“When the Covid pandemic hit last March I was working as cabin crew for Norwegian Air. We were originally furloughed and the last month we have all been made redundant as the company stopped operating.
“When I was first furloughed I set up a First Aid Instructor business to ensure I had something else to do if the worst happened. The business is going well, and when the opportunity to help with the Mass Vaccination centre came up, I felt I had the right skills and I really wanted to do my bit.
“I have been working at the Home Park vaccination centre since it centre opened as an administrator and I am now being trained as a vaccinator. It has been a fantastic opportunity and a way to use my existing medical knowledge.
“I love the fact that every day is different and there is such a fast pace – the days fly by!
“In the future I am thinking about staying in healthcare, maybe training as a paramedic or growing my business further.
“Although being made redundant from a job I loved was tough, the whole experience has given me new opportunities for the future – I am excited about what lies ahead.”
The murder of Sarah has shaken the nation to its core and the debate around violence against women has re-surfaced – this can only be a good thing. However, what I have seen on social media is a complex and nuanced subject turned into something that has, at times, divided the genders.
It’s tricky in the present political climate to talk about potentially divisive subjects – particularly when it’s talking out against a particular group of society. When we talked about ‘black lives matter’, there were calls for all lives to matter and now, the response is ‘not all men’. For me, this often negates the original points being made; in this case, it is that violence against women is a thing – but also, that we should be able to discuss it and its impact. I understand it’s not all men, all men understand it’s not all men. The intent is not to point the finger at our male colleagues, friends and family but to highlight that a large percentage of women have faced harassment, sexual assault, violence, abuse and are not believed or the fact that perpetrators are going unpunished. What follows are some grim statistics, a look at the responses from the police at the vigil held for Sarah Everard, and then a look at what can be done to help facilitate the conversations going forward.
Why did women across the country react so viscerally to this news?
When the issues of gender based violence is raised, Director of the Canadian Femicide Observatory for Justice and Accountability, Myrna Dawson, highlights that violence against women is “unique, and entrenched in our society, where…social structures ‘perpetuate and maintain gender inequalities’” (2020). In other words, violence towards women is the cause and consequence of social inequalities. If we, as a society, want to address this, then we need to recognise these differences in order to create meaningful preventative measures (World Health Organisation, 2009).
Domestic violence is still highly gendered – 91% of domestic violence crimes that cause injuries are against women, and three women every fortnight are being killed by a current or former partner in the UK (Nazeer, 2021). COVID has further frustrated the situation, with 91% feeling that it has worsened their current situation due to feeling isolated and afraid (Women’s Aid, 2020). A staggering 10 women and two children were killed by men in the first lockdown – three times higher than normal two weekly averages pre-COVID (Women’s Aid, 2020).
Sexual violence is still highly gendered – with 20% of women compared with 4% of men reporting sexual assault since turning 16 (Rape Crisis, 2017).
What is more disturbing is the rhetoric around violence towards women – and whether they are believed when they come forward. For example, a common myth, perpetuated by media is that women often lie about rape – when the truth is that for this very reason and the trauma of the processes, many don’t ever even end up reporting it to the police (Rape Crisis, 2021). In a research report commissioned by the charity Against Violence and Abuse (AVA), it highlighted that women were ignored by the wider system or blamed for their situations ‘time and time again’ (2019, Pg. 9). The same report also highlighted how for women with ‘multiple disadvantages’ such as race/ethnicity, immigration status, sexuality, socio-economic position and experiences living with disability, services aren’t sufficient or fit for purpose (2019).
‘The Secret Barrister’, an anonymous legal expert on Twitter discussed a current domestic abuse case they were working on and in an edifying account, highlighted why just saying ‘tougher sentences’ when addressing violence against women is not enough (2021). They went on to highlight that in domestic abuse cases victims often delay reporting out of fear, it then takes years for the police to investigate due to the complexity of evidence gathering (texts etc) – due to police cuts and refusal to fund ‘ Digital Investigation Units’ there is a backlog of at least 12 months to examine digital devices. When gaining medical records, witness statements, there is a need to liaise with the Crown Prosecution Service (CPS), which has also been underfunded and understaffed – more delays. Once a charge has been made, the case takes a further six months to go to court – not for trial – for the first hearing before a magistrate because of defunding! The case is then sent to Crown Court (if defendant denies charges) and joins the queue for trial slot – for at least a year because of underfunding – the thread goes on and becomes increasingly grim. They end by saying ‘There has never been a better time to be violent towards women and get away with it’ (2021).
Nazir Afzal, solicitor and former chief crown prosecutor for the North West of England, backs this up by adding that the prosecution rate for rape in this country is an unbelievable 1%! Afzal adds, ‘there’s a feeling, quite rightly, that rape has been decriminalised…there are many women who’ll never report a crime because of the way they were treated’ (2021).
The Vigil
I am sure everyone has a view and an opinion on this, mine is that the handling of it is going to need investigating and questions need to be asked. I can only comment on my observations of the police responses and the stark differences in the media between how the Rangers’ crowd was handled and how this peaceful vigil was handled.
Specifically the police statement on the Rangers’ crowd was:
“Our priority was public safety and this included reducing the risk of disorder, road safety and effective crowd management among the complexities of the vociferous crowd…An appropriate policing response was in place throughout the day and officers continually engaged and encouraged compliance with COVID regulations” (Sutherland, 2021).
On Friday 12th March, the Met Police recognised, in High Court, that they had no powers to put a ban on protests – indeed, even during a pandemic, people ‘should not be criminalised en masse for exercising their fundamental right to protest’ (Bradley, 2021, cited in Wall, 2021).
We all understand the photos, recordings and statements are contextual and none of us have the whole picture but the night’s actions deserve an enquiry and important questions need to be asked, specifically – did the police attempt to engage with those at the vigil respectfully and was the violence / physical force dished out with due cause? Dr Greenhalgh, a respected COVID advisor, spoke out against the measures taken – ‘they were outside, they were masked, they were quiet, they were not exercising heavily, scientifically this was a very low risk event until they were shouted at and attacked’ (2021).
Despite Cressida Dick’s statement clarifying the illegal nature of the gathering and the insistence that it wasn’t peaceful, many politicians have heavily criticised the response, including Sadiq Khan, who said the response was not ‘appropriate or proportionate’; Yvette Cooper (MP), who said she couldn’t understand ‘why the strength of feeling about violence against women was not being understood; Shaun Bailey (MP) described the scenes as ‘horrifying’; and lastly, Jeremy Corbyn, who said that the Met Police ‘must answer for their actions’ (Davies, 2021) the Home Secretary, Priti Patel has also requested a full report in to the incident.
What Next?
Involving everyone in the discussions is integral to change and the conversations needs to be inclusive. Dr Jackson Katz, educator and author, highlights that men need to realise that the same system that produces men who are violent to women, also produce men who are violent towards men, and that this should prompt a collegiate response between the genders ‘rather than being defensive and assuming women are bashing them or that they’re anti-men’ (2021). Dr Katz goes on to add that learned behaviour is passive – that awful murders such as this prompt us to think that the individual was ‘crazy, sick, diabolical’, instead of the fact that he’s a ‘product of a society that has social norms on a spectrum’ and that when you think of those norms on a spectrum it ‘implicates us all’ (2021).
Listening to each other talk – something Christopher Muwanguzi, former CEO of ‘Future Men’ strongly advocates, emphasising the importance of creating environments for all of us to tell our stories. He also encourages self-reflection ‘am I checking my unconscious bias? Am I asking my sister, mother, wife, friend how they have felt? Am I listening?’ (2021).
We are all also responsible for speaking out when behaviour or language is inappropriate so that we don’t perpetuate a system that enables harm. Dr Katz highlights how men can make it clear that they don’t ‘tolerate sexism or misogyny’ and call out this behaviour in peer groups – he calls it ‘peer culture policing’ – and building this approach into education at a young age is part of making this change significant.
When the #metoo movement really took off in 2017, millions of women worldwide came out with stories of sexual assault, abuse and violence – myself included. It was a game changer and toppled many powerful and influential men.
My sincerest hope is that this tragic case will do the same. So, I end with a wish. A wish that in the same way #metoo began changing culture, that the tragic death of an innocent women will provide the mobilisation required of all women and men in the country to change – culture, the justice system, working environments and the absolute necessity for women to be believed and listened to.
As Virginie Le Masson, researcher at ODI states – “For this to happen, it is the responsibility of governments to urgently make gender equality in education a priority. Meanwhile, civil society, particularly women grassroots organisations, must keep the pressure on – and the media must be their ally.” (2019)
Dawson, M. (2020) ‘More men are killed than women, so why focus on violence against women?’. Interview with Myrna Dawson. Interviewed by Jane Gerster for Global News Canada, 22 February 2020. Available at: https://globalnews.ca/news/6536184/gender-based-violence-men-women/ (Accessed: 14 March 2021)
This International Women’s Day, it’s important that we #ChooseToChallenge hetero- and cis-normative ideas of womanhood. For this reason we’ll be celebrating the incredible achievements of two LGBT+ women in history, who have accomplished great things, and made their marks on the Gender Equality movement. Of course the women’s rights movement should always be intersectional, so here are the stories of two amazing women from differing backgrounds who deserve to be celebrated.
Elliot Atkinson, LGBTQ+ Network Chair
Ernestine Eckstein (1941-1992)
Ernestine Eckstein was ahead of her time in terms of her attitudes towards LGBT+ activism. In 1965, at a time when gay activism was dominated by white people, she stood as the only person of colour on the picket line during an early gay rights protest in front of the White House. She was an extremely active member, and eventually vice president, of the New York chapter of the Daughters of Bilitis (DOB). The DOB was the first lesbian civil rights organisation in America, with the majority of its members being white and focusing on obtaining medical recognition of gay people.
Eckstein fiercely placed emphasis on direct action in the form of protest, rather than on medical legitimisation. She described demonstrations as an “educational process of calling attention to unjustness.”
She was the first Black woman to feature on the cover of the DOB’s publication ‘The Ladder’ in June of 1966 and in her interview, called for progressive activism inclusive of equality for transgender people, hopeful for LGBTQ+ solidarity. Eckstein was a visionary, understood the intersectional nature of oppression and the importance culturally inclusive coalitions.
Later, in the 1970s, she relocated and became involved in the black feminist movement, joining Black Women Organized for Action (BWOA).
In her 1966 interview with The Ladder, Eckstein said:
“I would like to see in the homophile movement more people who can think. And I don’t believe we ought to look at their titles or at their sexual orientation. Movements should be intended, I feel, to erase labels, whether ‘black’ or ‘white’ or ‘homosexual’ or ‘heterosexual”
In 1973, Sally Ride received a Bachelor of Science in physics and a Bachelor of Arts in English from Stanford, and continued on to earn her Master of Science and doctorate degrees in physics in 1975 and 1978.
Realizing that technological and scientific skills were essential to the future of the Space Program, NASA began searching for young scientists to serve as “mission specialists” in 1977. Ride was one of only five women selected for NASA’s class of 1978.
On June 18, 1983, Ride was one of five crewmembers aboard the space shuttle Challenger STS-7 (serving as the flight engineer), becoming the first American woman, and the youngest American, in space. When interviewed prior to mission launch, Dr Ride was of course, asked questions concerning her training. However, she was also asked how her fertility and ability to reproduce might be affected by going to space, and what makeup she would be taking with her. She graciously handled these questions, and said later that “It’s too bad this is such a big deal. It’s too bad our society isn’t further along.”
After her second shuttle mission, Ride worked on investigating the 1986 Challenger accident. After the investigation, she took the role of special assistant to the NASA administrator for long range and strategic planning. She later also became a member of the President’s Committee of Advisors on Science and Technology, and served on the Advisory Board of the National Women’s History Museum.
Though she married fellow astronaut Steve Hawley in 1982, they divorced in 1987, and was open about her relationship with Tam O’Shaughnessy. Meeting as children, their friendship blossomed into love, and their relationship as partners and business partners lasted 27 years. Ride was the first astronaut to be acknowledged as gay. When President Obama posthumously awarded Dr Ride with a Presidential Medal of Freedom in 2013, Tam O’Shaughnessy accepted the award on her behalf.
As a woman in science, Ride was passionate about helping young women foster an interest in science, and about improving scientific education. She eventually established Sally Ride Science with her partner O’Shaughnessy, and worked to encourage children from all backgrounds to explore STEM subjects.
International Women’s Day is a day to celebrate women and their allies. This year, it is specifically a day to challenge. To challenge behaviours. To challenge perceptions and stereotypes, and to challenge ourselves.
This is my story, by Camilla Redding
Camilla Redding, Deputy Chair of the Women’s Network
I’ve never been an overly confident person, although I can fake it when needed. I always thought I was a bit odd, a bit of an outsider. I don’t look the right way and I don’t like the right things and I have a mental illness. I suffer from personality disorder (traits of various ones rather than just one), and this can often distort my perception of me and the world around me. This is something I have suffered from for my entire adult life, although it was only diagnosed recently, and has really impacted my entire outlook on the world. I wake up in the morning and I never know how it will go. I may feel ok, or I may feel sad, worthless, incapable. But, I get up regardless. I get dressed and I got to work. I climb another mountain.
In work I enjoy my job. I enjoy the challenges it brings and I think I am good at it, although I have doubts all the time. I am surrounded by people who I enjoy working with, but who make me feel inadequate, not by any fault of their own, but because I cannot understand how I can even begin to compare with their ability and their knowledge. But I continue to work, to do my job and push through.
“I am a builder’s tea amongst a sea of chai lattes”
You see, if my world was the popular game “Among Us”, I would most certainly be the imposter. I don’t have any fancy degrees (although I did try twice, yes twice, and didn’t succeed either time as I just couldn’t cope with the pressure), I haven’t networked and rubbed shoulders with amazing people and I don’t have years of experience under my belt. I’m just me, a middle aged wife and mother, with greying hair and more junk in my truck then I would like, trying to get my head around how to juggle my perceptions of myself, and the perceptions of people around me.
When I heard we were setting up networks, I was curious about how they would work and what would be discussed. I intended to be, what I have now heard coined, an “elegant lurker”. I didn’t intend to participate but I wanted to understand if there were people like me. When I listened to the conversations taking place in the Women’s Network, I became aware that actually, I did have an opinion, I had something to say. I couldn’t possibly say it though could I? Who would possibly be interested in my opinion? So I bit my tongue, whilst having the conversation in my head a thousand times over. By the time my inner monologue had finished I could have put Oprah to shame. I did decide to push myself though, and put a comment into the chat box.
This is it, I can do this. I wrote my thoughts down and pressed enter, then waited anxiously for responses. What if they don’t like what I say? What if there is a spelling mistake? Why am I even speaking up? Those little, niggling voices were speaking up again. I frantically looked for a recall button, but, the responses weren’t scary or negative. People agreed with me and appreciated my input. I was being heard.
Reading this, you might be surprised that I am now the Deputy Chair of the Women’s Network. I certainly didn’t expect it to happen. I changed my mind multiple times before finally putting in my application, and I only did it in the end because I didn’t think it would get anywhere. Why would they choose me when there were so many talented people in the Trust? But, low and behold, along came interview day (which was terrifying by the way) and I faced the panel, and I talked, I smiled, I laughed and I breathed. I survived. It was ok. I was ok. Even if it didn’t go anywhere, I did something which terrified me and I made it through the other side. I gave myself a pat on the back for a job well done and I carried on about my day.
I was shocked when I was offered the position of Deputy Chair and I still have to remind myself every day that it is because I performed well, and not because of a lack of options. I thought “this is it; I have received some form of validation so now I’m fine”. But I’m not. Now I am swimming with the big fish, and it is so intimidating. Everyone is so smart, so passionate and educated about their cause. I am a builder’s tea amongst a sea of chai lattes. They are all friendly and supportive and it really is an amazing atmosphere, but it is hard for me to justify my presence when I feel so completely out of my depth. But, I smile, and I share my opinions and I offer my support. I tell myself to ignore those little voices in my head and do what I know I can do. Sure, I might not know loads of people, and I might not have a lot of qualifications, but I can make a pretty good spreadsheet and I have an eye for detail.
“I’m still pushing forward and I am still climbing mountains. I am still here, and not only am I surviving, I am thriving.”
Every day I have to challenge myself. I challenge myself to get up in the morning, to go to work, to interact with my colleagues and to push myself outside of my comfort zone. I challenge myself to look past my own perceptions and trust the honesty of those around me, rather than second guessing their motives (the amount of times I have had positive feedback and my head has said “they are just saying that to be nice” or “they don’t mean that” is really quite sad). I challenge myself to trust my instincts and to believe in the validity of my opinions, even if others don’t and finally, I challenge myself to believe in me, that I am worthy, that I belong.
We all face challenges. Whether those are physical or mental, or challenges in our professional or personal lives. When we are battling our own internal voice, it can be very difficult to be confident enough to challenge others. The fear of recrimination, of being made to look a fool or fear of confrontation can all impact our ability to speak up and say “no, this isn’t right”. There are times when we need others to speak up for us on our behalf, to lead the charge or to be the pillar of support. We all have a duty to do what we can to fight inequality, to challenge poor behaviour and question negative perceptions.
I know on the surface this all might sound quite negative, but underneath it all, it’s a story of success. A story of triumph over adversity. I’m still pushing forward and I am still climbing mountains. I am still here, and not only am I surviving, I am thriving.
In the words of the great Ru Paul: “If you can’t love yourself, how in the hell you gonna love somebody else?”
By Camilla Redding Deputy Chair of the Women’s Network Pathology Business Support Officer
It was the night before Christmas, when all through ED not a patient was stirring, except the drunk guy in 3. The nurses were stood by the station with poise, as all of a sudden the red phone made a noise. The doctor was quick to answer the call, and soon wrote the details of a terrible fall. The nurse in charge listened, as the doctor explained, “It’s someone called Nick, and he’s very bloodstained!” The team went to Resus to set up the bed, and a code red announced, due to damage to head. Away to the helipad the porters did dash, as news travelled fast, about the man and the crash. A guy with a beard had been on a roof, then slipped down the side for it was not skid proof. He was now immobile, in collar and blocks, it had happened close by, not far from the docks. “We’re coming by air, we gave txa, we won’t be that long” the paramedic did say. As quick as a flash, the consultant did come, With a hi, a hello and a where are you from? “Now Airway! Now Orthos! Now, Surgeons and Neuro! On, Belmont! On, Drug nurse! On, Scribe and CT! To the front of the booklet! Sign in we all must! Now stand ready! Stand ready! This is not time to fuss!” As the helicopter landed, and the trauma arrived, the team heard the hand over, and wondered if he’d survive. His red suit was cut off, the timer begun, and the lead asked for quiet, for the timid F1. “There are no signs of bleeding, just a bit by his ear, his airway is patent, his chest sounds are clear.” The X-ray was taken, the bloods they were sent, the check list was sounded, to CT they all went. They came back to Resus to await the result, and all gossiped intently about this curious adult. It’s Santa they joked and oh how they giggled, but he looked uneasy and started to wriggle. “Stay still you must, until we know all is well,” “But I need to get going” he started to yell. “I’ll just clean your wounds, as we wait the report,” he sighed, “ok fine” and let out a snort. His head wound was glued and no fractures to note, this mans incredibly lucky, all staff dared to quote. “Why were you there, on the building so tall?” “I couldn’t possibly tell you,” he had all enthralled. The radiologist called to confirm all was ok, the patient was sat up and started to say, “Thank you everyone, I feel really daft, but please get me some clothes, there’s a hell of a draft!” In NHS pjs, and a pair of grip socks, he borrowed the phone as he looked at the clock. He called up his buddy, he was anxious to go, he said he was worried about the incoming snow. Cannula out, he got up to leave, staff were all stunned at their Christmas Eve. They heard him exclaim, ‘ere he walked out of sight, “Happy Christmas to all, and to all a good night!”
By Junior Sister Ali Owen, adapted from the poem, ‘A Visit from St. Nicholas’ by Clement Clark Moore
This week, we are celebrating the Autism and Learning Disability Champion Awards for 2020 founded for hospital staff or teams that have provided an exemplary service and care for patients with a Learning Disability (LD) or who are Autistic. Usually each year we have an award ceremony with a celebratory lunch attended by the winners, people who use our hospital services and our staff members. This year, due to COVID, we are celebrating online with each day dedicated to different champions.
We think it’s very important that in spite of the COVID pandemic we still take time out to recognise, thank and congratulate individuals and teams in the incredible care that they give to improve the experience and feelings of our wonderful patients. It’s inspiring to see in their amazing efforts that the trust’s Reasonable Adjustment Charter is making such a difference in promoting personalised and compassionate care, benefitting both their patients and staff. We hope the award winners inspire others to show small changes and reasonable adjustments can make a big difference. This is a reminder that it isn’t things that make changes – it is people.
Once again a big CONGRATULATIONS and a huge thank you from all the LD and Autism Liaison teams, our CEO Ann James, Chief Nurse Lenny Byrne, Deputy Chief Nurse Bev Allingham, and most of all from our patients.
Richard Littlejohn and Liam Taylor: A key element of the Autism pilot has been to collect data that can be used for trust reports required to demonstrate the various aspects of service use and improvement. Both Richard and Liam have responded quickly and thoroughly to the requests made. Their contribution and attention to detail has been instrumental in the service audit processes. This has been highly valued by the Autism Service.
The Minor Injury Unit with Matron Nigel Booth and LDL nurses Natasha and Lesley
The Minor Injury Unit at UHP: Since moving to the Nuffield site the MIU team, supported by Stuart Quarterman, have ensured that they are accessible to patients with additional needs. This has included working with the LD Team’s Independent Advocate: making an easy read leaflet so patients know whether they need to go to the ED or MIU, making a short film explaining where the MIU is and how to access it and sticking a green line inside the building so patients can make their own way to the x-ray room from the main reception and back again.
Abbie Vincent : Abbie has been an immense help to the Autism service both through her dedication to her role as Chair for aDAPt (Derriford Autism Partnership). During the first COVID lockdown, when even though she was having to work from home, she took time to assist us with developing resources. This has helped the service to achieve areas on the work plan that would have been a challenge to complete without Abbie’s assistance. It has been a pleasure to have her working alongside us.
Natasha Teague with winner Kristina Ashe
Kristina Ashe: Having supported Kristina to make easy-read leaflets for patients during the first lockdown the team’s Independent Advocate asked her to consider being a link practitioner for the department. Since she agreed Kristina has been incredibly proactive and ensured everyone who works within Rowan House has been enrolled on the Learning Disability and Autism Awareness e-learning course, colour photocopied a bank of accessible leaflets and put them in most of the clinic rooms and created a team G-drive with a link to the patient resources page of the Learning Disability Liaison Team’s page on the trust website.
Malcolm Collins: Malcolm volunteered to help us ensure that alerts are in the notes of Autistic patients that we have identified and to continue to do this in the future. This action has been extremely helpful to the Autism Service as we have been able to use the time that would have been spent on this task on other key areas of our work plan; therefore achieving more for this group of patients. These alerts support the identification of patients who may benefit from Reasonable Adjustments, so the fact that this is being done promptly has a positive impact on patient care.
Alison James
Alison James: Alison has been nominated for this award due to the amazing work she has done within the specialist dentistry service for patients with learning disabilities. She works closely with the LD Team to ensure that people who are scared, worried or have extreme anxiety are able to get their dental treatment and has gone above and beyond in her care.
Julie Overnell and the Postbridge Team with LDL/Autism Service Manager Saoise Read
Julie Overnell and Postbridge: Julie has been proactive in arranging for her team to attend the Understanding Autism training and is planning to set up further training bespoke to her department. Postbridge have worked together with the Autism Service to react to challenges that have faced Autistic patients, particularly since the COVID restrictions added to the high anxiety that this group of patients already feel when attending the hospital. Julie and her team have been responded promptly and effectively when issues have arisen, ensuring that patients have the best possible experience on their ward.
James Metcalfe
James Metcalfe: James has been nominated for this award for making reasonable adjustments to ensure that people with learning disabilities get timely investigations. He uses the Learning Disability GA clinic regularly so that patients with additional needs can have the treatment they need.
Dr Mark Perry & Team: Some individuals who are Autistic can struggle with accessing healthcare due to a lack of knowledge and understanding of their challenges by healthcare professionals. Mark and the rheumatology team have taken the time to listen to a particular patient who has had years of difficulties within healthcare and whose health management has suffered as a result. They have taken on board advice from the Autism Service regarding the reasons for the historical events that have taken place and have looked past preconceptions to work together to provide the patient with individualised care. This willingness to be open to advice and to give the patient the time required with an understanding of the communication difficulties has been instrumental in a vast improvement in the patient’s quality of life and the start of rebuilding of trust of healthcare services.
Jill Sargent
Jill Sargent: Jill has been given this award for raising awareness of patients with a learning disability admitted to the ward, highlighting concerns of others who may not be alerted to the team and responding in a personalised way to individuals who may be more problematic when trying to obtain bloods and cannulation.
Follow the University Hospitals Plymouth Learning Disability Liaison Team on Facebook: DerrifordT and Twitter: @DerrifordT and the University Hospitals Plymouth Autism Service on Facebook: DerrifordAutism and Twitter @Derriford Autism
Dr Annette Rickard, Consultant in Emergency Medicine
When the global pandemic hit the UK, NHS emergency teams knew their challenging jobs were about to get harder.
Staff that work in the Emergency Department at University Hospitals Plymouth NHS Trust (UHP) are no strangers to working in a high-pressure environment.
As the largest acute hospital and major trauma centre for the South West Peninsula, they could anticipate what was coming. For many clinicians across the UK this was a terrifying time.
“The problem was perceived before it had really hit us. We know emergency medicine is hard at the front door.”
The Trust’s Clinical Psychologists, Counsellors, Occupational Health and Organisational Development teams came together to help. They wanted to provide psychological and practical support to those experiencing difficulty or mental health crises.
There was also a need for early intervention to protect the workforce from psychological distress and the potential for sickness absence that could put further pressure on the service.
From the resulting multi-pronged strategy, one of the projects implemented was a safe space for colleagues to talk.
Dr Annette Rickard, Consultant in Emergency Medicine at UHP said that in normal times, she would be able to invite close colleagues who were struggling for a coffee and chat. As Covid-19 made that impossible, she set up a virtual space to talk, in an informal setting. The virtual ‘Coffee and Vent’ sessions were launched.
Annette said: “The problem was perceived before it had really hit us. We know emergency medicine is hard at the front door. We know that frontline staff are at risk from burnout and PTSD. My first job was to publicise the virtual invitation into my space for a cup of tea and chat.”
The resulting conversations were a great success. 20, one hour-long Coffee and Vent sessions took place between March and October 2020, with varying numbers of attendees from just five people, up to 20 participants.
Helping to facilitate the safe discussion was Staff Counsellor Natalie Ashley, who helped hold the space and support people if they became upset or distressed. The Trust lead for Safety Culture and Psychological Safety, Matt Hill – with experience of working in the Emergency Department – was also on hand.
Staff Counsellor Natalie Ashley
Annette explained: “I gave a pre-amble at the start of each session for the benefit of any newcomers, stating that this would have been an actual coffee at my house where people could relax and chat about whatever was on their chests, or just enjoy coffee and listen to colleagues.
“You could say anything you liked. If people had any concerns about safety they could escalate those to an Emergency Medicine Consultant.
“Using the private chat function, we were able to signpost people directly. We had all sorts of conversations, sometimes related to Covid, and sometimes not.”
Themes discussed included work rotas, managing time for non-clinical work, team working and how to avoid silos, communication and leadership, and how to manage ‘post-COVID extraordinary effort fatigue’.
Annette added: “It was an opportunity to talk about issues where we could affect change within the department, but some of the conversations were just about listening.
“Some of our colleagues were at home with Covid at the time, some were shielding and feeling isolated, and it was a way of connecting us all.
“Many colleagues become regulars at dialling in, and it was particularly popular with the last rotation of doctors.
“The psychologist that joined us on those calls has become a friend of the Emergency Department and has been able to reach out to individuals on a more personal level. It worked really well.”
Comments from participants:
“The last group I found extremely beneficial especially after you all left, I had a sort of unofficial counselling session with Natalie, which I really appreciated.”
“Great session today and well hosted. There were some really interesting points in the conversation. I really liked the talk of teams and huddles and how they build connection and have practical benefits. I also liked the way the leadership behaviours were identified and recognised as being helpful. These are incredibly powerful.”
“Truly everyone is a legend and we need to keep that respect for each other, we are the ones who need to clap for each other.”
“We have the best ED in the world with the best people in the world. We are the only ones who can make it a better place for all of us.”
“Great session, really well hosted! I am keen and happy to be part of future sessions. Really interesting themes that definitely need attention and thinking about by us and the wider Trust.”
“Thank you and love you all amazing people. It will all be over soon and history for our children to learn from. Keep the ED family together”
Normally awareness weeks in this trust would involve banners and cakes, this year however, as we are all very aware, things are a little different.
But we do still want to raise awareness of the exciting role that is Advanced Practice, so we will do so from a distance, definitely a social distance.
If you want to join in on the week on social media, share using hashtags #AdvPracWeek20 and @uhp_nhs.
To help celebrate, a range of staff in Advanced Practice roles have given their experiences and thoughts about what this role means to them.
Tasha Kendall and Kim Pauling, Advanced Paediatric Nurse Practitioners (APNPs).
We both started within Paediatrics as the other APNPs were leaving, and therefore it was down to the two of us to pave the way for how APNPs could work within the department in the long term. We now have a trainee in post and we are hoping to recruit more to expand our team and to meet the demand on our services. Between us we cover: the Children’s Assessment Unit, Woodcock Ward, Wildgoose Ward, Paediatric Outpatients and hold the crash bleeps.
We work autonomously and alongside the paediatric medical team, whilst supporting the nursing team too. Our job within paediatrics is extremely varied, one day we could be teaching on medical inductions or departmental nurse training days, or creating patient information leaflets. On another we could be clinical and doing our prolonged jaundice and faltering growth clinics, seeing patients on CAU or helping in ED resus. We love the opportunities our role has and continues to present to us, and as a team we are passionate about driving quality improvement and change for our colleagues and the children that we see. It is a real privilege doing this job, and helping the children and their families in doing so.
Anna Jones, Advanced Clinical Practitioner (ACP) Lead for Acute Medication.
The role of the advanced clinical practitioner in acute medicine began when I qualified six years ago and now we have five others currently in post, with some of those qualifying very soon.
We cover the Medical Assessment Unit (MAU), the Acute Assessment Unit (AAU) and the Acute Frailty Unit (AFU) working alongside the medical team. We work independently alongside the consultants and aim to promote same day emergency care (SDEC) pathways, especially in the AAU.
We thrive on looking at new ways of working to ensure the best patient Journey is given to the patient. We are all able to prescribe and arrange diagnostics which means we can work more independently Working as an ACP in acute medicine means I am able to support the doctors who are rotated as we provide sound knowledge of the pathways like SDEC as well as the services we offer to try and discharge patients the same day. We also work closely with the emergency department to ensure patients who require a medical review can have this the same day, preventing a need for a bed. Having a nursing background really does provide diversity to our patients and enables us to also support the team holistically. We can also provide teaching to our nursing colleagues improving their clinical knowledge thus improving clinical decision making and patient care.
It’s a very rewarding job and each day we are learning new skills and knowledge which we can share with each other.
It is almost 20 years since a team of ANNPs were founded at Derriford. As we celebrate Advanced Practice week, we have a well established team of eight ANNPs with an additional trainee ANNP and a MSc ANNP pathway to secure our future workforce.
As ANNPs, we work across the four pillars of advanced practice. Adept in enhanced clinical skills, across a wide range of gestational ages, form those born as early as 23 weeks gestation to those born at full term; whilst having comprehensive knowledge, clinical reasoning and complex decision making capabilities, enabling us to lead in the management of neonatal care and interventions.
The team practice across several areas of neonatal care from delivery room resuscitation, within the Neonatal Intensive Care Unit (NICU), Transitional Care ward and postnatal wards and transportation within the south west peninsula, supporting our medical, nursing, and midwifery colleagues in providing a high standard of care to our smallest, most vulnerable patients and their families.
Rosie Forbes, Trainee Advanced Clinical Practitioner (ACP) in Oesophago-gastric.
I am a Trainee Advanced Clinical Practitioner with the Oesophago-gastric (OG) team at the Trust.
Prior to progressing into the advanced practice field, I gained experience in surgical and critical care nursing. I am currently studying for a Masters in Advanced Clinical Practice which enables me to assess and examine patients, formulate a working diagnosis, request investigations and prescribe medications to support efficient and timely care for patients.
My day-to-day role involves requesting and interpreting investigations, reviewing and prescribing medications, and assessing deteriorating patients who are under the care of the UGI/OG team across the surgical wards. I also frequently spend time with the surgical on-call team on the SAU; assessing, diagnosing, and commencing treatment plans for surgical patients. From time-to-time I attend outpatient clinics, theatre, and MDT meetings to enhance my knowledge and broaden my skills in the field of UGI/OG surgery.
I plan to finish my MSc in 2022. I am also keen to continue improving my skills in assessing and diagnosing surgical conditions, both in the inpatient and outpatient clinic setting. Furthermore, I hope to undertake training in surgical skills so that I am able to assist my surgeon colleagues in theatre.
Louise Walker, Advanced Nurse Practitioner (ANP) in Plastic Surgery.
There are three ANP’s within the Plastic Surgery Team (currently two trainees and one qualified). Working primarily within the remit of Trauma our role was originally used to take the on-call bleep away from the junior doctors so they would be able to attend theatre for training.
When we are on-call we receive referrals from all over Devon and Cornwall from a variety of practitioners. On a day to day basis we speak to people working in ED’s MIU’s, GP practices as well as dealing with referrals from inside Derriford. It is a wide and varied job; we make clinical decisions about treatment and follow up, deciding whether the patient needs to be seen immediately, at some point that the same day or within the next couple of days in our trauma clinic. We are also the first point of call for any patients in our own Emergency Department who need a Plastic Surgery input. The role also includes being part of the trauma meeting and ward round (if possible) each day.
As part of our work to develop the Plastic Surgery service one of our ANP’s implemented a telemedicine system for burns referrals in the Southwest. We were the first Trust to use it and it is now being utilised in other areas of the network. We would like to develop the role further with the implementation of a minor ops training programme so patients with less complex injuries do not have to go to main theatre, and the trainees are moving forward with Non Medical Prescribing to provide further autonomy to the role.
Ash Lowther, Advanced Clinical Practitioner (ACP) in Emergency Medicine.
We are a good sized team and have literally gone from strength to strength over the last five years, we still have two of the original ACP’s that started at the inception of the project – Emma and Becky.
We have 17 in total made up of one Senior ACP who has already credentialed and was the first ED ACP in Devon and Cornwall to credential with RCEM. Four senior ACP’s (post masters and NMP and in the third year of the RCEM portfolio), 10 trainee ACP’S (a mix of year one, two and three), and three military trainee ACP’s and varying levels on the programme. Our ACP’s are from both a nursing and paramedic background.
The ACP team now cover an almost 24/7 service and we hope that one day there will be a senior ACP on every shift in ED and that we will all have a core set of skills such as US skills, advanced resus skills, experienced decision making skills with the ability to work at the front door of the department and leadership skills to be able to manage individual areas within the ED. We work alongside the medical team in ED and are expected to see the next patient in the queue regardless of their presentation, we are really well supported by an excellent ED consultant and senior doctor team. The senior ACP’s closely supervise the trainee ACP’s to develop them in readiness for their year 1 ACAT (end of year sign off).
Some of the things we do but not an exhausted list; Majors Clinician, START Clinician, Trauma Primary Survey, Trauma Team leader, Cardiac arrest team leader, Ultrasound in trauma and for venous access, Chest drain insertion, Paediatric ED, Covid ED Clinician, Nurse education, Governance presentations, Management Meetings and Quality Improvement projects We hope to increase our team at a steady rate to what the departmental needs are, we are excited to be involved in helping to shape the future of the department which includes assisting with focus groups around the new department, teaching and mentoring the workforce both nursing and medical, but mostly we look forward to continuing to see patients as there are plenty of them in ED!
Wanna know more come and find one of us for a chat. We are so excited about the UHP celebrations for Advanced Practice Week 2020.
The Tissue Viability Team at UHP are here to work with patients who have particular needs in terms of skin integrity, wounds and pressure ulcers. Lead Tissue Viability Clinical Nurse Specialist, Siobhan Mccoulough, writes about the different models of care and the importance of aSSKINg ahead of Stop the Pressure Day on 19 November.
Two of the Tissue Viability Team – Siobhan and Emma
The SSKIN bundle has been identified as a key process/intervention in pressure ulcer prevention which has been tested widely since its development in the Ascension Hospital system in 2004 in the USA and more recently across the UK in programmes such as the 1000 Lives campaign, Transforming Care in Wales and Stop the Pressure Collaborative across the Midlands and East of England. The bundle methodology was designed to facilitate consistency in practice.
This developed a blueprint for change in pressure ulcer prevention. Part of this blueprint involved defining and prioritising best known evidence and practices, into a ‘bundle of care’.
The original SSKIN care bundle focusing on four key aspects of preventative care: Surface, Skin inspection, Keep moving, Incontinence, and Nutrition.
This above model has been in use as a gold standard for prevention and management of pressure ulcers. Initially brought over to the UK in 2004, it was launched first in Wales in 2009, Scotland in 2011 and adopted by NHS England in 2012. It has slowly been incorporated into acute settings in England . It has shown great results for not just reducing the amount of pressure ulcer incidences but raising awareness of the main components needed to be risk assessed and monitored for the at risk resident/patient.
This model is often benchmarked while investigating pressure ulcers as routine, such as root cause analysis. If any of the above SSKIN care components were not included in the individual’s care plan, or there are clear gaps in this model, it may indicate improvement is needed in the care setting.
As a CQC specialist advisor it is this model that I use first as a benchmark when checking care records and practices.
I have been completing root cause analysis for pressure ulcers in the community and long-term care settings for many years. As a tissue viability nurse and investigator clear emerging themes and gaps come up time and time again. When meeting with colleagues here in the UK and looking at international research, these challenges are similar.
One of these challenges is that the risk assessment completed may not have been holistic and did not incorporate all of the above model of prevention. Whilst the Waterlow, Braden are tools for risk assessing, the research shows that they do not allow for individualised care planning and our dated assessment tools. The updated Purpose T assessment tool developed in Leeds University by Dr Suzanne Coleman uses up-to-date research methods to develop its tool.
However none of these tools will tell you that your resident will refuse to be repositioned due to pain or not wanting to lie on their side etc, or that they tend to lean on their left elbow for most of the day. This must come from your observations and interventions explored.
The other is where the resident has full capacity or reduced capacity and there is an informal or formal carer in place that information must be given to them so that they understand their own risks to their skin, thus being able to make informed decisions with their care plan. Or that the carers fully understand how to prevent a pressure ulcer and know the early stages, such as non-blanching erythema (Category 1 Pressure ulcer), so that they can report.
It is great, therefore, that the NHS improvement updated recommendations have included two more letters to the acronym SSKIN, namely A – Assessment and G – Giving information.
The new recommended guidelines therefore are as below:
A – ASSESSMENT
S – SURFACE
S – SKIN INSPECTION
K – KEEP MOVING
I – INCONTINENCE
N – NUTRITION AND HYDRATION
G – GIVING INFORMATION
ASSKING
NHS trusts in England have been implementing the SSKIN bundles since 2012. The aSSKINg update has been implemented at UHP and the below video explaining these principles will be mandatory for all clinical new starters as part of their mandatory training.
A aSSKINg UHP video by the Tissue Viability Team can be found below:
The full brief of the NHS improvement recommendations including the ASSKING model is found below:
Whatever stage you are at for pressure ulcer prevention care planning, don’t forget to share your journey and successes at #stopthepressure on Twitter which is the national # for improvement, support and sharing of information.
This year we are celebrating WRD with blogs from our UHP Radiography colleagues.
Helene Baudains – CT Radiographer and CT Head Reporting Radiographer
My favourite thing about being a radiographer is the variety of patients you see and multidisciplinary teams you work with on a daily basis. We work in every part of the hospital, day and night and are always in demand. Being a Radiographer is more than just taking x-rays and although you are with a patient for often a short period of time the impact you can have on them and their care can be huge.
I am lucky enough to have been able to train as an Advanced Practitioner in CT head reporting whilst clinically being a CT Radiographer. This had allowed me to actively engage in helping to diagnose abnormalities found on a CT Head, and when working clinically, scanning patients from a large variety of backgrounds, ranging from GP, oncology trial, paediatric, major trauma and acute stroke patients, to name just a few.
I work with a fantastic team who are highly skilled in what they do and support each other really well.
Although some days can be challenging, I wouldn’t change the job I am in.
Chris Bowen – Radiotherapy Services Manager
I graduated from the South Wales School of Radiography as a Therapeutic Radiographer in 1993 and started work in Plymouth shortly after in 1994. Since qualification I have worked at all levels of the job and gained a wealth of experience over the years, working with many wonderful colleagues and patients. My job is very varied and no two days are the same. One day I could be attending a full day of meetings the next I could be donning a uniform and helping out with clinical work.
Over the years Radiotherapy has developed at a great rate offering many development opportunities and fulfils the profession ethos of lifelong learning.
There are many varied roles in Radiotherapy including:
· External Beam Treatment Delivery · Brachytherapy Treatment Delivery · Patient Support Services · Pre-treatment Radiographers performing CT scans · Clinical Site Specific Radiographers · Radiotherapy Planning
The best thing about my role is being able to manage and develop our passionate and dedicated group of Therapeutic Radiographers.
Their skill and commitment to provide exemplary treatment delivery and outstanding patient care to improve the patient experience is truly inspiring and I am proud to be able to work with such a brilliant group.
Louise Hancock – Lead Practice Educator, Diagnostic Radiographer and University Clinical Tutor
After graduating from the University of Exeter in 2010 I started my career as a Diagnostic Radiographer at UHPT within the X-ray department as Trauma and Plain film radiographer. I studied to be a radiographer as a mature student, knowing I wanted a more fulfilling career. Diagnostic radiography offered that, as it gave me the opportunity to work as part of team with patients and carers to deliver high levels of patient care, whilst providing a diagnosis to support treatments and aid recovery.
The part of my role I enjoyed most was teaching others. This led me to pursue Post Graduate study in Clinical Education and I now have a dual role as the Lead Practice Educator within the Plain Film Imaging department and a University Clinical Tutor for the University of Exeter Medical Imaging programme.
I love the opportunity both my roles present in shaping the future of the profession by educating the radiographers of here and now, and tomorrow. I have the privilege of working with passionate radiographers and students who feel proud of the role they play in the healthcare system.
As a team we have shown ourselves to be resilient, adaptable and compassionate.
Sarah Hitchcock – Band 6 Urology Lead Therapeutic Radiographer
My Name is Sara Hitchcock. I’ve been qualified for just under five years and the best part of my job is the patients. As we see the majority of patients for an extended period of time, being able to build a relationship with them and knowing that you are there to help is so rewarding. In our role we are involved with the planning and delivery of patients radiotherapy treatment, as well as providing pastoral care for them throughout.
As the Urology Lead I work particularly close with the Consultants and Specialist Nurses to continuously improve and advance our care for this specific group of patients. I found out about therapeutic radiographers when I was in Primary school, as my auntie had cancer and I would go with her to some of her radiotherapy appointments.
The kindness and support the staff gave my auntie through this tough time inspired me to become a therapeutic radiographer myself.
Michelle Kapoor – Trauma Plain Film Radiographer
Hello, my name is Michelle, and I am a Trauma Plain film Diagnostic Radiographer performing X-rays, who circulates through the general imaging department which includes;
ED
In-patients, Out-patients and GP patients which includes orthopaedics and oncology
And Theatre and Mobile imaging.
The role is very varied and I can find myself working with a huge range of different patients in any given week. I have been a radiographer for just over a year, I always been interested in anatomy and working with people, and found radiography through work experience at this hospital.
My role entails not only delivering high quality diagnostic imaging and patient care but also teaching and supervising newly qualified radiographers and students.
I feel like I have learnt so much in the last year working on the front line and COVID has definitely made this year interesting to say the least.
I feel so lucky to have such a great team who have supported me through this unique experience. Plymouth is such a lovely place to work and while it is home for me, I can’t say it has ever been boring.
Jeanette Owen – Lead Radiographer Theatre and Mobile Imaging
I am a Radiographer with 30 years’ experience, leading a team of radiographers delivering the Mobile Plain Film and Theatre Fluoroscopy Imaging service to 33 theatres and 40 wards, including four ITU’s. My patients are at the centre of what I do.
Every day is different, requiring me to simultaneously spin a multitude of plates. Today I start with imaging an acutely unwell ITU patient with head and severe bilateral leg injuries in trauma theatre. The four hour operation requires skill and special accuracy to manage complex imaging using an image intensifier, enabling the surgeon to align and fix the patient’s fractures. During this time I am also answering my bleep; wards requiring urgent mobile plain film chest x-rays on sick patients, theatres requiring unanticipated imaging, other theatres changing the order of their lists and altering the times that imaging is required. The fluctuating demands need constant management and co-ordination of the imaging service, continuous liaising with different services and staff groups – it’s all about excellent communication.
Amongst other tasks: incidents to investigate, equipment requiring fixing, job references, appraisals, audit, bookings to organise, equipment trials, and looking after my work tribe.
It’s challenging, insanely busy, fulfilling and I still love it.
Janet Villars – Sonographer
I have always wanted to work within the medical profession and after spending time in a radiography department at age 16 I knew that this was the career path for me.
Post qualifying, I started rotaring through fluroroscopy, mobile and theatres, general and orthopaedic Xray, with my most favourite in ED Xray. After 3years I specialised in paediatrics which involved neonatal mobile Xrays, MDT meetings, skeletal surveys and educating colleagues in paediatric issues. During this time I also worked in Ugandan and Kenyan hospitals, which was where my love of ultrasound began.
When a training post came up, there was no doubt that I wanted to apply!
I have the privilege of sharing in people’s life experiences, whether it be the joy (or sometimes sadness) of baby scanning, assessing ongoing treatment in patients, including abdominal, gynaecology and fertility specialities.
I enjoy meeting people from different walks of life and putting them at ease whilst trying to find a cause for their symptoms.
I was once told that I’d never regret training in ultrasound and that I really can make a difference to someone’s life and make or break their day. This has never yet proved me wrong!
If you want to join the day on social media, share photos using the hashtags #myradcolleague #WRD2020, and tagging @uhp_nhs on Twitter.
