A world outside our door – but it can feel a thousand miles away

Guest blog by Tommy Whitelaw – Dementia Carer Voices Project Engagement Lead, Health and Social Care Alliance Scotland.

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For the last few weeks I have been trying to get healthier with morning and evening walks and runs.  I say runs, but it’s mostly walking to be honest and I have to say I feel much better for it.

It has been a great way to clear my head before and after meetings, talks and take the time to think in a much clearer way.  On my walks there have been memories that make me smile and a few that have brought some tears.  It has taken me nearly 3 years since mum passed away to think more about me, who I am, who I was in many ways and to find the Thomas I was many years ago, as caring took its toll on all of who I am.

It has, I hope, made me a better person and I would not change caring for my mum for the world, she was my best friend and got me through the days and nights I struggled most.  That’s amazing my mum, who was facing so much more than I could, changed the landscape of the day with a knowing smile or squeeze of my hand.

It almost feels strange to be part of the world that sits outside my door.  That’s where the tears come from, we became so isolated from the lives we both knew the world was outside our door then as it is now but it felt so far away.  As our opportunities shrunk to be part of things that had been part of us and our living space shrunk as mums health deteriorated the world outside stretched further out of reach.  If we are truly going to support people to live and die well then we have to support people to reach the world outside our doors and bring the world outside in when we can no longer go on.

The national conversation asks what we need to create a healthier Scotland and talking about my experiences, and those of others in the same position, were what led to the creation of the Dementia Carer Voices project.  If we really want to have a better life for people living with dementia their families and carers then we have to support them to reach that world outside their door and keep walking through their doors as we did before dementia came along.  I feel so much better on my walks physically and mentally and every one of us has the right to be part of the world outside our doors and not be left with the isolation that comes their way to often.

A right to live well and absolutely a right to die well should be supported outside and inside our doors.  So let’s take the time to find out what matters and who matters to people let’s take time to stop the world outside our doors slip further away each day.

The Corner – Dundee

When thinking about the future, it is important to look at some of the current work and success stories in Scotland to help us direct our focus

The following guest blog from the Corner in Dundee does just that.

Guest blog by Manjeet Gill (Corner Co-ordinator), Francinne Carnegie (Community Learning and development worker) and Amy Miller (Health Promotion Worker).

The Corner is in its 19th full year of operation.  Over the years The Corner has consistently provided services and educational programmes to young people based on their identified health needs/trends.  The Corner staff team have worked closely with partner agencies to maximise resources in order to deliver all its services through Drop-in, on an outreach basis and Healthy Transition programmes.  Through listening to feedback from young people and partners, The Corner has continued to review and refine its services to meet the ever changing complex needs of local young people.  During this year, The Corner has further opportunities to develop and deliver enhanced Sexual and Mental Health services as well as delivering peer- led opportunities in Secondary schools, feeder primaries and communities.

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What The Corner offers:

  • Range of contraception and pregnancy testing, sexually transmitted infection (STI) screening and support.
  • Health Promotion and Information on a wide range of topics including drugs, housing and relationships.
  • Individual Support on a range of issues relevant to young people at their pace
  • Support to access legal advice, training & employment services
  • Access to PCs and internet
  • Events and Support/Interest based opportunities focusing on a wide range of issues and needs
  • Outreach with young people in schools, colleges and community bases
  • Local base for LGBT Development Worker and Addaction Substance Misuse Worker
  • The Peer-led Service’s Healthy Transitions Team trains S2 pupils in all High Schools to deliver a programme focussing on risk-taking behaviour to P7 pupils in the associated cluster schools.

The benefits of what we provide:

The Corner ethos places young people at the heart of what we do, through continual development of services by involving young people in consultation and focus groups. The benefit of this approach is that young people feel heard and valued – therefore they feel comfortable accessing all Corner services. In line with department of health criteria for young people friendly health services The Corner strives to respond to young people’s needs. For example, through survey monkey statistics we were able to establish that there was an decrease in young vulnerable people accessing the service as there was a higher number of professional and students coming through the drop in service. It was becoming difficult to offer a safe and welcoming environment for young people requiring intensive support, therefore, after months of analysis and feedback from young people, The Corner partnership management group decided to change the age range for all services to 11-19.Those aged 20-25 will be encouraged to contact the Corner for more information, if they are assessed as in crisis or vulnerable they will be either seen or signposted.

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For more information please visit www.thecorner.co.uk

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A Sense of Belonging

Guest blog by Claire McKenna, Primary Care Division and Dan Morris, National Conversation team.

Last week, we chatted with participants of the Cooking Group which is one activity developed within the Inspiring Scotland Link Up Project, hosted by Crossroads Youth and Community Association based at the Barn Youth Centre in the Gorbals, South East of Glasgow.

The Cooking Group, started in February this year is already showing signs that it is making a positive impact to the lives of the people who attend.

Some group members who are amputees and new to the area describe the cooking group and other activities being offered at the Barn as being a ‘god send’ in helping them fit in and create a ‘sense of belonging’ to the community. They have made new friends, gained confidence to venture out of the house and are now learning new skills to prepare a proper healthy meal that can last a couple of days!!

It was great to hear that people in the group are now forming strong friendships and are beginning to support each other out with the cooking group.  Just recently they have been visiting one member of the group in hospital and making sure everything will be all right for him when he gets home.

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This link provides some more details of the project:

http://m.heraldscotland.com/news/13200656.How_cooking_and_bingo_is_helping_tackle_deprivation_in_Scotland_s_poorest_communities/

Myself and Dan were touched by the enthusiasm and hard work that Eddie (volunteer) and Joe (Acting Link up Worker) puts into the project.  Already they have organised a day trip for the group to Ayr earlier this year and are now in the process of planning their Christmas night out.

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Here are a few points highlighted from the conversation:

  • Camaraderie – new life
  • Saving NHS money
  • Everything seems to be focussed on money/cost – can’t put a price on the how my life is now
  • The atmosphere is electric at the Barn  on open days

Both Link Up Gorbals and the Barn can be found on Facebook:

https://www.facebook.com/BarnYouthCentre/

https://www.facebook.com/linkupgorbals/

NHS Highland – ‘Being Here’ Initiative – Update

In a previous blog post we heard about the Being Here Initiative which is now seeing results success throughout NHS highland.

Background:

As we face and must meet the challenges of an ageing population and modern demands for healthcare services, the current model of healthcare provision in remote and rural areas is not sustainable.

That is why we asked NHS Highland to develop a proposal to look at new models of healthcare delivery that will support patients and healthcare staff.

The Scottish Government is providing funding of £1.5m in total over four financial years 2013/14 – 2016/17 for testing new ways of working in four areas across NHS Highland (Campbeltown, West Lochaber, Isle of Islay and Mid Argyll).

The steering group has established four work streams which are looking at recruitment and retention, learning and development, community resilience, and the ‘Rural Parliament’ approach, as well as on-going stakeholder engagement through learning and network events.

Progress to date:

There has been progress in a number of areas:

The programme has supported an ambitious creative recruitment exercise to attract health professionals to live and work in remote and rural areas of NHS Highland.  This included a high profile advertising campaign and launch of a micro-site.  A number of successful appointments have now been made which has resulted in some stability in the test site areas in Argyll and Bute enabling their models to progress towards a better integrated service. The rural support team in West Lochaber has been successfully formed with a number of key positions filled which will also enable an alternative less GP-focussed model to be progressed.

There has been much activity around training and education given that absence of remote and rural specific training programmes for GPs has been evidenced as an indicator in job attractiveness and quality of service provision. In Argyll and Bute a refresher training programme for GPs in acute care competencies was developed and ran in January 2015.  23 GPs from across Argyll and Bute attended with positive feedback from attendees and speakers. This is being aligned with existing NES activity.

  • In West Lochaber, the new model of delivering healthcare for the Small Isles commenced in 3 January 2015. It consists of a combination of improved community resilience and development of local skills to deal with healthcare needs, alongside a visiting service provided through NHS Highland’s new rural support team, initially led by two GP’s based on Skye. Telehealth facilities have been installed in the Small Isles Medical Practice on Eigg and it is planned to have iPads available on Canna, Muck and Rum to allow patients to access telecare by which they can speak to their GP just like in a face-to-face consultation. The rural support team includes GPs, nurse practitioners and paramedics.
  • NHS Highland has successfully chartered a boat service to provide a bespoke service picking up GP’s from Skye and transporting them to any of the Small Isles as required for the visiting service. Appointments have been made to Remote and Rural Health and Social Care Support Worker posts and training is underway. These posts will provide 1-2 hours per week of health and social care related support to any residents on the Islands who require support. NHS Highland has also been exploring the Nuka model of health care in Alaska and is testing the development of a Health Panel on the Small Isles. IT facilities have been developed to ensure effective remote access to the Small Isles from Broadford and Sleat Medical Practices and MacKinnon Memorial Hospital on Skye.
  • In Acharacle, NHS Highland has continued to progress implementation of the Rural Support Team to deliver primary care services in and out of hours for the practice areas. Further recruitment has taken place including a joint post with Scottish Ambulance Service.
  • In Islay, new service models are being implemented; the work being driven and led by the locality and GPs to put all necessary elements in place for a sustainable, high quality and affordable in and out of hours health service for the Island. Work is on-going to move towards an integrated nursing team for the island. This would see nursing staff working across both the hospital and community to ensure seamless care for patients and develop a flexible sustainable nursing workforce. The next step will be to include social workers, Allied Health Professionals, generic support workers and home carers to develop a larger integrated care team.
  • In Kintyre and Mid Argyll progress has been delayed due to difficulties with recruitment but GPs have now been recruited which will allow new models to commence from 1st April. Proactive communication with local communities will take place during March.
  • In Mid Argyll the project is now progressing with the amalgamation of Lochgilphead Medical Practice and Inveraray Practice. Three GPs have now been recruited.  Out of Hours will be provided from Lochgilphead with support from nurse practitioners based in the hospital and the community nursing team. The GP service at Inveraray remains fragile with a long term locum GP in place. The Scottish Ambulance Service are looking to put in place a fast response care for 6 months covering Kintrye and Mid Argyll to support the service once the pilot is established.
  • In Campbeltown agreement has been broadly reached with all 3 practices to establish a single out of hours GP service and a single GP practice led community hospital inpatient and A&E service. Campbeltown Practice has successfully recruited 1.5 WTE GPs to support this model.  Further work is now progressing with the Scottish Ambulance Service and with local communities in relation to out of hours response in rural Kintyre.

Caution in the Community

Guest post by Mark Kelvin – Programme Director National Links Worker Programme Health and Social Care Alliance Scotland (the ALLIANCE)

It is with some hesitancy that I write a blog reflecting on the modern-day visitation of ‘Care in the Community’. However good the concept, and however sound the values, the semantics often evoke memories of the cost-driven ambition of deinstitutionalization and ‘keeping people at home’.

It is again in an environment of austerity that the discussion of Care in the Community is taking place, so is anything different? Are we to believe that the motivation on this occasion is person-centred model of care? Does it even matter? If there’s a way of offering somebody a truly person-centred model of care that keeps them happy in their community for longer and in a way that’s light on the public purse – surely that’s a no-brainer?! So what’s the problem?

The National Links Worker Programme is a partnership project between the Health and Social Care Alliance Scotland and the GPs at The Deep End Steering Group, who are representative of General Practitioners working in the 100 practices serving the most socio-economically deprived populations in Scotland. It’s the first programme of its kind to explore this question with a focus on the primary care team.

The ageing workforce and struggle to recruit and retain new GPs is just one of the challenges facing primary care in Scotland. GPs, practice nurses, and their teams face a huge increase in demand for their services, and the nature of that demand is changing.

Previous research in Deep End practices has found that in one-in-four GP consultations, the person sought the help of their GP in relation to their social circumstances, for example poor housing, domestic abuse, and isolation/loneliness.

It’s right that people see their GP practice as a community health hub. GPs and their teams have often provided first-rate care to generations of the same family and as such have earned a deep level of trust. This natural source of support in the community is often the first point of access when citizens are in need of support. This change in the demand in services however is juxtaposed with the skill set of the traditional primary care team. That is until the introduction of the Community Links Practitioner.

As part of the Links Worker Programme, participating GP Practices host a Community Links Practitioner who supports people to identify goals and enable them to achieve those goals. They work with people to identify and enable access to local community assets (often through the ALISS online search engine) in an entirely person-centred way.

Connecting people in to their communities in this way is a vital upstream and preventative approach to health and wellbeing and Community Links Practitioners often support people who might find it difficult to access services alone. The programme works towards ‘self-determination theory’, which suggests that when a person has a high level of autonomy, health competence and relatedness, then they are better equipped to access the support and services available to them. Where people find it difficult to tap into these resources however, they are much more likely to succeed with a Community Links Practitioner by their side.

The Links Worker Programme isn’t limited to just individuals who work with the Community Links Practitioner. The Programme recognises the pressures and obstacles that the primary care team face in working more closely with their local community. The programme supports the GPs, practice nurses and receptionists to augment the capacities that they need for this to happen. A GP from a Links practice has recently reflected on her experiences of the programme and of getting to know her local community, you can read her reflections here.

The Links Worker Programme is a Randomised Control Trial and as such will provide a robust level of evidence in to the benefits of this approach. Official findings will be available in October 2016 but the results are already clear to the programme management team, with hundreds of people being supported to develop new friendships and identify new activities that are helping them to live well locally, this is truly what we mean when we talk about ‘care in the community’.

Sharing Lived Experience to Help Others

Guest post by Nancy Greig – Development Manager, People Powered Health and Wellbeing Health and Social Care Alliance Scotland (the ALLIANCE).

The People Powered Health and Wellbeing (PPHW) Reference Group* harnesses the lived experience of unpaid carers and people who use services and supports. This is a diverse group of people with lived experience who all have an interest in co-production and person centred care.

The PPHW programme supports the view that lived experience is equal to other forms of knowledge, evidence and expertise and that people who use health and social care services can make a positive contribution to their own health and wellbeing.

Since the group was established nearly two years ago, members have grown in their confidence and capacity to engage with a whole range of local and national initiatives including influencing policy steering groups and offering fresh perspectives when speaking at conferences.

Even more importantly, Reference Group members have been able to explore personal passions and have opportunities to share experience and learning. A number of the group are now involved in an action research project with the University of Strathclyde about how inclusion contributes to health and wellbeing. Each participant has chosen a topic that matters most to them.

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At their recent bi-monthly meeting the group took part in an asset mapping session where they identified their own personal assets, networks and the resources in their communities and lives that they use to look after their own health and wellbeing.

Here, Reference Group member and poet Glenn Merrilees talks about the range of activities he is involved in and what keeps him well.

The Reference group’s participation illustrates how people individually and collectively can get involved in a wide range of activity to spread awareness of what health means and how approaches can change for the future.

*‘People Powered Health and Wellbeing: shifting the balance of power’ (PPHW) is a programme led by the ALLIANCE and funded by the Scottish Government which contributes to the Scottish Government’s Quality Ambition that health and social care in Scotland should be person centred by 2020. PPHW is part of the national Person-Centred Health and Care Portfolio.

The central aim of PPHW is that people are able to influence their own health and wellbeing and contribute to the design, delivery and improvement of support and services, including peer support.

Email: pphw@alliance-scotland.org.uk

Web: pphw.alliance-scotland.org.uk

Twitter: @pphwscot

Living a Healthier Life in the Community

Remember Robbie Henry, whose story we shared a couple of weeks ago? Well, we managed to catch up with him last week at the Focus Centre in Galashiels, to find out how he was doing and what he has been getting up to!

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He told us that in 2013 Marie Barton, his Life Style Adviser, suggested that he join Walkit which is a Scottish Borders Paths to Health walk project.

DSC_0378-2More than just joining, he completed a training course to become a fully qualified Walking Leader.

Unfortunately, shortly after receiving his Leader certificate Robbie began to feel unwell with chest and back pain, he was referred to the Royal Infirmary for a triple bypass and had to stay in hospital for 5 weeks before getting back to his home.

Recovery normally would take around 6 months, however, due to the healthy lifestyle changes he has made and the coordination, support and rehabilitation of care received from Marie, NHS Borders, his recovery was much quicker and he was back enjoying the things he likes most within 4 months.

Mr Henry now leads 3 walking groups a week which are leisurely paced and last for around 2 hours. GP practices in the area are very good at signposting patients to Walkit. Participants include a variety of people – some who just need a bit confidence to get out and mix with others, people who have learning difficulties and newly retired people who find they now have the time to go a nice long walk.

Before each walk, Mr Henry carries out a full risk assessment to check that the walk will be suitable for the group that day – taking into account any special needs and making reasonable adjustments to time and so on. At the moment he is actively trying to build up Walkit in other areas by putting posters up around the town to encourage people to give it a go.

Mr Henry laughed when he told us that “his boots only last 6 months now!” –some people can have them for 3 years. He clearly loves every minute of being a Walkit leader. He said that it gives him a good feeling “when he looks around and everyone is chatting and looks happy”.

We managed to meet some of the members of the group for a coffee following their morning walk. We asked them “What did they like about being part of the group?”

They told us that not only was walking keeping them fit it also provided them with a safe environment to meet new friends who all look out for each other “when someone doesn’t turn up then we will make enquiries to find out if they are okay”. Taking part also opens up a lot of new interests and most importantly it “was a great way to find out what’s going on in Galashiels!”
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Mr Henry went on to talk about his allotments and explained that he now takes any extra produce (tomatoes, tatties etc) to a local shop who then sells them on for charity. He has also been busy helping a neighbour to dig his garden up and since then a couple of others have asked for his help too.

But it doesn’t end there – just recently he has been awarded the job of supplying the hanging baskets in the High Street, Galashiels for 2016. He has joined a Garden Centre Club and has recently purchased a new greenhouse. His nephew will be helping him to lay the foundations.

Mr Henry told us that he is very rarely at the doctors and his health “couldn’t be better”. People comment on how much energy he has.  He is “off Marie’s books” as he put it, but she still keeps in touch with him. He has now become an expert in managing his health, but he knows when to contact his doctor if need be.

“I’m up at 5 am every morning, and I’m never idle!” – What a remarkable man!

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