What a difference a day makes…


I was mulling over what to write about this week and was slightly stumped as to what to say.  You see it was one of those rare weeks where things seemed under control.  No less busy just less frantic. I’m always caught by surprise when they come along.  It’s a bit like running really fast to get somewhere but failing to notice that you’ve already arrived. So I stopped running,  got my breath back and looked around.  What to do…..?  Like most people I’ve a huge list of things to do but for the first time in months I had time.  I could decompress.

Working in the NHS means things can change at a moments notice so you can never be too complacent or relaxed.  It does require a bit of getting used to though.  One thing you are taught is never to say the ‘Q’ word. It’s rather like uttering Macbeth inside a theatre.  Any type of emergency that subsequently happens will be the sole fault of the ejeet who said the ‘Q’ word in the first place.

Establishing that things appeared to be ‘settled’ it was quite nice to actually have conversations with people that didn’t just revolve around work related issues.  People laughed.  We ate some cake.  We still got the work done but it had a different feel to it.  Work was, for a short while, quite a pleasant place to be.

While my head was above water, bobbing along, I noticed some others were not having such a great week.  Sometimes it doesn’t take a person to be flailing around or making a lot of noise to indicate they are struggling.  However as I’ve mentioned before they can be unintentionally overlooked if you yourself are so busy in your own drama to notice the subtle signs.  I often think if a person uses the word fine more than three times in a conversation then things are clearly not fine.  I realise this could be considered anecdotal rather then scientific however I believe it to be true.

I had one such conversation with one of my colleagues this week.  What was lovely though was I could do something to help.  Nothing obviously noteworthy or major but something I hoped tried to make their situation better.

Time it would seem was on my side this week.

Later on in the week I was asked what was more important – money or time?  While you can argue the case for more money in almost any job time really is the most valuable commodity.  You can’t make it last longer, you can’t save it and it can vanish when you least expect it.

So as I look forward to the coming week do I expect it to be as straight forward?  No.  That would be foolish.  I work in the NHS for goodness sake!  I will however take each day at it comes mindful of the difference 24 little hours can make……



Is Donald Trump’s Press Secretary suffering from an acute delirium?

img_5540This was one of the questions I asked myself in the week that saw the reality TV star inaugurated as the new President of the United States.  As we know during a delirium there is:

1. disturbance of consciousness (i.e., reduced clarity of awareness of the environment)

2. the development of a perceptual disturbance that is not better accounted for by a pre-existing, established, or evolving dementia

These two points came to mind as I listened to the explanation regards the diminished numbers of people who turned out to watch the inauguration.

‘This was the first time in our nation’s history that floor coverings have been used to protect the grass on the MallThat had the effect of highlighting any areas where people were not standing, while in years past the grass eliminated this visual’

In contrast we couldn’t fit anymore people in at Erskine for the delirium and dementia education day.

The evidence for delirium in care homes is poorly understood.  I think a lot of this has to do with the focus on acute care.  However there is increasing acknowledgement that care home staff probably care for as many, if not more, people with delirium.

One statistic puts the prevalence of delirium as somewhere between 8 -15%  Derek Barron, Director of Care, tried putting that in context for the staff. Erskine Home has 180 beds which could mean 14 – 27 residents could have a delirium right now.  More to the point do staff know for sure who those people are?

The reality of caring for people with delirium and dementia is not something I needed to teach the Erskine staff.  That would be hugely disrespectful for a start.  What I had hoped to get across was some of the understanding around delirium and how to diagnose/manage it.  Central to this is my belief that we should be challenging our own behaviours instead of those we believe to exhibit ‘challenging behaviours’ towards us.

This was something Janice McAllister spoke of in her talk on dementia.  We are ‘disabling people with our behaviours and attitudes’.  Janice was able to help us see life through the eyes of a person with dementia.  More importantly she was able to make us realise that it is the simplest of things that can make the world of difference.

Janet, head of physiotherapy, spoke about her approach of ‘do with’ rather than ‘do to’ in those with cognitive problems.  The idea that any rehab should be task specific reinforcing the need to know what matters to the person.  Not just what we think matters to them…

This theme continued as the daughters of two of the residents shared their perspective on the care their Mums’ received at Erskine.  They spoke candidly about the good and the not as good. You could tell it was hard to hear but what came across was their appreciation as well as admiration for the work the staff do.

Something that really resonated with me was the comment that ‘I have known my Mum for 56yrs and you have just met her’. I find myself saying something similar when I meet relatives which is why I am such an advocate for the ‘Getting to Know Me’ document.  I have the medical but none of the personal knowledge to help alleviate their loved one’s distress.

Tommy Whitelaw continued to inspire as he spoke about ‘being the one who makes a difference’

The day was summarised for me with Nadine Schofield of ‘Let’s Respect’ when she spoke about the importance of teaching care home staff the 3 D’s

  • Delirium
  • Dementia
  • Depression

Know about them and you’ve pretty much covered all of mental health in older people.

Something may have changed and reality may be to some a distorted nightmare. However on that day I left Erskine with a renewed sense of hope and faith in the goodness of people.







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At work the pressures to get people seen, assessed and home as quickly (and safely) as possible continues.  All week there were reminders of just how busy we were.  Emails, crisis meetings, phone calls from managers.  Even the TV offered no chance of respite – The NHS ‘crisis’ was making headline news almost every day.

Yes, the war of rhetoric versus reality seemed never ending.

It would be exhausting if it weren’t for the glimmers of light that insisted on shining through.  It’s been a really weird week in that respect.  Without particularly looking for them they appeared.  This is what I want to get into this week – inspirational people.

Throughout my life I have looked to others to inspire me with confidence, a sense of belonging and a sense of possibility.  Watching Barack Obama’s farewell speech this week however, got me thinking about not just how some are able to inspire, but why is it that we seem to need these people?  Why can’t we inspire ourselves?  Bear with me as I realise that may sound a bit conceited or even arrogant.

When Joe Biden was awarded the Presidential Medal of Freedom with distinction, he spoke about ‘getting credit he didn’t deserve’.  In fact his whole speech was incredibly humble and yet to many he is an inspiration.

I think we want to mirror aspects of our own character in other people whilst recognising that we are all a bit flawed.

So coming back to reality how do we do this?  Moreover, how do we do this at this particular time in the NHS’s history?

We are all trained to put the needs of our patients above anything else.  We need to remind ourselves though that we are as important as our patients. The system continues to limp on but if we as a workforce become sick who is going to take care of us?

How we do this is a matter of style (or taste). To quote Leslie Knope from Parks and Recreation ‘one person’s annoying is another person’s heroic and inspirational’

I am a fairly social creature so will look to bring people together with coffee, cake or a simple ‘how’s it going?’

That said, I do think we need to come back to the idea that we can and should inspire ourselves.  We need to tell ourselves ‘You’ve got this! You are amazing, cut yourself some slack.’ Easier said than done when all hell is breaking loose but if I may, can I suggest that you write down some inspirational phrases or quotes.  Put them on your desk so when you’re in the midst of chaos and cannot see, they will make you smile, they will reassure, they will offer hope.

Who knows they may even creep into your subconscious so that…

‘….every time it rains

You’re here in my head

Like the sun coming out

…..I just know that something good is going to happen

… I don’t know when

But just saying it could even make it happen’

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Say something…


Day one. New Years Day.  I volunteered to work the early shift as we were short. My most favourite day of the year is New Years day. It is literally the quietest day of the year.  The silence of the morning is amazing!  Not even the sheep or the cows are making much noise.  Its like having the whole world to yourself.

The noise was of course shattered by the hullabaloo of the acute receiving unit.  It’s about this time that beds become scarce.  Xmas isn’t too bad.  Not that illness is any less prevalent.  I think many people have this idea that they should ‘hang on’ over Xmas so by the time New Year comes they are usually pretty sick.

The only new year resolution you hear about is trying to get through the day without writing last year’s date in the notes.

Another thing you’ll hear people say is “When can we get back to normal?”.  Normal in the NHS is usually defined as a fully functioning multi-disciplinary team and various other departments working ‘normal’ hours e.g. social work, pharmacy etc.

To be honest I’m not sure there is a normal anymore.  When you have the head of the Red Cross talking about ‘responding to the humanitarian crisis in our hospital and ambulance services across the country’  it is not surprising that people may feel like they are working in a war zone.

Add in the changing language that some in management use (we don’t board, we transition care…) and it also has the feel of that scene in Titanic when the string quartet played as the ship sank.

So when I came across this book the other day I thought ‘You know what, yes! This is a book I need to read and apply in my working life’


I even showed it to colleagues and suggested we use it as a template for future job planning sessions.  Much hilarity!

However predictably I started to find it less funny.  In fact I was a little worried.  Not that I had any time to mull on it – work, work, work…….

Periodically that sense of unease would work itself to the surface.  I’d try to latch on for a closer look but some other issue would divert my attention.  It was only when a comment about the ‘prickliness’ of work colleagues came back in my mind did I really stop and think.

We were desensitising.

Now most of us are already desensitised to the minus X bed emails and phone calls (people are usually referred to as beds before ‘transitioning’ to patients).  No, my worry is we are desensitising to each other and that we’re too busy to notice or care.

So with this in mind one of my aims for the coming months is to try to bring people together again.  I’ll be honest, I’m not sure how successful I’ll be but I think its worth the effort.  If history tells us anything then we owe it to our NHS and the people it cares for.  That it includes the people working within it…..