A Call to Action on #AHPsDay

I’ve never been one for keeping a reflective diary but when composing a new blog I always take some time to look back at those I’ve written before. In Sept 2018 I wrote a blog titled ‘What’s next?’ and I believe that blog is just as relevant today as it was then.

Within ‘What’s Next?’ I talked about the role of AHPs in cancer rehabilitation, the inspiring people I’ve come across in my roles, and the need for a collective and sustained effort to embed rehabilitation in cancer pathways. All of which echoes with the themes of #AHPsDay i.e. to celebrate and inspire, to raise the profile of the individual allied health professions, to demonstrate achievement and impact, and to support integrated working.

Transforming Care After Treatment

As 2018 drew to a close, so too did a programme called ‘Transforming Care After Treatment’ (TCAT). TCAT was a 5-year partnership between the Scottish Government, Macmillan Cancer Support, NHSScotland, local authorities, the regional cancer networks, and people affected by cancer. Its aim was to support those diagnosed with cancer to live as well as possible for as long as possible. The programme funded a number of tests and demonstrated models which should be considered by Health Boards, Health and Social Care Partnerships and third-sector organisations, now and in the future.

The AHP contribution

One project delivered under TCAT focused on palliative and end of life care, and dietitians and occupational therapists were integral to the project’s success. Not only were cost efficiencies demonstrated (through fewer admissions, fewer unnecessary tests and a better understanding of individual needs), but more importantly, quality of life improved and more people died in their preferred place of care. AHPs played a crucial role in these outcomes, and their resourcefulness and resultant ‘Teach, Advise, Assist’ model meant significant value was obtained from very little investment in AHP services. Despite this, ongoing funding has remains challenging and that threatens the long-term outcomes and future of the work.

Another project was the ‘Cancer Related Cognitive Changes’ project which was developed and tested by clinical psychologists. This successful project is now being delivered collaboratively by psychologists and occupational therapists across Scotland in Maggie’s centres, hospices and NHS Health Boards, improving access and maximising outcomes for those experiencing memory and concentration problems as a result of cancer and its treatment. The effect of this issue on people affected by cancer cannot be underestimated and I would urge readers to take a few minutes to watch the following short video to see just how much impact a project such as this can have on individuals and their loved one.

Video: Cancer Related Cognitive Changes and Their Impact on Me

Demonstration of need and future focus

The Holistic Needs Assessment (HNA) was a tool used throughout the TCAT programme by a majority of the 25 project teams (n=19). With over 2,800 HNAs completed during the programme, we now have a better understanding of the issues affecting people with different types of cancer at different points in the cancer pathway. The most frequently reported concern at every point in the cancer pathway was ‘Tired, exhausted or fatigue’. This issue and many of the others commonly reported (see figure 1) are issues successfully addressed by AHPs. As such, I would argue that there is enough evidence for us to begin to re-consider how we collectively organise and resource our cancer teams here in Scotland.

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Figure 1: Top 5 Concerns Across the Cancer Pathway from Johnson and Campbell 2018

Transforming Cancer Care

My hope is that Transforming Cancer Care Programme (TCC) will be one vehicle for this change. Announced in August 2019, TCC has three individual strands:

  • Building on the learning from TCAT,
  • Rolling out Improving the Cancer Journey, and
  • Exploring Prehabilitation.

As mentioned in previous blogs written by both myself and my AHP colleagues working in cancer services, Prehabilitation is part of the rehabilitation continuum, and guidance published in July 2019 calls for a multi-modal and tiered approach. The three core strands of prehabilitation are:

  • Physical activity and exercise interventions,
  • Nutrition, and
  • Psychological support.

Given the tiered model advocated (universal, targeted and specialist) there are a large number of services we can pull on to ensure everyone affected by cancer gets the best start in their treatment pathway. However, the guidance and evidence is clear – AHPs are vital for delivery and successful outcomes.

A call to action

Thus, with all of the above in mind my thoughts once again return to my previous blog… However, this time instead of asking ‘What’s Next?’ I’m encouraging my AHP, clinical, and third-sector colleagues, as well as those affected by cancer to demand that AHPs and multi-modal, tiered and across-the-pathway rehabilitation are next.

Contact

If you’re inspired by #AHPsDayScot and have a story or experience to share, why not get in touch with me at:

Debbie.provan@nhs.net or @DebbieProvanRD with #AHPCancerRehab

Tell me what you’re working on, what impact your service has had on people affected by cancer, what you need to transform your service, how AHPs have helped you to live well after a diagnosis of cancer, or how your experience could have been better with AHP support.

I look forward to hearing from you!

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Debbie Provan is a Registered Dietitian and works as the Regional Lead for Living With & Beyond Cancer with the West of Scotland Cancer Network. She is also a PhD student at the University of Glasgow and works with Macmillan Cancer Support to embed rehabilitation across Scotland.

References:

Johnson L and Campbell K (2018) Transforming Care After Treatment Final Wrap Up Report. Available at: http://www.woscan.scot.nhs.uk/wp-content/uploads/ENU-TCAT-Programme-Evaluation-Wrap-Around-Bulletin-November-2018-TCAT-PB-141218-Paper4b.pdf

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Allied Health Professions Day 14th October 2019 Celebrate, Appreciate, Inspire

AHP Day 3rd Oct

Some of you may be aware that there is currently a Health and Sports Committee conducting an inquiry into “what should primary care look like for the next generation”. Whilst this may sound very formal and daunting, it is fundamental that AHPs are at the centre of this conversation.

At the last team meeting before Christmas (sorry to mention that word in October) in my first year as AHP lead, we were asked what our Christmas work wish would be … mine was to never have to say “And AHPs” again and here we are, automatically included.

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So how do we help this to become the norm and develop further?  This shift has not happened overnight. Before the 2018 GP contract, the perception of primary care services was one of mainly GPs; General Practice staff; Dentists and Optometrists.  There is never one reason for a change such as this but I believe that there are some key ingredients:

Relationships – influencing the right people and understanding their interests is key. What matters to an 80 year old living at home, a dietitian or to a Chief Officer may be different but all are of equal importance

Tests of change – good qualitative and quantitative impact data looking at the difference made for patients, the service and the interaction with the wider system and community, is vital.

Collaborative working and leadership – one of the main reasons the musculoskeletal

services development has moved so quickly is because areas across the country worked together to demonstrate their impact.

Looking to the future of what could be, this can be hard when we are trying to just keep up with the day job. That said, change doesn’t have to be and arguably shouldn’t be a sudden wholescale change: “The next big thing is the next small thing”

One thing we have recognised as the primary care team develops, is that we don’t need specialists. We need high quality generalists with specialist skills and knowledge. A physiotherapist may have a specialist knowledge in MSK but equally relevant they may also have a number of years of generalist training, which is invaluable in primary care.

We are starting to see growth in occupational therapists maximising their generalist skills helping people with physical and mental health problems.

So, what could the future look like? If I have a problem with my foot, do I go straight to see a podiatrist? Not necessarily if we continue to build and develop multi-disciplinary teams with extensive generalist skillsets set as well as specialist expertise…however, I am interested to know what your answer would be to “what could the future look like for AHP practice in primary care?”

Contributor

 

 

 

 

Jan Beattie; Professional Advisor for Primary Care; Scottish Government

Jan.beattie@gov.scot

@JanAHPO

Journeying through Dementia in Aberdeenshire #SelfManagement

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Self-Management Week is 7th -11th October and takes place every year to raise awareness and showcase the huge benefits self-management can bring to people’s lives. Enjoy reading about our AHP approach to self-management when working with people living with #dementia.

We are delighted to share with you our experience of delivering Journey through Dementia in Aberdeenshire. Journeying though dementia is an evidence-based programme that has been co-created by occupational therapists and people with dementia. It aims to promote continued engagement in meaningful activity through equipping individuals at an early point of their dementia journey with the knowledge, skills and understanding of ways to continue to do the things they enjoy for as long as possible.  This is our first ever blog and we have designed it as a question answer so we hope you enjoy reading about our experience of implementing evidence to our practice in NHS Grampian.

Can you tell us a little about Emma and Bridgetta?

I am Emma Ingram and I have been working as an Occupational Therapist in Older Adult Mental Health for the past 4 years. I currently work in the Banff and Buchan area. This area is very rural and has strong links to the farming and fishing industry. I feel strongly that more resources and opportunities are required for individuals with dementia that live in rural areas.

 My name is Bridgetta Menton. I am originally from Ireland, however moved to Aberdeen in 2012 to pursue my occupational therapy career.  After graduating from Robert Gordon University in 2017, I was delighted to be offered my current post in NHS Grampian, within the older adult mental health services. Growing up in a rural farming community, I thoroughly enjoy working across rural communities in the south of Aberdeenshire.

What were reasons for you wishing to be part of the Journeying through Dementia demonstrator sites?

Journeying through dementia was a perfect programme for us to be involved with, as we both share an interest in early intervention and supporting people with a dementia diagnosis. We have been involved in a number of projects which focus on early intervention and self-management, therefore Journeying through Dementia gave us the opportunity to increase our knowledge and skills further in these areas.  Working in rural communities we were aware of the limited resources available to people with a dementia diagnosis. Journeying through dementia allowed us to deliver an intervention within a rural setting whilst promoting the importance of activity.

What difference did you see as the impact of Journey through Dementia?

 “My dad is really enjoying the group on Thursday morning. Telling me everyone gets on well and has fun. But teaching him how to deal with dementia, he was tidying up as that’s what you had been speaking about one week. Thank you so much for your support and kindness”.

This feedback highlighted the positive impact the programme had on our participants, in providing them with support in understanding their condition, whilst also highlighting the importance of engaging in their daily activities.

 As the group progressed, we were taken aback by the change in how our participants perceived themselves and their abilities. They expressed being more “motivated” and “confident” in doing the things that they need and want to do.

 In sessions participants reported feeling “embarrassed”, “frustrated” and “isolated” when discussing symptoms associated with their dementia such as changes in their communication. They reported this prevented them from socialising with family and friends in the communities. Through group discussion we observed an evident reduction in participants’ anxieties, as they came together as a group, openly acknowledging the changes following their diagnosis.  The mutual understanding and support encouraged participants to accept these changes instead of trying to hide them and avoid community activities.

What do you think was the impact to your practice?

The programme highlighted the importance of completing pre-screening and assessment in our occupational therapy practice.  Prior to the group, we spent time screening referrals and completing appropriate occupational therapy assessments. This process allowed us to formulate a group where participants were at similar stages in their dementia journey.

Journeying through dementia allowed us to see the benefits of providing an occupational focused group in a rural setting. Working in Aberdeenshire, we really saw the need for more community resources for people living with dementia. The feedback received from family members and participants emphasised the positive impact the group had on participant’s engagement.  We would hope to be able to provide more occupational focused groups in rural communities.

 What was the key to success of Journey through Dementia?

The three factors which contributed to the positive outcomes of our group were the environment, pre group screening and facilitation.

  1. Environment: We both agreed that the environment aided group participation. We held the group at Banff Library, this venue was easily accessible and participants were at ease within their surroundings. We had access to tea and coffee facilities which was also great.
  2. Pre group screening. Appropriate pre group screening resulted in our group members being at similar stages in their dementia journey. We felt that this had a positive impact on the overall group dynamics and outcomes of the group.
  3. Facilitation: Participants shared positive feedback on our facilitation skills during and after the group. As facilitators we ensured that the group was carried out in a relaxed and fun manner whilst using the Journey through Dementia Tool kit to guide group discussions.

One final sentence to share your experience of Journey through Dementia?

We really enjoyed being part of this improvement project as it allowed us to utilise our Occupational Therapy knowledge and skills in a creative and innovative way.

 Contributor

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Emma Ingram and Bridgetta Menton
Occupational Therapists, NHS Grampian
Twitter name: @emza1015

Journey through Dementia has been delivered by occupational therapists in Fife and Aberdeen.  However, we are delighted to share with you, Alzheimer Scotland has recently been awarded a self-management projects funds from The Alliance offering us the opportunity to spread “Journey through Dementia” to an additional three other areas of Scotland. Follow us at this blog or @AHPDementia or email Elaine at ehunter@alzscot.org to find out more.

 You can find out more about Journey through Dementia

Blog posts

Poster

Shared at Alzheimer Scotland conference 2019 https://www.alzscot.org/sites/default/files/2019-07/AHP_Poster%20-%20Journey_Through_Dementia.pdf

The value of the Alzheimer Scotland occupational therapy intern post to me as a training occupational therapist

Hi, its Danielle again, the Alzheimer Scotland occupational therapy intern. I have fast approached the end of my internship and I thought I’d share some of the things that I have learned over in my nine weeks.

Overall, it has been such a fun, enjoyable and unique experience. It has really challenged my perception of dementia and has significantly increased my knowledge of the condition.

The Scottish Dementia Working Group (SDWG) shared some of the adaptions they have made in their lives which supports them to continue to engage in occupations. Whether its leaving £20 in the back of their wallet for a taxi if they get lost or using a tracking device to help find their keys, these are the little things that support them to maintain their independence. I will use these ‘top tips’ or adaptations in my future career as an occupational therapist. As a thank you to the group, I created a small frame which included 4 words that represent the things the group has taught me about dementia.

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They are as follows:

1. Unique:

Each one of the members had unique interests, personalities and backgrounds. Dementia is one thing they had in common but each individual member had their own preferences, likes and dislikes. This was especially evident when it came to making tea. Some liked two milk one sugar, no milk just black and ‘just a drop of milk please’. We must not assume that people living with dementia have the same interests.

2. Live well:

The group were evidence that you can live well with dementia. By staying active, maintaining connections and making small adaptations to their lives, this supported each member to live a happy and fulfilling life. Most of the members spoke about living in the moment as they were unable to predict the future. This helps them to make the most out of each day. As a nation, we can struggle to focus on the here and now, but this is something I will make a conscious effort to do.

3. Independence:

Maintaining independence is one of the members 5 priorities. The group showed that supports such as technology, dementia services and dementia friendly communities enables them to maintain their independence. Since accepting their diagnosis of dementia, the members are not afraid to ask people for help. Most of the members carry a card that explains their diagnosis and they often use it in places such as cafes, banks or supermarkets. Using this card supports them to ask for help and reduces their frustration and anxiety in having to explain their condition. Small adaptions like these, supports the members to independently engage in their community.

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4. Empower:

The group empower people living with dementia to make their own decisions throughout their dementia journey. They have also helped me to gain a better understanding of dementia and has empowered me to work in collaboration with people living with dementia throughout their dementia journey. Its important to focus on the person, not the diagnosis.

Overall, this internship has challenged my perception of dementia. As a grandchild of someone who lives with dementia, this occupational therapy internship has been a useful resource for my family and for me as a training occupational therapist. It has been such a fun, creative and enjoyable way to expand my knowledge and understanding of dementia.

If you would like to find out more about the group or to get involved, please contact SDWG on 0141 410 1171 or sdwg@alzscot.org.

Follow us on twitter @S_D_W_G

Visit our website http://www.sdwg.org.uk/

Contributor: Danielle Timmons

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The occupational therapy intern roles gives students from Queen Margaret University the opportunity to enhance their knowledge and understanding of dementia. It runs for 10 weeks over the summer and it gives the students the opportunity to work on various projects that capture the voice of people living with dementia, subsequently reflecting organisational priorities. My previous degree was in social science and I will be commencing my final year of the MSc in Occupational Therapy (pre-reg) in Queen Margaret University in September 2019.

How a dementia dog changed my life

Dementia Dog Project

Dementia Dog Project is an innovative partnership project with Alzheimer Scotland. The project supports families living with dementia, both at home and in community settings. You may have seen their recent campaign to make sure new families are matched with a dementia dog through the #InThePictureCampaign.

The trained dog can provide support by aiding and prompting daily routines for waking, eating, taking medication, exercise, socialisation and sleeping patterns. In our latest guest blog, we hear from Henry who is living with vascular dementia and speaks about how his dog, Uno has helped with his everyday activities.

How a dementia dog changed my life

All about me19th sep

Hi, my name is Henry and I live with vascular dementia. I worked as a police officer for 30 years which I really enjoyed. I’ve been a member of the Scottish Dementia Working Group (SDWG) for the past 10 years, and I would consider myself to be ‘living well with dementia’. I can’t predict the future, so I take each day as it comes. I used to play football, but I give it up some time ago due to my diabetes. When I was 40, I joined a bowling club which I attend weekly with my friends and family. In 2005, I became the president of the bowling club and my son is soon to be this years president. The social aspect of the club is excellent, and I love meeting up with my friends. The club is walking distance from my house and I often walk there with my dementia dog Uno. During the winter months, I play carpet bowls which I equally enjoy.

Where did you hear about the dementia dog project?

I heard about the dementia dog project through one of the members of the SDWG. The member brought his dementia dog to our meetings and when I met the dog, I knew that one would be great help to me also. I had two yorkshire terriers in the past, but they were more like ‘lap dogs’. I got in contact with the Dementia Dog Project and I did three months of training with a dog called Uno, who now lives with us. I had just come out of hospital and was temporarily in a wheelchair. I remember being on a small path and training him to walk behind the wheelchair. I was worried that I would forget all the commands but my wife was also involved in the process, so she helps with the commands now and again. While in training, Uno spent some time with the students in Castle Huntly prison who used to walk him daily. I visited Uno in the prison but I didn’t mention that I was a retired policeman. I got to meet the student that walked Uno everyday and they showed me photos of Uno as a puppy. Its great for the students in the prison as it gives them a sense of purpose and responsibility.

 Can you tell us a bit about Uno and when he came to live with you?

After three months of training, Uno came to live with us. We were worried that he wouldn’t settle at first but on his first night, he came straight up the stairs and got into his basket that we had for him in our room. Since then, we never looked back. Uno has two beds in the house, one in our bedroom and one downstairs. Uno is trained to get my medication and we are waiting to hear back if he is eligible to be trained as a medical dog. Uno can detect if my blood sugars are low and he puts his head on my lap to prompt me to test them. If Uno does something for me, he is always rewarded with a treat. After Uno was placed with us, he underwent an assessment to ensure his suitability. I knew Uno would pass the assessment as he did everything perfectly that day. Uno loves human company and he is never far away.

How has Uno changed your life?

Uno has not only changed my life but my wife’s life also. Prior to Uno, my wife was reluctant to leave me alone in the house. Uno has given my wife the confidence to go out without me as she knows that Uno will support me if something goes wrong. One day I collapsed in the house and Uno stayed beside me until help came. It is amazing how intuitive he is. Uno is also trained to wake me up in the morning. Uno taps his nose off the back of my hand. If I don’t wake up on the third attempt, Uno goes downstairs and alerts my wife. Sometimes I am too tired to get up, but Uno still alerts my wife! My daughter lives in London and Uno has been over to see her 7 times. I often get anxious in large queues, but I get to use the fast track security in the airport. Uno travels on the plane with me and just lies on the floor as we are flying. I keep his jacket on so people know he is a working dog. Uno helps keep my independence

The dementia dog project is completely reliant on donations. There are 12 dementia dogs in the country, and I am passionate about giving more people, the opportunity to have access to a dementia dog of their own. I hold some fundraising events for the project, and I encourage my friends to do so also. I live in hope that someday, the project will get more funding and give people the same opportunity to ‘live well with dementia’. Uno has certainly changed my life.

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For more information on the dementia dog project please visit www.dementiadog.org or email  bark@dementiadog.org

If you would like to find out more about the group or to get involved, please contact SDWG on 0141 410 1171 or sdwg@alzscot.org

or follow us on twitter @S_D_W_G

or have a look at our website http://www.sdwg.org.uk/

This post was developed from conversations Henry had with Danielle Timmons, the 2019 occupational therapy intern at Alzheimer Scotland. The occupational therapy intern roles at Alzheimer Scotland gives the student the opportunity to enhance their knowledge and understanding of dementia while also generating outcomes of value and relevance to people living with dementia and help deliver the SDWG strategic priorities.