Team Update

Issue 74 November 2010 www.nhshighland.scot.nhs.uk

Director of Public Health’s Annual Report looks at the challenges ahead

Alcohol misuse, smoking and obesity are major public health challenges facing NHS Highland, according to the first annual report from its Director of Public Health.

Dr Margaret Somerville’s report also highlights the increasing number of older people in the local population and the corresponding increase in the number of people living with long- term conditions, such as hypertension, depression, asthma, coronary heart disease, diabetes and cancer.

And it looks at lessons learned from last year’s influenza pandemic and explains that a major challenge for the future will be preparing and planning for climate change.

Dr Somerville, (pictured top right) who took up the post in February of this year, points out that the health service, along with the rest of the public sector, still has to deal with these issues at a time when their budget is under increasing pressure.

She said: “This report reflects my own observations about the health of people in NHS Highland in my first few months in post and the major challenges that lie ahead if we are to continue improving health and closing the gap between the best and worst off in society.

“With the prospect of real cuts in spending on health over the next few years, it is more important than ever that we do not lose sight of the long-term health improvement work through which we hope to contain and reduce health service use and cost.”

Dr Somerville explained that the population of NHS Highland had increased by more than 5% over the last 10 years and was predicted to increase by a further 10% over the next 20 years, with the number of people aged over 75 more than doubling in the same period.

She said: “Health care over the next 20 years is likely to be dominated by the growing population of older people, particularly the rapidly increasing numbers of people aged 75 years and over. Inside… p3 Lean arrives at “While many older people remain fit, active and able to live independently, Caithness there needs to be a fresh approach to helping and supporting the minority of p7 Teleneurology on the elderly population who are frail with multiple long-term conditions.” Skye p9 Renal patients on She added that the increase in long-term conditions associated with the their bike rising proportion of older people, particularly the very elderly, also p12 Get ready for Winter challenged NHS Highland to think differently about how it approached the p14 TAG Skills Centre management of these conditions. The aim is to enable people to live as independently as possible for as long as possible by supporting them to p15 Getting Greener manage their own conditions.

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Life expectancy in Highland currently averages 76 years for men and 81 years for women and is increasing in line with the rest of Scotland. However, overall, Scottish life expectancy is lower than in some parts of Europe.

Dr Somerville pointed out that up to half of all circulatory diseases and cancers could be prevented by tackling the major risk factors, which include alcohol, smoking and obesity.

Her report records the success so far in reducing premature deaths from circulatory disease and cancer and it gives details of the cost to NHS Highland of alcohol misuse, smoking and obesity.

Work done by the public health team suggests that 90 to 100 hospital beds in NHS Highland are likely to be occupied every day by people with conditions attributable to alcohol, smoking and obesity at a cost of £15.4million per year.

Dr Somerville said providing targeted individual and group support to help smokers stop smoking coupled with wider initiatives, such as banning tobacco advertising and smoking in public places and promoting smoke-free homes and cars, had led to a steady decline in the number of adults who smoke.

NHS Highland’s Smoking Cessation Service has grown steadily over the last two to three years. During 2009, 3,789 people attempted to quit and 46% of them were still not smoking after one month, compared to a national average of 38%.

But Dr Somerville pointed out that around a quarter of the adult population still smoke so these efforts must continue to further reduce the number of people so doing.

She said: “We are now taking the same approach, of helping individuals to change their behaviour both by direct support and developing environments that encourage these changes, to reduce alcohol consumption and obesity levels. However, it is too soon to note any encouraging trends in the levels of these risk factors.”

Dr Somerville explained that the current economic climate made it even more important that decisions on how to use the available resources had to be made bearing in mind that the cost of every intervention resulted in less money being available for another intervention.

She said: “Health care policymakers must consider the balance between the benefits of treating ill-health and the benefits of preventing ill-health. We need to continually review which interventions work, offer good value and provide the greatest benefit to the largest number of people.”

The Director said lessons had been learned from the flu pandemic in 2009 - when huge efforts from public health staff, frontline health staff and many others successfully managed the major local outbreaks. Existing plans are now being modified for future use.

However, she added that, while it was important to continue to plan for new pandemics, the major public health challenge for the future would be from climate change, which would have impacts on the world’s supply of food and energy availability and security. She said mitigating and adapting to climate change would involve major changes in the way we live, work and provide health services.

Dr Somerville said: “Health improvement interventions are effective and cost-effective. We have to invest in the preventative work in order to prevent ill-health in the future.

“At a time of financial constraint, the easiest answer would be to cut the long-term work in favour of dealing with the here and now, but we are saying that the long-term health improvement work must continue.”

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Lean arrives at Caithness General Hospital

Caithness General Hospital staff “leaning” at the Value Stream Mapping

Staff in Caithness are working hard on their LEAN project with the support of external management consultants GE (funded by the Scottish Government) and NHS Highland Lean Leaders. A large number of staff attended Lean Awareness Sessions and Basic Training over the last month. They then participated in a Value Stream Mapping Exercise or VSM. This was held in Wick in mid November. Key staff from across the hospital took part. This included senior nursing staff, consultants, radiographers, physiotherapists, occupational therapists, pharmacist, laboratories, porters, social work and managers. During the Value Stream Mapping they set out step-by-step how patients are admitted to hospital and discharged following treatment. This was considered in detail with any unnecessary steps identified and potential solutions explored. Improvements will be tested during a Kaizen week starting on the 6th December. The main work streams are; Developing and testing a Combined Assessment Unit, Implementing Daily Board Rounds/ Ward Rounds, reviewing Documentation, managing inappropriate attendances and admissions from A&E and testing a new appointment system and Duty Radiographer role in the Radiography department. See below and on page three for views from staff taking part. Locality General Manager Pauline Craw said: “It’s been a really good two days with improved team working across the hospital.”

It’s been very interesting, it has given us a chance to talk about things that have been issues for a while. There have been some really good ideas so far. If everyone is prepared to give it a go and think “out of the box” we could make some really good changes. It’s good that all departments are represented and we can think about how the hospital might work together without staff worry- ing or feeling threatened.

Tracey Macleod, staff nurse, Bignold ward.

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Caithness General staff talk about lean

It’s been a good couple of days. I was completely shattered by the end of day one; it was quite intense but very worth- while. It has pulled everyone and the wards together.

There are a lot of positive attitudes in the room and a respect for each other.

Pat Magee, Senior staff nurse, Rosebank ward

It’s been very interesting. I’ve worked in the hospital for 19 years but only really see my bit of the process so it has been really good to see the bigger picture.

If we could standardise things to reduce duplication of paperwork etc that would be a real benefit.

Drew Macleod, Porter

It’s been hard work but good work. The big benefit is that everyone is here so it’s a round view. It highlights exactly what’s going on in each area. It can be hard to listen to some of it and not take it as criticism. The impact one ward can have on another has been highlighted. Too much change all at one time could have a detrimental impact on staff morale.

Nancy Mackay, Staff nurse, Queen Elizabeth ward

It’s a good opportunity to voice opinions, to be heard and to feel valued. The important thing will be improved communication be- tween staff groups which will be of value to patients.

Doreen Berry, Senior physiotherapist Rosebank and Bignold wards

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Raigmore Hospital to test giving patients early notice of their date for surgery

The possibility of giving patients early notice of their date for planned surgery is to be tested in the New Year. The plan is to agree a date for surgery with the patients after they have had their pre-operative assessment. This will initially be tested in the ear, nose and throat department.

It’s just one of the improvement ideas to come out of the theatre scheduling and administration Lean project running in the Surgical Division. Early in the improvement work it was discovered that patients could wait for up to five weeks to be sent their date for surgery. While this didn’t delay the actual operation it is an unsettling time for patients and their families as they wait to have the date confirmed. The concept was tested during the Kaizen week at the end of September. The initial feed-back from patients and staff was encouraging and it has been agreed to progress to the next phase of testing.

The plan is to create a new role of “scheduler”; a person who sees patients who have passed pre-operative assessment and gives them a choice of dates using the New Ways criteria. If the patient agrees a suitable date the theatre slot and hospital bed will be booked. The patient can then prepare for their operation and ward and theatre staff has earlier information on who is coming in.

Andrew Ward leading on the change commented: “If we can implement this system it will reduce anxiety for patients, improve the information we have to plan operations allowing us to plan ahead. It should also ,reduce cancellations as we will be agreeing a date with patients (instead of just sending them a date) and they will also have more time to prepare for their operation. We need to work through the detail though and so we are really grateful to staff in ENT Department, colleagues in pre-op, theatres and waiting list department for taking on this work.”

New focus on work as part of recovery Vocational rehabilitation and employability events were held in Inverary, Inverness and Wick earlier in the year. People who attended were those involved in rehabilitation which promotes people to be fit to stay in work or return to work. The events provided an opportunity for staff from NHS and other agencies to look at how they ensure a patient’s goals around work are always part of their recovery plan. Fit for work case manager Eileen Website said: “We sometimes forget to ask the work question but the evidence shows that most people want to stay in or return to work and that good work is good for people’s long term health. ”

For more information contact:

Eileen Webster Fiona Begbie Fit for Work Case Manager Project Lead - NES [email protected]

Why not visit the Good Work, Good Health: Vocational Rehabilitation website at Www.knowledge.scot.nhs.uk/work.aspx

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Reducing duplication in pre-operative assessment The charge nurses in orthopaedic pre-operative assessment and the general pre-operative assessment suite have been finding ways to merge elements of both their services.

A lot of detailed work with input from anaesthetics colleagues has revealed that many of the steps in the process for patients going to both units are generic.

This raises the possibility of bringing both teams together in one area of the hospital and using some staff for both groups of patients, reducing duplication. It has also been a catalyst for wider review of the service across Highland, including standardising documentation and patient information.

Chrishan Folan said: “This has been extremely hard work but it’s worthwhile as we are beginning to make real progress. Pre Op Assessment is pivotal to the smooth running and cost effective process of elective surgery. Our aim is to make sure that we provide a consistent service across Highlands and Western Isles. Both patients and staff will benefit from this. We are getting great leadership and support from Dr Howes (Consultant Anaesthetist) and it’s been good to network more closely with our colleagues.”

Head of Service for orthopaedics Mr Sean Kelly said: “I commend the work bone by both the Charge Nurses under difficult circumstances. The demands on the Pre-Admission clinics are very significant.

“Their work has highlighted areas where the two clinics can be more efficient in the generic component of the assessment.

“I am reassured that the PAC is still going to be able to continue to offer the specialist components that are required in the individual surgical specialties."

Old signage now history Another component of the improvement work included looking at patient information. The scope covered appointment letters, leaflets and signage within the hospital. It was discov- ered that wording in letters often didn’t match up to wording on signs. Over the last two months all old signage has been removed from the Hospital. The oldest sign removed dated from 1975!

A specialist company has been brought in to provide advice as to how to improve our sign- ing strategy. While this will require a modest investment the potential benefits are priceless. It will make it easier for us to direct patients around the building and ensure that they arrive for appointments on time.

All patient letters are in the process of being systematically reviewed to make sure they are consistent with the signage in the building and that the information is clear and well set out. For example patients going to a colorectal clinic will be told they are looking for signs for the Dunvegan Suite. Previously the letter said colorectal no such sign exists in the hospital.

Mary Glasgow and Donna Smith who have been leading on this work said: “This may seem like minor problems but in fact it was having a negative impact both on the patients’ experi- ence of care and disruption to clinical staff. During the Kaizen we spoke to one staff mem- ber who had been interrupted 80 times in one morning by patients who needed directions. The patient’s received a polite and helpful response every time but it’s obviously not ideal. I think we’re on our way to ironing out a long standing problem for Raigmore.” Page 6

Teleneurology development for Skye patients

The introduction of a new telehealth service in Skye means more neurology patients can be seen locally with fewer having to travel to Inverness for appointments.

Video conferencing is already widely used by NHS Highland as a way of connecting health care staff who work in different places.

The new teleneurology service is a joint project between NHS 24’s Scottish Centre for Telehealth and NHS Above: Dr Bethany Jones with onscreen Highland and follows the successful establishment of colleagues Chris McSorley, Charge Nurse, telehealth initiatives between the two organisations. Portree Hospital, and Marie MacPhee, Nursing Auxillary It will enable patients to receive the care they require as close to their own homes as possible, thus saving the time and inconvenience of travelling, and will mean the consultants can see more patients in the available time.

NHS Highland Clinical Services Development Manager Kate Earnshaw said: “We are delighted we are able to offer this service to the population of Skye and Lochalsh. By doing so, we can ensure that services remain as local as possible, reduce the amount of travel for our patients and shorter waiting times for appointments.

“Telehealth opens up lots of opportunities for remote and rural health care and, although this is happening initially in Portree, we hope to soon extend this service to Broadford.”

The new clinics in Skye will be held two to four times a year for patients with a variety of conditions. Patients who are new to the service and those with certain conditions, such as Parkinson’s disease, will still require face to face consultation but for many patients their clinic appointment can take place via video conferencing.

Patients will be able to see their Consultant by way of a television screen and vice versa. A nurse or nursing auxiliary will support the patients with the videolink during the teleneurology appointment.

NHS Highland Consultant Neurologist Dr Bethany Jones said: “Communicating with patients is not affected by the fact that it takes place via a screen. In fact some patients have remarked that they prefer it this way as it is less daunting!

“I anticipate being able to develop these clinics further and, while they will not be able to replace neurology clinics, I hope that patients will feel the full benefit of being seen closer to home and having to travel less.”

Kirsten MacCallum was one of the first patients seen at the clinic. She said: “My appointment went well and it was easy to build up a rapport with the Consultant in Inverness. Communication was clear and easy to understand and I felt able to ask all the questions I needed to about my condition and treatment.

“By using telehealth I have been saved the stress and hassle of a five hour round trip to Inverness in the winter. I did not have to take time off work and there was no need to arrange childcare. I would gladly have further appointments this way and would advise other people to try it.”

Cathy Dorrian, Service Development Manager for the Scottish Centre for Telehealth, added: “The teleneurology services we have set up across Scotland in the last five years have been very successful and there are high levels of satisfaction with the service

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amongst our patients.

“We have worked very closely with NHS Quality Improvement Scotland on establishing clinical standards for teleneurology in Scotland. Using telemedicine in this way can improve patient access to specialist neurological services and we hope to continue to roll out similar services to other remote and rural areas of Scotland in the future.”

Teleneurology has been working well between Caithness General Hospital in Wick and Raigmore for the past two years and, with the successful introduction of teledialysis between the renal units in Inverness and Wick, as well as video conferencing being used for some patient consultations between Inverness and the Western Isles, the introduction of this system on Skye is being welcomed.

Blood borne virus training launched online

BBV 1000 is a new and easily accessible online Blood Borne Virus (BBV) training course which is planned to reach 1000 members of staff across NHS Highland by March 2011.

Developed in conjunction with the Scottish Training on Drugs and Alcohol (STRADA), BBV 1000 is an initiative designed in Highland to provide access to online BBV training for all staff in all locations across Highland. It is available to both NHS and non-NHS staff.

Hepatitis B, Hepatitis C and HIV are examples of Blood Borne Viruses,or BBV. Anybody can be infected with them without displaying symptoms for many years. With this training course, staff will gain knowledge of BBV appropriate to their place of work, It will help keep them safe and allow more patients and others at risk of BBV infection to be di- rected to the best place for testing and treatment.

Staff can enter and interrupt the training programme at any time, and will have access to the most up to date thinking on blood borne viruses,

BBV 1000 is split into manageable sections and has been designed to allow staff to com- plete sections of the training course at their own pace, either while at work or at home. Us- ers can leave the session at any time and return to where they finished off when they next visit. A certificate will be issued at the end of training.

BBV 1000 also gives staff access to the many disciplines and organisations involved with BBV and provides access to a discussion and networking forum to allow a greater under- standing if required.

Lorraine McKee, Health Protection Nurse Specialist for NHS Highland said: ‘In the first quarter of 2010 in Scotland 567 new cases of hepatitis C were diagnosed. This is an in- crease of nearly 7.5% on the first quarter 2009. Two thirds are male and 50% are known to have injected drugs at some point in their lives. The ages of those diagnosed range from 20 years old to over 60 years old. Of those diagnosed with hepatitis C 21% were diagnosed in hospital, 19% in GP surgeries, with the majority of the rest diagnosed by Addiction and Harm reduction services in the community.

Any of the patients you see may have a blood borne virus. Those affected can be from any walk of life and they do not come from a specific age group. It is important that those at risk of BBV are identified so that we can direct them to the most appropriate services for testing and treatment.

For further information on the BBV online learning please go to www.projectSTRADA.org

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Renal Patients get on their bike

The Renal Unit at Raigmore Hospital and its 2 satellite units have been running an exercise programme for haemodialysis patients since 2006, which was initially set up by one of the exercise link nurses, and is now managed by the Unit’s physiotherapist.

End stage renal disease (ESRD) presents with numerous comorbidities. These are exacerbated by high levels of inactivity and aging, leading to muscle wasting. The benefits of exercise for ESRD patients are well established and date back around 30 years. Studies have reported both extensive physiological and psychosocial benefits including improvements in: peak oxygen consumption, blood pressure control, muscle mass, cardiovascular function, nutritional status, diabetic control, lipid profiles, functional capacity, independence, depression, pain control, fatigue and quality of life. Exercise on dialysis has also been shown to improve the quality of dialysis by increasing blood perfusion between the working muscle and circulation, leading to a greater removal of waste products from the muscle to then be removed by the dialysis.

There is now a nationwide move towards offering exercise facilities for dialysis patients and this has lead to the development of a national group of around 60 healthcare professionals (nephrologists, physiotherapists, dieticians) which aims to collaborate research, develop guidelines and promote the role of exercise within this group of patients.

Exercise rehabilitation for renal patients is recommended in many major Guidelines including SIGN, KDOQI and UK Renal Association Clinical Practice Guidelines.

An initial assessment is completed by the physiotherapist, which includes exercise goal setting with the patients and they are screened to ensure they are safe to participate in the programme. Patients cycle from 5-40 minutes three times a week during dialysis using recumbent bikes designed to be used with the dialysis chairs. All nursing staff are trained on how to apply the bikes and complete a safety checklist before each bike session.

Patients have demonstrated improvements in physical tests, function and mood, which are evaluated 3 monthly. They have individual exercise diaries and receive a certificate at the end of each month of how far they have cycled.

At present there are 14 patients using the bikes regularly at Raigmore who cycled 81 miles, 4 at Belford Hospital who cycled 53 miles and 2 at Caithness General Hospital who managed 20 miles through the month of October!

Patient feedback includes:

• ““I find the renal bicycle programme to be beneficial as not only has it helped improve my overall fitness, which has been shown in my physical tests, it has also shown to improve my quality of dialysis through improved blood results.” • “It’s definitely helped with my muscles. The year before I started dialysis I felt really weak but then the bike made a big difference.” • “I don’t get walking the same as I did before so feel the bike is a great help.” • “It’s really helped with my leg cramps.” • “I now find it easier to get up the stairs.”

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Scottish Patient Safety Programme Driving Quality through Improvement Congratulations to the Raigmore Critical Care team who have achieved their SPSP target of 300 days between Ventilator Acquired Pneumonia (VAP) for the first time this month.

The Process was to reliably implement the IHI’s (Institute for Healthcare Improvement) VAP ‘Bundle’:

• Sedation to be reviewed and, if appropriate, stopped each day • All patients will be assessed for weaning and extubation each day • Avoid the supine position, aiming to have the patient at least 30o head up • Use chlorhexidine as part of daily mouth care

Success was achieved through Multi-Disciplinary teamwork and by applying the Model for Improvement. Each separate element presented its own challenges and many PDSA (Plan, Do, Study, Act) tests of change took place. The team enlisted the help of medical physics to design a protractor for each bed space to accurately measure the 30 degree bed elevation. Culture change has taken place in terms of understanding the methodology, revising paperwork and producing checklists, ensuring regular and contingency checks are built into the system and communicating each achievement with the whole team.

“For a long time we thought that preventing VAP was unachievable but now we no longer view VAP as an inevitable complication. It was through examining our processes that we realised we need to change specific practices in order to achieve reliable implementation of the bundle for every patient every time”

Argyll and Bute Mental Health

Argyll & Bute Community Health Partnership (CHP) held 22 public events in October in supermarkets across the CHP to speak to as many people as possible about mental wellbeing, keeping mentally well and the mental health redesign. The stall was set up at the entrance and a ‘Steps for Stress’ booklet and a news release about the Redesign was handed out to shoppers.

Early feedback was that the take-up of booklets and other items was very good and there was great interest on the part of shoppers. Page 10

Healthcare Support Workers Mandatory Induction Standards

Managers and supervisors are reminded that all new Healthcare Support Workers starting work on or after 1 January 2011 must make a commitment to attain the new Mandatory Induction Standards within 3 months. This applies to all new starts, including fixed-term and bank contracts.

Healthcare Support Workers are staff other than registered healthcare professionals. So this includes all administrative, hotel services and estates staff as well as non-registered staff in nursing, AHP and laboratory settings.

The Mandatory Induction Standards and all supporting documentation can be found on the NHS Highland Intranet. Click on the “Staff” Button and select Healthcare Support Workers from the drop-down menu. Included on this webpage are workbooks and guidance for reviewers; these are designed to help you assess whether staff have met the standards and are able to sign up to the Code of Conduct.

All recruitment documentation has been updated to reflect the new requirements, and it is essential that managers recruiting staff who start work on or after 1 January highlight the new standards at interview. Further guidance on recruitment matters is available from Employment Services.

The purpose of the new standards is to ensure patient safety. In most cases it should therefore reflect what is already happening in wards and departments across NHS Highland. But we will be required to assure the Scottish Government that we are applying the new standards rigorously and consistently, so managers of new appointees will be contacted throughout the initial three months with reminders about timescales.

For further information visit the Intanet webpage or contact Donald Shiach, Pay & Equality Manager ([email protected]).

Wear it PINK at Raigmore Congratulations to the Medical Staffing and Employment Services Teams at Raigmore Hospital who took part in October’s ‘Wear it Pink’ day, raising funds for the breast cancer campaign.

They raised a grand total of £410 on the day through a bottle / gift stall, selling cakes and sweets and a competition allowing you to guess how many scarves Personnel Assistant Shiria Rashid owned.

They also had a Gents Racer Bike which went to the highest bidder.

Many thanks to everyone for their donations and to those who came along to support and take part in the fun.

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Get ready for Winter

How prepared for winter weather are you?

Last winter Scotland experienced some of the coldest weather and the worst snow and ice that we have seen for many years. For many there are vivid memories of the widespread disruption to travel, burst pipe misery and damage to properties all over Scotland including businesses.

Because even an average winter is likely to include cold snaps and snowfalls, ice, storms, high winds, heavy rain and fog, the Scottish Government has published information to help you and your family get prepared early.

Ready Scotland (www.ReadyScotland.org/ ) contains practical advice and simple steps you can take to protect yourself, your family, your community and your business from the worst effects of all kinds of weather.

The Scottish Government also wants to hear from members of the public who have any ex- periences to share with others about how to deal with winter weather. You can send an email to [email protected]. to pass on your top tips for coping with winter weather to others who need help.

Local authorities across Scotland take considerable steps to maintain public services and keep roads clear, whatever the weather. But the key to being properly prepared is what you can do, in your own home, and with your neighbours, to minimise the effects of winter weather where you live and work. So don’t get caught out this winter. Visit www.ReadyScotland.org/ today, and start getting ready for winter.

Opportunity to find out more about help for people with memory problems Two events have been held in the Highlands to offer information on the help and support that is available for people with memory problems.

Both were arranged as a result of partnership working by NHS Highland and Alzheimer Scotland.

A series of drop-in events for people worried about their memory and for their relatives, friends and carers were held in Grantown on Spey, Aviemore and Kingussie to enable local people to find out more about dementia and what support and services are available in the area.

Community Mental Health Team Occupational Therapist, Mary Duncanson, said: “We know there is a huge unmet need in this area. Often referrals come to us when there is a crisis, but we really want to see people at an earlier stage.

“I feel strongly that, just because someone is given a diagnosis of dementia, of whatever type, it does not mean that his or her life stops. Life can still be worth living. Occupational Therapy can help someone continue to live life to the full, but safely.”

And representatives of NHS Highland and Alzheimer Scotland attended the seasonal flu clinics at the Duthac Centre in Tain to provide information to the people attending for jabs.

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Lynda Forrest, who is NHS Highland’s Programme Manager for the Mental Health Collabo- rative, said: “We were keen to let people know that we were available to discuss these is- sues with people if they wished to do so. We were also able to offer guidance on how they might access practical support, if they wanted it.

“We have been working closely with GPs and the available data shows that there are hun- dreds of people with mild to moderate dementia who have not yet been diagnosed but may be worried about their memory.”

Anyone wanting further information on Alzheimer Scotland services in should call 01463 711707 or by email at [email protected]. The charity also operates a 24 hour freephone Dementia Helpline on 0808 808 3000.

Getting kitted out for participation

Do you need to get some feedback about a service or care from your patients but don’t quite know how best to go about it? Then the new Participation Toolkit might just be the bit of the jigsaw you are looking for. It offers a number of tried and tested methods along with some more recently developed approaches. The purpose is to help you select a suitable method to engage patients in the design, delivery and evaluation of health services and to ultimately improve the quality of care.

The Participation Toolkit has been compiled by the Scottish Health Council as part of the support it provides for NHS staff in delivering Patient Focus and Public Involvement. While it is not an exhaustive list of the possibilities it outlines twenty-two ways for you to get participation and produce a report of the findings. As well as emphasizing the importance of evaluating activities and feeding back to those who take part it offers tips on ethical issues, accessibility, health and safety, expenses and some additional useful resources.

Patient Diaries, Graphic Facilitation, World Café and Storytelling are just some of the ways to involve members of the public as a group or alternatively to involve individuals in their own care that are illustrated by the Toolkit. In addition to the tried and tested techniques, the Toolkit includes many modern and innovative approaches such as digital storytelling and social networking. Each technique and how to use it is explained in detail along with their pros and cons.

The Participation Toolkit is available for download from the Scottish Health Council website www.scottishhealthcouncil.org. Alternatively, there are a limited number of hard copies available. For details of how to get a copy the number of the Local Highland Office is 01463 723 930.

Remember for both local and national participation guidelines to look on the NHS Highland Public Involvement page on the Intranet http://intranet.nhsh.scot.nhs.uk/Org/CorpServ/ HumanResources/PublicInvolvement/Pages/Default.aspx

STOP PRESS

Look out in the New Year when the NHS Highland newsletter will be re- branded for 2011.

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TAG skills centre open day at new premises in Inverness

A European funded project providing training and support to people with mental health problems to help them return to work or further education has moved to new premises in Inverness.

TAG Highland, which is led by NHS Highland, works out of 10 skills centres throughout the Highlands with Inverness being the central office, but until recently it did not have a

Above: Daniel Ward, TAG Nairn and TAG permanent base in the city. Easter Ross Training Coordinator, Susan Thomson, Cap Gemini Service Desk And it held an open day on Tuesday November 16 for Analyst, and Marion Mackay, TAG invited guests so they could see the new premises at Highland Manager. Rowans, New Craigs, Leachkin Road, and to raise awareness of the work that is done there.

Marion Mackay, who is manager for TAG Highland, explained that they had been based in a number of different buildings on the old Craig Dunain site, all of which had been temporary arrangements and were too small. The skills centre and workshop had been in separate locations and the workshop was shared with another organisation.

The new premises bring together both the Training and Supported Employment Unit and the workshop for Social Enterprise TAG Trading on the one site. TAG Trading generates income by providing a picture framing and printing service, as well as selling a range of garden furniture and other wooden items to order.

Mrs Mackay said: “Both staff and clients are very happy in their new workplace. It has raised morale, motivation and effectiveness. It has also resulted in more referrals by word of mouth and made us proud of our accommodation.”

TAG Highland is mainly funded by the European Social Fund (ESF) and has been successfully working in partnership with a number of different organisations and public bodies for around 20 years.

From TAG Highland to work

Susan Thomson (pictured), of Nairn, was referred to TAG Highland by her Community Psychiatric Nurse and trained with the project before returning to work. She is now in full-time paid employment with Cap Gemini.

She said: “At first it was a bit scary until I got to know the tutor and the general routine.

“I had left school, some time ago, with no formal qualifications. TAG Highland helped me gain up to date and relevant qualifications. This gave me a sense of confidence and I felt equipped to move on to employment.

“TAG Highland has helped me in several ways. It helped me to socialise with others and build up into a working routine with structure to my day. Accessing the TAG Highland unit gave me a reason for getting up in the morning. It gave me something to do and stopped me from descending into the cycle of isolation.

“I would recommend TAG Highland where you can meet people, get qualifications and generally get back on track.”

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Getting Greener

Winter is approaching and so too is the prospect of shorter daylight hours and colder weather. At home and in the workplace our use of Heat and Electricity will increase in the coming months. This newsletter’s theme is to identify what is going on that you can get involved in to reduce the impact of both this year….

At Work - Energy Toolkits For most of us the energy spent in the workplace means very little time to us. Yet at over £7million every year (inc. Water) a small difference in behaviour can save a lot of money. The government believes that we waste around 10% in our buildings that good housekeeping would prevent. Imagine saving £700,000 a year!

To help with this an Energy Toolkit has been produced for local management for Energy in our hospitals; and some of our larger offices. NHS Highland has to meet national demands and knowing where we use our energy on a site by site basis will aid efforts in future improvement. This will require local Energy Enthusiasts to come to work with Estates/ Energy Manager but together we can tackle this level of wasted expenditure.

At Home – Free Energy Packs In recent days the Scottish Government has announced a special sponsorship of Energy Monitors and Energy saving adaptors (for T.V./Digital box/Sky etc). This is also part of a national marketing campaign. Scottish Gas are giving these away free. NHS Highland is seeking 100 of these packs to help in our promotions but EVERY household can call and get their own. The weblink is suffering some difficulties but to get your own please call (free) on – 0800 512012.

Colleagues who have tried these simple to connect Energy monitors inform me of the ease to use and understand. They provide the means to see where large peaks occur (when you use the tumble dryer, kettle, electric shower) and where small differences like switching short use items like a Microwave or light off can actually save on money. These will not save you money on their own, they will however help to change you, and your family’s bad habits!

What will save you money is the Powerdown adaptors that come with the pack. This allows for the freeview box or Sky (or anything that requires 24 hr updates) to work whilst powers down the other things when not in operation – e.g. T.V. It is expected that on average these can save you around £47/yr without doing anything else.

At Home There are opportunities for staff and patients to gain from a large award to Highland Council in relation to improving their homes if they live in on of 3 Highland Wards. A fuller article on this can be found on p14.

Other Updates

Kessock Bridge Upgrade – this is to happen soon. Essentially there will be disruption to traffic for a sustained period of time. Details are to follow however if you are to be affected, e.g. such as a daily commute to work, now is the time to start thinking about how it is likely to impact and what can you do to reduce this.

If you have any suggestions or views re how this could be handled with a lowering impact, e.g. Park and Rides, Carsharing…, please forward to me and I will link in with the appropriate bodies.

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Cycle-to-Work Scheme – The number of staff taking advantage of this scheme for this year’s promotion was 218. The scheme is now closed for the year but the numbers reflect another great deal of interest in moving away from the Car.

Future Newsletters The “Going Greener” articles are aimed at making Energy real for you at Work and at home. The more information we have, the better the quality of article we can provide. If you wish to contribute, or advise on areas we may want to pursue, please do so via myself on [email protected] or direct dial – 01463 704618.

Free insulation and advice to Highland households

Householders in three wards across Highland are being urged to take advantage of a Scottish Government programme which could make their homes warmer and help save money on energy bills.

The Highland Council has been awarded £490,000 by the Scottish Government to deliver the Universal Home Insulation Scheme (UHIS) in 3 Highland wards – Badenoch & Strathspey; East Sutherland & Edderton; and Skye. UHIS has the following objectives:

• To provide universal energy efficiency measures to a large number of Highland households.

• To deliver emission savings and assist in reducing fuel poverty.

The Scottish Government scheme offers householders a free home energy audit and free impartial advice to help reduce fuel bills through the Scottish Government’s Energy Assistance Package. For private households identified as needing cavity wall and loft insulation, the scheme offers free surveys and installation by Eaga Scotland. Referrals can also be made to social landlords identifying potential insulation works in their properties.

Over 16,000 households will receive mail from the start of November which will provide further information on the offers available. Peter Rickard, Centre Manager of the local Energy Saving Scotland advice centre which is organising the campaign on behalf of The Highland Council says “As we approach the winter period, it is more important than ever that people find out how they can insulate their home more effectively and reduce their heating costs.

We are urging householders to act now and call 0800 512 012 and speak to one of our friendly advisors. The offer of free insulation means that every household in these areas can benefit from a warmer winter and lower energy costs.”

The funding for the Universal Home Insulation Scheme lasts until the end of March 2011 so households should act now to make sure they don’t miss out. They should call local Energy Saving Scotland advice centre free on 0800 512 012 as soon as possible to speak to an advisor.

Margaret Davidson Chair of Highland Council Housing & Social Work Committee says “This is a win:win situation for householders in these three rural areas of the Highlands. Not only will they make their homes warmer this winter but they will also save money on their energy bills.”

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Wick pupil’s breastfeeding awareness poster to be used throughout Highland A poster designed by a pupil at Pultneytown Academy in Wick is to be displayed throughout the Highland area to raise awareness of the importance of breastfeeding.

Loryn Duffus, 11, won a competition run by NHS Highland and Highland Council following breastfeeding awareness sessions for primary 6 and 7 pupils in schools throughout the Highland Council area.

And her classmate, Natalie Cornwall, also 11, was placed second in the competition that attracted entries from primary school pupils from all over the Highlands.

Loryn won a family pass to Landmark Park at Carrbridge and Natalie won a family pass to the Highland Wildlife Park at Kincraig, Kingussie.

Loryn’s poster was launched at Pultneytown Academy in November and the school was presented with a framed copy.

Head teacher Lilian Wark said she was pleased the children in Primary 6 and 7 had been made more aware of breastfeeding.

NHS Highland Infant Feeding Advisor, Karen Mackay, said the sessions had proved a huge success in schools across Highland and there had been a good response to the competition.

She explained that breastfeeding now formed part of the curriculum for excellence, so NHS Highland joined forces with Highland Council to deliver breastfeeding awareness sessions for Primary 6 and 7 pupils. These sessions were launched during Breastfeeding Awareness Week in June.

Mrs Mackay said: “Research has shown that girls make their minds up about how they are going to feed their babies by the age of 11.

“We made up educational packs, which look at mammals and how they feed their young, and then move on to how humans feed their babies, including pictures of celebrities who are known to breastfeed their babies in public.

“The pack also includes information on the Scottish Breastfeeding Act 2005, which makes it illegal to stop someone breastfeeding in public, and we talk about the health benefits and have a general discussion about breastfeeding with the children.”

Loryn’s poster will be used in NHS Highland and Highland Council properties throughout the Highlands. It will also be displayed in shopping centres across the region.

Dental SVQ’s

Congratulations to trainee dental nurse Deirdre Eaglesham – Dental Nurse at Dingwall Dental clinic who has completed her SVQ in Dental Nursing.

Congratulations also to Iona Mackay and Lorna Barbour, Camegheal Dental Clinic; Lorna Baxter, Albany Dental Clinic; and Sarah Beattie, Inverness Dental Centre who have all completed SVQ in Oral Health Education.

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Blarbuie Woodland, Lochgilphead

Blarbuie Woodland (pictured) is on the edge of Lochgilphead and is partly in the grounds of Argyll and Bute Hospital. In 2002 a number of individuals, including NHS staff, started to discuss the need and potential for restoring the woods for the benefit of users of mental health services, other specific groups, and the wider public. A Partnership was formed and work began on the ground in 2004, and the site was opened as a public park in 2007.

Many training workshops and events have been held, and patients of Argyll and Bute Hospital, disabled people, school children and members of the wider public and visitors have walked in the Woods or been involved in open days and hands-on activities. In 2008 research was undertaken into the impact of working and walking in Blarbuie Woodland on health and well-being.

The Woodland is currently run by a charity-led consortium, but remains in NHS ownership. The Blarbuie Woodland squad maintain and improve easy access, and produce firewood, compost, plants, and timber products, but they also add to the site and experience through artistic expression, so that the woodland walk is an ever-changing experience.

Islay Dental Raise Awareness of mouth cancer action month

The Oral Health Improvement team helped to raise awareness of Mouth Cancer Action Month in Islay by organising an event for the campaign.

Running for the duration of November, the campaign features the tagline ‘If In Doubt, Get Checked Out’ and urges the public to visit their dentist for oral screening.

Professional check-ups and regular self-examinations are the best route to early detection of mouth cancer. Early diagnosis saves lives, improving survival chances from just half of cases to more than 90%.

Early warning signs include ulcers which do not heal within three weeks, red and white patches in the mouth and unusual changes in the mouth. A professional check-up can help save lives in mouth cancer cases.

Margaret Formby Dentist and Ailsa Bermingham oral health educator were in Islay Pharmacy for free oral screening examinations on November 2nd 10am -1pm. There was also a drop in held for NHS staff at Islay Hospital on Monday November 1st 10am-1pm as part of Islay Hospital Healthy Working Lives.

Pharmacist Catriona Brodie commented: “We are delighted to get involved in Mouth Cancer Action Month in Islay. It is vital that people are aware of the risks and are checked regularly for signs of mouth cancer – early detection saves lives.”

Both mornings were well supported with twelve members of staff attending the NHS Healthy working lives session and thirteen members of the public calling into the pharmacy for oral screening.

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Knowledge and Skills Framework Update

Current News… As this article is being written over 56% of staff within HEAT target E10 are using e-KSF as part of their annual Personal Development Review; 23% of staff have a completed review which is signed –off and a further 4% have a review which has been signed-off by either the reviewer or reviewee but not both. If you are in the last category please look at your review document to ensure it is completely signed-off.

Engagement levels are increasing rapidly and there is lots of great work being carried out by staff and managers to ensure this achievable target is met.

If you have not started using e-KSF yet, maybe because you have lost, forgotten or never received a user name and password, or you are not sure what to do, then please use the contact details at the end of this article to arrange for someone in your area to assist or train you.

Guidance material is also available on the Learning & Development intranet site where a range of short guides can be accessed, the guides range from those for managers wishing to create/submit or resubmit KSF outlines to guidance on evidence for your review.

Accessing e-KSF… To access e-KSF you require an nhs.net email address, if you do not have one speak to your manager or complete form AR1 (Access Request Form) available from eHealth; you also require a unique e-KSF username and password; if you need more information about this please contact Aileen Trappitt in the Learning and Development team, 01463 706877 or email [email protected].

KSF – Staff feedback… “Just a quick email to thank you for taking the time to visit our office… (we) now feel far more comfortable with using the system. Having an enthusiastic person guide you through it makes a huge difference”. (Audit Coordinator, Raigmore).

“I no longer have shelves full of paperwork for my staff regarding their annual reviews, I can access everything I need using e-KSF; my staff are starting to engage more as they have their own login details, I need to remember to provide the time for them to enter evidence but usually 15 minutes or so a week is enough”. (Charge Nurse, North CHP).

“Some of us attended the KSF Road Show recently and found it very useful, it was informal and we felt comfortable asking daft questions, we were shown how to enter evidence and save it for our review” (Staff Nurse, Mid CHP).

Training… Many staff are successfully using e-KSF already, some are self taught and some have par- ticipated in the training that is available through e-Health, the following courses are currently available to staff in North Highland:

K1001 for Reviewees and K1009 for Reviewers/Managers

Please note that these courses require a basic working knowledge of personal computers; places are also extremely limited so managers are requested to consider sending staff on the course who will have the capacity to cascade the training back in the work place.

For more information regarding these courses please contact e-Health on 01463 257500 or view the information on the e-Health intranet site.

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For staff in Argyll and Bute e-KSF training is delivered by David Templeton 01546 604978 ([email protected]).

David delivers combined sessions for both Reviewers and Reviewees and sessions are be- ing run across localities throughout Dec and Jan. Please look out for posters in your area showing dates for each locality.

PDP&R, e-KSF refresher and short e-KSF demonstrations are available from;

Sally Munro 07810 180968 or email [email protected], Argyll and Bute

Paul Simmons 01463 706885 or email [email protected], Highland

Retiral Corner Eric Wiseman (pictured right with Director of Nursing Heidi May) has retired after over 30 years of working as a nurse (in a variety of fields) in Inverness and the surrounding area.

Qualifying as a Registered General Nurse in 1976 Eric went on to qualify as a Registered Nurse for Mental Deficiency and then a Registered Psychiatric Nurse in 1977, that being the year he also took a job as a staff nurse (soon became acting charge nurse) at Craig Phadrig.

Qualifying as a Health Visitor in 1979 he went on to become a Health Visitor in Inverness before joining the community infection control team as a Clinical Nurse Specialist in 1991. Eric stayed with infection control until his retirement, albeit in various locations around Inverness, and from 1997 he was also working one day a week with the Public Health team on TB control.

A number of staff from both hospital and community turned up to send Eric off in style at a tea party earlier this month. While they will miss his skills with ‘google’ they wish him all the best for a long and happy retirement with wife Jacqui and their three children.

Dr A George F Aitken (pictured left) has retired after 26 years service as Consultant Radiologist to Raigmore Hospital and the Highlands.

Dr Aitken qualified in Medicine at Aberdeen University, graduating in 1975, and was a surgical houseman at the RNI in Inverness before moving to Canada to do Family Practice. Tempted into a career in Radiology he trained in Edinburgh under Prof Eric Samuel before returning to North America where he was a staff radiologist, later Assistant Professor, in Seattle.

The lure of the Highlands proving too strong he returned to Inverness in 1984 as Consultant to the old Northern Regional Hospital Board, bringing prized new skills in CT and Ultrasound with him. Dr Aitken has made a great contribution to Highland Radiology over the years since then, and has been a particular champion of the community hospitals.

An accomplished pianist and outdoor enthusiast he will have no trouble occupying his retirement years, despite already having knocked off all the Munros, Corbetts, and most of the Grahams! A large gathering of friends and colleagues attended his retirement dinner in the Kingsmills Hotel to give him a warm send off.

If you wish to acknowledge a colleague’s retrial please send copy (no more than 200 words) and a photo to [email protected] or [email protected]

We can only accept electronic copy / photos

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Letters to NHS Highland

“Can you please pass on our before being transferred to the “I would like to thank all involved thanks to all the staff at Dunaros Western General. with helping me after I took a A&E and Hospital in Salen Isle Your on-duty staff of Dr Halliwell faint in the stairs of Raigmore Of Mull. and nurses Hazel Wiston and Hospital. Our daughter broke her arm Lindsay Martin reacted swiftly The staff were fantastic - Drs, during our recent holiday to the and efficiently in preparing me nurses etc. One person stood island. The level of care for the journey and probable out to me with her kindness, a and personal attention shown surgery. young auxiliary nurse who by ALL the staff was second to I would also like to thank the approached me when I felt none and gives our family faith ambulance driver and unwell at first and was so in the NHS overall. Thanks to paramedic who looked after me proactive in my care. I am sorry them all she is now on the mend during the journey, keeping me I don’t have her name but she and back to her usual chirpy as calm and as pain free as really was my ‘Florence self.” possible. Nightingale’. A patients relative from We how live in this delightful I had 10 years emergency Midlothian part of the world are indeed ambulance experience and fortunate in having such a can’t get over how fantastic all “I would like to record my thanks wonderful facility close by, involved were in my care. for the professional and clinical staffed by excellent My family owe Raigmore a great care I received when I was professionals. debt for the excellent care we taken to your hospital with a Thank you all very much have had over the years, severe post operative infection indeed.” grateful thanks.” A Patient from Argyll A Patient from Easter Ross

A letter with a difference sent out NHS Highland Dental Services this month.

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Special Care Baby Unit and local charity benefit from silver wedding anniversary

A Dingwall couple who recently celebrated their silver wedding anniversary asked family and friends for donations for the Special Care Baby Unit (SCBU) at Raigmore Hospital in Inverness and a local charity instead of presents.

Graham and Linda Campbell were delighted when the donations totalled £680, which is being shared equally between SCBU and Headway Highland – a charity which provides help and support to people affected by brain injuries. Above: (l-r) Mairi Macdonald, Staff Midwife; Graham Campbell; Scott Campbell; Janie King, Mr Campbell explained that their son Scott, now 12, Headway Highland; and Linda Campbell had been cared for at SCBU for a short while after he was born in April 1998.

He said: “Scott was born in Fort William, but he was rushed to the unit because he was five weeks early and had breathing difficulties. We were very grateful for the way they looked after him. We obviously said thank you at the time, but we have never had a chance to say thank you properly like this until now.”

They also wanted to make a donation to Headway Highland because Mr Campbell suffered a brain tumour nine years ago and both he and his wife have received a lot of help and support from the charity.

He said: “My wife found it particularly helpful to be able to talk to people who understood about what was happening to me after the tumour was diagnosed and during my recovery.

“Our silver wedding anniversary seemed like a great opportunity to thank both SCBU and Headway Highland for everything they have done for us and to raise awareness of what they do.”

Sharon Lawrence from SCBU said: “We are very lucky in the Special Care Baby Unit with all the support we receive from members of the public. Ex patients often visit the unit with their parents even into their teenage years and beyond, and the staff love to see how well they are doing. Strong links are forged between the unit, past and present patients and indeed the Highland community at large and all the generous support that the unit receives is greatly appreciated.”

Free access for Health Professionals to the V3 NHS Scotland webcast Library

We would like to draw your attention to a valuable resource now available to all Scottish Health Professioanls. As the name suggests the V3 NHSCasts is a vast collection of webcasts created over the years by Video3 Technologies covering a range of topics from the 18 Weeks RTT programme to the NHSScotland Annual Event presention from 2007- 2010.

The library is constantly being updated and we care currently re-mastering many of the older presentations made before 2008. We would like to stress that this resource is free to all Scottish Health Professioanls and you can access the presentations at www.video3uk.com/nhscats.

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Focus on: the Allied and Complementary Medicine Database (AMED)

Can water remember? This intriguing question was posed in a paper in the early 1970’s by the late French scientist Jacques Benveniste and caused a major discussion around homeopathy which is still reverberating today. Recently the writer Simon Singh had a bruising encounter with the British Chiropractic Society which has spilled over into discussions around the law of libel. What is the truth about chiropractic - is alternative medicine trick or treatment?

The Allied and Complementary Medicine Database (AMED) may help illuminate these and other queries. The database is available through the OVID database suite of the Knowledge Network [http://www.knowledge.scot.nhs.uk/]. It is a production of the Health Care Information Service of the British Library and covers journals in complementary medicine, palliative care, and several professions allied to medicine. The database is updated monthly and covers from 1985 to the present. The database has its own internal subject heading structure and there is the facility to use the tree structure for searching. Additionally the permuted indexing facility allows quick finding of alternative terms for a subject.

Whether you are a skeptic or not AMED is a very useful database to use when considering questions relating to alternative therapies and is a good supplement to the mainstream medical, nursing and allied health databases.

For more information on this and other databases and their uses please contact the Highland Health Sciences Library – 01463-255600/ext. 7600.

The Library also holds material on alternative therapies some covers of which are illustrated (right). If using online version of Team Update click on book cover to access book details in library catalogue – other wise use the catalogue at: http://libcat.stir.ac.uk

Rob Polson ([email protected]), Highland Health Sciences Library.

Smokefree NHS Highland

Useful Helplines and Websites for Information and support on Smoking Cessation

• Highland Smoking Cessation Service—lo-call 0845 757 3077

• Smokeline 0800 84 84 84

Occupational Health are now offering smoking cessation support to the staff of Raigmore Hospital. This can include one to one support for smoking cessation as well as advice in regard to products such as nicotine replacement therapy . Appointments can be made within Monday to Friday 9-5pm. Please phone 01463 706147 (ext 6147 for internal) for an appointment.

Smoking Cessation Support Service for New Craigs and RNI staff at New Craigs hospital call 07920247930 to make an appointment.

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