Taking the Plunge

Allied Health Professionals Jane, Lorna and Pauline of NHS Ayrshire and Arran share their experience building relationships between the third sector and the NHS.

---

 

Hi, we are Jane, Lorna and Pauline, three Allied Health Professionals (AHPs) working for NHS Ayrshire and Arran who took a plunge into the unknown. In 2014 we put our size 10 walking boots on to take a romp into what is now known as the ‘Third Sector’ but which was previously known as the ‘Voluntary Sector’.

We had keys links with Chest Heart and Stroke Scotland, Health and Social Care Alliance, Scotland (ALLIANCE) and Age Scotland who welcomed us in – as did all the Third Sector organisations we approached.

Background

What led us to dip our toes in? We successfully applied for a NES AHP Career Fellowship which allowed funding for practicalities like funding our time to learn and develop. This meant while we were involved in learning activities with the Third Sector, we knew the people who receive our AHP services were not being left without a service. The aim of the Fellowship was to improve AHP’s knowledge, understanding and relationships with the Third Sector to support more effective cross sector working, facilitating co productive working.

‎ What did we do?

• We asked lots of questions.
• We met with many people who work or are closely linked with the Third Sector.
• We went to cross party working groups at Scottish Government.
• We met and listened to people who benefit from the Third Sector.
• We attended conference events.
• We embraced technology by blogging and podcasting.

What did we learn?

• The depth and breadth of expertise that lies behind the ‘charity shop front’.
• The Third sector is out there delivering first class and innovative person-centred care and often when other services have finished.
• The Third Sector is embedded at a strategic level, for example in shaping policy at Scottish Government level and in developing National Guidelines.
• The range of key roles and opportunities available for AHPs in the Third Sector.
• As AHPs and with our service users we can all benefit from truly working co productively.

Moving forward

As a result of our improved links with the third sector we have already been able to develop a number of initiatives which will continue in to the future, supporting our service users to live fuller lives in the community, this has included a new an Inreach Communication Group in affiliation with CHSS as well as a Multi Morbidity bid to the Integration Fund to improve access to physical activity and self management options for the people of Ayrshire and Arran.

As our fellowship draws to a close we need to keep our walking boots on with an embedded foot firmly in the Third Sector. Our role will be to share our new knowledge, encourage others to dip a toe in and to initiate change.

We all need to find out what is happening on our doorsteps, take time to build new relationships and develop meaningful partnerships.

We need to see it as our job.

Take a plunge with us.

---

 

If you would like any more information please do not hesitate to contact us by e mail:

• Jane.Holt@aaaht.scot.nhs.uk
• Pauline.cuthbert@aapct.scot.nhs.uk
• Lorna.Lowdon@aaaht.scot.nhs.uk

Scotland addresses chronic pain

Everyone knows what pain is. It is part of everyday life, and though always unpleasant, usually serves to protect us – for example by making us rest an injured limb, or forcing us to withdraw our hand from the flame. But sometimes this “normal” pain keeps going, after the danger is gone, the injury healed, or when there is an underlying disease that keeps producing pain. This is when it becomes chronic pain.

A major European study found that 1 in 5 people currently has chronic pain. Our own research in Scotland found that, in people aged over 75, this figure was as high as 60%, and the pain was more often severe, disabling and debilitating. It can affect physical, psychological and social health, and leave people feeling isolated and depressed. Some of us assume that “aches and pains” are a normal part of growing older, and that we should tolerate this in silence. However, there is no need to do this, and we desperately need our healthcare services and treatments to address this problem effectively.

Fortunately, chronic pain has recently begun to receive the political and scientific attention it deserves. In 2008, after many years of lobbying and commissioned reports, the Scottish Government recognized chronic pain as “a long-term condition in its own right”, probably the first government to do this, and stimulated progress in policy, research and development.

Professor Blair H. Smith

The Government and NHS Scotland collaborated to establish a national pain service improvement programme, and appointed the first Lead Clinician for Chronic Pain (“Pain Tsar”). They agreed a chronic pain service model, with an identifiable, standard “patient pathway”, from management in the community, rightthrough to highly specialist clinics, meeting the needs of people of all ages. Implementing this model is a priority for all NHS Boards, under the Government’s NHS Scotland 2020 Local Delivery Plan Guidance, supported by pain Service Improvement Groups in each Board. Approval has just been given for the first residential chronic pain service in Scotland, providing intensive treatment for those most severely affected.

What about new treatments for chronic pain? Although some established drugs have been “re-purposed” or developed to be delivered in new ways, there have been no new drug classes since the non-steroidal anti-inflammatory drugs (such as ibuprofen), in the 1960s. The search for new drugs is constant, but only one part of the story. We continue to develop non-pharmacological treatments, including psychological approaches and physiotherapy. Self-management (including education, increasing physical activity, and personal goal-setting) should always form part of the overall management. This is the subject of our research programme, funded by the cross-Council Lifelong Health and Wellbeing initiative and focusing on older adults.

In Universities and the NHS all across Scotland, researchers are actively pursuing improvements in the understanding and treatment of pain. In March the University of Dundee hosted the 4^th Annual Scientific Meeting of the Scottish Pain Research Community (SPaRC). SPaRC’s aims are that (1) treatment of pain in Scotland is informed by the best evidence; and (2) pain research in Scotland addresses the most important clinical questions. SPaRC presents an active and internationally-competitive approach to addressing chronic pain, ranging from molecular mechanisms of pain and drug response, to population-based trials of service innovations.

The internationally-renowned Scottish Intercollegiate Guideline Network (SIGN) published the first evidence-based guideline covering the management of chronic pain, in December 2013. This impressive project identifies and collects, for the first time, the best available evidence for all forms of non-specialist treatment, and includes versions for patients and professionals internationally.

We have recognized and begun to address the problem, but much more work is needed. More information about SPaRC and chronic pain is available for patients and professionals at www.chronicpainscotland.org.

Blair H. Smith is Professor of Population Health Science, University of Dundee; and Consultant in Pain Medicine, NHS Tayside

 

Patient Opinion working with Age Scotland

We are pleased to welcome guest blogger, Natalie Deacon from Patient Opinion to our blog to talk about how Age Scotland and Patient Opinion are working together to help improve health services in Scotland.

We are delighted to announce today that Age Scotland are our newest charity to use the Patient Opinion widget on their website!

Age Scotland and Patient Opinion believe your stories can really make a difference to our health services. We are excited about our collaboration and look forward together, to help get your stories heard by the right people.

Who are Patient Opinion?
Patient Opinion is an independent website about your experiences of UK health services, good or bad. We pass your stories to the right people to make a difference.We are a not for profit social enterprise and we believe that the stories of patients and carers can help improve health services across the UK.

We use the power of the web to carry the voices of patients and carers into the heart of health services. You can share your experiences of healthcare anonymously, we never disclose any information about the person who is telling the story.  All stories are published on the Patient Opinion website for everyone to read and the NHS can then respond to your comments to tell you how they are using your experiences to make services better for everyone.

We currently work with Diabetes UK, Hepatitis Scotland, Angus Long Term conditions, Chest, Heart and Stroke, Stroke Association, Fife Young Carers and many other national charity organisations.

Over74,000 stories have already been told on Patient Opinion with lots about Scotland and lots about older people.

What is the widget? If you have recently used the NHS you can use the Patient Opinion widget to share your experiences and we can pass on your thanks or concerns to the relevant health board. Patient Opinion asks the health service to respond to the feedback you share, but does not reveal your identity. The widget means it is easy and convenient to share your story with Patient Opinion though Age Scotland’s website.

See Patient Opinion in action:  We recently had a story from a patient who was having problems with the  ENT appointment booking system at Raigmore hospital. Their concerns were taken seriously and a positive change was made because of the comments they shared on the Patient Opinion website.

Tell your story today!

Falling and sleep

This week Age Scotland was asked to comment on sleeping prescriptions and hospital beds.  Doug Anthoney reports.

The potential for some prescriptions for sleeping problems to increase falls risks for older people was in the news this week.   Common treatments for insomnia, including Benzodiazepines such as temazepam, can cause drowsiness during the day, particularly in older people who are already at increased risk of falls. They can also lead to drug dependence. Some experts have called for increased use of Circadin instead, which was licensed in 2007.  It uses a slow release form of the hormone melatonin to regulate sleeping patterns is not associated with falls risks.

As falls account for seven in ten fatal accidents in people aged over 65, and more than half of all injuries, we said that any side-effects of sleeping treatments that make falls more likely should to be taken very seriously.  Older patients and GPs should be made fully aware of risk factors associated with drowsiness, so that they can make informed choices with regard to sleep-related prescriptions.

This week we were again asked to comment on a reduction in hospital beds in Scotland.  We said that yes, this could be a problem, as it’s essential that older people who need high quality hospital care get it. However the figures might also show that the Government’s efforts to reshape care are paying off, as more older with chronic conditions get the care they need to remain in their own homes.  If this is the case, the figures would represent a successful outcome that reflects what older people consistently tell us is there preference.

For us, the crux of the matter is that services and support available outside of acute care settings genuinely meet the needs of individuals, otherwise there is a risk that emergency hospital admissions will continue to rise and needs not be met.

Doug Anthoney is Age Scotland Communication and Campaigns Officer.  This post is part of the ‘Tomorrow’s Fish and Chip paper’ article series reporting the hot topics Age Scotland has been discussing with the media each week, and the Charity’s response.

Are our hospitals letting down older people?

This week health watchdog Healthcare Improvement Scotland (HIS) published a summary report of its inspections of older people’s care in acute hospitals between August 2012 and April this year.  Age Scotland’s Doug Anthoney responded.

It’s reassuring that 95% of patients reported good quality of care during their stay in hospital, however we can’t ignore that 5% say otherwise, representing a large number of older people who feel let down by the NHS. 

It’s very disappointing that 6 months on from the first HIS bi-annual summary report inspectors are still finding examples of incomplete or absent paperwork proving that patients have been screened for conditions such as dementia, malnutrition and pressure sores, and that plans have been put in place to personalise management of their care accordingly.  While HIS reports, it doesn’t explain, and it is high time that the NHS in Scotland gives older people an account of why this is happening and what can be done to address the problem.  We’re particularly concerned to learn of widespread confusion around powers of attorney, where in place; with records often unclear what decisions could be made on behalf of a patient.

It’s also disappointing that among the many daily positive interactions between staff and patients there are still examples of heedless comments and careless actions that are disrespectful of patient privacy, undermine their dignity or unnecessarily interrupt their meal-times.  NHS Boards should make it clear to staff that this is simply unacceptable, and ensure on-going training reinforces the message.

There are encouraging signs that overall ward environments are improving, meal-times are becoming better protected from interruption, and staff are more proactive in seeking patient feedback on their needs.  Examples of hospitals going the extra mile to keep patients active and stimulated are particularly welcome as they help ensure when people go home they are less likely to have to return.  We would like to see this becoming the rule, and not the exception.

We also welcome evidence that inspections work, with inspectors reporting real improvements during some follow up visits. HIS’ intention to increase the number of unannounced inspections is therefore good news for Scotland’s older people and their families.

Doug Anthoney is Age Scotland Communication and Campaigns Officer.  This post is part of the ‘Tomorrow’s Fish and Chip paper’ article series reporting the hot topics Age Scotland has been discussing with the media each week, and the Charity’s response.

Tomorrow’s fish and chip paper: Time to bump up the beds?

This week the Herald Newspaper launched a campaign calling for a review of NHS beds capacity.  Age Scotland Chief Executive Brian Sloan responded.

The Herald’s NHS: Time for Action campaign is a welcome contribution to the debate on how best to meet the health and care needs of our ageing population.  With 90% of people seen and discharged within four hours it is clear that A&E is still working well in most cases.  However, it is also evident that emergency health services are under pressure and the experience of some A&E service users is unacceptably poor. In the rush to ensure health and care services meet the challenges of changing demography, we must not be panicked into seeing an ageing population as a drain on public services.

Most older people are healthy: around two-thirds of those aged 60-74, and more than half of those aged 75 and older, report very good health, whereas for both age groups the proportion reporting very bad health is around one in 10.  And while 3000 older people need 20 or more hours of care at home each week, 40,000 are providing the same level of care for their friends and family members.

The Herald is right to ask if more beds will be needed in the future, or whether steps can be taken to bear down on demand so that the NHS of the future will be able to cope within its current capacity.  To a large extent the answers are already clear and there is a risk that a further beds review might shed little fresh light on the underlying issues.

The Scottish Government’s Public Bodies (Joint Working) Scotland Bill is laudable in its aim to tackle the disconnect between health and social care services that too often lead to unnecessary hospital admissions. But it should be underpinned by human rights principles, and the influence of Scotland’s third sector needs to be strengthened; voluntary groups and social enterprises know how to enable older people enjoy good quality of health and life in their own homes.

Furthermore, by shifting the long-term balance of resources into prevention, from encouragement and opportunities for active lifestyles that reduce the risk of falls, to community transport services that reduce social isolation, we can do far more to minimise the pressure on acute services in the first place.

The crunch question is how we can invest in these preventative services while maintaining acute and emergency care until there is clear evidence that demand has fallen. This is likely to involve increased spending now to reap the rewards later, something which will require political leadership and public buy-in.

The Herald rightly points out, people may want health services protected but are often unwilling to pay the price. A vigorous and candid debate is required to establish a consensus on how we will fund the move to more preventative health and care services and in what circumstances a reduction in beds, locally or nationally, may be the price to pay if we ourselves wish to remain out of hospital in future.

Tomorrow’s fish and chip paper – New bills, old debts

Doug Anthoney offers Age Scotland’s take on this week’s news stories.

This week saw publication of a long trailed Bill to join-up, and so improve, health and social care services – the snappily titled Public Bodies (Joint Working) (Scotland) Bill.  We’ve been campaigning for this for quite some time, and have been broadly supportive of the Scottish Government’s proposal; namely to make NHS and Councils work together in delivering health and social care services, with pooled budgets and shared targets and accountability.

So, does it cut the mustard?  A first review (we’ll be trawling it repeatedly over coming weeks) suggests much is as expected, which is pleasing.  But we’re concerned that a watered down duty to merely ‘consult’ the third sector might marginalise the role and influence of the many voluntary groups and social enterprises that play such a crucial role in keeping older people healthy, happy and independent in their homes.  Our call for the Bill to be underpinned by values and human rights also seems to have been ignored.  We’ll be raising these points with Alex Neil, the Cabinet Secretary for Health and Wellbeing, next week.

The week’s other big story was publication of Scottish Widows UK Pensions report which scores Scotland lowest for retirement preparations.  It claims that over a third of Scots (39%) who could and should be preparing financially for their old age are under-saving for retirement, nearly three times the UK average (14%).  Meanwhile, our aspirations for retirement income have increased to £24,500 per year, almost double what the average person retiring at 65 could expect (£11,200).  The research also found that we are entering retirement with an increasing number of credit commitments, including loans, mortgages and credit card debts.

Scottish Widows, while inevitably signposting people to its own services, has highlighted a serious issue, and behind these figures are many people who will be very anxious about their future incomes as they approach retirement.  Things look a little better for future pensioners, with the introduction of a flat rate state pension of £144 per week in 2016, and with automatic enrolment in workplace pensions, but this does nothing for those on the brink of retirement now.

What can be done?  Westminster and Holyrood could, and should, put energy into alleviating poverty among our current pensioners, we said.  Employers can also help their older employees to plan effectively for retirement, as the most enlightened already do.  And individuals can take action to maximise their income; for example by calling the Age Scotland Helpline for a benefits entitlement check, and by making use of the Pensions Tracing Service to see if they have a forgotten historic pension pot.

Doug Anthoney is Age Scotland Communication and Campaigns Officer