The Big 5

An updated bed management plan is now in place across our hospitals. This plan has been developed with clinicians to continue to manage patients in ‘coloured’ zones depending on their risk of coronavirus (COVID-19).

We have wards coded to different colours. These are as follows:

• BLUE: COVID positive
• YELLOW: Suspected COVID
• WHITE: Non-COVID
• WHITE ELECTIVE: Non-COVID (elective shielded patients)

This:

• Supports streamlining COVID areas as non-COVID need increases
• Aligns with the national suggestion of ‘blue’ areas for COVID
• Support the additional requirements for ‘white elective’ areas to shield patients requiring urgent surgery

Using the correct personal protection equipment (PPE) in each area is important because:

• This PPE equipment helps reduce the risk of people from coming into harm.
• These items help to stop the spread of coronavirus - if they are used properly they can help save lives.
• This PPE  will minimise the risk from airborne, droplet and contact transmission.
• Hand hygiene should be done regularly, within the WHO 5 moments and after taking off the PPE which will help to prevent ongoing environmental contamination.
• They will help protect you and your patients both now and in the future.

Since March 20th the Trust has issued almost 4.5million individual items of PPE, including more than 1million aprons and 2million gloves..

Currently PPE is required in all clinical settings (including community settings such as the patient’s home) when clinical staff are within two metres of a patient.

Week 2 of the Trust’s Big 5 campaign looks at the importance of taking regular breaks throughout your working day and when you go home. Take a break is a key part of Occupational Health and Wellbeing Service’s Flourish campaign and we hope you find the following information, tips and guides help to support your own health and wellbeing.

Taking a break gives you the chance to take a breather and to replenish your energy levels to help you feel
refreshed and motivated throughout your day. This can be done by eating a healthy snack or having a drink,
physically resting and taking a mental break from things. As well as it being important for your general health and wellbeing, taking a break is important for our patients too as it allows you to make the best possible decisions when caring for our patients. Taking regular breaks and having a rest are essential to ensure you are providing safe, effective patient care to the best of your ability.

We have therefore summarised below the key points of why taking breaks matter.

Taking a break allows you to...

• Re-evaluate your goals for the day and assess what you want to achieve today
• Refocus - a brief rest helps you to refocus on the work at hand
• Injury reduction – taking a break can help reduce injury during physical jobs such as bending, twisting and carrying
• Creativity boost - increase your creativity and problem solving
• Reduce stress - take some time out, unwind and have a bit of you time.

What can you do during at work?

Plan your breaks - plan your breaks at the start of the day and try not to work more than 5 hours without a break. Getting some fresh air is vital to maintaining both good physical and mental health.

Have you done the Flourish mile yet? See how you can easily walk a mile outdoors at each hospital site. If you work in the community remember to get your steps in and take a break in between visiting your patients.

Work out while working from home – as many colleagues are currently working from home don’t forget to take a regular break and plan a work out.

Work as a Team - plan your shifts and support each other to take your breaks. This is not about making you take a break at a time that is disruptive but at a mutual time that works for the whole team.

Create a ‘Take a Break’ culture – as a managers and team leader you should lead by example and create the right environment for you and members of your team to take a break.

What can you do when working night shifts?

When you are work a night shift it is just as important to take a break when lack of sleep and tiredness can affect both your physical and mental wellbeing. View our guide to shift work.

What can you do?

• Eat well and keep hydrated try to stick to a normal eating pattern and maintain a balanced diet. Keeping hydrated is essential for all age groups and is something we should all be aware of 365 days of the year, to keep us fit and healthy through every season. It is especially important during the Winter months to remember to keep drinking plenty of water throughout the day and don’t let caffeinated hot drinks like tea and coffee become a substitute.

• An easy way to spot signs of being dehydrated is by checking your urine. Dark and strong smelling urine is a clear sign that you need to drink more fluids. View our Hydration Chart and monitor your wee to see if your dehydrated

• Take short naps like a power nap of about 15 –20 minutes during your break. Make use of eye masks or ear plugs.

What can managers to?

• Identify rest areas where night staff can take a rest, a quiet room with comfortable chairs is essential and make sure your team is aware or where they are situated in their areas of work.

• Effective rota planning is key and try to minimise frequent changes between day and night shifts.

This week’s focus of our Big 5 campaign is ‘It’s ok not to be ok’. We have all heard this saying or something similar, however, we know that there are still a large number of people - both working within our Trust and living in local communities - who struggle with various mental health and wellbeing issues and feel that they are suffering alone. 

That is the case during ‘normal’ times but we’re not living in a normal world at the moment so there may be more people needing a little extra help and support for various reasons.  

The purpose of this week’s campaign focus is to recognise the importance of us all looking after our own mental health and wellbeing but also being aware of those around us and how they might be feeling. We also want to make it clear that no-one is alone. There is lots of support out there and we will share more details of this over this week.  

In the meantime, if you need support at any time or just need someone to talk to, please contact our Occupational Health team who can offer a range of therapies, referrals - both self and management referral. For more info please call 01524 512290 or email occhealth.referrals@mbht.nhs.uk. 

Tips for looking after our mental health and wellbeing 

It’s completely normal to feel sad, stressed, confused, scared or angry during a crisis. To help deal with the pressures and look after ourselves, there are a few simple things you can do: 

• Try to put aside some time each day to check in on your sense of wellbeing and the clarity of your thoughts 

• Talking to people can help. If you are living on your own, it is important to keep in touch with family, friends or neighbours on the telephone, using video calls or on social media 

• Regular exercise can help to relieve anxiety and improve wellbeing. Try to keep active by going on a daily walk, run or bike ride. There are also home workout videos available on YouTube, Instagram, or via fitness apps which can provide suggestions for exercise routines and help you to keep fit 

• Try to limit worry and anxiety by lessening the time that you and your family spend watching or listening to the media coverage that you perceive as upsetting 

• Maintain a healthy lifestyle, including eating a balanced diet and aiming for between six to nine hours of sleep each night 

• Try to avoid smoking, drinking excessive amounts of alcohol or taking any other drugs 

• Try to look out for your physical and mental health at this time. Wash your hands regularly and only leave your house if absolutely necessary in order to limit the chance of infection. Draw on skills that you have used in the past to manage adversity and help you to manage your emotions 

Our Occupational Health team is here to help. They offer a range of therapies, referrals - both self and management referral. For more info please call 01524 512290 or email occhealth.referrals@mbht.nhs.uk. 

Am I really ok? 

If someone asks you how you are, is ‘good’, ‘fine’ or ‘ok’ your go to answer? Is it a factual interpretation of how you are actually feeling? Sometimes, we get so used to working at a million miles an hour and saying we’re ok that we don’t recognise how we are actually feeling or what our feelings are telling us. Take a moment to stop and think about the following questions… 

• Do you feel a lack of feeling of accomplishment or feeling ineffective in what you do? 

• Do you feel emotional exhaustion - like you have nothing left to give? 

• Do you feel disconnected from the relationship of caring for the patient, family and colleagues? 

• Do you feel withdrawal, from social events and loss of interest in activities previously enjoyed?  

If you answered yes to any of the above, talk to your line manager or someone you trust about the impact on your work, and make a referral to the Occupational Health team who have lots of different types of support available. You can contact the team on 01524 512290 or email occhealth.referrals@mbht.nhs.uk. 

You can also get help and support from: 

• Mental Health First Aiders - we currently have 54 Mental Health First Aiders in our Trust to support and signpost anyone to appropriate help if required. Please visit the Occupational Health team intranet page  

• NHS Helpline - Call 0300 1317000 between 7am and 11pm or text ‘FRONTLINE’ to 85258 24 hours a day 

• Cancer Care Therapy Services - Call 03330 150628  or 01524 381820 

Breathing techniques 

People cope with stressful situations in very different ways. One of the most simple and effective methods to calm your mind in a stressful or anxious situation is to breathe. Seems easy, right?  

One very good calming breathing technique is called box breathing. This technique can be used for stress, anxiety and panic takes just a few minutes and can be done anywhere. 

• You will get the most benefit if you do it regularly, as part of your daily routine 

• You can do it standing up, sitting in a chair that supports your back, or lying on a bed or yoga mat on the floor 

• Make yourself as comfortable as you can. If you can, loosen any clothes that restrict your breathing  

• If you're lying down, place your arms a little bit away from your sides, with the palms up. Let your legs be straight, or bend your knees so your feet are flat on the floor 

• If you're sitting, place your arms on the chair arms 

• If you're sitting or standing, place both feet flat on the ground. Whatever position you're in, place your feet roughly hip-width apart 

Once you’re comfy and ready to go: 

1. Let your breath flow as deep down into your belly as is comfortable, without forcing it 

1. Try breathing in through your nose and out through your mouth 

1. Breathe in gently and regularly. Some people find it helpful to count steadily from one to five. You may not be able to reach five at first 

1. Then, without pausing or holding your breath, let it flow out gently, counting from one to five again, if you find this helpful 

1. Keep doing this for three to five minutes 

For more hints and tips, You can contact the team on 01524 512290 or email occhealth.referrals@mbht.nhs.uk. 

Caring for our children’s mental health and wellbeing 

Whilst we know this is a difficult time for all of us, we can’t forget that it may be a very unsettling time for children. If you have a child in your life, there are a number of things you can do to make sure that they understand what is going on and how to deal with their feelings. These include: 

• Try to talk openly about the Coronavirus with children and explain what is happening in a way that is appropriate for your child’s age. A book for children four to nine years old has been released on www.nosycrow.com to support parents in talking to their children about COVID-19 

• Children may respond to stress in different ways, such as being more clingy, anxious, withdrawn, angry, agitated or bedwetting. Try to respond to your child’s reactions in a supportive way and encourage them to express their emotions. If children find it difficult to articulate their thoughts and feelings, encourage them to do this creatively, for example by drawing or painting pictures of their ideas 

• Playing games and exercising regularly relieve anxiety and improve mental wellbeing. Try to provide safe opportunities for your children to go outside for exercise, for example on a daily walk or bike ride as a family. There are also a large number of resources available online, such as the Joe Wicks’ PE videos on YouTube 

• Try to keep regular routines and schedules as much as possible, or create a new weekly timetable, including time set aside for learning, exercise, playing and relaxing. Websites such as www.twinkl.co.uk  have lots of resources and ideas which can support parents with home schooling. There are also lots of ideas for fun games and activities on www.bbc.co.uk/cbbc  

• Try to keep children close to their main caregivers and avoid separating children from siblings or parents as much as possible. If separation occurs, for example from hospitalisation or isolation of symptomatic family members, ensure that children can maintain regular contact with them via telephone or video calls. 

Support available 

The very essence of this section of our Big 5 campaign is that ‘it’s ok not be ok’. There may be times when we need some extra support to get through; it’s ok to ask for help, and there’s lots of support out there.   

Support within the Trust 

• Occupational Health Team (Ext 42290 / 01524 512290 / occhealth.referrals@mbht.nhs.uk)  

• Counselling  

• Cognitive Behavioural Therapy  (CBT) 

• Hypnotherapy 

• TRiM 

• Mental Health First Aiders 

• Nicola Harvery and Pete Sariwee (Ext 42290 / 01524 512290) 

• Respect Champions  

• Karl Hinchliffe (07970 204132 / Respect.champions@mbht.nhs.uk)  

• Freedom to Speak Up Guardian  

• Heather Bruce (heather.bruce@mbht.nhs.uk) 

• Ask Sami (Ext 49700 / 01524 519700 / ask.sami@mbht.nhs.uk)  

Support outside of the Trust 

• NHS Helpline (0300 131 7000 between 7am and 11pm or text FRONTLINE to 85258 24 hours a day) 

• Cancer Care Therapy Services - can be non-cancer related concerns (03330 150628  or 01524 381820)

• Samaritans (01524 61666 or call free on 116 123) 

• Mind (0300 123 3393 / https://www.mind.org.uk)    

• NHS Mental Health Helplines  

• Mental Health UK Supports people affected by Mental Health   

• Trauma Response Network  

Electronic resources available 

We’ve said it numerous times but there really is a huge amount of help and support available. If you are someone who likes to access help electronically, there are a number of good quality electronic platforms that would be worth you looking at. Some of them are also offering free or discounted access for NHS staff at the moment. We’ve highlighted some of the most popular ones below. 

Headspace 

If you sign up with your Trust or other NHS email address, you can access Headspace Plus at no cost until 31 December 2020. A section of this app called ‘Weathering the Storm’ includes meditations, sleep and movement exercises to help you out, however you’re feeling. To register visit their website and follow the instructions on the page.  

Sleepio and Daylight 

Free access to Sleepio and Daylight for NHS staff is available until 31 December 2020. This is available to all NHS staff in England, including those who do not currently have an NHS email address, such as medical students and former staff returning to the workforce.  

• Sleepio is a clinically-evidenced sleep improvement programme that is fully automated and highly personalised, using cognitive behavioural techniques to help improve poor sleep 

• Daylight is a smartphone-based app that provides help to people experiencing symptoms of worry and anxiety, using evidence-based cognitive behavioural techniques, voice, and animation 

To sign up visit their website and follow the instructions on the page.  

Unmind 

Unmind is a workplace Mental Health platform and they are offering free access for NHS workers during the pandemic. They empower organisations and employees to measurably improve their Mental Wellbeing.  It could be sleep, stress, productivity, or even your ability to support others during a difficult time – all delivered in bite-sized chunks through audio, video, and interactive content. To register, visit their website and follow the instructions on the page.  

Move GB 

NHS staff are being offered a free MoveGB membership to allow you to join live streamed classes hosted by their local instructors, plus get access to on-demand workouts so you can work out anytime that suits you. To register visit their website and follow the instructions on the page.  

If you would prefer support face to face or over the phone, please contact our Occupational Health team who offer a range of therapies and courses to colleagues. You can contact the team on 01524 512290 or occhealth.referrals@mbht.nhs.uk. 

We also have 54 Mental Health First Aiders in our Trust to support and signpost anyone to appropriate help if required. Please visit the Occupational Health team intranet page for more information.

This week’s focus of our Big 5 campaign is ‘Speak Up’. The purpose of this week’s campaign focus is to recognise that – regardless of which department, site or team you work in - raising concerns should be considered ‘business as usual’. It is one of the ways that we can all work together to make sure that patient safety and quality of care remains our highest priority.

It is really important that we all feel empowered to raise concerns if we see something that isn’t right or that may compromise safe patient care. It is also essential that colleagues know that they will be listened to and supported by the Trust if they do raise a concern.

What is Freedom to Speak Up?

The ‘Freedom to Speak Up’ initiative came as a direct result of the lessons learnt from the 2013 Francis Report on the Mid Staffs Scandal public inquiry. The report was published in 2015 and found that, historically, concerns raised by NHS staff were often not welcomed and, in the worst cases, staff were treated very badly.

This attitude ultimately endangers patients and makes staff feel powerless and unable to speak up.

Shortly after the publication of the FTSU review, Heather Bruce was appointed as UHMBT’s Freedom to Speak Up Guardian – one of the first in the country.

Heather’s role is to ensure that staff concerns are listened to and dealt with accordingly, and to provide guidance on how those working in our services can raise and escalate concerns, including outside of usual line management structures.

Raising a concern

If you have a concern about patient or colleague health and safety, professional or ethical misconduct, bullying, or anything that does not reflect what we expect as part of our vision and values, you can follow the below steps to raise a concern:

• Step 1 – If possible, raise your concern at the time.
• Step 2 – Raise with your line manager if that is appropriate.
• Step 3 – If you remain concerned, contact the Trust’s FTSU Guardian, Heather Bruce, at heather.bruce@mbht.nhs.uk or 07890 587013
• Step 4 – If you do not feel that the matter has been handled correctly, you can contact:

- Shahedal Bari, Lead Executive Director, shahedal.bari@mbht.nhs.uk

- Bruce Jassi, Lead non-executive Director, on bruce.jassi@mbht.nhs.uk

- Aaron Cummins, Chief Executive, on aaron.cummins@mbht.nhs.uk

· Step 5 – If you feel that this matter cannot be dealt with within the Trust, then you can raise your concern by phoning the national speak-up helpline on 0800 0724725 or contacting the Care Quality Commission.

Don’t forget that at any time, you can also contact your Union Reps and/or our Respect Champions for advice and support.

You can also raise your concern via our dedicated FTSU app. The app is available to download for free from the Apple App Store or Google Play for Android, and gives staff all the information they need on raising a concern and what to expect next. Concerns can be submitted anonymously, however feedback can only be given if a name is provided. Take a look at this short animation which explains more about raising a concern.

All concerns are treated confidentially.

Visit our website for more information about Freedom to Speak Up, including how to raise a concern, or UHMBT staff can contact Heather Bruce, FTSU Guardian, directly at heather.bruce@mbht.nhs.uk or 07890 587013.

The final part of our Big 5 campaign focuses on ‘be kind’.

It seems such a simple thing to say but if we’re honest with ourselves, we don’t always get it right and we cannot underestimate the impact being kind has on those around us.

There’s times when we all feel stressed and under pressure and this has been amplified during the current pandemic. However, no matter what is going on, it has never been more important to be kind and treat others like we would expect to be treated.

Being kind means lots of different things to different people. It doesn’t have to be anything huge - it can be as simple as a smile, saying thank you or asking how someone is or someone making you a nice cup of tea.

No matter what is going on, we’re all in this together. We are all facing the same challenges and doing our best so we need to remember that and look out for each other.

Why is kindness important?

There are lots of reasons why and here’s just a few:

• It can create positive feelings and a sense of reward
• It can give you a feeling of purpose and self-worth
• It can help you connect with others
• It can improve your physical health by reducing stress, boosting happiness, lowering your blood pressure and releasing endorphins to boost your mood
• People remember how you make them feel more than what you say.

There are many ways to be kind and it doesn’t have to involve financial cost. Often simple gestures like a phone call to someone you haven't spoken to in a while, collecting someone's shopping or medication, writing a note or card with kind words or sending a motivational text to someone who is struggling can be beneficial to the recipient and the person carrying out the act.

Remember - kindness is contagious. If someone sees you offering a helping hand, they’re more likely to do the same.

It’s also really important that we are kind to ourselves. We all spend so much time looking out for others that we forget about number one. There are some really simple things that we can all do to be kind to ourselves:

1.  Give yourself some ‘me time’ each day to do something that makes you smile
2. When you do something you’re proud of, stop for a minute and dwell on it. Give yourself a pat on the back and tell yourself well done
3. If you mess up (which we all do) or you’re angry at yourself for something, let it go and forgive yourself
4. Take care of yourself - get enough sleep, eat well, exercise regularly, etc
5. Respect yourself – trust your own decisions, stop comparing yourself to others, form your own opinions, etc
6. Remind yourself of your good qualities
7. Believe in yourself – have faith in your own ability and judgement
8. Stop trying to be perfect – no-one is!
9. Accept yourself – we all have our strengths and weaknesses and we will all get things wrong every now and then
10. Treat yourself once in a while!

Each day, do one nice thing for yourself and make a point of thinking about at least one thing you like about yourself. The more we do this, the more it will become a part of day-to-day life.

Being kind isn’t always about something we do or don’t do. It can very much be about what we say and how we say it or the way in which we act. Our behaviours and attitudes are crucial and have a very big impact on relationships and teams working well together. They are what people see, hear, remember and tell others about.

Research, along with feedback, shows getting them right will contribute to improved patient and staff experiences.

Our Behavioural Standards Framework (BSF) was developed by colleagues across the Trust and sets out the behaviours and attitudes expected of all staff which are not explicitly described in our job descriptions. This includes the personal skills and attributes around ‘how’ we are expected to approach our work and should combine with the professional and technical skills to inform every action we take.

They demonstrate:

• How we do things
• How we treat others
• What we say and how we say it
• How we expect to be treated.

Each and every one of us is expected to adhere to the attitudes and behaviours in the BSF and we should all be held accountable if we let our standards drop. Thankfully, the vast majority of our colleagues live by these standards, but we don’t always get it right. No matter what is going on, there is no excuse for poor behaviour and we want to know about it if you experience it from a colleague or patient / visitor so we can take appropriate action.

Most of our colleagues display the kindness and positive behaviours we expect of them but there are occasions when this doesn’t happen. If you experience or witness poor behaviour, we urge you to speak to somebody at work you can trust such as your line manager, a colleague, trade union representative, Workforce team, Respect Champion, Freedom to Speak Up Guardian, Health and Safety or Occupational Health Department. You are not alone; support is available.

Saying Thank You

We mustn’t underestimate the impact that saying ‘Thank You’ can have on those around us. We are all working exceptionally hard in difficult times and it is sometimes easy to take this for granted because working in this way is how we ‘always do it’ in Morecambe Bay. However, that doesn’t make it any less special or valued.

Just think about a time when someone has said Thank You to you for something you’ve done and how that’s made you feel. These two simple words can completely change your day. Our ask is that you all take the time to thank at least one person each day - it can be a colleague, a patient, a visitor, or a loved one - and it can be for any reason. The reason why and who you thank doesn’t matter - it is about spreading some positive vibes and showing those around us that we appreciate what they are doing.

If you want to send a Thank You message to someone that can be shared publicly, you can send a colleague or team a message of encouragement, a Thank You, or just some words of support on our website here.

We have to mention the outpouring of support from our local communities since the start of this pandemic. From the numerous kind donations to taking to their doorsteps to clap for your hard work each Thursday; they really have been behind us and I know we all appreciate that.

So, next time someone says Thank You to you for your hard work, thank them for their support. It really is a team effort and our communities play a huge role in that.

We can’t finish this without a huge THANK YOU to each and every one of you and all those supporting us.

10 simple steps we can all take to be kinder in our lives

1. Give a compliment to at least one other person
2. Ask someone how they are and really listen to the answer
3. Go out of your way to help someone else
4. Hold the door open for someone behind you
5. Be constructive in your criticism
6. Say thank you
7. Check in with those colleagues working remotely or in the community or perhaps shielding. Perhaps suggest a virtual cup of tea, fun virtual quiz or game
8. List five things you like about yourself
9. Random acts of kindness - make someone a brew, tell someone well done, leave someone a nice note, etc
10. Smile!

If we all commit to doing at least three of these each day, just think about how much more positive the world would be for all of us.