examined 19,697 deaths of residents of Dumfries and Galloway occurring over the 11 years from 2000-2010. In that whole period, home deaths averaged 26.5% – above the average for the United Kingdom.

But we also found that the proportion of home deaths was in decline. Fewer people in Dumfries and Galloway died in their own home in 2010 (23.2%) than had done so in 2000 (29.6%).

Now in England and Wales between 2004 and 2010 the proportion of home deaths rose – from 18% to 21%.  But still to a level lower than in south west Scotland.

For me, a fascinating finding of our study was that between 2007 (when new recording procedures were introduced) and 2010 an increasing proportion of deaths occurred in the eight bed specialist palliative care unit of our main acute hospital. The proportion of all deaths in the region that took place here went up from 6% to 11%.

Compare that to a recent increase in England and Wales in the proportion of deaths occurring in hospice: from 4% to 6%.

We also found that where a person dies is in some measure determined by the cause of their death.

People with dementia and those who had experienced a stroke were very unlikely to die at home, and much more likely to do so in a care home. Almost 44% of people dying with heart disease did so at home but an almost equal proportion (41%) died in hospital – something worth investigating further. Most cancer patients (52%) died in hospital but almost 28% died at home.

Where next?

We have shown that the likelihood of dying at home is reducing in Dumfries and Galloway. Elsewhere that trend seems to be ‘bottoming out’.

Will we observe the same thing for the period after 2010? And what would the results be like if we did this study for the whole of Scotland?

Researchers are rarely satisfied with their results. The urge to better explain and extend the range of our studies is ever-present. But findings such as those from this new study in Dumfries and Galloway can upset prevailing assumptions. They give us a chance to look at trends and their causes. And if we are advocating for more specialist palliative care resources they show clear evidence of an increasing workload.

David Clark is Head of the School of Interdisciplinary Studies, University of Glasgow Dumfries Campus and a Wellcome Trust Senior Investigator.

Predictors of place of death in South West Scotland 2000–2010: Retrospective cohort study, Heather Black, Craig Waugh, Rosalia Munoz-Arroyo, Andrew Carnon, Ananda Allan, David Clark, Fiona Graham, and Christopher Isles. Palliative Medicine, 1-8, February 2016 (currently available online until 23 February 2016)

In the media:

• Proportion of home deaths falls in South-West Scotland, University of Glasgow news, 9 February 2016
• Palliative care study finds decline in number of people dying at home despite wishes, The Herald, 9 February 2016
• Deaths at home falling despite most wishing to end lives there, Lizzy Buchan, The Scotsman, 9 February 2016
• David Clark interview on Good Morning Scotland, BBC Radio Scotland, 0745 9 February 2016 (available online until 10 March 2016)
• Study finds fall in proportion of home deaths in south west Scotland, Tom Moran, ehospiceUK, 9 February 2016
• Home death figures down, Sharon Liptrott, Dumfries and Galloway Standard, p9, 11 February 2016
• Drop in deaths at home, Dumfries Courier, p15, 12 February 2016

(media reports updated until 17 February 2016)

Reproduced from the blog http://endoflifestudies.academicblogs.co.uk/changes-in-place-of-death-in-dumfries-and-galloway/

Top of the Pops (My Top Ten) by @gbhaining

This blog is to celebrate the fact that after twenty seven years I have taken the life changing decision to retire from NHS Dumfries and Galloway. I have had the honour and privilege of being the Alzheimer Scotland Dementia Nurse Consultant for the past two and a half years.

This is an effort to describe some of the work undertaken during my time as nurse consultant and I had an idea that I’d try to link it to popular songs thus the rather dated Top of the Pops theme.

I must say that I’ve gone with the titles in the hope that some of the lyrics reflect my comments.

So let’s begin. 

10. Another Brick in the Wall (Pink Floyd). I was delighted to be appointed as Alzheimer Scotland Dementia Nurse Consultant for NHS Dumfries and Galloway in December 2012. This was a new post and with the support of others I pretty much developed and evolved the post in keeping with the national standards, strategies and drivers. I believe I have built the foundations required to take this agenda forward.

 

9. We are the Champions (Queen). In the past two and a half years I have had the absolute privilege of leading and supporting Dumfries and Galloway’s Dementia Champions. I have to say they work extremely hard advocating the best care for people with dementia when they have to be admitted to our acute and community hospitals. This is one of the pieces of work that I am extremely proud of and I want to thank each and every one of them for being so motivated, enthusiastic and most of all for engaging with me.

 

8. Long and Winding Road (The Beatles).This journey has been challenging however I have built up some excellent professional relationships. I have flown the flag for dementia and I truly believe there is a far greater understanding of the needs of this group of people. I believe we have turned some of the corners and I’m sure as an organisation we will continue to do so.

 

7. Feeling Good (Nina Simone).I think that there is a great willingness to work together to make services person centred and to deliver care at the right time and in the right place. This fills me with pride and optimism.

 

6. Funny How Time Slips Away (Willie Nelson).Personally it feels like yesterday I was starting my nurse training and trying to figure out how to put my nurses’ hat together! I’ve had a fantastic career and learnt so much over the years. I’ve worked with some fantastic people who’ve encouraged, nurtured and seen my potential. That’s something I will be eternally grateful for. We all need to do this and help people develop and reach their maximum potential.

 

5. 9-5 (Dolly Parton). Although it should read 8.30am – 5pm there will be no more “Working 9-5” for me!

 

4. 40 Hour Week (Alabama). Time now to rest, relax and enjoy my family life, catch up with friends and find time for all those things I’ve always put off.

 

3. It’s Five o’clock somewhere (Alan Jackson and Jimmy Buffet). Self explanatory I think!

 

2. When All Is Said and Done (ABBA).I hope that I have left the beginnings of a legacy for people living with dementia, their families and carers and that they will recognise a change as this work continues. We never know the time when we, our families and friends will require services and I’m sure we will continue to strive to deliver the best standards of care for all our citizens.

AND NUMBER ONE THIS WEEK IS !!!!!!

 

1. So Long, Farewell (Rogers and Hammerstein – The Sound of Music).I officially retire on the 28^th August. I wish all my colleagues and friends well and want to say thank you so much for everything!!

Gladys Haining is an Alzheimer Scotland Dementia Nurse Consultant for NHS Dumfries and Galloway.

 

 

 

 

 

Mental Health Change Programme by Ian Hancock

Government policy, changing demographics, epidemiology, health inequalities and increasing public expectations services, requires NHS Scotland to flex and bend to meet healthcare needs of the Scottish public.

The challenges faced by NHS Dumfries and Galloway Mental Health Service Directorate are no different from the national perspective, and have required innovative thinking which have seen the development of better ways of working.

The demographic changes facing Scotland are well documented, with the number of people in Scotland aged over 65 projected to increase by 22% by 2020, and by 63% by 2035. The over 75 population is predicted to increase by 23% and 82% over the same period and the over 85 population will increase by 39% by 2020 and 147% by 2035. Our current service will need to adapt to meet the healthcare needs of this growing population

We all recognise the benefits of keeping people at home, or within a homely setting, as close to their family, friends and local community. The Mental Health Service works closely with patients, carers, statutory and third sector colleagues to provide services that, wherever possible, prevent unnecessary hospital admission. There are, however, times when admission to a hospital is necessary and with this in mind, we have been developing our services over a number of years, and have seen a huge shift from hospital based care to community settings. We need to capitalise on our previous successes and have identified ways in which we plan to move ahead over the coming years.

The Mental Health Service Directorate comprises of four large component service teams (Mental Health, Learning Disability, Substance Misuse and Psychology) and within these teams there are a range of individuals from different professional backgrounds (nurses, AHPs, administrative staff, HCSW, Medical Staff, Psychology, and workforce business partners from Workforce Directorate, Finance). We have 2 in patient units based in Midpark, and in Darataigh in Stranraer, and have numerous community bases across all 4 localities

Over the next few years, the Mental Health Directorate will continue to strive to provide care that aligns with contemporary healthcare policy and legislation, and do this in a collaborative way with our stakeholders. In order for us to ensure appropriate services are being delivered, and that will meet the health needs of the general public of Dumfries and Galloway, we will continue to focus on a number of specific areas.

We will consider ways in which our inpatient beds are configured and consider opportunities to improve individual’s experience of in patient care, whilst developing inpatient services in line with our changing demographics. Services will be based on patient need rather than age.

We will support and evaluate the current 24/7Crisis Assessment and Treatment Pilot Service (CATS), based in the Out of Hours/Accident and Emergency Unit

We will develop our IDEAS (Interventions for Dementia, Education, Assessment & Support ) Service, a team designed to enhance skills in statutory and non statutory services specifically for individuals with a diagnosis of dementia.

We will develop a model of care that takes into account the challenges associated with our more remote and rural areas.

We will develop services which provide early interventions for people with memory problems, and develop Health Care Support Workers to work with families living with dementia.

This is an exciting time with significant challenges to face. We think, however, that we can offer a modern and effective service, within budget, but that such successes will inevitably rely on continuing to build strong working relationships with our service users, carers, and families, colleagues from all health and social care settings, and third sector partners.

Ian Hancock is the General Manager for the Mental Health, Learning Disability, Substance Misuse and Psychological Services Directorate

Dementia Champions in Dumfries and Galloway by @gbhaining

Who are we?

Across Dumfries and Galloway there are currently 116 dementia champions on our register. We come from a variety of professions and backgrounds including:-

• Nurses
• Allied Healthcare Professionals
• Social Work
• Care at Home
• Chief Executive Offices
• GP Medical Centres
• Community Nursing
• General Hospital
• Mental Health Hospital
• Community Hospitals

How do we become a dementia champion?

As dementia champions we have attended training either locally or nationally. The training provides us with knowledge of dementia, some of the complications and the impact a physical illness can have on a person living with dementia. Listed below are some of the topics included in the training:-

• Understanding dementia
• Communication
• Environment
• Promoting person and family centred care
• Community connections
• Working with families and friends
• Promoting health and well being
• Stress and distress
• Sexuality
• End of life care
• Supporting and protecting people’s rights

We are keen to stress that this training does not make us “experts” but gives us a greater understanding of dementia.

Our Charter.

As dementia champions we have developed and agreed a charter which outlines how we plan to promote our role and support people with dementia and their carers when we are delivering care.

How can you (our colleagues and teams) help us to help you?

If a person living with dementia or cognitive impairment is admitted to hospital or being seen by services check whether they have a copy of “This is Me”. This document can provide us all with very important information and can assist us to make sure we are supporting each person in the best way possible.

Effective use of “This is Me”

• If the person doesn’t have a copy of “This is Me” offer them one to complete along with their family and friends.
• “This is Me” can contain information which is not always readily available at first point of contact.
• Encourage all those working with the person to read “This is Me” and talk to them and their family about the person’s preferences.
• “This is Me” should be easily accessible and ideally left with the person to allow them to share with staff working with them.
• Sign the document after reading as this allows families and carers to see who is involved in the delivery of care.
• You must also make sure that “This is Me” goes back home on discharge as this document is very important to the person it belongs to.

You will see from our charter that we are striving to introduce ourselves to people with dementia, their families and carers during episodes of care. The ward or department may not always have a dementia champion on duty but you can assist us by making sure that everyone in the area knows who the dementia champions are and how to contact them.

We all wear badges as a means of identification so make sure you know who we are!

We will do our best to help, support and answer any queries you may have, however, as we’ve previously said, we are not experts! If we can’t advise you we know who to go to find out.

Development and Training.

We keep ourselves up to date by attending at least one of four development sessions organised for us each year. Our charter states we have to attend a minimum of one development session annually but we are encouraged to attend as many as possible.

These sessions cover a variety of topics but all help us to understand how we can best support people with dementia, their relatives and carers. The sessions are facilitated by Gladys Haining our Alzheimer Dementia Nurse Consultant and Alice Wilson Deputy Nurse Director. As dementia champions we are involved in decision making around specific topics we want to further our knowledge about. These sessions also give us an opportunity to discuss our role, share examples of good practice and discuss some of the challenges we face as dementia champions.

We rely on you as our colleagues and managers to facilitate out attendance at these sessions and your support is greatly appreciated.

To summarise:

• We, given the opportunity, can support and advise you on aspects of dementia and how to support people with dementia during episodes of care.
• We may not always be around, but, please make sure your department has up to date information about the dementia champions, who we are, when we’re on duty and how we can assist both staff and people with dementia.
• If we can’t assist you or answer queries we will seek help and support from some-one who can.
• We want to be able to help and support you as much as we can, so make sure you utilise the skills and knowledge we bring to the team.

If you require more information about dementia champions please contact:

Gladys Haining
Alzheimer Scotland Dementia Nurse Consultant

Tel: 01387 246981 Email: – ghaining@nhs.net Twitter @gbhaining

The Home Based Memory Rehabilitation Programme by Emma Coutts

When I took up my post as an Occupational Therapist, within the Mental Health Substance Misuse and Learning Disability Service as a new graduate, I was unsure what to expect!! Having had a placement within the service I was familiar with the client group and the team however coming into this as an OT is very different to being a student! And my first initial thought was ‘what will I be doing as an OT?’

This is where the Home Based Memory Rehabilitation (HBMR) programme comes in! First suggested to myself and Corinna Sidebottom (OT, who started at the same time as me) back in 2012 as a possible piece of work we could develop within the service, who knew the success this would have?!

HBMR was originally developed in Belfast City Hospital in 2007 by Advanced Specialist OT Mary McGrath. It was developed as part of the cognitive rehabilitation approach for the treatment of people with acquired brain injury; however was found to be equally appropriate for the rehabilitation of cognitive deficits, including memory problems due to early stage Alzheimer’s disease.

It has been recognised that the main approach to helping people with memory difficulties to engage within their activities of daily living is to try to find ways to compensate for impaired memory, through memory rehabilitation strategies.

The idea of cognitive/memory rehabilitation interested me – we often associate rehabilitation with the likes of having had a broken bone and regaining the function within the specific limb, but we don’t commonly associate this in relation to Dementia (or at least, I didn’t!).

Cognitive rehab is defined as an individualised approach which should focus on real-life, functional problems a person experiences. Central to this is an understanding of the person’s strengths, abilities and deficits from a holistic approach, which as a profession, incorporates our core beliefs.

So what exactly is the HBMR programme? And how as new band 5s, were we going to develop this and pilot it within our service?

After various meetings we developed a modified version of Mary McGrath’s programme and we were then ready for a 6 month pilot.

Our HBMR Programme

The HBMR programme is a 4-6 week programme, delivered to the client, in their own home with caregiver/family support where appropriate. The pilot programme consisted of 4 sessions:

1. Remember where you have put something
2. Remember what people have told you
3. Remember what you have to do
4. Remembering people’s names and coping in social situations

Each session covered a range of memory strategies such as a memory book, memory board, post-its, safety checklist, using a calendar, medication checklist to name a few. These are all things any one of us could use within our daily lives to remind us of daily tasks.

The key to the programme is the structure and repetition of emphasis placed on the strategies and so each time a new session is delivered, all previous strategies are revisited to ensure the client is using these and is confident in doing so. It is this repetition that encourages new learned behaviours within people with early stage memory impairment and creates the habits that are more likely to be remembered as memory loss continues. 

 

 

 

 

 

HBMR Programme – Pillot Results

Following our 6 month pilot, we compiled our evaluation – which in my opinion not only demonstrated the effectiveness of HBMR but also highlighted that people with early stage Dementia, can learn new skills!!

The graph below clearly demonstrates that following completion of the programme, at 3 month review there was a significant increase in the number of memory strategies clients were using. And as a result, a slight decrease in the number of reported memory difficulties they experienced. 

Our Success!

Since completion of our pilot we have been working on promoting HBMR and how we can further develop this.

A key highlight of the whole process for me has to be winning ‘Best Community Support Initiative’ at Scotland’s Dementia Awards in Glasgow. Although probably the most daunting, as this involved making a small speech!! 

 

Our poster has also won at national events and was displayed within the poster presentation at last year’s Alzheimer Europe conference. 

The HBMR programme also features within Alzheimer Scotland’s ‘Allied Health Professionals Delivering Post-Diagnostic Support: Living Well with Dementia’ Publication which can be found at: http://www.alzscot.org/news_and_community/news/3197_three_new_publications_for_allied_health_professionals

The future of the HBMR programme

We are currently looking at how to develop the programme, with a view to sharing this locally and nationally. Since pilot completion, we have reconsidered the session topics and we have now created additional areas we feel are important to cover. The programme still takes place over 4-6 weeks however now covers the following areas:

1. Remember your priorities
2. Remember what people have told you
3. Remember what you have to do
4. Remember people’s names and coping in social situations
5. Remember to keep your brain active
6. Remember your bearings

We are also considering other possible ways to deliver the programme such as the use of technology.

We have also been looking into the branding of the programme and are looking to have our resources and manual ready within the next few months and as mentioned, we hope to share this both locally and nationally!

I am probably very bias about the programme as I have been involved from the beginning! but I hope reading about the effectiveness of HBMR, has encouraged you to think about the ability to learn new skills in early stage Dementia and how this may impact on future practice…..after all – Dementia is everyone’s business!!

Emma Coutts is an Occupational Therapist with the Mental Health and Learning Disability Service at NHS Dumfries and Galloway.

Communication by @kendonaldson

“My father was in hospital for 2 weeks and not once did I get to speak to a doctor”

“All it would have taken was a phone call, I kept asking day after day, but no-one bothered”

“We were watching Mum get sicker day by day and we knew she was dying but we couldn’t get anyone to talk to us about it. They kept changing drugs and trying new things but nothing was working. We knew she was going to die”

These are just a few quotes from recent complaints that I have read and demonstrate a very common theme – we are not very good at communication. There are many aspects to our failing in communication; with the patient themselves, between specialist teams or between primary and secondary care but it’s the communication with families and loved ones I wish to focus on in this blog.

To illustrate my point here is a short story. A friend of mine texted me about a year ago. I was aware that her mother had been in hospital but did not know the details. This was the text she sent me…

I decided to phone the hospital myself and managed to get through to the Consultant looking after her mother. He started to tell me the details but I stopped him and asked him to phone my friend – she was the one who needed to know. His response was “I’m in an MDT meeting and too busy. Tell her to call my secretary and I will meet up with her in a few days.” I was a tad persistent, gave him her mobile number and said “Please phone her today. 5 minutes, thats all it takes.” He was unhappy but said he would try. A little later I received the following text…

(Note my text was ‘Not Delivered’. Great communication!!)

And the next day….

So, a 5 minute conversation with the consultant completely changed that individuals ability to function at work and at home. 2 weeks of agitation, worry and poor sleep gone….in 5 minutes. So why hadn’t that conversation taken place much earlier? Why did the consultant feel the need for a ‘face to face’ meeting? I would agree these are always much more satisfactory for all concerned but they are sometimes difficult to organise and end up delaying the communication for days. All it took was a phone call.

It got me thinking about my own practice. Do I speak to relatives enough? Am I proactive in phoning families to update them on their loved ones progress? The answer to this was no, so I had to do something about it.

It may seem an overly simplistic approach but what we have done is introduce a ‘Ward Sticker’ (see below) which is effectively a checklist which we put in our patients case sheets at least once a week (sometimes less, sometimes more). Now this list covers many things of which ‘Family discussion’ is only one but it is a way of ensuring that, on a ward round, someone has asked the question “Has anyone spoken to the family?” If the answer is no then we can organise that it happens but what I often do is just pick up the phone and call them. Unless it’s really bad news I don’t see any problem with a phone chat and, often, the information I get from them is extremely useful and changes management plans.

Do I get it right all the time? Again, no. It was only a couple of weeks ago that my colleague reviewed a patient in our Medical High Dependency Unit who I had seen several times over the preceding few days. She was young and very sick and, he informed me very politely, no one had spoken to her daughter since admission. I was mortified but then we don’t use the sticker on MHDU. Am I becoming reliant upon it? Must do better!

There is no doubt our patients are getting older, more complex and are increasingly muddled, especially on admission. Making a clear and definite diagnosis takes longer and often feels less than satisfactory – ‘Probable UTI’ or ‘Probable Stroke’ – and its in these scenarios that early family input can make a massive difference. You can feel like you are working in the dark but when you pick up the phone and speak to someone who knows the patient well, and really cares for them, then it can become clearer and, I think more importantly, you can allay that loved ones fears about what you are thinking of doing in the way of tests and treatments.

So if there was one thing I could ask it would be this – think about the family and loved ones early on in admission (preferably the first day) and use your phone a little more. A quick phone call can make a big difference and will often calm their anxieties, make your life easier and, perhaps, reduce the number of complaints coming through the system.

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

It’s obvious…isn’t it? by @AliceWilson771

It seems pretty obvious to me that recognising and celebrating the achievements of staff is a good way to make them feel valued and to increase motivation at work. We know that people who feel valued deliver a high level of care to patients and clients and support their colleagues in the workplace; so why do we not do more of it?          

My mother always said “there’s more than one way to skin a cat”….the point is: recognising achievement and valuing people doesn’t have to be a big deal, it can done in different ways: a quiet thank you at the end of a shift or a hard week, a word to show you have recognised where someone handled a situation well or showed particular kindness to another person, a smile to acknowledge an individual or sharing some good feedback with a team….and including their boss so they have extra recognition!

In the heat of the busy day this recognition can be forgotten and no-one notices but when it is remembered everyone feels better for it and shares that feeling of being a bit lighter in their step; and therein lies my first challenge….every day for a week tell someone when they have done something well – and then just keep telling people!

Sometimes you just have to think BIG!

……… and that’s what happened on Friday 22^nd August when Dumfries and Galloway celebrated some of the things we do well and recognised the achievement of some of our staff. I personally must pay tribute to the hard work and effort that so many people put in to making a fantastic event and a special mention to Tracee and Nicola (pictured having a well deserved cuppa) who kept us all right on the day…THANK YOU ALL!

We celebrated:

Dementia Champions – not only the Champions themselves who presented and who received their awards but also the fantastic partnerships that make the programme possible and that was the forerunner for the national Dementia Champions programme – born in D&G, it has a ring to it! We are also able to celebrate the recruitment of 2 Doctors and 2 Non Executive Directors to our next cohort, not to mention 2 footballers…yes, you did hear right! We heard about a fantastic piece of work using football to help people with dementia and that led to 2 of our local Queen of the South football club members signing up to take part – this is going to be an interesting cohort!

Learning Disabilities Champions – again, we heard presentations from the achievers as well as reflecting a great training partnership and seeing the achievers receiving their awards

Mentors – celebrating the support that staff give to students whilst they are on placement and learning about the reality of the career they have chosen

Mentor of the year, May Houston and mentoring team of the year, ward 14, with Mike Sabin, Associate Nurse Director, NHS Education for Scotland

Flying Start – celebrating the achievements of newly qualified Nurses, Midwives and AHPs as they launch into their new careers

Care and Compassion – celebrating the work that individuals and groups did as a result of care and compassion workshops which had a huge impact on them

Releasing Time to Care – recognising all the work that teams have put in to complete modules of the programme and make improvements in the way in which they work

The achievers are all pictured with Ros Moore, Chief Nursing Officer for Scotland who spent all day at the event, talking to staff and hearing about their individual pieces of work – what a great opportunity for staff to be able to tell their story directly to the Chief Nurse

Ros was not the only dignitary at the event, we had our Chief Executive and Executive Nurse Director as well as many of the Non Executive Directors and representatives from Scottish Government, NHS Education for Scotland and our partner organisations and most importantly all the staff who attended and helped to make it a great day

Then we finished it off with cake, cut by representatives of all our achievers!

This day was not (just!) about showing off what fantastic work we do here but about sharing it so we can do more and about putting the people who have achieved things at the centre of our celebrations.

My second challenge is for you to share with me, preferably by commenting on the blog, some good work you know about or are involved in so others can read about it

As for celebrating…same time next year??……………..we’ve already started planning!

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

Land of our Fathers’ by @JeffAce3

One of the most striking features of this utterly brilliant Commonwealth Games has been the dominance of Welsh competitors. Very occasionally this has shown itself through the winning of medals but, most often, it has been through that most highly prized of awards – the moral victory. It is only fair to reflect, however, that Wales also provided one of the negative stories of the Games when the hurdler Rhys Williams, 30 year old son of legendary Welsh winger JJ Williams, failed a drug test. It’s fair to say that this shocked me to the core. How I asked myself could JJ, hero of the 1974 Lions, wing partner to the incomparable Gerald Davies, a man whom I vividly remember watching in his spring-heeled pomp, have a 30 year old child? The answer is devastating in its simplicity; the 70s were long ago and I’m getting a bit old.

I’m not alone. The ageing of our population seems sometimes to be talked of in the same tone as peak oil or an ice free arctic, something that should worry us certainly, but also an issue that will affect us sometime in the reassuringly distant future. But for Dumfries and Galloway, such complacency would be utterly misplaced. We are in the front line of the most profound demographic change that western society has ever experienced; it’s happening now, and it’s happening in Dumfries and Galloway more dramatically than in any other region in Scotland.

Here’s our population pyramid compared to that of Scotland as a whole.

 

It’s immediately clear that the term ‘pyramid’ is a misnomer. We have a bulge of population in the older age groups that overshadows the population of children and younger adults. Year by year this bulge is moving up through the age bands, causing a shrinkage of the working age population and an increase of those in the over 65, 75 and 85 age brackets. This is not a far future phenomenon; this is happening to us now and will be the dominant issue in determining the shape of health and social care provision until the population distribution broadly stabilises in the mid 2030s. Ken will do a blog to mark this event (probably beamed straight into your brains by the grandchild of Twitter).

At this point, I was going to start talking about the pressures on health and social care generated by this population shape. I will come to this, but first I think it’s important to say how truly wonderful it is that we’re able to present these figures. What we see here is an absolute triumph of post war healthcare in Britain that’s allowed people to live longer, healthier lives than ever before. We have made enormous progress in reducing mortality from big killers such as stroke, heart disease and cancer and this rate of improvement does not appear to be slowing. A population that’s older than ever before is an achievement to celebrate and something that our clinical and support teams should regard with a sense of pride.

Having said that… Here’s a diagram showing the relationship between age group and the usage of acute beds (expressed as proportion of total ‘bed-days’) at the moment. It’s very evident that age is currently a key driver in hospital occupancy, a fact that becomes somewhat uncomfortable if we think back to that population bulge moving inexorably upwards. And remember that over 80% of health contacts take place outside the acute sector so this profound shift in demand is affecting every aspect of our care.

Essentially, we have a health and social care system that is not designed for the unprecedented demographic change now underway. We will need to change and change both rapidly and radically. On the single issue of acute bed use, for example, we will need broadly to reduce that correlation between age and bed days by around 40% over the next 15 to 20 years. This is a scale of change similar to that undertaken by mental health services over the past decades, but is something never before evidenced in acute care.

There are good reasons to be optimistic about our capacity to deliver this change. One of the most important of these is the forthcoming integration of health and adult social care services. The model, already approved by Council and shortly to be presented to Health Board, will see all of health and adult social care brought under one management structure. This should create far greater flexibility for teams in addressing problems such as delayed discharges. Integration is not a cure-all solution but, if we get it right, it should enable a wider range of solutions to be identified and implemented within localities that will allow our older population to be cared for where safe and appropriate outside of an acute setting.

This is, however, an optimism based on a mechanistic modelling of the future numbers and patient flows. That’s all very well. But, whilst important, it’s not how our service will be assessed or how we should judge ourselves. Our success should instead be measured by the quality of care and support that we deliver to this changing population. I’ve recently completed the Dementia Champions training programme (a superb course which I’d recommend to anyone who has the chance to participate). The programme makes us confront areas where our service does not meet the needs of this vulnerable group or their carers. In one module, for example, we spend a day with current carers of people with dementia discussing their recent experiences and the difficulties they’ve faced in accessing properly coordinated and effectively tailored support. In others, clinical experts present latest thinking on issues such as the quality of pain management or the progress in improvements in end of life care.

There are some great local examples of outstanding person centred care for this patient group. But there is also overwhelming evidence that there is a long way to go to ensure that we reliably provide the level of support to individuals and their carers that maximises potential for independent living and tailor hospital experience to meet individual needs. Some of this we can address relatively easily (give or take £200M); the new acute hospital opening in just 3 years time is being designed using latest thinking on dementia friendly design and will provide a far more appropriate environment for the care of patients with degrees of confusion or dementia. But the much more significant change required is to shape the care provided by health, social care, independent and third sectors in a way that is most effective for that individual, their families and their carers. To do that, we will need to increase the depth of knowledge about our individual patients and their circumstances to a degree that feels daunting in a future of ever shorter hospital stays. It’s a future that will require far better information sharing between agencies and a level of coordination between care providers that is nowhere near reliable at the moment. The integration of health and adult social care gives us a great start on this journey, but there’s an awful lot of redesign still to be delivered.

I think this ambition to transform dementia care is important not only because it’s so plainly the right thing to do, but also because I believe that if we can get services and support right for this most vulnerable group of older adults, we’ll also transform it for the rest of the older population. The key principles of working with families and other carers, integrating our support across agencies and trying to enable as high a degree of independence as possible all apply to the wider population of older adults as well as to the cohort of patients diagnosed with dementia.

It is this approach that will see us succeed both in dealing with the numbers bulge and securing the far greater prize of providing coordinated person centred care and support for our older adult population. Then we’ll deserve the medal and have the moral victory!

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