Wednesday 25 July 2012

The sun is out!

Dad and I enjoying the sunshine
Dad and I enjoying the sunshine
There were many occasions during my father’s nine years in three different care homes when I honestly wondered if having dementia was a byword for keeping people in captivity. Day after day, week after week, residents were kept cooped up indoors, which during most of the year was relatively understandable due to the English weather, but on hot summer days people would still be sat inside, in their bedrooms or the lounges, sometimes not even with a window open, eating in stuffy conditions where food can begin to smell very unappetising, watching mindless television, consigned to a life most criminals do not endure.

It strikes me, writing this on a beautiful hot, cloudless English summer day, how torturous it must be to be kept inside, tempted by that blue sky and sunshine, feeling the heat, and being without anyone in the world to help you go and make the most of it. Everyone in those homes was retirement age, a supposedly golden time in your life of relaxation and enjoyment. You do not have to be stuck in an office, factory, shop or restaurant earning your living, you have done your work, now is your time to sit back and soak up the good things in life - why should having dementia change that?

For me that is the key point – dementia is perceived to change everything, and yet the disease is not who the person is, and unless as a result of their dementia the person has developed a phobia of going outdoors, scared perhaps of the uncertainty, unfamiliarity or perceived vastness of it, or has another medical condition that requires them to remain indoors, then there is no reason to keep them inside during perfect summer weather.

Sadly there were so many days, identical to today, where we would be the only family sitting outside with our relative. Carers were generally too busy, too short-staffed or lacking in the confidence needed to utilise the lovely garden, and successfully negotiate any health and safety challenges that might come from bringing residents outside. Even more disappointingly most relatives demonstrated a similar reluctance, even though they saw how much dad enjoyed his long hours of fresh air, sunshine, alfresco dining and napping under his panama hat.

Whilst familiarity and security in their environment is very important for people with dementia, stimulation and reminiscence are too. Most people will have enjoyed outdoor life when they were younger, and those with dementia may have particularly strong memories of summer days free and happy in the sunshine. If someone has led any sort of outdoor life in the past, and shows a willingness or interest in being outside, especially in such glorious weather, denying them that is akin to keeping them a prisoner in a life that they have not chosen and do not deserve.

There was a lady at one of my dad’s homes whose family openly admitted that she had loved the outdoors her whole life, sitting out in all weathers, tending her garden, eating  all her meals outside and having family BBQ’s. They said she would have felt like a ‘caged bird’ to be kept inside, and on the occasions when she was brought out into the garden, listening to her talking about the birds and flowers while lapping up the sunshine made it very clear just how much she loved it. Yet because she could not ask to go outside, both the carers and even her family very rarely took her into the garden. Her dementia effectively consigned her to being a spectator on a life that she must have been longing for but no longer had.

Providing people are well cared for and supervised outside (as they should be wherever they are), it is the most wonderful place to be for the fresh air and sunshine (a lot of people, especially the elderly, are deficient in vitamin D for example), and also for the emotional wellbeing provided by the natural stimulation of birds, plants and wildlife. Many care homes have sensory gardens (that I wrote about here) where scented, tactile plants are growing, and water features provide visual delight and also much needed serenity, calmness and tranquillity.

Another key benefit, and one that is often completely overlooked, is the advantages to eating outside. Fresh air, and even some mild exercise if appropriate, can stimulate appetite. Poor eating and drinking can often be a problem as dementia progresses, but appetising food served outside can help to remedy this. BBQ’s, done safely, can provide wonderful aromas to tempt an otherwise flagging appetite, and even having afternoon tea parties outside can revitalise jaded routines.

Good weather, of which we get precious little in the UK, generally puts most people in a better frame of mind, and this is no different for those who are living with dementia. Not only does their health and wellbeing benefit from some consensual outdoor activities, families and carers can have immense enjoyment from helping to facilitate this. Some of our most special memories, and photos, of my dad during his dementia come from our many hours sat outside with him. These were positive, happy times when the simple beauty of nature could make dad’s dementia an almost distant memory. Nothing really beats exploring the great outdoors with your relative, and if they love it as much as my dad did, you will be so glad that you had that experience together.

Until next time...

Beth x

You can follow me on Twitter: @bethyb1886

Wednesday 18 July 2012

Ending the 'chemical cosh'

One of the things I feel most passionately about in dementia care is the inappropriate use of antipsychotic medications.  For many years these have been commonplace when doctors, nurses and care professionals have sought to quell the symptoms of dementia amongst their patients, but the side-effects, turning people into zombies and dramatically increasing the risk of early death, have always made them something I am completely against.

We experienced the use of these medications in my father’s early hospital admissions, firstly when he was diagnosed with dementia, and then when he had to return to hospital because his residential care home could not manage his behaviour. It was on this second admission, before he lost half his body weight from three months in the elderly mentally infirm ward, that we really experienced the ‘chemical cosh’ at first hand.

Dad was a big, imposing man, who walked constantly, displayed agitation, confusion and some aggression, and an all-consuming desire to get out of the secure confines he found himself in. For the staff on that over-stretched, demanding ward, the simplest answer was to put him on medication so that he wasn’t a ‘problem’ to them anymore. Our ‘problem’ with this, however, was considerable. Visiting someone who was suddenly struggling to walk and talk, was sleepy, incoherent and frankly even more confused, was alarming to say the least.

Even with our then fledgling knowledge of dementia, we were convinced there was a better way, and challenged the ward staff. Our success was very limited however; they had their policies, and clearly had been allocated a staffing budget that did not allow for the one-to-one care needed to replace the easy-to-administer ‘chemical cosh’, with the more time-consuming and specialised therapeutic care that we were advocating.

Moving dad to his first nursing home brought a refreshing change in attitudes. The staff were keen to remove the medication, and supported by the GP this was successfully achieved. For us it was exactly what we wanted, we had dad back. No matter what his symptoms, we found ways to manage them, and the care home staff were, for the first time, able to get to know the real man behind the dementia, and what a blessing that was. His sayings, mannerisms and conversation all tumbled out, the staff fell in love with him, and this gave them a connection to him that became vital as the  years passed and his dementia progressed, slowly robbing him of his ability to shine in the way that he had. Now, with their knowledge and love of dad, they could help him, stimulate his memory and trigger those moments that brought light and laughter into his life.

Our worst experiences of the ‘chemical cosh’ were approximately eight years ago, and thankfully times are changing. A government initiative, combined with some pioneering work by forward-thinking, innovative medical professionals, has brought about a 52% reduction in prescriptions of antipsychotics in dementia patients between 2008-11. Alarmingly, however, there are some significant regional variations that prove the fight against this culture of pumping vulnerable, elderly people with medications that carry a strong risk of hastening their death, is still sufficiently alive to warrant even tougher action.

One of the most disturbing aspects to the use of antipsychotics is the way in which carers and families of people with dementia are often not consulted about their loved one being treated with these drugs. It must be remembered that as well as patients suffering as a result of being inappropriately prescribed antipsychotics, their relatives do too. Not only is it very upsetting to see the changes in your loved one, it is robbing you of precious time that you will never get back, and should these drugs shorten your relative’s life, you will have to live with that forever.

Antipsychotics should only ever be an absolute last resort, something you give when every other avenue, including all therapeutic and complimentary therapies, have been exhausted. Drugs may be an easy option for healthcare professionals who do not know a patient, and therefore simply want to make their own working lives easier, but it is inhuman and frankly barbaric to subject a person to the life these medications will force upon them and their loved ones.

Clinicians need to listen to carers and relatives and be influenced by them, rather than the propaganda of drug companies or pressures from lazy care homes looking for an easy option to manage challenging behaviour. They also need to be educated in some of the pioneering therapies that are proving how you can care for someone with dementia without the need for antipsychotics. Great work is being done in music, art and reminiscence therapies for example, whilst often the simplest things, like spending time with a person, talking, listening or engaging them in something practical that they enjoy or that was part of a previous routine, can make a huge difference.

These are not complex or difficult tasks for care professionals, they just require dedication, personalisation and compassion – three key aspects of successful dementia care. Using a ‘chemical cosh’ could never be described as representing any of these qualities, and if the UK is truly striving for a gold-standard dementia service, then the challenge to any professional seeking this ‘quick fix’ is to find an alternative way forward.

Until next time...

Beth x

You can follow me on Twitter: @bethyb1886

Thursday 12 July 2012

Why are we waiting?

Whenever politicians are due to proclaim on issues of health or social care, my heart invariably sinks. Well intentioned though some may be, and whatever party-political persuasion they have adopted, I always feel that they never quite grasp just how personal, and therefore important, these policy areas are to the people they are in parliament to serve.

Our well-being, and any decline in that which results in the need for care, is something that occupies most people’s minds at some point, and with increasing frequency diseases like dementia are pervading into previously happy families, bringing with them huge emotional and financial costs and, unlike in the political world, decisions that cannot be avoided.

No one is denying that care is hugely expensive. It is labour intensive by its very nature, needs to be extremely mobile and flexible when helping to keep people in their own homes (which undoubtedly is what the vast majority of people want, no matter what their age or needs) and involves huge overheads and logistical problems if someone does eventually need residential care.

It is also something people really struggle to plan for, mostly because it is impossible to predict if and when illness may strike and if it does, working out what you may have to pay to receive care as there is currently no universal standard on accessing care (all 152 councils in England can set their own eligibility criteria).

Last year it was recommended that a cap should be introduced so that people know that they will never have to pay more than £35,000 in their lifetime for care. Naturally this raised expectations that finally, after so long in the wilderness, social care would become a transparent system whereby you knew the maximum you would have to pay should you need these services, and families would not be in for a nasty surprise.

Typically, however, because politicians need to look at ‘cheaper options’ there is still no concrete plan to move forward with legislation that is craved by people whose lives are affected by this every single day. I have friends whose parents were forced to sell their homes to fund care, losing family homes and inheritance to pay for something that throughout their working lives their parents had believed they had already paid for should the need for care arise.

I accept that the state has burdens on its resources that outstrip what is available to spend, and care with its high cost, complexities, and the growing demands of an aging population is a massive drain on budgets already, just by funding people who do not have any assets to pay for their care. Ultimately, however, this is about long-term strategy, effectively spending to save. Without a clear, fair and workable social care system, healthcare costs spiral. The huge injustice of the blatantly two-tier system we have now, right down to the differences in residential fees being paid by privately funded and publically funded people, has to change, and fast. If people are going to have to contribute to their care costs, they should know what their maximum liability will be, otherwise old-age and ill-health become like playing roulette.

I also feel, probably because of my personal experiences, that there is nothing more important to fund than the care of our most vulnerable people.  Either England is a compassionate society or it isn’t, and while our politicians decide whether it is, people can spend weeks languishing in acute hospital beds, costing the NHS a fortune because they do not have the right care package, or being sent home with inappropriate or non-existent care packages that mean they will be back in the very same hospital bed within a few days or weeks.

So what have the government offered people in England? A belief that capping care costs is the ‘right basis’ for change, but no commitment on what the change will be. A deferred loan scheme for people who need to pay for residential care, meaning that the cost of care can be taken from their estate after their death. However the state will charge interest on this (currently, where this scheme is available, interest is not charged). A national standard for getting access to care, ending the postcode lottery where councils set their own criteria for funding (although if your council happens to be more generous than others you may be in for a shock), and a pledge that you will be able to move your care package to another local authority should you wish to, without having to be re-assessed.

There is also a proposal to pilot a scheme to make personal care at the end-of-life free, to reduce the burden on hospitals. On the face of it this is an excellent idea, but it has to be borne in mind that if people are not able to have the care they need in the months or years preceding this time, the end of their life may come considerably sooner than it should do, which in any compassionate society is a scandal.

The glaring omission comes in the lack of a real framework for change, and on the key issue of capping fees, we are no further towards a resolution than we were before the Government’s announcement. In fact, potentially there may be no concrete decision until the next spending review, so it is possible that legislation is years away. The government say they want people to, “Get the care and support that they need to be safe and to live well so they don't reach a crisis point,” but by delaying this decision for such a long time, many people will wonder if those in power really care about their well-being at all.

Constantly fighting the system, trying to work out what you are entitled to, at the same time as dealing with the trauma and emotional upheaval of a loved one with a disability or illness, is exhausting for families at the very moment when they want to spend quality time with their loved ones, and particularly in the case of terminal diseases like dementia, make the most of every single day.

The plan to cap care costs may be on hold, but sadly the need for care will never be on hold. The politicians may want to delay their decision, but every day people across England are faced with health and social care decisions that cannot be delayed. Some of us do not get to walk away and think about what we are going to do for a few years.

Until next time...

Beth x

You can follow me on Twitter: @bethyb1886

Tuesday 10 July 2012

A sensory journey

In everyday life we can often take being able to see, hear, smell, taste and touch for granted. Senses give context to the mundane, stir our emotions, affect our body language and have the power to make the ordinary, extraordinary.

Many of us will spend much of our disposable income on making our homes and our lives as appealing for our senses as possible, so it is obvious that applying that same focus to the environments and lives of people with dementia can make a huge difference to the quality and richness they find in each day.

Bland, sterile, faceless environments do not benefit people with dementia. From contrasting colours to calming music or voices, aromas that stir fond memories, favourite foods, and compassionate reassurance to alleviate anger or remove fear, the opportunities to enliven the senses to bring positive therapeutic benefits are extensive, and yet they are often not fully explored.

In some care homes sensory rooms have become very popular, not least because staff who were perhaps sceptical previously see the clear benefits on their residents' moods, emotions and wellbeing. These rooms can have a wonderfully calming effect on people who are experiencing agitation due to their dementia, and are as valuable as other standalone therapies like music (that I wrote about here) art, gardening or exercise.

Soft, possibly coloured lighting, tactile fabrics, comfy chairs, delicate aromas, relaxing sounds and, crucially, the opportunity to put the person with dementia in charge of what they do by making the room safe for them to move around and try different sensations, is a very enriching activity, particularly when enjoyed with loved ones, offering the chance for renewed family interaction and exploration.

I have visited care homes where they have interpreted the idea of sensory areas in many different ways, for example through having daylight rooms, beach rooms (complete with sand and gentle wave sounds), and sensory gardens with waterfalls and pathways that have been planted up with tactile plants and scented flowers. Conversely I have also walked down many corridors that offer no stimulation, with rooms leading off of them that are virtually identical, and people sat blankly staring into the distance while others are agitated or wandering around a seemingly never ending space that offers them nothing for their wellbeing. The difference in these atmospheres is what separates person-centred care from conveyor-belt care.

For our part, we tried to make my dad’s room a place of sensory delight. For dad, a particularly successful therapy was that of touch. Having been an active farmer all his life, his hands were desperate to be busy again, and without something to hold he was at a loss with that to do with them. Life-like miniature versions of farm animals were dad’s salvation; their soft faux-fur was perfect to stroke, and he could hold one under each arm to cuddle.

This approach was successful because not only did it solve the idle hands problem that dad was experiencing, it solved it by tapping into the touch sensation to calm and relax him. As in all things dementia related, personalisation is the key to therapeutic interventions, and this becomes even more important when the person with dementia has limited or completely non-existent use of one of more of their senses.

Dementia can create huge isolation by its very nature of putting the person with it into their own world that none of us can truly be a part of, but when someone cannot see or hear what is happening to them, who the people are around them and why they are being offered or given particular care, the world is an altogether more frightening place.

A lot of dementia training focuses on explanation and demonstration, not taking into account what happens if the person with dementia cannot benefit from that. If someone cannot see that a carer is trying to feed them, or cannot hear what the meal is and that it is now time to eat, they are likely to panic. If you were blindfolded, given ear plugs and then had someone jabbing at you with a spoon you would probably panic too. Therefore assessing someone’s sensory abilities, whether that be through checking their hearing, eyesight, ability to respond to taste (sometimes tastes need to be stronger as taste buds become duller) and smell (my father could not remember how to blow his nose for the last few years of his life, meaning that he had a permanently blocked nose and sneezed daily) is extremely important so that when it comes to touch, this is appropriate, expected and welcomed.

Touch is what ultimately brings true compassion, and can, when part of person-centred care, compensate for the deterioration of any of the other senses. Touch reminds us of how we are nurtured from birth, and for someone with dementia, those memories of being protected and loved are very empowering. Dementia is a hard road to travel, but making it a more sensory journey nurtures the person, and if there is one thing we would all like to be able to do for a loved one with dementia it would be to make life just that little bit easier for them.

Until next time...

Beth x

You can follow me on Twitter: @bethyb1886

Thursday 5 July 2012

From care to catastrophe

Back at the start of D4Dementia I wrote about the importance of continuity of care for people with dementia. It cannot be over-emphasised just how beneficial this is, not only to the person living with dementia, but also their families and indeed people working as carers. The chance to form a bond with a person is what can give the greatest job satisfaction and leads, in turn, to the most compassionate and personalised care.

We were particularly lucky that my father formed a bond with a carer that lasted from the day they met to the day dad died – indeed this man even came to dad’s funeral. In the almost eight years in between, this carer brought such joy to my father’s life that it could honestly be said that dad was often more pleased to see him than he was any of us.

As a family we valued this carer’s input into dad’s life higher than any other professional we worked with, so imagine our heartbreak when a change in ownership and management at dad’s nursing home resulted in wholesale changes to the care structure. Suddenly wonderful staff who had delivered an excellent CQC report just a few months previously were now leaving, bullied, ostracised and driven away, initially we suspected for racial reasons before it became clear that whatever your skin colour or race, if you were well-liked you were not wanted.

What you soon discover as a relative, when you try to halt this tide of change, is that A) private companies can run care homes as a dictatorship rather than a democracy so long as they can keep the inspectorate happy, and B) that as a relative you have no say over what happens, CQC are reluctant to support you, and the only real option you have is to move your relative to another home.

In this case, having no say included having care plans made for my father without any consultation with or agreement from us, carers who knew my dad being forced to implement care plans that went directly against what they, and us, knew to be in dad’s best interests, and no care review for a year. Ultimately this led to a chain of events that resulted in my father being admitted to hospital with pressure sores and a catastrophic aspiration pneumonia that would eventually kill him.

You cannot force intransigent managment to answer your questions, you cannot change the dictates on your relative’s care, even though you know your loved one better than anyone else, and when you turn to CQC for help, you are left very disillusioned by the incredibly slow response, lack of transparency in their actions, and that fundamentally they seem very unmoved by so many vulnerable elderly people being at risk.

Add to this the loss of care staff who you have known since the day your relative moved into the care home, and whose work and reputation you would defend as both a relative of someone in their care and also as their friend, and you have a situation where you feel utterly helpless. No matter how many times you mull it over in your mind, you will never find a resolution to the fundamental question of why people with no knowledge or understanding of dementia, no concept of compassion or indeed a caring bone in their body, would wish to run a care home where the most vulnerable, sensitive and highly dependent amongst our cherished elderly live.

To see what had been such a happy home, where relatives, residents, staff and management worked together, pulled apart within a matter of weeks is something I will never forget. Not only did my dad lose the continuity of care that had added immeasurable quality and richness to his life over all those years, our time with him was blighted for weeks by on-going arguments, upset and disharmony. We lost friends, happiness and actually, in the end, dreaded visiting.

Having a loved one in a care home is hard enough for any family, but it is the bonds you form with staff, and the joy and comfort you see them bring to your relative, that make it bearable. There is no price you can put on that, and no agency that you wouldn’t beg for help to try and halt the tide of catastrophe. Tragically, having persevered with trying to change a situation we clearly could never change, we had actively begun to seek a new home for dad when, on that fateful night in March 2012, he aspirated on his own vomit five times, setting up a pneumonia that his body just could not fight off.

My advice to anyone going into the caring profession, be it as a carer, nurse or in a management role, would be don’t do it unless you can care about others as much as you do your own flesh and blood. If you are a manager, don’t be a dictator, don’t treat residents as a commodity, and don’t make the lives of their families unbearably hard. When staff are loved by residents and relatives it is for a reason; we know how hard it is to find these wonderful people, and how special they are, so listen to us. Finally, above all else, remember this: care homes are for caring, prisons are for punishment.

Until next time...

Beth x

You can follow me on Twitter: @bethyb1886

Tuesday 3 July 2012

Treat others as you would wish to be treated yourself

Ask most people caring for a loved one with dementia what they dread the most, and a common theme will probably be hospital admission. For so many reasons, hospitals and dementia patients are a combination that is fraught with problems, and whilst pockets of good practice do exist in the NHS, far too often the experience that people with dementia and their families have is one characterised by a lack of understanding, poor care and even neglect.

Moving anyone with dementia to a new environment, let alone one that is so alien to them, will inevitably cause problems. People with dementia generally do not react well to any change, and most hospitals are not dementia friendly; they are busy, noisy, imposing places with clinical smells, high-tech equipment and a constant stream of new faces.

If an illness makes hospital admission unavoidable, the person with dementia will often be in a more confused state anyway due to infection, and that, combined with the environment they find themselves in and staff who are so busy that they do not have time to spend with patients, is a powder keg situation. Dementia patients often deteriorate in hospitals; even if the hospital successfully tackles the infection that they were admitted with, pressure sores can develop through lack of turns and regular pad changing, they can lose weight from limited or non-existent feeding of quality food (my father shockingly lost half his body-weight during a 3-month stay in an elderly mentally infirm ward), become dehydrated once they are taken off IV fluids, and their alertness and general cognition can markedly decline, possibly never then returning to its original state once they are discharged.

It is well known that hospital staff are under huge pressure. On the occasions that my father was admitted to hospital with either pneumonia or bladder infections, he very rarely had the same staff member looking after him consistently, staff were grossly over-stretched, and as a family we were spending all day every day with him just to make sure that he was fed, shaved, comforted and had all his needs met. This often also involved us demanding to see doctors or other professionals just to ensure that dad had the assessments he needed in a timely fashion, and that his care was of the same standard as someone who can articulate what they are feeling and needing.

Not only can you legitimately argue that families should not have to do this, the greatest concern is surely for the many people who have no family to speak up for them. Dementia patients deserve the same level of care as any other patient, and in fact often need significant extra attention to ensure that their needs, both physical and emotional, are met, thus giving them the best possible chance of recovery.

So how do you improve the way hospitals treat patients with dementia? Staff training is a huge issue, with staff across all disciplines having very patchy knowledge and understanding of dementia. Specialist environments need to be created that offer reassurance and extra assistance for dementia patients, and there needs to be better co-ordination across departments to ensure that the person receives all the treatment that they require, and has a discharge planned that is appropriate for their needs.

Empathetic and compassionate stimulation is important, as are therapies that engage the person with something that they enjoy. Equally vital to a successful recovery is good nutrition and hydration, which is something I wrote about in more detail here. Freshly prepared, appetising and well-presented food is needed not just for good health, but because of the feel-good factor it provides for a person’s wellbeing. It needs to be remembered that a good meal can be the highlight of someone’s day, and when those days are long and arduous, there is nothing that is more welcome.

Dementia patients often cannot articulate when they are hungry or need help to eat, and when they need assistance, this can often be very time consuming for staff if the person is to be given the quantity of food they want and need. Swallowing problems are also common as dementia progresses, and both the quality and consistency of food and the way in which the person is fed become acutely important – if any of these elements are wrong, the person can aspirate (where something taken orally goes into the lungs instead of the stomach), which can result in a potentially fatal pneumonia.

Some hospitals are becoming more dementia friendly. Taking dementia patients off of acute medical wards and into specialist wards, where they still receive expert clinical care but where staff are specifically trained in dementia, is a step in the right direction. Befriending schemes can provide a lifeline to dementia patients to reduce isolation, increase stimulation and provide non-drug related therapy. Another excellent initiative is the Butterfly Scheme, which is already in use in some hospitals. It is designed to alert all staff to the fact that someone has dementia, and through the training they have received, staff offer a specific five-point targeted response to the Butterfly symbol, enabling them to meet the additional needs of someone with dementia . ‘This is me’ leaflets are also useful in providing background information for staff, although these will only be truly effective if staff have the time to both digest that information and then act on it.

Hospitals provide life-saving treatments every day, and on many occasions the prompt and expert care that my father received saved his life and gave us precious extra years with him, but the worry of having him in hospital was immense, not just from the point of view of whether he would recover or not, but also because of concerns about the treatment and care he would receive whilst he was there. The pureed food he was given was revolting, pressure sores become worse rather than better (even though he was given an air-flow mattress), his agitation (from being in bed, hungry and ignored) would be misinterpreted as pain and inappropriate medication given as a result, he was expected to answer questions and give information that he clearly did not have the cognitive ability to provide, and he endured a constant stream of new faces, noise and confusion, often being moved to different wards very late at night.

I would like to think that the NHS, with so many caring people working for it, can provide a far higher and more consistent level of care for dementia patients across all hospitals in the UK. Most staff want to be facilitated to do their absolute best for their patients, particularly the most vulnerable, people with dementia deserve care that gives them dignity, respect, comfort and a speedy recovery, and families want reassurance and faith that everything that can be done for their loved one is done, and done to an exceptional level.

As my father always said, treat others as you would wish to be treated yourself.

Until next time...

Beth x

You can follow me on Twitter: @bethyb1886