Help with Constipation

Here is some great practical advice about how to help kids with constipation. It is the advice local Paediatric Consultant, Dr Owen Galt, gives out in his clinic, here in Morecambe Bay:

 

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Help with Diarrhoea and Vomiting

Here is a great video, done by my colleague Dr Owen Galt, Consultant Paediatrician here in Morecambe Bay, talking about how to help kids with D&V – loads of great practical advice!

 

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Is Our Work Killing Us?

So a huge study from Norway tells us that being inactive at work and sitting at our desks for too long is as dangerous to our health as smoking and is a major cause of early death.

 

Hour’s activity ‘offsets sedentary day’
http://www.bbc.co.uk/news/health-36895789

 

Here is my response:

 

 

 

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Learning to Celebrate Success

iu-2The NHS really is amazing. Today, I have been at the NHS confederation (confed2016), a conference which helps to set the pulse and rhythm of the health system over the following 12 months. I heard Dame Kelly Holmes speak movingly about her own experiences, help she received from across the NHS and how grateful she is to live in a country where there is such excellent healthcare available to everybody, no matter how rich or poor. As a double Olympic champion, she highly values her personal relationship with her GP, keeping care local and personal. She would not be where she is today had it not been for the superb care she was given when in the depths of depression only a year before she was able to achieve her dream. Had it not been for surgery, physiotherapy and nutritional expertise all from people working within this incredible system, she would never have accomplished what she has done in her career. And not only her, there was a moving tribute from her mother who has also had significant health problems over the last year.

 
In a time of austerity, although in the OECD countries, there have been 260,000 extra cases of missed cancer in the past year, not one of them has occurred in the UK!! The NHS is staffed by brilliant, caring, compassionate people, who are pursuing excellence in the care they provide. The NHS is able to provide some of the best health outcomes in the world and is still rated as the best health organisation in the world by the World Health Organisation, despite having one of the lowest government expenditures in the developed world.

 
We hear so much negativity in the press about failures, pressures, targets and financial strain that it is no wonder there is a low morale at times amongst the staff. But Kelly Holmes tells us that we must learn to celebrate our successes, because in our dark times (and there are many in the field of healthcare), it isiu-1 vital that we keep hope alive. There were many times, when the press was against her, out for a good story, many times when things did not go to plan, but the celebration of her successes along the way kept her hope alive. We are going to have days when we get it wrong. We are going to have increasingly more situations in which we feel squeezed, hard pressed and floundering, but there is so much we are doing every single day that literally transforms the lives of countless individuals. We look people in the eye and tell them our names, that we will be caring for them and that they matter to us. We compassionately communicate the best and worst of news. We use our skills to arrange appointments, clean, bathe, bandage, measure, test, diagnose, operate, teach, manage, cure, deliver new life, care for the dying and so much more. This is nothing short of amazing.

 

1973049_861ba277[1]I am so grateful for the teams I work with at Ash Trees Surgery in Carnforth, Lancashire North CCG and Better Care Together around Morecambe Bay. We are doing brilliant things together every day, as are countless teams across the UK. Part of the culture shift we need to see is for us to lift our heads, celebrate what is excellent and use it as fuel to propel us further forward into the love and good of the future. I thank God for the NHS, it is worth remembering what a treasure we hold in our hands and continue to be grateful for the privilege it is to serve people through it. If we don’t learn to celebrate our successes, we may not find the reslience we need for the path ahead. But with hearts full of gratitude and a sense of achievement, we can continue to go for gold.

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5) GIVE (5 Ways to Wellbeing)

Here is my latest vlog on using the 5 ways to wellbeing to help change the culture of the NHS.

 

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4) KEEP LEARNING (5 Ways to Wellbeing)

Here is the 4th vlog in a mini-series, exploring the 5 ways to well-being from the New Economics Foundation to help transform the culture of the NHS.

 

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Healthy Conversations

We live in a political climate in which it appears that those in power do not listen to the voices of the ‘multitude’ (e.g. with the current protests around the NHS and education), but press ahead with their own agendas regardless. This is not only true of the current government, but a symptom of the way in which our entire political systems are set up. Here in Morecambe Bay, we need to recover the power of people movements and decide together what kind of future we want. Here is an invitation to come and be part of the emerging conversations about health, well-being and the health system around the Bay.

 

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The Transformative Power of Listening

One of the hats I wear is to be the Clinical Lead Commissioner for Maternity Services in North Lancashire and I chair the Maternity Commissioning Group for Morecambe Bay. iu-1Over the last few years, Morecambe Bay has been under huge public and governmental scrutiny due to some sad and significant failings at UHMBFT, our acute NHS Trust. This lead to the in-depth and wide-ranging “Kirkup Review” through which we have learned together some sobering and important lessons.

 

In 2013, we carried out what is called a ‘Picker Survey’ in the Bay and had a startling reality check. 44% of the women we aimed to care for told us that they did not feel treated with kindness or respect. It was a devastating figure for us to hear. So, learning from the ‘Leeds Poverty Truth Challenge’, we learned that we needed to allow ourselves to really listen to what women were saying to us, to hear their stories and let the impact of those stories begin to change us. One of the great advocates for women, compassionate care, kind listening and careful communication in this area is Mel Gard, a Doula, who facilitates our ‘Maternity Services Liaison Committee’ (MSLC) around the Bay. The MSLC is a group of women and men who use our services, which Julia Westaway must be credited for facilitating so well. Over the last three years in particular, they have taken the time to build relationships with those of us whoiu-4 commission and provide services and in effect ‘speak truth to power’. Mel and many others have brought to us stories of times when listening and communication skills have been excellent within our maternity service and times when they have been clumsy at best and detrimental or abusive at worst. This has begun a culture change and a survey carried out in 2015 has seen this startling figure reduce to 26% (we know this is still far too high, but it is a vast improvement).

 

It is only in encountering the ‘other’ that we are really changed. Alan Alda says this, “Listening is being able to be changed by the other person.” There is no point in hearing the stories and impact of poor communication on our patients if it does not fundamentally change us and our practice. In the NHS, we’re so used to being the experts that we sometimes think we have the right to tell people what they should do, rather than really listening to them and understanding what is important to them, the person who is the expert in their own life and situation. It is partnership and not dictatorship that we need. It is a willingness to learn together rather than an arrogance that knows how to ‘fix’ things that we must develop. So, together with the MSLC we have devised an entire learning exercise for all those who work within our maternity service. We are going to allow ourselves to encounter the ‘other’, on their terms, not ours, and let the impact of their stories transform us. So, in the next couple of weeks, women from around the Bay are going to film and tell their stories in a variety of ways and this film will then be used as a learning tool for every person who works in our service around the Bay, including cleaners, the nursing auxiliary team, midwives, obstetricians of all grades etc in some wide-ranging attitudinal and communication training. Amazingly, we have just won a national grant of £65000 to help us do this really well, thanks to the exceptional work of Lindsay Lewis, our lead manager and Sascha Wells, our Head of Midwifery.

 

NAWIFUThe idea is straight forward. By hearing the real life stories from around the Bay and allowing ourselves to be impacted by them, we will then use some reflective conversations, and techniques from the ‘Art of Hosting’, to allow the power of real listening to change us and transform our practices. I am so grateful for the women and men who have been brave enough to tell their stories. I am grateful to our senior team that we have bimgreseen willing to be humble and be impacted by these stories. I am grateful for relationships and partnerships that are being established between those of us who provide services and those who use them. I am grateful for the tenacity of people who want to see our cultures change. I am grateful for ‘The Leeds Poverty Truth Challenge’ and its far reaching consequences. I am grateful for the opportunity to break down barriers and find positive ways forward. I am grateful for the transformative power of listening and the change that can happen when we really encounter another human being. Better Care Together is so much better when we work together with those we are trying to serve.

 

Stanley Hauerwas said this: “I was smart, but I had not yet learned to listen.” The NHS is full of really smart people. When we learn to listen, our ‘smartness’ will become real wisdom, and with wisdom, we can bring real, lasting change.

 

 

 

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Better Care Together – We Have to Fix the IT

iu-4In all the places I have seen an ability to try something radical and new in the sphere of health and social care (Valencia and Arkansas being two prime examples), I have witnessed one key component. They have fixed the IT! It is really not beyond the wit of man, though I accept it is not altogether straightforward. However without it, change is painfully slow and it is extremely difficult to make the kind of changes we need to see. I do not understand why the Government will not invest in this area appropriately. Here in Morecambe Bay we need to crack this nut if we’re going to be able to let go of our past and embrace a truly collaborative and integrated way of working.

 

The benefits to everybody would be huge. Patients would have safer, more streamlined and ultimately more affordable care. This would cut the complaint and litigation culture to an absolute minimum. Clinicians would be able to work far more collaboratively, effectively, safely and efficiently. If we allow ourselves to imagine just what a difference it could make then we will act to make this a reality.

 

There have been some great strides forward made here by the excellent work of GPs like Tim Reynard and George Dingle, who are developing some fantastic new ways of working and building relationships between primary and secondary care. But their efforts are being hampered by a lack of a truly integrated system.

 

As just one example, take the referral process. If a patient comes to me asking for a referral, which may also require some complex tests to help reach a diagnosis, currently there is so much wasted time and effort plus duplication of work that it is an absolute farce. Say someone comes to see me with a suspected rheumatological condition. Currently, I can see them, assess them, order some (but not all tests) and then refer them. My notes will be on my computer system, but my letter to the consultant may not fully convey all the intricacies of the history I have taken over weeks. My letter has to be written and sent off (on occasion they get lost in the system, causing huge frustration to the patient). Then the consultant sees them……..she will probably order further tests, which she will then write to me to organise, or have them done at the hospital, then she will see the patient again. She will then start some treatment, but will write to me to prescribe it and then the patient will then come to collect it from my surgery. She also asks me to refer onto our community physio teams (a letter I read at 7pm after 11 hours of non-stop work, when I want to get home for my kids’ bedtime stories). There are several points of frustration for everybody involved in the process, not least the patient with wasted time and resources along the way (plus extra letters to answer complaints for missed referrals or whatever else might go wrong).

 

In an integrated system, the patient sees me. I write good and detailed notes, which I link to the consultant rheumatologist, assigned to work alongside my practice, Unknown-5with a short note attached. She then liaises with me in a straightforward way about the case, decides what extra tests are required and these are organised (within appropriate resource allocation) ahead of the consultation. The consultant sees the patient, with a full history and set of investigations. She agrees a treatment course with the patient, prescribes the necessary drugs, which automatically appear in the electronic record, so my team can print out the prescription and the patient can pick it up. She also simultaneously links her consultation to the community physio with a short note and her therapy can be arranged in a slick and easy fashion. This has saved loads of steps, time, energy, complexity and errors. It is a basic example. There are many more areas, like maternity care, patients with complex medical problems involving the care of multiple departments etc where this is simply a no brainer.

 

So what is stopping us? Actually it’s pretty straight forward. 1) A lack of sensible and adequate resourcing from the government within the Vanguard system, which would allow us to make significant changes in a small amount of time. Instead of concentrating on a few Vanguard sites and allowing us to really flourish, things have become far too watered down across way too many experimental initiatives and the funding promised has not been made available. This really needs to be rectified. I’m sure there are things we could also streamline within our Accountable Care System. 2) Stupid competition laws and sweeteners offered to some of our partner providers to use certain IT systems which are clunky and unfriendly when it comes to creating platforms that can talk to each other, have slowed us down. We need a focused and joined-up approach. 3) Priorities. My argument is that without integrating the IT fully and investing in front end smart IT that promotes self care and more appropriate use of resources, we will not achieve together what we could in a way that will benefit everybody.

 

In short, we need to fix the IT. It is the solution to a vast majority of our problems and will allow us to really have Better Care Together.

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Better Care Together – Hope for the Future

iu-4My last post, “Time to Face The Music” was deliberately provocative. We cannot simply keep on doing what we’ve always done or nostalgically hold onto the ‘good old days’. As previously stated, it simply isn’t sustainable and we’re only deceiving ourselves if we think it is.

 

We find ourselves in a a different (post flood) landscape, a terrain that requires a new way of being together. And we are fast learning, here in Morecambe Bay, that it’s not just enough to break down the traditional barriers between Hospitals, GPs, Mental Health, Community Nursing, the Emergency Services and Social Services. No, we have to go much wider and deeper than that if we’re going to develop a radically new way of working that is sustainable. We need to develop a Wellness Service that is of high quality, able to continually improve and offer compassionate, excellent, affordable, safe and accessible health and social care to everyone in our community. In order to do so, we need every person in every community to partner with us. We need partnerships with education, business, sport, justice, housing and the voluntary sector to name just a few. Old silos must be broken down and centrally driven targets must be re-examined to give communities the ability to creatively flourish together.

 

We need big conversations across the sectors of society about what it really means for us to be well and how we can take better responsibility for ourselves and each other. It is so much more than just physical and mental health. It must include a wider understanding of social and systemic health also (see earlier posts on this).

 

And this is exactly what our team in Morecambe Bay is trying to do.images We’re not always getting it right and we’re learning some really tough lessons along the way, especially that our old habits of trying to fix things die hard! Real engagement takes time, but in the process of doing so, we are seeing 3 core principles emerging out of our focused work in Carnforth that we believe to be important keys to unlock this process in every community.

 

As we listen and engage with local people and communities, firstly we are seeing community leaders naturally rise up to make a difference and help increase the well-being of their area. We have many varied examples of amazing initiatives beginning. Secondly, we are seeing clinical leadership that is evidenced based and responsible, but empowers others to make a change. Thirdly we are seeing culture change beginning to emerge, with a more effective coaching culture and a focus on the wellness of those who deliver the care within our communities.

 

iuConversations really matter and carry within them the dynamic potential to make significant and lasting change, as we learn not only to talk differently, but to act differently as well. In the NHS, we have some expertise, but the true experts of their own lives and communities are the citizens we serve. We must change to be much more in conversation with them rather and lose the role of ‘grandma knows best’!

 

 

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