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Today Blue Stream Academyâ€™s Healthcare & Lifestyle Magazine Autumn 2019 Issue 3

The Lottery of Addiction

Codependency on Codeine

Ishbel Straker - Page 19

Katie Tennant - Page 26

Anti-Social Media A Sign of the Times Claire Havey - Page 4

Issue 3 Front Cover

BSA Today is the Healthcare & Lifestyle magazine from Blue Stream Academy. We are the UKâ€™s leading provider of online training for GP Practices, Nursing & Care Homes, Hospices and Urgent Care Centres. Our mission is to standardise the UKâ€™s healthcare training for a consistent delivery of quality care, through better staff education, experience and development. We have developed a suite of interactive training modules that are easy to use, cost effective and in line with CQC outcomes. All our modules are also RCGP accredited and CPD certified, providing over 100 hours of online training. If you have any comments, suggestions or ideas, please contact our editor Brady Braddock via email: brady@bluestreamacademy.com. Alternatively, you can write to us at the address below: Blue Stream Academy Suites 11, 12 & 16 Riverside Business Centre Foundry Lane Milford Derbyshire DE56 0RN Phone: 01773 822549

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Any NEW customers who sign up between 23rd September and 2nd December 2019 will receive use of any of our eLearning suitesfor 18 months, whilst only paying the cost of 12 months. Essentially â€˜18 months for the price of 12 plus VAT'.

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BSA Today | Issue 3

contents From the Editor's Desk...

e’re officially entering Autumn, that wonderful time of year when the leaves turn golden brown and the nights start closing in ready for winter - we have lots of great articles to keep you informed and entertained during the cosy season.

Look Who's Talking Ishbel Straker, an expert in the field of addiction and mental wellbeing talks to us about the dangers of online gambling.

The overall theme of our Autumn edition is ‘addiction’, a subject that is widely publicised but sometimes surprisingly misunderstood. Addiction is an issue that many of us will encounter at some point in our lives and for this reason we wanted to give an unbiased, no-nonsense insight into the various types of addiction and how they can affect people from all walks of life. I would like to take this opportunity to personally thank our amazing contributors for creating such empowering and insightful content for our readers to enjoy. We genuinely love what we do here at Blue

Stream Academy and people like you make BSA Today magazine possible. We believe that any good business should regard people as far more than just ‘employees’. This is evident with the recent release of our integrated HR system, a product that we’re all immensely proud of as we continue to lead the way for eLearning in healthcare. So, as BSA Today continues to grow and gain momentum, we are incredibly excited about the future. We once again look forward to providing you with the latest and greatest topics from across the UK's healthcare landscape. Thanks for reading!

Brady Braddock

Editor

Anti-Social Media

Does 69 Still Happen After 69?

Check Your Conkers

Codependency on Codeine

Practice Managers: Jack of All Trades or Masters of Many?

Autumn Breaks - Home and Away

Don't Feel SAD This Autumn

Ask Abi

#TeamBSA & @BlueStreamNews

BSA Today's Photo Competition

Puzzle Corner

There's still no official medical definition of social media addiction, but it remains a very real problem. Claire Havey tells us more. Why a lot of what we think about testicular cancer is wrong.

Andy Briggs has spent 25 years as a Practice Manager and managing partner in a large semi-rural GP practice and here discusses the evolution of a Practice Manager.

Blue Stream Academy Awarded ISO 27001

Psychedelic Therapy: A 'Middle Way' Forward for Psychiatry

In 2016 a 6% annual increase in the number of antidepressant prescriptions was recorded, why is this increase not having more of an impact on the prevalence of depression?

Gambling: The Lottery of Addiction

Ishbel Straker, a Consultant Prescribing Nurse, talks to us about the severity of gambling addiction and what's being done to curb it.

www.bluestreamacademy.com

Just because people enter later life, it doesn't mean that needs for affection and intimacy in relationships diminish. In recent years, figures have shown a substantial rise in the misuse and prescription of opioid medicines, but the addictive potential of codeine, can ruin lives like an illegal drug.

It's always nice to get away and an ideal time to venture out is during the beauty of autumn - when the temperature has dropped and the colours of the leaves are turning golden... For some, the change of the season brings along feelings of depression, most commonly known as Seasonal Affective Disorder. We've put together some tips to help beat these feelings.

Our resident agony aunt Abi is here to answer your questions.

Find out what has been happening over at Blue Stream HQ and what we have planned for the autumn months. Take part in our photography competition, where you can win a print of your photo and a 'snappy' £50! Just for fun, see if you can solve our sudoku...

Anti-Social Media A Sign of the Times

As it stands, there’s still no official medical definition of Social Media Addiction, but it is a proposed diagnosis related to the overuse of social media and believe us when we say, it is a very real problem. Article by Claire Claire Havey Havey Article by

ave you ever thought about how much time you spend using social media? How often does your mind instigate you unlocking your phone and checking social media, just to see what you might have missed in the last 10, 20, 30 minutes? Would you agree that this process is worryingly similar for a smoker, someone who is physically and psychologically dependent on nicotine? A smoker will think about smoking, and will then subsequently feel the need to smoke, and will therefore light a cigarette. The same can be said for someone whose habit is social media. But does this mean they’re an addict? What is Addiction? The NHS defines addiction as “not having control over doing, taking or using something to the point where it can be harmful to you.” When you think of an ‘addict’, what does your mind conjure? Do you see someone using Heroin? Or do you see someone using social media? They’re both addicts, but only if they’ve both lost the power of choice to be able to stop. Addiction is a very powerful word and one that can be used quite frivolously and, in some cases, unnecessarily. If a person cannot participate in their everyday life whatsoever because instead, they are or would prefer to be on social media, then they are addicted.

To understand whether or not social media has taken over a person’s everyday life, you need to observe how they act and behave in the -quite probably short amount of time- when they’re not on social media. The Warning Signs of Social Media Addiction We have learned that there are definite signs to look for to identify whether someone has an addiction to social media. You might even want to reflect on these signs for yourself. The seven most visible signs of social media addiction are: • Spending excessive amounts of time on social media • Unreasonable anxiety or irritation if the immediate ability to use social media is delayed • Corresponding anxiety or irritation when social media use is blocked or otherwise unavailable • Increasing social isolation in favour of spending time on social media • Poor work or school performance or non-attendance as a result of spending time instead on social media • Increasing anxiety, insomnia and unexplainable mood swings when not on social media • Lack of interest in relationships, especially marriage and sexual. We believe that a person whose social media usage is so excessive that it interferes with what is considered ‘normal

social functioning’ is someone who at least needs to be evaluated. The person on the road to social media addiction is someone who will prefer this activity over most other things. They will lose interest in other hobbies; physical social interaction will be put on the back burner; there will be little desire to get out of the house and do things. In its most severe form, social media addiction results in the same types of scenarios we see with other behavioural and substance addictions; the addictive behaviour takes over as the primary controlling factor in a person’s life. Most decisions are made based on using social media; going online determines the course of the addict’s day; if the addict has to choose between social media or doing something else, social media usually wins. This is when professional support should be a priority. Fear of Missing Out (FOMO) The fear of missing out is a social anxiety characterised by a desire to stay continually connected with what others are doing. Society has fallen into the grip of FOMO; the fear of missing out on something or someone more interesting, exciting or better than what they’re currently doing, a term which has become popular with the rise of social media use. For those who overuse social media, FOMO will play a big part in their lives and will be one of the reasons why they’re overusing social media. They’ll say it’s not “interruption”, but connection. But when you think about it, it’s not really “connection” either. It’s the potential for a different connection; a desire to experience something other than what they’re presently experiencing. It may be better, it may be worse, but they won’t know until they check, and therein lies the compulsion. FOMO creates a vicious cycle for social media users; if they don’t check what’s happening without them, they become anxious and fear that they’re missing out. But then by checking social media and seeing that things are happening without them (because of course they are, not everyone can be involved in everything), they’re anxious because they subsequently believe they’ve missed out.

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Treating Social Media Addiction The best thing a person can do is to accept they have a problem and to ask for help. This is what we call a ‘red flag’ or a person’s ‘defining moment’; the thought and acceptance that they have truly lost the power of choice and that they need- and most importantly, want- to gain back control of their life.

“

FOMO creates a vicious cycle for social media users; if they don’t check what’s happening without them, they become anxious and fear that they’re missing out.

When a person is addicted to drugs or alcohol, treatment follows a standardised process of detoxification, which safely removes the drugs from the body, followed by therapeutic treatment, which removes the desire to take the drugs again and advocates complete Article continued on Page 6 abstinence from drugs or alcohol in the future.

But with process addictions like social media, the treatment process differs slightly in that abstinence is generally accepted to be unachievable for the addict’s future. Instead, more focus is given to developing and learning coping strategies to allow the person to develop a healthy relationship with social media without it taking over their life. There are typically five stages of treating social media addiction: 1. Reducing Time Online Just like the heroin user needs to stop taking heroin, the social media addict needs to cut down on the amount of time spent online. In this sense, and in the immediate shortterm, the goal of abstinence is the same. It is vital that the addict is cut off from social media completely at the start of treatment, so that all psychological emotions that arise from going ‘cold turkey’ can be addressed in the next stages of treatment. 2. Counselling Social media addicts undergo the same types of counselling utilised for alcoholism or drug addiction. The most effective form of counselling in this regard is known as cognitive behavioural therapy (CBT). This therapy was originally developed to help people struggling with depression and other mental illnesses; it has proven rather successful as an addiction treatment as well. Through counselling, the addict can explore why it is that they prefer to spend their time online instead of in the realworld.

3. Group Support Social media addicts generally find group support to be very helpful. Group support provides mutual accountability, which is as important in social media addiction as in any other addiction. Group members rely on one another to hold them accountable and help carry them through the difficult times 4. Coping Strategies Developing coping strategies is critical to treating social media addicts. Unlike those recovering from alcohol or drug addiction, social media is not a tangible thing that can simply be cut off. Social media use is all around us and will only get bigger and more encompassing on life. Therefore, the recovering addict needs to learn coping strategies to be able to live in the digital world without returning to compulsive behaviour. 5. Compulsive Behaviour is the Earmark of Addiction Social media addiction is a very real problem. It ruins relationships, drives spouses and partners away, jeopardises financial stability, and alters cognitive function; just like heroin does. The common thread between the social media addict and the heroin addict is the presence of uncontrollable compulsions. Where the heroin addict is compelled to inject despite knowing the damage it causes, the social media addict battles uncontrollable compulsions to be on social media. Compulsive behaviour is the earmark of addiction. It is fair to say that using social media will not always result in addiction. Most children, young adults and adults have very healthy relationships with social media. But there will always be those whose hobby becomes habit; habit becomes dependency and dependency becomes addiction. What’s important is to recognise that, either in yourself or in a loved one, and get the help you need. For more information, please visit UKAT's website: www.ukat.co.uk

Dr. Jeff Foster www.drjefffoster.co.uk Dr. Jeff Foster is a GP with an interest in Men's Health. If you have any questions on men's health, please contact Dr. Foster at contact@drjefffoster.co.uk

rom an early age, boys become aware of their testicles, and as they progress through life, they become more conscious of their presence, their function, and also their disease risk. It is now commonplace for various public health messages to remind us of the importance of self-examination and there have been multiple media campaigns and celebrity advocates who have stressed the importance of being aware of the symptoms and signs of testicular cancer. In fact, testicular cancer is a rare disease that has received a lot of attention, probably for the wrong reasons. Testicular cancer has an incidence of around 2400 new cases in the UK per year. In men, it is the 17th most common cancer, accounting for only 1% of all cancers affecting males. Interestingly, over the last ten years, the incidence of testicular cancer has increased by almost a tenth. This is unlikely to be due to any changes in true disease prevalence, but more likely a greater awareness of the condition, and the changing attitudes of men towards their own health. In general, survival rates from testicular cancer are very good, with Cancer Research quoting a 98% survival rate at ten years (approximately sixty deaths per year). Given that other cancers - of the prostate, lung, bowel, head and neck, kidney, lymphoma, bladder, oesophageal, and melanoma

and leukaemia - are all more common than testicular cancer, why do we focus so much on its awareness and selfexamination? There are several reasons, probably the main reason for testicular cancer awareness, is the association we have as men with our own testicles. Testicles are part of what makes us male, they are responsible for sperm production and testosterone, two of the core elements that make up what it is to be a man. More so, men tend to have a protective obsession about their genitalia and a general awareness of the disease processes that can occur. While every man should be concerned about the risk of lung cancer, most men worry more about the personal impact of testicular cancer. It does though help to set risk factors in context. For any illness, they are usually divided into two types: modifiable risk factors - those we can alter through medication or lifestyle, and non-modifiable risk factors - such as age or sex. For testicular cancer, nonmodifiable risk factors include the following: • • • • •

Being Caucasian. Having a genetic abnormality that results in an extra X chromosome. Undescended testicles (cryptorchidism). Previous testicular cancer. Being tall. Men who are taller than average, have been shown to have an increased risk of testicular cancer.

• • • • • •

Family history. Men whose father had testicular cancer are around 4 times more likely to develop it, just as men with a brother who had testicular cancer are around 8 times more likely . Fertility problems. There is some association between men with a lower sperm count, or high levels of abnormal sperm, and an increased risk of testicular cancer. But the underlying pathophysiology is unclear. Men who have a long-standing inguinal hernia are more likely to develop testicular cancer. Hypospadias. Those born an abnormality of the penis and urethra. Having HIV or AIDS. The presence of calcium specks in the testicles (testicular microlithiasis). Testicular cancer is not increased in men with microlithasis who are otherwise healthy. But men who have this condition along with other testicular cancer risk factors (such as fertility problems or undescended testicle) may have an increased risk.

As for modifiable risk factors for testicular cancer, the situation is much more complicated. Testicular cancer is unlike the more common cancers such as bowel cancer or lung cancer, where known carcinogens such as processed meat or smoking have a direct causal association. As such, reducing risk of testicular cancer through lifestyle is more difficult. A systematic review performed in 2018 looked at the link between exercise and testicular cancer, and found that while some studies showed a decreased risk of the disease, others showed an increased risk. Overall, for this modifiable risk factor, the evidence is inconclusive. It is important that children identified as having undescended testes are surgically corrected as soon as possible and immune-suppressing conditions are treated effectively. There have also been some studies that have suggested that pregnant women exposed to certain chemicals could increase the risk of their future male offspring being either infertile, or having an increased risk of testicular cancer. This, however, is not really a modifiable risk factor, as an adult male can do nothing about www.bluestreamacademy.com

events that occurred while he was in the womb. Overall, there are no proven ways to reduce the risk of getting testicular cancer through lifestyle modification. The other reason that men are so conscious of testicular cancer, is the promotion of testicular selfexamination. It is accepted that finding cancer early on helps improve survival rates, and this is where the notion of self-examination becomes important. One of the earliest known recommendations to perform testicular self-examination dates back to 1977 in an article entitled “Various ways in which individuals can help detect cancers early”. At that time, there was no evidential base for this recommendation, and indeed, even now, the chance of discovering a significant abnormality from routine testicular self-examination is so low that it would take 50,000 men examining themselves for 10 years to prevent one death from testicular cancer.

“

Testicular cancer has an incidence of around 2400 new cases in the UK per year. In men, it is the 17th most common cancer, accounting for only 1% of cancer affecting males.

Even so, that is not really the point of self-examination. Many cancers affecting males, such as prostate cancer and testicular cancer have no screening process or screening tests available, and there are virtually no modifiable risk factors, especially for testicular cancer. To compound the problem, funding for research into male cancers remains much lower than for female cancers (for multiple reasons). Rather, the greatest benefit for self-examination of the testicles in men is to raise general awareness. It is, admittedly, likely to promote unnecessary anxiety in the majority of patients that find a lump and which turns out to be a benign epididymal cyst, but it is also likely to lead to a much better chance of finding that 1% of patients who do have testicular cancer.

For men’s health conditions which lack funding, screening tests, or even ways we can make changes to their lives to reduce risk, the one thing we can all do regularly is feel our balls, and though for the majority it will not alter the outcome, for a few men at least, it may save their lives How to Check Your Conkers

Check your testicles once a month whilst in or after the shower. If possible, stand in front of a mirror. Check for any swelling on the scrotal skin.

Check one testicle at the time, gently rolling it between the fingers, remember to feel up the spermatic cords on the back side of the testicles.

Look for hard lumps, smooth or round bumps, changes in size, shape or consistency and any painful areas.

R H Practice Managers: Jack of All Trades or Masters of Many? If we jump into our time machine and nip back to 1950 to visit a GP, we will likely come across a male GP working from their home supported by their wife who worked as a receptionist, assistant and anything else that was needed – that might explain the basis for your job description! OK, that’s a huge generalisation, but practice managers, as a role, didn’t exist.

he Royal College of General Practitioners wasn’t formed until 1952. GPs were initially simply paid capitation fees. It wasn’t until 1966 that new terms of service, 'the family doctor charter', were agreed.

Andy Briggs Andy spent 25 years as a practice manager and managing partner in a large semirural GP practice, during which he met the challenges of the ever-changing NHS environment. Active within practice manager groups, practice based commissioning and CCGs, he now works within the system supporting practices to meet the new challenges of extended access and Primary Care Networks.

The charter bought about changes in the way GPs were paid under a system that became known as the “red book”. The red book enabled GPs to claim up to 70% of the cost of ancillary staff plus 100% of premises costs. GPs who took on the care of patients outside of core hours were paid additional fees. The charter was a turning point for general practice allowing GPs to improve their premises, employ staff and come together to form partnerships. This change, little more than fifty years ago, created the seedbed from which today’s practice manager role grew. The introduction of general practice fundholding (GPFH) in 1990 required organisational and inter-organisational management at a higher level. IT wasn’t very prevalent. When I joined my practice in 1993, computers were

“dumb terminals” used mainly for prescribing and repeat prescriptions. Patient notes were still handwritten and lists of patients awaiting operations were based on T-cards. IT crept in and two systems ran sideby-side for many years. Claims for reimbursement and items of service were paper-based requiring capable systems to capture the activity and process the paper forms for payment. Once payment was received the payments would be reconciled against the claims. GPFH and increasing organisational complexity saw more managers being recruited. Many developed from existing administrative staff, hospital administrators, ex-forces or bankers, some were nurses. The breadth of background and experience within a group of practice managers has always appeared to be an immense strength. For many, the role of practice manager was “a Jack/Jackie of all trades”. The speed at which the role of practice manager changed has been at the same pace as the changes to the

NHS and the increasing expectations of patients. General practices range hugely in size and configuration resulting in an equally diverse management requirement. In some practices the GPs are "visionary" requiring a very operational manager; in practices where the GPs are “hands off” the role may be both operational and strategic, but they all face very similar challenges. Managers in smaller practices may be more diverse than those in larger practices where multiple managers might share the diversity of work allowing for a degree of specialisation. Practice management has grown massively since the days when the need was simply to ensure reimbursement was claimed for and received. The breadth of tasks continues to increase as general practice develops. Over the past few years, there have been incentives for practices to work together, this is now formalised with the development of Primary Care Networks (PCNs). Managers now find that their complex role leading and motivating teams needs to be applied across several practices that often have different cultures and, sometimes, different motivations. So, we agree that a practice manager’s role covers a wide range of tasks requiring many different skills. While many other jobs have equally broad requirements, I believe that the uniqueness of practice management is in the accountability and consequences for their actions.

“

To precis a famous quote – 'Any fool can make things more complex, it takes a touch of genius to make it simpler' and that’s the purpose of these support organisations.

Managers may be employed, partners or directors, but I have found that responsibility and accountability often sit on their shoulders alone. It’s not good enough to be a “Jack/Jackie of all trades” because the consequences of getting it wrong are often immense in their disruption and/or cost. Managing staff is no longer limited to Betty the receptionist and Alison the secretary. Often multi-profession teams, some of whom may work with the practice but are employed by another organisation adds another layer of complexity and risk. The cost and consequences of getting it wrong are potentially horrendous and expensive. Managing the building, often used beyond its designed capacity, has become increasingly complex, not just in the building infrastructure, its maintenance and repair, but room allocation and use. Back-to-back room use and hot-desking are tough enough without adding the human element of staff not wanting to vacate a room at the end of their session. www.bluestreamacademy.com

Poor financial management makes for a very tense time with the partners and accountants. Surely practice management includes the responsibility for other organisations paying the practice on time and using remittance advices that are comprehensible and linked back to something vaguely familiar? Managers are often expected to challenge the behaviour of their “Boss”. Why isn’t Dr X adhering to the local formulary, “doing QOF (Quality and Outcomes Framework)”, reporting and engaging with significant events and assisting in the resolution of complaints? To keeping their practice viable, many managers are constantly reviewing:

• How can I improve productivity? • How do I improve the financial performance ensuring that any additional services we offer are value for money? • How do I improve the effectiveness of the practice?

• How do I ensure compliance and governance • both in medical services and staff employment? All of this is made more challenging due to: • the constant changes demanded by the NHS • the unachievable patient expectations • the lack of clarity, ambiguity and conflicting guidelines in much of what is demanded from the practice • often the lack of support for change from partners and staff who believe that change is optional. With such a challenging and diverse workload, accompanied by high levels of accountability, managers need the support of great teams. Managers are very often the leaders in their practice and may well be, or become, the leaders within PCNs. Just as there needs to be good leadership, there also needs to be good “followership”. Followership is a straightforward concept. It’s not about being shackled and blindly following the leader. Excellent followers are empowered, motivated and focused on the success of their organisation, their team and their role. Everyone supporting each other, including leaders, to deliver high-quality care and everyone taking responsibility for the success of the organisation as a whole. Followership is also about taking on the leadership role when it is required. The job of a leader is not to create more followers, it’s to create more leaders. Effective managers don’t just rely upon their practice team, they will have a wider team of supporting partner organisations who help the manager shoulder the burden. To precis a famous quote – 'Any fool can make things more complex, it takes a touch of genius to make it simpler' and that’s the purpose of these support organisations. As an example, accountants are relied upon to a varying degree, depending upon the manager’s financial ability. Article continued on Page 12

Accountants should not baffle anyone; they should be able to help everyone to understand the financial picture. One practice I worked with wanted help following an acrimonious partnership split. I discovered that they had never understood capital accounts and referred to them as “funny money” and had left their capital accounts behind when they split, not realising that it was money they had put into the business and paid tax on! An expensive lack of understanding. Management tools and resources are equally important. Bespoke payroll packages or outsourcing the payroll. Websites where policies and protocols can be downloaded and even ones that will write policies for you if they don’t have the subject you are looking for. All of these resources are designed to make life easier and, hopefully, develop as the needs of practices develop. One such resource that made an immediate impact upon me as a practice manager is Blue Stream Academy, when they launched the eLearning suite for GP practices. Not only did the eLearning suite hit the ground running, but it continued to develop. The company welcome and respond to feedback about their product, making it better and more useful with every new version they release. They keep an eye on the future to ensure that the suite of training always has the modules necessary before they are needed. The eLearning suite is configurable to each practices’ needs and met my requirement of making a complex issue less complicated. The management dashboard allows training to be tracked for all staff. Being web-based, it is accessible to staff from home. This is particularly useful when employing new staff to

enable them to complete some basic training before they set foot into the premises. On the day that new staff arrive the manager can see they have completed and passed several modules such as Fire Safety, The Principles of H&S, Infection Control (non-clinical), Equality & Diversity, Display Screen Equipment, GDPR, Induction, Information Governance etc. This ensures that new staff have acquired a level of understanding and insight into the practice and some of the requirements of the role. Just as patients are frustrated by every person they have contact with, asking them the same information, then so managers become frustrated by entering the same information into many different stand-alone systems. The eLearning isn’t connected to payroll or the rota system or HR files and so forth. Staff details must be entered into several different systems. Changes to staff details need to be replicated in many systems. Don’t we all wish for a single, integrated system that covers a great deal of the HR complexity to make our life easier? Those wishes are beginning to be granted with the introduction of Blue Stream Academy’s HR System that is designed to take the headache out of many aspects of staff management. Duplicating staff data is eliminated because it links to the eLearning suite pulling basic staff data from that. The initial version of the HR system didn’t just include the ability to add staff details but also rotas and rota management. In my experience, rotas have always been problematic, often paper-based, it’s very easy for misunderstandings to occur as staff have the wrong version of the rota. The system not

only allows the easy creation of rotas but displays it to the member of staff when logged in and emails it to them. The entire system is accessible from home, smartphones and tablets. Holidays are booked through the system and approved by a manager. Running totals for holiday, pending and refused requests are all shown.

However, in my view, the greatest benefit of this system is knowing that it will continue to develop and continue to make life easier for managers. The system solves real-life problems that managers have while improving productivity and effectiveness and supporting the delivering of compliance.

Other absences are added by the manager. All this information is available through the dashboard and also through a comprehensive reporting system.

I am told that Blue Stream Academy has the vision of creating a single hub to deliver solutions for managers as they continue to be “Jack and Jackie of all trades and masters of many”

As if that’s not enough problems to solve for managers, Blue Stream Academy has since released further enhancements, solving more challenges and reducing the need for paper records. Additional details about staff, including a second phone number, gender and ethnicity, will be available in the system for HR purposes. A new feature will make it possible to upload and link documents to a user’s HR profile. Users will also be able to edit their basic contact details, but not their work or leave details. When creating a rota, the system will automatically pick up when staff have holiday, other absences and training scheduled. This feature will then create warning notifications on the rota for HR administrators. HR Administrators will be able to create leave for users plus there will be features to add further details for leave or absences.

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Blue Stream Academy are ISO 27001 Certified Blue Stream Academy Ltd, the UK's leading provider of online training to the healthcare industry, are pleased to have achieved this certification.

ie are delighted to announce that Blue Stream Academy, the UK’s leading provider of online training to the healthcare industry, has achieved ISO27001:2013 certification.

Over recent years, and particularly since the introduction of the General Data Protection Regulation (GDPR) on 25th May, 2018; there has been an increased focus upon how the personal data of individuals is used, managed and protected; increasing the responsibility placed upon the organisations responsible for controlling and/or processing the data. ISO27001:2013 is a comprehensive internationally recognised framework defined by the International Organization for Standardization (ISO), which establishes best practices and controls with regards to Information Security Management Systems (ISMS). This ensures that risks are identified, and measures put it in place, enabling management and/or reduction of risks to the information held. This means that Blue Stream Academy Ltd. have: • Identified information security risks and systematically evaluated them taking into account the impact of threats and vulnerabilities. • Created a set of controls to mitigate these risks. • Ensured a management process reviews these risks and controls. • Committed to an ongoing programme of internal audits. • Have been audited by an ISO accredited certifying body to test for conformity.

About Blue Stream Academy Blue Stream Academy have developed a suite of interactive training modules which are easy to use, in line with CQC Outcomes, cost effective and providing proof of competency for GP Practices, Nursing/Care Homes, Hospices, Urgent Care and Carers. Providing more than 100 hours of accredited training and having issued over 4,500,000 hours of Continually Professional Development to almost a quarter of a million users in more than 5,000 organisations; there is no better place to go to ensure the competency of your employees and ensuring CQC compliance.

“Quality and integrity are part of our core values; given the importance of data within the healthcare industry, information security is naturally a major area of focus for the Company and a responsibility that we take very seriously. It is great that the significant effort and involvement from every Blue Stream Academy employee to achieve the ISO27001 certification has been recognised, and is further evidence that we are constantly challenging ourselves to improve our service to meet, or where possible, exceed the needs and expectations of our customers.”

Stuart Walsh - Chief Information Security Officer (CISO) at Blue Stream Academy

“Our customers can be assured that we operate as professionally as possible and treat information security as a top priority. Our attainment of this internationally recognised standard, audited to the highest possible standards by BSI which ensures that we’re aligned with the requirements of our customers, who deserve the highest possible levels of adherence to any regulations relating to information security/data protection.” Shelley McCart - Chief Executive Officer (CEO) at Blue Stream Academy The certification and audit were undertaken in June 2019 by the British Standards Institution (BSI), the UK’s national standards body. Extensive reviews will be undertaken annually to ensure continued conformity. To view a copy of our certificate, please see www.bluestreamacademy.com For further information about the ISO27001 standard, please visit the International Organization for Standardization website: www.iso.org

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Article by Hannah Douglass and Dr Robin Carhart-Harris

Psychedelic Therapy: A 'Middle Way' Forward for Psychiatry

Doctors issued 36 million prescriptions for antidepressant drugs in 2008, one decade later this number had more than doubled to a staggering 70.9 million. Two years previously, in 2016, a 6% annual increase in the number of prescriptions was recorded, the largest increase of any prescription item for the fourth year running.

iith depressive disorders listed as the thirdleading cause of disability in 2017 and an estimated 10% of the population being afflicted by this debilitating disorder at some point in their lives. Why then, is the increase in antidepressant prescription rates not having more of an impact on the prevalence of depression? Not much more than half of patients show a clinically meaningful response to first-line antidepressant medications. Of the remaining non-responders many exhibit resistance to subsequent treatments. The most detailed and up-to-date meta-analyses suggest that antidepressants have only a modest superiority over placebo and questions remain over their side-effects and treatment adherence, plus systematic biases in their evidence-base related to the massive industrysponsorship and dissemination of antidepressant drug research. The pharmacological and cognitive revolutions in psychiatry and psychology, which culminated in the discovery of the selective serotonin reuptake inhibitors (SSRIs) and development of cognitive behavioural therapy (CBT), were heralded as successors to the obscurantism and dogmatism of psychoanalysis. However, whatever the limitations of psychoanalytic psychotherapy, the fact remains that most patients prefer talking-therapy over drug treatments, and yet,

unlike antidepressant drugs, even the brief, evidence-based talking-therapies such as CBT are comparatively expensive, and schemes designed to improve access to them have not been hugely successful, with patients often sitting on waiting lists for several months before being seen. Added to this, psychotherapy appears to have no better efficacy than antidepressants and problems remain over its typically slow therapeutic action, poor treatment adherence and high rates of relapse. There has existed, for too long, a stark and artificial schism in mental health between the biomedical and person-centred approaches. It cannot be the case that one side of this divide is right and the other wrong, although such perspectives have been commonplace in mental health, particularly among a certain generation. Psychiatry has always been the black-sheep of medicine, as the focus of its practice is the intrinsically subjective human mind. Try-as-it might to convince the world that it is just as biological and objective as other domains of medicine, the fact remains that it cannot be: however intimately related there may be, the human mind and brain are categorically distinct phenomena and it is an error to neglect either side of this unique coin. With positive public engagement initiatives currently underway to change the way mental health is

viewed, one can feel hopeful that such progressiveness will extend up to psychedelic therapy – a truly hybrid or “middleway” therapeutic model that seeks to combine precision pharmacotherapy with psychotherapy in a synergistic way. This approach rests on an increasingly popular principle in mental health research that the brain is not an isolated organ, neither from the rest of the body or its environmental context. With its emphasis on the importance of synergies between complementary approaches - i.e. a specific drug and brain action combined with the shaping of a particular psychosocial context - psychedelic therapy is in many ways an exemplar “biopsychosocial” therapeutic model. The history of psychedelic therapy is a history of unrealised potential. Psychedelic plants such as psilocybin-containing mushrooms (i.e. “magic mushrooms”) have been used since ancient times by certain cultures. Catalysed by the discovery of LSD in the 1940s, psychedelics were prescribed and researched extensively in psychiatry the 1950s and 60s – before becoming the target of a conservative prohibitionist campaign fuelled by misinformation and scare-mongering. Meta-analyses of the research done during this period have tended to support the view that psychedelics can be very effective when used appropriately. Fast-forward half century to the present day and a growing evidence-base is amounting for psychedelic therapy. Building on a foundation of human neuroimaging research and a small-scale feasibility study of psilocybin-therapy for treatment-resistant depression, our newly founded Centre for Psychedelic Research at Imperial College London is presently halfway through a 60 patient double-blind randomised control trial comparing psilocybin therapy with a 6-week course of SSRIs.

evidence-base for informing harm reduction messages while simultaneously identifying how best to harness the therapeutic effectiveness of psychedelics. Unsurprisingly, initial results have revealed that responses to psychedelics are highly context-dependent, being contingent on such factors as: 1) the intention one brings to an experience, 2) the people one is with when the drug is taken, and 3) personality traits that are predictive of sensitivity to the drugs’ effects. Given our special interest in how the effects of psychedelics compare with those of conventional antidepressant medications, we recently set-up a sister project to these psychedelic surveys, with harmonized outcome measures so that we can compare findings from naturalistic-use of psychedelics with standard clinical-use of SSRIs. However, for this project to be successful, we are entirely dependent on the support of primary and secondary care professionals, who we hope will refer patients to this study by providing them with a weblink and encouraging them to sign-up as soon as they begin a course of standard antidepressant drugs If you would be interested in referring your patient(s) to the SSRI survey study, please find contact information on page 18.

Recruiting for this trial has been a challenge but initial results are promising, with the blind broken at the primary endpoint (6 weeks after treatment inception) so that normal care can resume. The primary outcome measure in this trial is emotional processing and its neural correlates, measured via functional magnetic resonance imaging (fMRI). Based on previous work, we have hypothesised that psychedelic therapy works differently to SSRIs because of a differential action on emotional processing. More specifically, we predicted that effective psychedelictherapy enhances an individual’s ability to accept, release and process intense emotions, whereas treatment with SSRIs works via moderating emotionality so that the individual can more easily “get by”. In recent years, to supplement our controlled research, we have begun to sample naturalistic-use of psychedelics using a web-based survey tool (psychedelicsurvey.com) completed in a prospective way: before and after planneduse of a psychedelic. Different surveys have been created for different contexts: e.g. “micro-dosing” with a psychedelic (i.e. the semi-regular use of very low doses of a psychedelic), use of psychedelics within organised retreats (some of which are legal in certain countries) and use of psychedelics in any other context. Part of the motivation behind these surveys has been to collect so-called “big data” so that we can acquire a solid www.bluestreamacademy.com

Ishbel Straker www.ishbelstraker.co.uk Ishbel Straker is a Consultant Prescribing Nurse who runs a private clinic on Rodney St, Liverpool. As an expert in the field of Addiction and mental wellbeing, Ishbel is focused on offering a bespoke service to her patients, combining clinically evidenced therapies such as Cognitive Behavioural Therapy, Motivational Interviewing, Solution Focused Therapy as well as a prescribing service if appropriate. Ishbel works with people who are both physically and/or psychologically impacted by mental health issues or addiction. Working together with the patient to set goals through one-to-one therapies working within national guidance frameworks. Ishbel additionally has a range of onward referral pathways to ensure continuation of care. Ishbel has a keen interest in working with women with the following issues: • Perimenopausal

• Recreational drugs

• Relationships

• Stress

• Struggling with work • Gambling • Alcohol

• Anxiety

Ishbel studied Psychiatric Nursing at University of Central Lancashire and gained her Masters in Prescribing at the University of West London. Over the past ten years she has held senior positions in several national organisations including Director of Nursing. Her priority has always been quality care for her patients and this is what she strives for on an individual patient basis and nationally through her strategic policy work. Ishbel is a recognised expert in the field of Addiction and co-existing mental health problems. She writes a bi-monthly column for the national magazine; Drink and Drug News and writes a monthly mental health column for the Liverpool Echo. She is an experienced Expert Witness and is an Honorary Clinical Lecturer for Middlesex University, supporting research and the training of clinicians. Ishbel also supervises senior nurses in various organisations which includes clinically advising on complex patients.

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Gambling: The Lottery of Addiction

s we drove into the car park with the large TK-Maxx, B&Q, Next Home and Mothercare all in clear view, I noticed that positioned very comfortably next to the Harvester was a BETFRED. “That’s odd,” I remarked to my husband, who incredulously stated that in reality it wasn’t actually that odd and some people’s everyday lives and routines are structured around placing a bet.

Of course, I know the extremes of this from working in the field of addiction for fifteen years and have seen an increased smattering of such addicts, but the statistics show that the UK is a nation of gamblers. I initially found the idea of the Great British public avidly working out a multitude of complicated odds and combinations before finding the nearest betting shop to risk their pay check, baffling and frankly absurd. But with the gambling industry generating fourteen billion pounds in 2017 and 76% of the UK population playing the national lottery and using scratch cards on a weekly basis, I soon came to realise that there was a wider issue at large. It is important to note that it is no more confusing to me that someone would jeopardise the weekly shopping

budget on a horse race, than a person’s need to drink or use a mindaltering substance to feel normal, shopping continually to feel fulfilled, exercising obsessively to the point of injury or to spend every waking moment holding a gaming controller and staring at moving pixels on a screen. I am aware people do all of the above and they are all recognised addictions I see on a regular basis, but gambling seems to have its grip on the nation without most people even being aware. Data shows that the National Lottery in retail outlets are used by 58% of the population, Scratch-cards are used by 32%, private betting/slot machines 24%, other lotteries 22% and betting on horse/dog races are last at 21%. Looking from a societal perspective, I feel gambling and alcohol fall into similar categories. Both are legal, both are socially acceptable to most people and both have friendship and social elements to them. They are also incredibly accessible and are promoted by celebrities, making them almost ideals to strive for. But most importantly, they are both a rapidly escalating issue, creeping up on users until it is too late and they

Article continued on Page 20

have slipped into a cycle of managing the physical and financial consequences of these addictions. The Gambling Commission in 2017 estimated a shocking 430,000 people were problem gamblers and that men were seven-and-a-half times more likely than women to develop a problem. Due to the fact that men are statistically greater risk takers and more impulsive, this is of particular relevance when dealing with chasing financial losses. Also, statistically more at risk from addiction are young people from black and minority ethnic (BME) backgrounds, people with mental illness and people who misuse substances.

They also provide the following SMART Goal Planner, Access, Time and Money worksheet, My Gambling Diary, Me Today Planner, What Will I Gain worksheet, Building a Support Network worksheet, Mood Diary, Boundaries Map and Stress Checklist. There are specialist providers that can treat gamblers, either as inpatients or in the community. As a clinician when assessing gambling behaviours in a patient we use the following recognised tools: • LIE/BET Questionaire • South Oaks Gambling Screen (SOGS)

Gamblers are unable to switch on their computer without a barrage of popups inviting them to have a game of online poker, blackjack or place a bet. With one click the addiction is satiated and the patient has stepped into the cycle once again. While only 4% of people nationally gamble online, almost 35% of at-risk gamblers do it online.

• Brief Biosocial Gambling Screen (BBGS)

So, why do people gamble? The answer is how long is piece of string? Like any addiction, gambling makes the patient display isolating behaviours in an attempt to hide the issues. It is tempting to believe it is about money or having a competitive nature. In clinical terms, the phases of gambling look like the following: winning, losing, desperation, hopelessness. Its an everlasting cycle that can only be broken with an affirmed decision to change, seek help and ultimately stop.

The DSM-5-2013 Gambling disorder – diagnostic criteria must meet 4 out of 9 criteria with 4-5 criteria: mild gambling disorder, 6-7 criteria: moderate gambling disorder, 8-9 criteria: severe gambling disorder.

There is now far more support widely available and resources can be sought online in the form of self-help part of the initial treatment is being open and honest in where the pitfalls lie. GamCare has some fantastic resources that allow a person to work through the addiction and discover where they need to be through workbooks and online support.

3. Has made repeated unsuccessful efforts to control, cut back, or stop gambling.

They provide blocking software that prevents the barrage of temptation for those who are online and have used this as a forum for their gambling practices in the past.

• DSM-5 Gambling Disorder Criteria • NORC Diagnostic Screen for Gambling Problems Self Administered (NODS-SA) • GHQ-12.

1. Needs to gamble with increasing amounts of money in order to achieve the desired excitement. 2. Is restless or irritable when attempting to cut down or stop gambling.

4. Is often preoccupied with gambling (e.g., having persistent thoughts of reliving past gambling experiences, handicapping or planning the next venture, thinking of ways to get money with which to gamble). 5. Often gambles when feeling distressed (e.g., helpless, guilty, anxious, depressed). 6. After losing money gambling, often returns another day to get even (“chasing” one’s losses). 7. Lies to conceal the extent of involvement with gambling. 8. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling. 9. Relies on others to provide money to relieve desperate financial situations caused by gambling.

There are recognised neurological & cognitive difficulties symptomatic with gambling which include; a Decreased Orbitofrontal Cortex, Basal ganglia & thalamus which affects speech, movement and posture. The combination of such symptoms is parkinsonism. Mesolimbic/dopaminergic abnormalities have a significant role in the control of addiction. Similar pathology is seen in obsessive compulsive & addictive disorders and Corpus Callosum – fractional anisotropy. There are also measurable symptoms to note with a patient who chase losses: impulsiveness, has difficulties with cognitive flexibility and time management estimation, deficits with working memory and diminished performance on inhibition and decision making.

We have moved on leaps and bounds with the pharmacological treatments for gambling addiction available. The following are now reasonably successful and worth consideration within specialist services.

“

We have moved on leaps and bounds with the pharmacological treatments for gambling addiction available... naltrexone and opioid antagonists have shown the most promising results...

Naltrexone and opioid antagonists have shown the most promising results for gambling disorder to date as they modulate dopaminergic transmission in the mesolimbic pathway and decrease the urges to gamble as well as the gambling behavior itself. In conclusion, despite the clear increase of gambling issues, there are positive steps being made to treat those who want help. However, with all addictions, the first step is to seek help and those who are most likely to be faced with the initial problems are GP’s. With online resources and referral pathways within addiction services and private practice at their fingertips, GP’s have a plethora of outlets to point their patients towards, benefitting from not only therapeutic tools but prescriptive provision. For further information, Ishbel can be contacted at

www.ishbelstraker.co.uk

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Does 69 Still Happen After 69?

Just because people enter later life it does not mean that needs for affection, and intimacy in relationships necessarily diminish...

Esther Wiskerke www.facebook.com/cuppa69

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Imagining that people of 69 and above are still sexually active or at least interested in intimacy, is a thought that hasn’t been fully embraced yet by society.

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Ihat depends on many factors, physical suppleness being one. Rose* and her old school friend Tom* were both 75 years old when they met again. They married. She lived until 93, he until 103. Rose’s daughter-in-law shared with me that she firmly believes that their marriage gave them a new lease of life.

How mistaken the youth can be. After overcoming the first shock that gravity really makes “things sink” and that bearing children does alter a woman’s body, it is well reported that mature people are more confident and thus their sexual pleasure may increase. In fact, sexual transmitted diseases are on the rise in the over 50’s age category.

Not everyone is sexually active in later life or are still as adventurous as they used to be. That doesn’t mean that the need for affection, intimacy and a relationship necessarily diminish.

Imagining that people of 69 and above are still sexually active or at least interested in intimacy, is a thought that hasn’t been fully embraced yet by society. This doesn’t have to pose a problem for the elderly who prefer a cuddle as opposed to a hot water bottle to keep them warm at night. As long as they remain independent, like Rose and Tom, what happens in the bedroom remains a private matter.

Rose and Tom were lucky. They both lived independently, were in reasonably good physical health and had full mental capacity. Both were also supported by their families, who were happy for them. Although there is a current trend that sees some companies swapping their glamourous models for “real people” with perhaps not so flawless skin and a “love-handle” or two, overall sexuality is portrayed in society as something for the young. Teenage children tend not to be able to bear the thought of people of their parents’ age still being sexually active, let alone that grandpa gets his wooden leg over grandma.

However, linked to older age is a potential deterioration of health. This may be a cold shower for love and affection. Firstly, because an illness may diminish the interest in erotica. Overall, this does fit with the line of expectation of most people. Secondly, a physical illness may restrict the ability to source or initiate

intimacy, but the desire for it may not diminish. Thirdly, a neurodegenerative condition such as dementia or a stroke may affect someone’s mental capacity, but certainly does not automatically equate to someone being unable to have sex or a disinterest in the topic. In fact, a neurodegenerative condition causing atrophy in the frontal lobe in the brain (the area which regulates social and emotional inhibitions), may even increase sexual behaviour. Consent is one of the most important ingredients of a healthy sexual relationship. Thus, when unable to give consent, it automatically means that legally ‘the actor or initiator’ of the sexual act commits an offence according to the Sexual Offences Act 2003. In some instances, the situation is crystal clear and thanks to the extensive safeguarding awareness of health care staff, vulnerable people are protected.

their (elderly) parents happy, but what if the 40-year-old cleaner is making Dad very happy? It is perfectly normal that children do not think through the sexual life of their parents. Lucy’s* mother was widowed at 38. She met a soldier after the war and visited him regularly in Scotland. It wasn’t until Lucy’s mum had passed away and she found letters between mum and ‘her friend in Scotland’ that she realised how passionate the relationship had been. However, a situation can arise where children are suddenly confronted with the sexual behaviour of (one of) their parents. For instance, a daughter may walk into a dementia care home to visit her mother, only to find her kissing a man in the living room, whilst she is standing there with her dad on her arm watching in horror.

But what if the situation is less clear? What if you previously enjoyed ‘nurse role play’, but since your diagnosis with dementia ‘the real nurse in your life’ is having none of it? What if you have shared the same bed for 50 years with your spouse, but as you move into a care home, you are separated? What if you (a masculine truckdriver) always have had a full set of ladies’ clothes, neatly stashed away in the loft, for you to enjoy when nobody else was home? Where will you store the pleated skirt in a care home, especially as you haven’t even shared with your children that dressing up at times makes you feel authentic? Research shows that due to a heteronormative society gay people sometimes feel that they must go ‘back into the closet’ the moment they enter a care setting. And then there are the (grown-up) children. Most children prefer to see

That these situations are highly complex is an understatement. It is understandable that emotions may be heightened between relatives and care staff, or even within families. A son-in-law shared with me that he was the only one visiting his mother-inlaw in a care home after she developed a relationship with another resident. She had suffered years of abuse on the hands of her late husband. He felt that

those final years were the happiest in her life, yet all her children had abandoned her out of disapproval. Equally staff’s own background and attitude towards sexuality all play a role. Care home management may find balancing ‘living well with dementia’ according to the Prime Minister’s Challenge on Dementia and staying within legal parameters as tricky as 69year olds balancing for 69 *Names have been altered as per request of the family.

Built up an appetite for the topic? Esther Wiskerke is one of the speakers at the Royal College of Nursing (The Joy of) Sex Beyond 70 event; an initiative that promotes discussion and raises awareness for the right to have companionship, love, intimacy, relationships, sexuality and affection in later life, especially when affected by a long term health condition. This takes place on Monday 23rd September 2019, 5:30pm, 20 Cavendish Square, London, W1G 0RN You can also follow Esther on Facebook at www.facebook.com/cuppa69/

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Codependency on Codeine

In recent years, figures have shown a substantial rise in the prescription and misuse of opioid medicines such as codeine, which are generally used to treat moderate to severe pain. Too much of any painkiller can be damaging to a person’s health, but the addictive potential of opioids like codeine, can ruin lives like an illegal drug. Article by Katie Tennant

study* on opioid prescribing trends shows that between 1998 aand 2016, opioid prescriptions increased by 34% in England, and the Office for National Statistics notes that codeine deaths increased from 131 in 2016 to 156 in 2017; an increase of nearly 20%. In response to this rise, the Opioid Expert Working Group have begun a review that will look at the benefits and risks of opioid medicines, including dependence and addiction. How Does Codeine Work? Codeine is an opiate; a drug that is derived from opium, the chemical that originates in the poppy plant. It is used in prescription medicines, such as Codeine Phosphate and can also be prescribed or bought over the counter as a combination medicine, mixed with other substances like paracetamol, aspirin or ibuprofen.Codeine is first and foremost a painkiller, and whilst

some people may take it for other purposes (medicinal or recreational), most users will initially take it to relieve pain that hasn’t been relieved by milder painkillers. Codeine works to relieve pain by reacting with the receptors in the brain that are responsible for pain and pleasure. This means that not only do they relieve pain, but they can also bring on intense pleasurable feelings of warmth, relaxation, sleepiness and a general sense of wellbeing. It may be these intense pleasurable feelings that can encourage people to take the drug again to replicate the experience. When people first start taking these medicines, they may be unaware of how prolonged use may affect them. Over time, the body can build up a tolerance to codeine, meaning a person may need to take a higher dose to get the desired effect. Even if the codeine

is taken as prescribed or directed, a person can find that they become dependent and need to take a certain amount of codeine just to feel ‘normal’. It may only be when the person tries to cut down their codeine use or tries to stop taking codeine altogether, that they experience unpleasant withdrawal symptoms, which are only suppressed by taking more codeine.

“

Although not easy, it is important for clinicians and patients to recognise and address misuse and addiction and address this as soon as possible to avoid a pandemic of addiction.

People can find themselves in a cycle of misuse, dependence and addiction, just by taking a medicine that they have been prescribed or have bought over the counter.

*Source: https://www.thelancet.com/ journals/lanpsy/article/PIIS22150366(18)30471-1/fulltext?dgcid=raven_jbs_etoc_email

Of course, these medicines do have their place, but it is vital that people only take them whilst they are still suffering with serious pain. When the pain starts to alleviate, the codeine has done its job, and it is important to then switch to a milder medicine, that doesn’t carry the same risk of addiction. Views of a Clinical Pharmacist I recently spoke with Davina Gadhia, a clinical pharmacist who has worked in various environments where she has experienced opioid addiction. She explained that opioid addiction may be initiated within General Practice or could be continued following hospital discharge. It is also observed within NHS 111, with health professionals witnessing pill-seeking behaviour from individuals who are dependent on opioids. Whilst working in a drug and alcohol misuse service, Davina found that easy access to opioids was an issue and that there was a lack of patient awareness. She believes that patient education is vital, and although information regarding the risks of opioid medicines is already provided on the packaging and in the patient information leaflet, she questions how many patients actually take note of this. Even if patients are made aware of the risks of taking codeine, the realisation of addiction is often only felt after taking the drug, and at this point the person may already be dependent.

Professor Jamie Coleman, Chair of the Opioid Expert Working Group, said, “no one should be unaware of the potential risks of opioid medicines”. may encourage friends and family to purchase further supplies or could buy more codeine from different pharmacies. There are drug and alcohol specialist services that patients can access. These services can educate patients and provide them with support; however, they rely on patients who are willing to recognise that they have an addiction problem or are misusing codeine. Davina believes that, “although not easy, it is important for clinicians and patients to recognise and address misuse and addiction and address this as soon as possible to avoid a pandemic of addiction”. How Can We Ensure That These Medicines Are Used Appropriately? The first step is to ensure that clear and prominent information is provided to anyone that interacts with these types of medicines, making sure that they are well informed of the risks of taking them and that they fully understand how to use them safely. Access to codeine-based medicines may also need to be reviewed, to ensure that individuals cannot take advantage of these easily available medicines.

Their study on the benefits and risks of opioid medicines will look at the changes that could be made to the labelling and packaging of opioids, as well as the Summary of product characteristics and patient information leaflet. They want to ensure that the warnings on opioid medicines are consistent, clear, relevant and represent the known risks of tolerance and addiction. The study will look at both prescription and over the counter opioid medicines, and review the way that these can be accessed.

“

They can also bring on feelings of warmth, relaxation and general sense of wellbeing...it may be these intense pleasurable feelings that can encourage people to take the drug again to replicate the experience.

This study is still in its early stages and has not yet been published. I hope that the conclusions of the study present some ideas on how clearer information can be provided to people who will take these medicines, and ensure that they are educated on the known risks of tolerance and addiction

Davina spoke about the rules regarding over the counter codeine-based medicines. In pharmacies, they are only sold as a maximum of 32 tablets in a pack. These restrictions may stop some individuals from misusing codeine, however, individuals demonstrating pill-seeking behaviour www.bluestreamacademy.com

Autumn Breaks - Home and Away

t's always nice to get away and what better time to escape than when the temperature has dropped and the colours of the leaves are changing? Here are a few ideas in the UK and further away….

1. Staithes on the place to visit this autumn. You can get cheap flights and North York Moors Head here throughout September and October and take a boat trip to see dolphins, porpoises and whales as they head southwards.

2. Bowness-on-Windermere

On the shore of Windermere, this is the perfect place to come for all ages. Whether it’s sailing or walking around the quaint town that you’re interested in, there is plenty to do here. If you’re feeling nostalgic, there is also the World of Beatrix Potter to wander around, also perfect if you have little ones with you.

3. Gdansk, Poland

If you feel like going further afield, Gdansk is the perfect

accommodation, and once there, the food and drink prices are more than reasonable! With stunning architecture, museums and lots of bars and cafes you will never get bored!

4. Budapest, Hungary

Famous for it’s thermal spas, Budapest has plenty to offer! Full of history and architecture for you to explore during the day, and restaurants and nightlife in abundance to keep you entertained into the night! Again, cheap flights and hotels can be found. Perfect for a romantic getaway or a jaunt away with friends, there is definitely something for everyone.

1. 4.

2. 3.

Don't Feel SAD This Autumn This Autumn

t’s that time of year when the nights and mornings are getting darker and the temperature is getting cooler. For some, thoughts of warm clothes, bonfires, falling leaves and nights by the fire fill them with joy. For some, the change of the season brings along feelings of depression, most commonly known as Seasonal Affective Disorder. Here are some of our tips to help alleviate the feelings of SAD:

Try to Exercise

Even though you may not feel like it, taking a walk, going for a swim or hitting the gym will help as it releases endorphins. You’ll feel so much better for getting out of the house!

Eat a Healthy & Balanced Diet

It’s easy to indulge in carbs and sweet treats when you’re feeling low, but try to swap these with plenty of vegetables and healthy stews. They’ll make you feel better all winter, and you won’t regret your healthy choices when spring comes around.

Socialise

Although you may dread the thought of leaving the house, let alone make plans, make an effort to meet up with friends and family for a coffee or maybe a walk (even a film night can help to boost your mood!)

Light Therapy

Some people find that light therapy improves their SAD symptoms. Here are a few products we have found that are suitable for both work and at home.

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Ask Abi...

Blue Stream Academy team member, Abi, is here to answer your questions and give advice to our readers. Feel free to contact Abi via email: bsatoday@bluestreamacademy.com!

Dear Abi,

One of my members of staff has a track record of regular sicknesses and leave due to personal circumstances. The individual is fantastic when at work, however the number of sick leave days are ever-increasing, with regular absences taking place on a Monday (following what her colleagues often believe is a heavy weekend of partying and socialising), or a Friday prior to preannounced social plans. When I sit down with the individual to try and assess what we can do as an organisation to help, she simply dismisses the absences and puts them down to having a low immune system and bad luck with viruses, however I’m concerned that there could be more to it. How do I approach this situation in an appropriate manner to try and assist the individual, and hopefully get her back into the workplace more consistently? Thank you for you help! Anon

Dear Reader,

Thank you for getting in touch with your problem!

I’m sorry to hear that you are struggling with this member of staff, this is an ever-increasing occurrence that many managers come across, particularly with the interest of increasing the employee’s wellbeing. You’ve done the right thing by sitting down with the person to talk about what you can do to help. I’d suggest inviting the employee for another quiet one-to-one conversation. Openly discuss the frequency of their absences and explain that this is causing concern. At this point, you may want to ask them if everything is ok out of work, if they are coping well with their workload, colleagues and daily environment, and ask if there is anything that can be done by management to increase their wellbeing whilst employed by the organisation. It is important that consideration is given to any personal problems your colleague may have and do offer ways to help if you can, but if appropriate, draw the employees attention to your company policies and agree a set time period to monitor future absences Hopefully at this point, your employees absences will begin to improve, and you are doing the right thing by continuing to check in on their wellbeing. If they don’t improve for any reason, you should consider further action in line with company policy. I hope this advice can be of assistance.

Abi

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An Evening in the Sky guests

#TeamBSA

n September 8th Team BSA are taking part in a Charity Skydive to raise money for Bluebell Wood Children’s Hospice. Six of us will be jumping out of a plane at 15,000 feet to support this incredible cause.

A handful of our auction prizes

Bluebell Wood Hospice cares for children and young adults, along with their families, whose lives are sadly just too short. When we heard about the great work they do, we decided to brand ourselves the ‘Blue Stream Super Six’ and became committed to reaching our goal of raising £2,000 for the charity. To reach this target, we organised a bake sale, a lucky dip, a car boot sale and an amazing charity auction evening, bringing our total fundraising efforts to an incredible £2,695.90 at the time of writing this article. Matthew Sheridan, Bluebell Wood Children's Hospice Corporate Fundraiser attended the event and we hope he enjoyed it as much as the rest of us. We were blown away by people's generosity and want to thank everyone that got involved - either by donating prizes or giving their time, money and support. All that's left now to do is the jump itself - so wish us luck (gulp)! If you have any suggestions for future fundraising ideas, please feel free to get in touch via email or telephone.

Brady and Natalie with Matt Sheridan and partner

Meet the Team My name is Mark Cowlishaw and I have been the Sales Director for Bluestream for over 7 years. Over the years I have enjoyed watching the company go from strength to strength and seeing how our eLearning solution has developed. I am really proud of managing a team of talented and enthusiastic people who give 110% effort on a daily basis. We have lots of exciting things planned for the next few years which I’m looking forward to get out to our customers. In my spare time I enjoy spending time with my wife and 3 sons, travelling the country. I also love watching Formula 1 and cooking up delicious feasts! www.bluestreamacademy.com

Brady and all at TeamBSA.

@BlueStreamNews

After a busy summer of feature development and updates, the team are excited to announce the following updates and releases. Epilepsy Awareness eLearning Module Our Epilepsy Awareness module covers the following topics: • What is epilepsy?

• Different types of seizures. • Living with epilepsy.

• How to respond in the case of an epileptic seizure. Communication eLearning Module This module helps you communicate successfully with colleagues and service users alike. It covers:

Updated Equality & Diversity Module Module Review Mode We have now launched a ‘Review Mode’ feature, which allows all trainees to access and review module content after completing a module and receiving a certificate – meaning staff can update and refresh their knowledge at any point throughout the year.

• Types of communication

• Successful communication

• Barriers to effective communication • Reducing barriers to effective communication • Confidentiality

BSA Today's Photography Competition

ie are delighted to reveal the above photo as the winner of the Blue Stream Academy Autumn Photography 'Light' Competition. Congratulations to Mark Anthony from Croydon, Surrey who has won this issues photography competition! Last issue we set the theme as 'Light' and this beautiful photo of a double-rainbow in Cologne, Germany shows just that. "The first night I arrived at my hotel in Cologne, the sun was setting and I saw this view from my hotel window... I had my camera already charged and I clicked off a few shots. It's not often you see a double rainbow - but seeing it whilst the sky was red during sunset made it extra special!"

- Mark Anthony, winner.

The theme for the next issue is 'Black & White'. Submit your photo for your chance to win and get your entry printed in the next issue of BSA Today! You will also win a frames A4 print of your photo along with ÂŁ50 in prize money. To enter, simply email your entry to bsatoday@bluestreamacademy.com with the subject line 'BSA Today Issue 04 Photography Competition'. The deadline for this competition is 11th November 2019, and we'll announce the winner in Issue 04 of BSA Today. The successful photo chosen by our resident photographer will win the prizes! Terms & Conditions apply and can be found online at www.bluestreamacademy.com

Puzzle Corner The puzzles here are for a bit of fun - but if you would like to win £50, why not enter our photography competition?

'Black & White'... is the subject of the competition on Page 34.

Leaves That Don't Fall I have wood but no bark, and leaves that don’t fall,I am made up of branches, and come in sizes of all. I am completely devoured many times, over and over by a worm of a kind. If you want to know the answer of mine, look for the secret that I’ve stored inside. What am I?

Crossword

See if you can complete our crossword based on the theme of this issues articles! Dotted around the magazine are the answers! Across

2. A type of depression that comes and goes with the seasons 4. Imparting or exchanging of information by speaking, writing, or another medium 7. A place for users to create and share content 11. A type of therapy using drugs such as LSD and MDMA 12. Learning conducted via electronic media Down

1. An opiate drug used to treat pain 3. A company department responsible for all employees 5. The fear of missing out 6. A port city on the Baltic coast of Poland 8. A common condition that affects the brain and causes frequent seizures 9. The condition of being dependant on particular substance or activity 10. Take risky action in the hope of a desired result www.bluestreamacademy.com

Alla Moda

Derby County FC

Derbyshire Fencing

Fort Menswear

Fresh Basil

Hand Picked by Henrietta

Katie Weeds

Little Creations Company

The Little Kitchen

ManCave

Merv Spencer Photography

Milford Hypnotherapy

Ripley Glass Ltd Mill View Pole Academy

Monki Do Tattoo

Oliver Cowlishaw Personal Trainer

Primsisters Country Decor

Ripley Glass

White Peak Distillery