A tale of two families: diabetes and rugby

Posted by Ruth Boocock, Senior Lecturer in Dietetics, Teesside University

The rain is coming in sideways, the mud is three inches and counting, a Sunday afternoon somewhere in the North of England. My rugby family. Amongst the rain, probably beneath four or five bodies, my seventeen year old daughter is having fun.

A whistle goes and a rain sodden, mud covered monstrosity jogs towards her family on the touch line. An upper arm extended, a mobile phone waved at a discreetly protected sensor and a blood glucose level read. Sometimes it’s an insulin pen to compensate for the adrenaline, other times a sports drink to refuel, such is the trial and error process of educating herself on what management routines work for training and matches. Blood glucose responses to physical activity for this recently diagnosed teenager with type 1 diabetes are highly variable based on activity type and timing and require different adjustments (Colberg et al, 2016)1. There are looks of course. Some parents are confused but a hurried whisper and the confusion is quickly replaced by respect. No mess, no fuss, just ordinary life. There are more important and more exciting things to do. Opponents to fell, tries to be scored. Rugby here, really has no barriers. A progressive, modern, attractive, dynamic and inclusive sport played by all (World Rugby, 2017-2025 vision)2.

Today is World Diabetes Day and the theme for 2019 is ‘The Family and Diabetes’. The aim, to raise awareness of the impact that diabetes has on the family and support network of those affected, as well as promoting the role of family in the management, care, prevention and education of diabetes.

On the rugby pitch my personal and professional life comes into sharp focus. I have spent the last twenty years as a dietitian sharing the journeys of people with diabetes. From the familiar insulin dose adjustment which offers greater freedom to eat and exercise while minimising glycaemic excursions (changes in blood glucose levels), to the battle of weight management and diabetes polypharmacy (the use of multiple medications). Weight loss for those with type 2 diabetes unlocking a future without diabetes or at least the ability to rationalise the use of diabetes medications.

Willowy wings take to the pitch alongside broader hardier oaks. At its best they complement each other wonderfully. From helping to prevent and manage medical conditions to reducing the risk of type 2 diabetes, the benefits of sport and activity on a person’s physical wellbeing are huge. But only 63% of adults are physically active for the recommended 150 minutes weekly, with figures lower still for children (Department of Health and Social Care, 2019; Sport England, 2019)3,4.

Rugby helps to maintain or improve aerobic capacity (the ability of the heart and lungs to get oxygen to the muscles), strength and balance and bone health and contributes to meeting the physical activity guidelines. Other benefits to exercise include reduced stress and improved self-esteem. Rugby reminds these girls that nobody’s self-worth comes from how they look or the perfect make-up or beautiful hair or high fashion clothes of online celebrities. There is a wonderful freedom here but also a challenge. Obesity. There is a fine line between giving girls and women confidence in their bodies and shape while also encouraging those patterns of healthy eating that will allow them to play at their best and get the most out of their training and their life. We do not always get the balance right. Push come to shove however they are out there two-to-three-times a week, come rain or shine working incredibly hard, growing as team mates and women, and reducing their risk of developing type 2 diabetes by 30-40%. That has to be an excellent beginning.

On the pitch there is just the team, on the side lines the wider rugby family. Sometimes also the diabetes family. Nicknames abound. Banter flows. Yet there are no labels. There are no diabetics, no 'fat girls', just a team and its friendships, its victories and losses, its celebrations and of course, lots and lots of mud.


Ruth’s current doctoral studies seek to identify barriers and enablers to the implementation of diabetes remission strategies for adults with type 2 diabetes recently diagnosed within general practice in one of the most deprived local authority districts in England.


References:

1. Colberg et al. (2016). Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care; 39(11): 2065-2079. https://doi.org/10.2337/dc16-1728
2. Accelerating the global development of women in rugby 2017-25. https://www.world.rugby/womens-rugby/development-plan?lang=en 
3. Department of Health and Social Care (2019). UK Chief Medical Officers' Physical Activity Guidelines. https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report
4. Sport England (2019). Active Lives Adult Survey: May 18/19 report. https://www.sportengland.org/media/14239/active-lives-adult-may-18-19-report.pdf

Images:

1. 'Logo for the World Diabetes Day' by International Diabetes Foundation via Wikimedia Commons: https://commons.wikimedia.org/wiki/File:World_Diabetes_Day_logo.svg
2. Published by: West Park Leeds Girls Rugby ‘Meet your #innerwarrior’ event, with thanks to Kurt Nutchey

Can Scottish inventiveness curb the nation’s alcohol habit?

Posted by John Mooney, Senior Lecturer in Public Health, University of Sunderland

 Churchill is defeated by a Temperance movement MP - Dundee election result in 1922

“Of all the nations of this earth, perhaps only the ancient Greeks surpass the Scots in their contribution to mankind…” 

Sir Winston Churchill

This often cited sentence from the great orator’s canon of memorable expressions, frequently (in social media posts at least), is accompanied by a story of the number of times in a normal day ‘the typical Englishman’ is obliged to thank his Northern cousins for gifts bestowed:

From the spreading of ‘Dundee marmalade’ in the morning to his whisky night-cap it is easy to lose count of those almost innumerable causes for daily gratitude. In these days of Prophet Greta, perhaps the less said about ‘TarMacAdam’ and the internal combustion engine the better… but in our defence there is always Kirkpatrick MacMillan’s bicycle to offset that carbon footprint!

It’s no accident of course that pride of place be afforded in the above account to Scotland’s national drink of distilled and malted barley – renowned the World over for its unparalleled quality and distinctive dalliance on the palate. Scotland’s broader relationship with alcohol however, has not traditionally been a reputation to which one might raise a glass and is perhaps better summed up by the lovable and tragic Rab C Nesbit (right). The real tragedy of course being the excessive and abiding toll of alcohol related illness and premature death for which Scotland is infamous and also near the top of the World league table, for all the wrong reasons...

And yet, the nation’s pioneering spirit (of the non-liquid variety!) and very inventiveness in the face of a challenge may yet serve up another exemplar for others to follow. In May 2018 Scotland became the first country in the World to introduce legislation that set a minimum floor price for a unit of alcohol (MUP). While other fiscal mechanisms have been tried and tested for tackling cheap alcohol, MUP has consistently shown the greatest promise in modelling studies, since it cannot be “absorbed” by the retailer [1].

Sure enough, the first evaluation of the population level impact of MUP has found the policy to be associated with reduced alcohol purchasing. In line with model predictions, the reductions were largest for those households purchasing the most alcohol and for those drinks with the cheapest alcohol content [2, 3]. The very modest impacts on household budgets and the effect of reducing alcohol purchasing / consumption the most for those at greatest risk of harm also in line with predictions [4], helps counter any serious criticisms that the policy represents a regressive measure by unfairly targeting the economically disadvantaged. In the words of the Glaswegian novelist Val McDermid, on BBC Television’s Question Time in 2017: “There is nothing regressive about preventing people in Scotland’s poorest communities drinking themselves to death with cheap alcohol”.

Returning to the bigger picture, Scotland’s appetite for policy innovation to tackle alcohol harms is by no means restricted to minimum pricing. Rather, MUP is seen as only one component of a ‘whole system’ approach to tackling this most intractable and culturally embedded of public health problems. Bringing drink driving levels into line with the lower threshold in place across the rest of the EU [5] and incorporating health outcomes as a long overdue legitimate alcohol licensing objective [6], being two potential ingredients in the mix…

The Scottish ‘double edged’ relationship with alcohol can be best summed up by another snippet of Churchillian wisdom, a man who by all accounts was not unaccustomed to enjoying a ‘brandy before breakfast’:

"Whisky has killed more men then bullets, but most men would rather be full of whisky then bullets." 

Sir Winston Churchill

Perhaps the pragmatic recognition of a population’s natural affinity for a risky behaviour responsible for such a significant health burden is the first step towards realising that only meaningful restrictions in access mediated through price and availability, as well as legislative sanctions, might yet constitute the best defence against our worst excesses. Most Scots, myself included, know only too well of the devastating impact alcohol can exert on friends, families and communities. Maybe that is why we are most responsive to the remedies!


References:

1. Meier PS, Holmes J, Angus C, Ally AK, Meng Y, Brennan A: Estimated Effects of Different Alcohol Taxation and Price Policies on Health Inequalities: A Mathematical Modelling Study. PLoS Med 2016, 13(2):e1001963-e1001963.
2. Mooney JD, Carlin E: Minimum unit pricing for alcohol in Scotland. BMJ 2019, 366:l5603.
3. O’Donnell A, Anderson P, Jané-Llopis E, Manthey J, Kaner E, Rehm J: Immediate impact of minimum unit pricing on alcohol purchases in Scotland: controlled interrupted time series analysis for 2015-18. BMJ 2019, 366:l5274.
4. Holmes J, Meng Y, Meier PS, Brennan A, Angus C, Campbell-Burton A, Guo Y, Hill-McManus D, Purshouse RC: Effects of minimum unit pricing for alcohol on different income and socioeconomic groups: A modelling study. The Lancet 2014, 383(9929):1655-1664.
5. Haghpanahan H, Lewsey J, Mackay DF, McIntosh E, Pell J, Jones A, Fitzgerald N, Robinson M: An evaluation of the effects of lowering blood alcohol concentration limits for drivers on the rates of road traffic accidents and alcohol consumption: a natural experiment. Lancet 2019, 393(10169):321-329.
6. Mooney JD, Sattar Z, de Vocht F, M Smolar M, Nicholls J, Ling J: Assessing the feasibility of using health information in alcohol licensing decisions: a case study of seven English local authorities. In: Lancet Public Health Science: 2016; Cardiff: The Lancet; 2016: 78.

Image:

1. Election result in Dundee in the 1920s when Churchill was defeated by a Temperance movement MP. With thanks to Eric Carlin, Director of the Scottish Health Action on Alcohol Problems (SHAAP).

The hardest thing was admitting that I was stressed at work...

To coincide with International Stress Awareness Week Annabel Gipp writes about workplace stress and shares her personal experience of working in the NHS.

Stress is something we all experience at some point in our working life, academic studies and at home. It’s almost become a standard for measuring how our day has been. I can recall many a time when I have exclaimed ‘That day was pretty unstressful!’, where this has really been code for ‘I’ve had a really great day’.

Being in employment has been found to have a beneficial impact on the health and wellbeing of a person, and helps to reduce workplace inequalities. Sadly however, being in low paid, insecure employment can actually contribute more to stress than being unemployed according to the National Institute for Health & Care Excellence. In non-manual workers, the most common cause of workplace absence was stress.

Workplace stress in defined as a harmful reaction people have to undue pressures and demands placed on them at work. Stress can manifest in a variety of mental and physical symptoms. Mentally, this includes:

• Trouble concentrating
• Negative feelings towards yourself, others and situation 
• Difficulty processing information or thinking logically 
• Constantly worrying something awful might happen 
• Forgetfulness 

This can also manifest in physical symptoms:

• Dizziness/ hyperventilating
• Trouble sleeping 
• High blood pressure 
• Chest pains 
• Tension and muscle pains 
• Fatigue 
• Digestive problems 

All of these can make it very difficult to focus on work or study, or even just keeping your home and socialising. This can result in a vicious circle which can worsen stress: 

A paper written by the Health and Safety Executive in October 2019 estimated that there were 602,000 workers across the UK suffering from work related stress, depression and anxiety. This resulted in 12.8 million working days lost and 54% of all working days lost to ill health were as a result of stress, anxiety and depression. The biggest cause of a build-up of stress was due to increasing workload, tight deadlines, too much responsibility and lack of managerial support.

It is also acknowledged that stress, depression and anxiety are more prevalent in public sector industries such as education, health and social care and public administration. Sadly, trends of reported workplace stress seem to be increasing slowly year-on-year, with 1,800 per 100,000 workers reporting work place stress in 2018/2019.

Stress has been linked with increased risk of many chronic health conditions, including heart disease, high blood pressure and depression. It has also shown to have links with immune system suppression, including in the progression of cancers, gastrointestinal disorders such as irritable bowel syndrome, skin conditions, neurological and emotional disorders.

So, stress is a very serious condition that needs to be reduced wherever possible, and organisations have a part to play to help manage it as much as possible.

Sadly it is not always possible to remove stress completely. I work in the NHS, and the nature of working in this organisation can potentially increase stress. Using this as one example, workers within the NHS are often faced with increasingly large workloads, stretched budgets, emotionally distressing situations or challenging patients - which can all increase stress.

I have had to take some time off work due to workplace stress. For me this was caused by a number of factors but what helped me return was a very supportive manager and team, and adjustments at work to help manage my caseload.

For me, the hardest thing was admitting that I was stressed at work. I felt guilty for letting the team down and that I should be able to manage. However, reducing the stigma around workplace stress is essential, as seeking support allowed me to return more quickly and stay in work.

So what can we do? The NHS Employers Website has a great tool to assess how you are feeling today, and it’s essential to check in on yourself. Having space to reflect and allowing yourself to voice worries or anxieties can help and give you time away from the stressful environment.

Trying to connect with people around you and with meaningful activities can all be helpful as well. But the key message is to seek support when you need it, from whoever you feel able to seek this from. Be it a colleague, friend, GP or charitable service, talking is essential and no-one is an island.


Annabel is a Floating Dietetic Clinical Specialist at Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV). Practitioner of Public Health, Faculty of Public Health, Trade Union Representative for the BDA (Association of UK Dietitians) and Staff and Dietetic Wellness Champion.


Good sources of information:

• Health and Safety Executive: http://www.hse.gov.uk/statistics/causdis/stress.pdf
• NHS Employers: https://www.nhsemployers.org/howareyoufeelingnhs
• NICE Guidance: https://www.nice.org.uk/guidance/ph19/chapter/1-Public-health-need-and-practice
• Psych Central: https://psychcentral.com/lib/the-impact-of-stress

Image:

1. "According to HR you haven't had any stress-related illnesses yet." by Grizelda Grizlingham via University of Kent, British Cartoon Archive (Reference number: GGD1406, Published by: Prospect, Sep 2017, with thanks to Copyright holder: Grizelda Grizlingham): https://archive.cartoons.ac.uk/Record.aspx?src=CalmView.Catalog&id=GGD1406&pos=11

Research on the go with women in walking groups

Posted by Stephanie Morris, Research Fellow, University of York

In this blog Steph reflects on the use of mobile ethnography in a recent study of the place of walking groups in the lives of women in deprived areas of north-east England.

Ethnography’s signature method, participant observation, or ‘hanging out’, provides rich data inaccessible by other forms of qualitative research. Mobile ethnography, as the name suggests, uses this methodology in the context of mobility. It can involve ‘go-along’ interviewing (See Carpiano 2008, Kusenbach, 2003) and participant observation as researchers travel and converse with participants.

When conducting research with women in walking groups, I found that mobile ethnography facilitated inclusivity and openness. For example, some women were interested in participating in the study, but uninterested in having a formal ‘sit down’ interview. So this approach opened up the study to those who might not usually opt to take part in research. Walking with study participants also enabled me to build rapport in a more ‘natural’ way than in a one-off interview, when the research and participant go in ‘cold’. Walking and talking, what the women did on the walks, encouraged free and open conversation: participants talked a lot to me about the intricacies of their lives, as they did with each other.

Mobile ethnography produces data which I feel is not likely to be created in static interview interactions. In ‘go along’ informal interviews, objects and embodied experiences along the route are often talked about. Conversations ranged from discussing fly tipping and historical features in the landscape, to sharing experiences of bodily sensations whilst walking in all weathers! Walking with the groups also provided a first-hand experience of the sense of safety and solidarity that comes with group walking. The following excerpt from my fieldnotes* shows an example of how this happened:

"As we walk along, Ashley who is in front of us by a few metres, points out that there is a hole in the path. She puts her stick down it and shouts to us to be careful of the hole. We do the same for the people behind us. Less than a minute later, Lisa says ‘step’, as there is a slight step in the hard soil and she is warning me about it. I do the same for the people behind me, and I get the feeling that I am being watched out for, and that I am instantly doing the same for the others."

Acts like this also quickly make the researcher feel part of the group, an insider participant-observer.

Despite its broad affordances, mobile ethnography is not without its challenges. The logistics of note taking when walking are tricky to say the least! I used the note function on a smartphone to take notes and took photographs along the route to remind me of encounters noteworthy of description. I walked with a Nordic walking group, which was even more difficult as I often had to carry the Nordic poles in one hand or clip and unclip at the group’s brief stops to quickly take notes of conversations or observations. However, as it was usual for people to walk alone for moments during walks, these times provided me with opportunities for note-taking. Conducting ‘go along’ formal interviews with a voice recorder was for the most part unproblematic; however, external noise was an issue at points near busy roads.

As with all ethnography, doing it well requires a lot of time and emotional labour. For instance, as transcribing fieldnotes is time intensive and needs to be completed as soon as possible after participating in the activity/group being studied, this task can clash with life’s other responsibilities. Likewise, as participants can become friends, research relationships and boundaries need to be carefully negotiated. And lastly, when using a method that helps to build rapport and relationships valuable for research, at the end of a project it can be difficult to say goodbye (and it was particularly hard to say goodbye to the many pleasures of group walking!).

There are many other contexts where mobile ethnography could contribute to health research, including but not limited to other physical activity and sustainable travel interventions. Why not give it a try?!

*Anonymised using pseudonyms

Eradicating poverty through empowerment: what’s the responsible thing to do?

Posted by Stephen Crossley, Senior Lecturer in Social Policy, Northumbria University

On this day, 17th October, in 1987, at the instigation Father Joseph Wresinski, the founder of ATD Fourth World, an anti-poverty movement, around 100,000 people congregated in Paris to honour victims of poverty, hunger, violence and fear. Five years later, and following the death of Father Wresinski, the United Nations announced the day as the International Day for the Eradication of Poverty, and published a resolution by the General Assembly that, amongst other things, ‘invited all states to devote the day to presenting and promoting, as appropriate in the national context, concrete activities with regard to the eradication of poverty and destitution’.

This year is the 27th anniversary of that resolution and the theme of this year’s observance is ‘Acting Together to Empower Children, their Families and Communities to End Poverty’. Themes such as this matter. How people in poverty are spoken about has consequences for how they are viewed, and the solutions that are put forward to address poverty. Discourses of empowerment are often used by governments and service providers to encourage people to view themselves as active agents with the ability, if not the responsibility, to change their circumstances for the better. This reflects attention away from what governments themselves can do.

In an examination of ‘dimensions of family empowerment’ within the ‘troubled families’ discourse in England, Sue Bond-Taylor (2014) highlights the merging of empowerment talk with encouraging families to take responsibility for both their situation and the improvement of it. This occurs not only in the ‘troubled families’ discourse, but also in the practices of family workers, suggesting that families are empowered ‘only in so much as they are compliant and accept the normalising discourses of the services through engagement with their agendas for change’ (2014: 12). She argues that families’ participation in the programme ‘merely legitimates existing power relations under a veneer of empowerment discourses’ (2014: 8). 

In another similar research project examining how education services engaged with disadvantaged families, Fretwell et al (2018: 1056) highlight how a project exhorted parents to take greater responsibility for the educational performance of their children and to take measures to address it. Notions of empowerment were deployed, particularly when discussing employment:

This aspect of the programme was couched in a discourse of empowerment. The parameters of choice are firmly circumscribed, though. Parents can choose which activities to pursue, but they are not free to choose just anything; they must make the right choices. Empowerment is thus restricted to making choices within conditional limits and is itself a strategy of government; a sanctioned means for producing the kind of active citizen demanded by neoliberalism (2018: 1056).

One of the most powerful organisations in the world
is encouraging us to 'act together' to end poverty 

It is therefore interesting, perhaps even worrying, to note that one of the most powerful organisations in the world, made up of over 190 national governments, is encouraging us to ‘act together’ to ‘empower children, their families and communities to end poverty’, as if the responsibility for ending poverty lies primarily with ‘us’ as individuals or with the people experiencing poverty. Not only are impoverished groups expected to deal with and be ‘resilient’ about their own hardship, and the problems that come with it, but they’re now also expected to be the solution. Nelson Mandela argued powerfully that overcoming poverty was an act of justice, not a gesture of charity, and John Veit-Wilson (2000, 144) has noted that the responsibility for ending poverty ultimately rests with governments:

“Ensuring that all the members of society, residents in or citizens of a nation state, have enough money is a clear role which governments can adopt or reject, but they cannot deny they have the ultimate power over net income distribution.”

It is shameful that this is where we are at in 2019. Poverty continues to exist because of political and economic decisions, by powerful groups, regarding the allocation of resources, both nationally and globally. Impoverished communities lack political power because they lack economic power. Nobody feels the need to empower millionaires or politicians to take greater control of their lives. Perhaps if we increased the economic power of those living in poverty, we might find that they were more fully able to participate in society and there might be less need for ‘empowering’ projects and services. That would be the responsible thing to do.


Stephen is currently working with Kayleigh Garthwaite (University of Birmingham) and Ruth Patrick (University of York) on an online project exploring representations of people living in poverty in the UK. This blog also appears on their website www.whatstheproblem.org.uk



References:

Bond-Taylor, S. (2015) Dimensions of Family Empowerment in Work with So-Called ‘Troubled’ Families, Social Policy and Society, 14 (3): 371-384. DOI: https://doi.org/10.1017/S1474746414000359

Fretwell, N., Osgood, J., O’Toole, G. and Tsouroufli, M. Governing through trust: Community‐based link workers and parental engagement in education, British Educational Research Journal, 44 (6): 1047-1063. DOI:  https://doi.org/10.1002/berj.3478

Veit-Wilson J (2000) Horses for Discourses: poverty, purpose and closure in minimum incomes standards policy. In: Gordon D and Townsend P (eds) Breadline Europe: The Measurement of Poverty. The Policy Press, Bristol, pp 141-164. https://policy.bristoluniversitypress.co.uk/breadline-europe

The website for the International Day for the Eradication of Poverty can be found here:
https://www.un.org/en/events/povertyday/

Images:

1. Courtesy of the United Nations Department of Economic and Social Affairs: https://www.un.org/development/desa/socialperspectiveondevelopment/international-day-for-the-eradication-of-poverty-homepage/2019-2.html
2. 'I like the campaign so far, Bob- I've already made my poverty history' by David Austin via University of Kent, British Cartoon Archive (Reference number: 86494, Published by: The Guardian, 02 July 2005, with thanks to Copyright holder: Janet Slee): https://archive.cartoons.ac.uk/Record.aspx?src=CalmView.Catalog&id=86494

Research journey for hospice evaluating its innovative dementia care

Posted by Nicola Kendall, Namaste Lead, St Cuthbert’s Hospice and Dr Sonia Dalkin, Senior Lecturer in Public Health and Wellbeing and Lead of the Fuse Healthy Ageing Research Programme

To celebrate World Hospice and Palliative Care Day, we wanted to share part of St. Cuthbert’s Hospice’s research journey, in collaboration with Northumbria University. Specifically, we wanted to share some of the innovative activity that has been taking place in practice surrounding ‘Namaste Care’ and the evaluation of it with Fuse funding.

What is Namaste Care?

As dementia progresses, family carers describe a changing relationship and sense of loss, which can cause significant distress. Finding new ways of communicating is important to help the family carer and person with dementia to maintain a good quality of life. ‘The End-Of-Life Namaste Care Program for People with Dementia’ (Namaste Care) challenges the perception that people with advanced dementia are a ‘shell’, a ‘living death’; it provides a holistic approach based on the five senses. Early evidence suggest that it can improve communication and the relationships families and friends have with the person with dementia.

How has St. Cuthbert’s Hospice used it?

St Cuthbert’s Hospice in Durham has started to provide Namaste Care in the person’s own home, as opposed to its more traditional use in care homes. We train volunteers who are then matched with a person with dementia, in terms of personality, abilities and interests, for example. Volunteers visit the person, usually weekly for two hours and try to build a bond with the person living with dementia and the family.

Why did we want an evaluation?

Evaluating Namaste Care has proved challenging for many organisations. It is straightforward to measure reduced number of falls, less infections and reduced agitation, but teasing out the nuances of why the approach works requires more detailed study. Also, we were aware that our use of Namaste was somewhat novel, with only one other hospice in the UK implementing Namaste Care in people’s own homes. A team at Northumbria University, led by Dr Sonia Dalkin applied to the Fuse Pump Prime fund and was successful in attaining a small pot of funding to do some preliminary evaluation of our use of Namaste Care.

What did the evaluation find?

The preliminary research found that when used in people’s own homes Namaste Care has positive outcomes, such as increasing engagement and social interaction. Previously, social interaction had potentially been overlooked in the literature as an important outcome of Namaste Care. This was particularly important for carers who felt that their loved ones with dementia often didn’t have any interaction with others, beyond those living with them. The importance of matched volunteers was also highlighted, and special relationships were built between volunteers and the person with dementia. Family members would often use the time when the volunteer was present as respite as opposed to taking part in the session, and this highlighted interesting perspectives on their involvement in Namaste. The evidence suggested that those who care for a person with dementia at home provide continuous care and have little input from other services, therefore provision of two hours contact with a trained Namaste Care volunteer allowed them to concentrate on other things, knowing that the their loved one was in safe hands. This is in contrast to the usual delivery of Namaste Care in care homes, where family members may feel more able to get involved as they do not provide continuous care.

What next? 

Book for organisations and carers
interested in using the approach

• Delivery of Namaste Care in various settings
The ethos of the Namaste Care approach has proved transferable into various care settings at St Cuthbert’s hospice. We now run a Namaste inspired ‘Potting Shed’ Men’s Group and we deliver Namaste Care at the bedside in an acute hospital. We are also in the early stages of discussions about taking Namaste Care into prisons, either via staff training or training prisoner buddies. We are very proud to say that due to this and other work we have been shortlisted as finalists for ‘Best Team Award’ in the 10th National Dementia Care Awards 2019.

• Spreading the word
The Hospice has developed a training programme which is steadily gaining popularity. Nicola Kendall (Namaste Lead) has also written a book as a guide for other organisations and carers who are interested in using the approach: ‘Namaste Care for people living with advanced dementia - A practical guide for carers and professionals’. The book is now available from Jessica Kingsley Publishing.

• Research
Nicola has just attended the Namaste Care International Conference and continues to take Namaste Care from strength to strength at St Cuthbert’s Hospice. We are now planning to further evaluate our work, building on the findings of the preliminary evaluation and the guide book… Watch this space!

Policy, procedure, practice and plate-spinning - how to achieve a work-life balance

Posted by Susanne Nichol, Better Health at Work Award Programme Coordinator, Northern TUC

I regularly wish for an extra hour in the day, or a day in the week and I even more regularly feel like my frenetic movement from place to place whilst grabbing various coats, bags, children, laptops, papers and other extraneous articles is accompanied by the Benny Hill theme tune. And I know that I am absolutely not alone in this daily plate-spinning, multi-tasking blur that is reality for the vast majority of parents, carers – and well, everyone else!

However, I am fortunate to work for an employer that has a raft of measures in place to help me restore some balance. For example, having flexi-time means I can get a much needed hit of endorphins by going to the gym or out for a power-walk on my lunch hour, or before I have to sprint through the school gates lest my youngest child becomes an accidental boarder.

The Better Health At Work Award (BHAWA) is a regional flagship public health programme that is the result of a long-standing (currently celebrating a decade of making workplaces healthier), progressive partnership between 11 of the regional local authorities. This was evaluated in 2012 by Durham University, received a RAND Europe award in 2018 for its impact on health and wellbeing, and due to cross-organisational working between Local Authority specialist public health practitioners, academics and Fuse, was a featured element in the Prevention stream of the recently awarded regional NIHR Applied Research Collaboration (ARC) funding.

As BHAWA Coordinator I have contact with literally hundreds (currently over 400) workplaces across North East England and Cumbria, who cumulatively employ nearly a quarter of a million workers. One of the mandates of the BHAWA is that participants survey their staff biennially (at a minimum) and ask them what topics/ issues they’d like to see addressed or get more information/ support on and more often than not, work-life balance is ubiquitous in the top 5.

To me, this presents more of a challenge for both employer and employee than some of the other regular top 5 entries such as healthy eating, physical activity and mental health. Work-life balance encompasses all of those things and more, and whilst the application of all health topics is subjective, this even more so, as we all have our fulcrum in a different place – with a large measure of economics thrown in. Most of us would like to work less time for the same pay, but currently business demands and finances often make this unviable; conversely, whilst going to 3 days instead of 5 might give you perfect work-life balance, most of us wouldn’t be able to sustain a 40% reduction in salary.

Unfortunately, there is no quick fix or magic wand. However, there are multiple ways and means to mitigate work-life imbalance and to actively facilitate a redress in the right direction. The BHAWA takes a holistic approach to workplace health that emphasises making positive changes to all aspects of the workplace, from the infrastructure and logistics, to the pervading culture of staff and management engagement and interaction – and everything in between.

So, how do they do it and what does ‘good’ look like? Well, based on my six years of experience I can safely say that the best employers take a wholesale approach and embed health and wellbeing into the holy workplace triumvirate of policy, procedure and practice.

It all starts with having fit for purpose policies in place, specifically such as Flexible Working; one of our workplaces operates a best practice ‘Adult Working’ policy, which is uber-flexible, employee-led and based around a mutually trusting relationship, so if Costa is a conducive place for them to deliver their work in between school-runs or meetings, then so be it. More and more participants are also introducing ‘stuck not sick’ policies that allocate a bank of ‘reserve’ hours that people can use to deal with unexpected issues, such as an ill child or a flooded kitchen.

Then there are underpinning procedures like regular and supportive line management, meetings/1-2-1s that start with the question ‘How are you?’ which allows for an open dialogue and an easier conversation around any issues and hopefully a subsequent resolution. But, what is of paramount importance is the active implementation of policy and procedure. If an employer has the best policy in the world, yet nobody actually knows about it, then it’s not worth the paper it’s written on. Awareness, buy-in, good communication/training and a practical approach is imperative here.

Having managers who are properly supported to understand and apply the policy in practice is fundamental. They can do this in various ways; by advertising jobs as flexible from day one, supporting a range of flexible working options such as home-working, flexi-time, or compressed hours; reminding colleagues that they can (and should) take their lunch break/leave and can attend medical appointments or workplace campaigns or activities like on-site flu jabs, or a lunch-time yoga class, without it being detrimental to pay.

One thing is for certain - work-life balance is for life and not just for a week



Image:

1.  'plate spinning' by Clancy Mason via Flickr. Attribution-NonCommercial 2.0 Generic (CC BY-NC 2.0): https://www.flickr.com/photos/clancy123/1805082629
2. 'I'm working through my lunch hour. Work - life balance survey' by David Austin via University of Kent, British Cartoon Archive (Reference number: 84983, Published by: The Guardian, with thanks to Copyright holder: Janet Slee): https://archive.cartoons.ac.uk/Record.aspx?src=CalmView.Catalog&id=84983