Dumfries & Galloway Health & Social Care

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Draft Integration Scheme published

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The Integration Scheme for Dumfries and Galloway has been reviewed, revised and updated. This is a draft document until 2nd December 2023 to give people a further opportunity to provide comments and/or suggest changes.

After this time, this will become a final draft document and submitted to NHS Dumfries and Galloway Board and Dumfries and Galloway Council for approval for submission to Scottish Ministers. 

Once agreed by Scottish Ministers, the document will become the Integration Scheme for Dumfries and Galloway.

Please contact Vicky Freeman, Strategic Policy Lead with your  comments at vicky.freeman2@nhs.scot by 2nd December 2023

As this is a draft document at this time, it should be noted that it is still subject to some minor changes and alterations.

Please click here to view the Draft Integration Scheme:

https://dghscp.co.uk/wp-content/uploads/2023/11/Revised-Integration-Scheme-V6.doc

Work Experience 2023

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DOZENS of pupils from across the region have been offered a taste of life working in health and social care.

A total of 91 pupils took part in Dumfries and Galloway Health and Social Partnership’s work experience week from 25th to 29th September.

Medicine, laboratory science, Care, IT and estates were just some of the areas where the S4 to S6 pupils were working – getting to take on work themselves, and sit in on everything from tooth extractions to surgeries.

Freya Pardoe from Lockerbie Academy was one of seven pupils who were assigned medicine, and she said: “I thought my work experience was phenomenal.

“I had the absolute best time, I was so thankful to everyone I worked with, and it’s confirmed to me that medicine is the path that I want to take in my career.”

Medical Director Dr Kenneth Donaldson was one of the senior managers from the Partnership who attended an event at The Bridge on the Friday afternoon where pupils gave presentations on what they had experienced and learned over the course of the week.

Speaking at the event, Dr Donaldson said: “It’s been a fantastic afternoon, just hearing the experience of lots of school students – and in particular for me hearing from those who were doing the medical block.

“We know there is a lot of school students out there who might be thinking about doing medicine but are just not sure, and this opportunity to actually see what it offers, and the different range, is just invaluable.

“We’re really keen that we get people locally who are getting into medical school. Obviously, our hope is that they might come back to Dumfries and Galloway in the future because we really want to boost our recruitment number, and I see this as a very good start for that – so it’s been a very encouraging afternoon.”

Many of the pupils who took part in the week noted their surprise at the very wide breadth of roles which feature in the delivery of health and social care.

Sharon Williams from Dumfries Academy was among the block of pupils working in administration within general practice, and she said: “Before doing this programme I always thought that the main roles in the hospital were just the doctors and the nurses – I never really appreciated the rest of the staff.”

Similarly, Luka Stores from Wallace Hall Academy described the estates team as ‘unsung heroes’.

He said: “We went to DGRI, Mountainhall, we had a few jobs at Annan and Lochmaben. We had some small jobs, like hanging a picture of Major Tom in Annan, and we went about DGRI looking at the generators and the air handling units. It was a mix of everything, and really good.”

He added: “The estates department, nobody really speaks about it, but it’s actually really interesting how much work they do and how little they’re recognised.”

Other pupils were placed with health care support workers within the community, within the dental centre, within Human Resources, IT, Administration, Home Teams, Medical Physics, Recruitment and Support Services, and alongside pharmacists, ophthalmologists, public health workers, radiologists, practice educators, nurses and allied health professionals such as physiotherapists, speech therapists and occupational therapists.

NHS Dumfries and Galloway Workforce Manager Vic McDade said: “We’ve had yet another great work experience week, which has allowed pupils an insight into the very many and varied careers which exist within health and social care.

“Hopefully this week gave them a taste of what life might be like after school, and the very many fantastic and varied career opportunities the NHS can offer them.

“And with a bit of luck, a good number of the pupils who we’ve welcomed will go to choose a career within health and social care – and they’ll perhaps go on to work in those roles within Dumfries and Galloway.

“I’d like to thank everyone who took part, and the schools who support this. I’d also like to thank our amazing staff for helping to make these young people feel welcomed and appreciated as they’ve got involved in so many areas of our work.”

DGHSCP Intrapreneurship Programme

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DGHSCP Intrapreneurship Programme

Dumfries and Galloway Health and Social Care Partnership (DGHSCP) are delighted to launch an exciting new programme that we believe can make a real difference for local people and how we provide care and support.

Applications are now open for the Dumfries and Galloway Health and Social Care Partnership Intrapreneurship Programme, delivered in partnership with The Lens.

‘Enabling people to live well at home for longer’ is an ambition we all share and we are delighted to announce that DGHSCP is partnering with The Lens on a second Intrapreneurship Programme with the hopes to continue transformation across all areas of our health and social care system.

To learn more about the vision of the Programme, hear from David Rowland, Director of Strategic Planning & Transformation.

An investment fund of £50k was committed for the pilot Programme earlier in the year where five teams received investment to deliver their ideas after pitching at an Investment Day. To find out more about the day, watch the video here.

Launching today, the Programme will build intrapreneurial capability and capacity across DGHSCP and is a fantastic opportunity for professional and skills development. Those who participate will: develop business development and innovation skills, confidence, and leadership capabilities.

We know that it is often the people closest to the problem who have the best ideas. If you’ve got an idea that will enable people to live well at home for longer, DGHSCP would like to hear from you! Apply for the programme to have a chance at securing investment for your idea.

How to apply and who can get involved

Applications are now open and will close on the 21st November 2023.

You can find information on the application process, the application form and more details about the Programme here.

It is often the people closest to the problem have the best ideas. The Programme is open to all people who deliver health and social care and support, including unpaid Carers, third sector and other sector organisations.

Moving forward

I’m sure you all share our excitement as we take this significant step towards making our vision a reality.

This is a unique, exciting opportunity for you to make a real difference to the lives of the people of Dumfries and Galloway, and we look forward to hearing your ideas over the coming weeks.

If you have any questions at this stage, please do not hesitate to contact Jenny Coxon, Programme Manager at The Lens, who would be delighted to assist via hello@lensperspectives.org.uk

Actions agreed to address bed-based intermediate care needs

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ACTIONS to address the region’s bed-based intermediate care needs were agreed at today’s meeting of Dumfries and Galloway Integration Joint Board (IJB). 

Members agreed a flexible model for some beds in settings such as care homes, along with proposals to work with communities on plans for how facilities, such as cottage hospitals, will play a role in meeting health and social care needs in the future. 

IJB chairman Andy McFarlane said: “As we plan for the future, it is very clear that we face a massive challenge in meeting the increasingly complex needs of our population. 

“Continuing with the existing approach to bed-based care which sits between the two acute hospitals and people are able to manage independently in their own home is not going to work. 

“We know we have to adapt, and make strategic use of all our available resources in order to provide the treatment and care our population will require over the next 15 to 20 years. 

“I’m very pleased, therefore, that the report which came to the IJB today provides us with the best way forward, working together with our communities to develop an approach that best meets their needs.” 

The Right Care, Right Place report results from extensive community engagement earlier in the year which was then followed by 12 weeks of formal public consultation in the summer focused on four areas: 

  • The findings of the Right Care, Right Place: Intermediate Care engagement programme earlier in the year 

     
  • A description of how intermediate care is delivered, and the forecast of what will be required in future  
  • The proposal to introduce a flexible approach to intermediate care, to allow bed capacity to be allocated to different roles depending on demand 
      
  • Ideas on how intermediate care should be delivered in each local area, over three timescales – 1-2 years, 5 years and 10-15 years  

Director of Strategic Planning and Transformation David Rowland said: “We’re extremely grateful to everyone who took part in Right Care, Right Place. 

“During the consultation we heard a strong and clear message from people across the region that they want to see bed-based palliative and end of life care delivered within their local communities as a matter of priority and that we also need to make provision for local step-up and step-down care.   

“The approach agreed at IJB today means we can start implementing a flexible approach to bed usage.  

“We will now be working closely with local care home owners to support them to expand capacity to deliver bed-based intermediate care within local communities. 

“We will also now be looking to build on the conversations we have had throughout this year and will be sitting down with local communities to start planning how we make best use of our wider facilities to meet their health and social care needs in the medium and longer-term.  

“As always, we need to undertake this work with our communities with a mutual appreciation and recognition that we don’t have boundless resources, and that within Dumfries and Galloway, as nationally, we face major challenges in areas such as finance and recruiting to vacant posts.  

“As the Right Care, Right Place consultation set out, we believe that key to meeting this increasing and increasingly complex need is flexibility – both in the way our care provider organisations are structured and positioned to deliver care, and also in the way that our populations adapt to ensure that finite resources are employed as effectively as possible, and that we all work to support each other as members of our communities.” 

Two options for Wigtownshire maternity services to go out to consultation 

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CONSULTATION on the future of Maternity Services in Wigtownshire is set to begin, after two options were presented to Dumfries and Galloway Health and Social Care IJB today. 

However, seeking to clarify expectations, the IJB notes that neither of the two options means birthing facilities will be available to all expectant mothers in the area – instead exploring birthing options for the low risk pregnant population in the Wigtownshire area. 

Chairman of the IJB Andy McFarlane said: “It’s well reported that hospital-based birthing services in Wigtownshire were halted in 2018 as a result of shortfalls in the number of qualified midwives required to ensure the safety of mothers and their babies. 

“As a Board, we have recognised strong feelings on this issue, particularly around the current travelling required for many births, and a local desire to establish a way forward.  

“Earlier this year, under two independent chairs and a national midwifery expert, engagement took place with people in the community and with staff in order to gain information to help shape potential options for the future of services. 

“Several options were developed by the independent chairs following engagement with stakeholders, and these went through a scoring process. 

“At the end of that scoring, two front-running options for births in the area were tied – the current arrangement which provides only for low-risk home births and a second option which would include pre-planned births at Galloway Community Hospital, again only for the same relatively small number of low-risk births.  

“While conscious that this was an independently chaired service review, it is important to recognise that this was a local service review which should include contributions and views from professional NHS staff. By doing so, it was noted that both option 1 and 2 scored the same on the day, with option 2 narrowly preferred by the independent chairs when the local professional scores were excluded.” 

The report by the independent chairs, NHS Ayrshire and Arran Medical Director Crawford McGuffie and NHS Ayrshire and Arran Executive Nurse Director Jennifer Wilson, came to the Transformation sub-committee of the IJB on August 10 2023. 

Mr McFarlane said: “The two options were discussed at that committee. Feeling there was a lack of a decisive outcome, and with no proposals or options having yet been taken out for the public to consider, a recommendation was agreed that two options be taken out for formal consultation. 

“This proposal was agreed at the meeting of the IJB on Wednesday 27 September, with a view that these possible options should go out to consultation so that the perspectives people offer in response can help inform and shape the ultimate decision making. 

“For the avoidance of doubt, and contrary to some reporting, neither of these options would represent a full birthing service in Wigtownshire. High risk births have always been advised to deliver in the Dumfries and Galloway Royal Infirmary and this would remain the advice. 

“The second option is for pre-planned births in hospital which are assessed as being low-risk – and the last statistics for Wigtownshire showed that this was 23 per cent of all pregnancies in the area. 

“We’ll be looking to move to consultation as quickly as possible, and expecting this process to provide everyone with full information and understanding about both these options, and their implications – with details to be published in due course. 

“The IJB does not have a preferred outcome here, and we are keen that consultation takes place so that everyone within the community can help shape a model for childbirth that will serve Wigtownshire for years to come.” 

IJB committee considers report on Wigtownshire maternity services

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A REPORT on the future of maternity services in Wigtownshire was considered on Thursday by a sub-committee of the region’s Integration Joint Board.

Head of Midwifery Laura Boyce said: “I’m very pleased that the report has been presented to this sub-committee of the IJB setting out options for the future of maternity services in Wigtownshire.

“I’d like to express my sincere thanks to the two independent chairs, NHS Ayrshire and Arran Medical Director Crawford McGuffie and NHS Ayrshire and Arran Executive Nurse Director Jennifer Wilson, and for the support provided by professional midwifery expert Angela Cunningham.”

The local service review of maternity services in Wigtownshire was launched on January 18 under independent expert chairs, seeking views from stakeholders to help inform approaches.

On Thursday, Dumfries and Galloway Integration Joint Board’s (IJB) Transformation and Innovation/Futures Committee met with the purpose of considering and discussing the findings in the report and the next steps in moving towards a sustainable approach – to be taken on through the full IJB.

The report set out the work which had taken place to review maternity services and engage with the voice of our local communities, families who had experience of maternity services in Wigtownshire, as well as wider staff groups.

This review was undertaken in the context of the temporary suspension of low-risk, intrapartum maternity services at Galloway Community Hospital which came into effect in 2018 due to staffing pressures.

Option one represents the birthing service currently available in Wigtownshire. It would comprise continued care provision from Community Maternity Hub (Oak Tree Family Centre) and support for home births, but with no provision for intrapartum care within Galloway Community Hospital.

Option two would comprise the continued care delivery from Community Maternity Hub (Oak Tree Family Centre), with the addition of a planned, on call birthing option for low risk births from Clenoch Birth Centre within Galloway Community Hospital.

Under either option, there would be no midwives routinely based at Galloway Community Hospital for wider aspects of care.

Both options achieved the same score of 78 in the scoring process, inclusive of NHS Dumfries and Galloway professional leads who participated in the process. Option two was the preferred option of the professional experts independent to NHS Dumfries and Galloway, with a score of 80.

The report also noted the resource implications for resuming births on a planned, low-risk basis at the Clenoch Birth Centre, at an associated cost of about £103,000.

Contrary to some media reporting, the report was very clear that option 2 would only be for planned, low-risk labour and birth and would not be suitable for all births in the Wigtownshire area.

In the most recent data for Wigtownshire, 23% of all pregnancies were assessed as low-risk. Risk assessment throughout pregnancy and birth is undertaken following nationally recognised standards.

There is a need to highlight that, other than for location, the service provided under the option for planned, low-risk births in the Clenoch Birth Centre would be the same as the regionwide home birth service currently provided for expectant mothers in Wigtownshire.

On Thursday, the Dumfries and Galloway Integration Joint Board’s (IJB) Transformation and Innovation/Futures Committee decided to recommend to the full IJB meeting of September 27 that the two options are taken out to public consultation.

Click here to learn about Right Care, Right Place - our consultation about bed based intermediate care

Consultation underway on bed-based intermediate care

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Consultation on bed-based intermediate care within Dumfries and Galloway is now underway, running from April 14 to July 7.

Upcoming drop-in consultation events Lockerbie Town Hall tomorrow, April 21, from 3pm to 7pm.

The consultation will be focused on how to best deliver, as close to local communities as possible, the help people receive between an acute hospital setting and what they are able to manage at home, either independently or with support. 

Details on all in-person drop-in events along with online consultation documents for completion can be found at the website www.dghscp.co.uk/rcrp-consultation

Intermediate care consultation

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Consultation to focus on local bed-based care

A STRONG desire to see bed-based intermediate care delivered in the heart of local communities emerged from a major piece of public engagement. 

Building on the feedback received, a period of formal consultation is now set to be launched by Dumfries and Galloway Health and Social Care Partnership – focused on how to best deliver, as close to local communities as possible, the help people receive between an acute hospital setting and what they are able to manage at home, either independently or with support. 

Key to this is a proposed flexible approach to bed-based intermediate care. This could see a proportion of bed capacity within settings reallocated to different roles, such as palliative or ‘step-down’ care – helping to meet a variety of need in the heart of local communities. 

Introducing the consultation which will run from April 14 until July 7, Director of Strategic Planning and Transformation David Rowland said: “We had a fantastic response to our Right Place, Right Care: Intermediate Care engagement, with people right across the region coming forward to share their thoughts and experiences. 

“Bed-based intermediate care takes in everything from care homes to cottage hospitals, extra care housing and short breaks providing respite, and recognises the importance of care and support at home.  

“We need to develop approaches aimed at best meeting the healthcare needs of the local population where these cannot be met at home but do not require the services of a district general hospital. 

“It’s an area set to play an important role within our region over coming years, and so it has been very important to get people’s input to help inform and shape our approaches.” 

Key outcomes from this work is –  

  • Initial modelling which sets out the capacity believed to be needed in each location in years to come. 
  • Proposed discussion around facilities which either currently play a role or which could in the future. 
  • The proposal of a flexible approach to the use of beds.  

Mr Rowland clarifies that, within the flexible approach, each bed would continue to have a set use. 

However, the beds within any facility might not all serve the same purpose – with different ongoing roles for different beds, informed by local need. 

Mr Rowland said: “What we are talking about is using the total capacity more flexibly. With care homes, for example, it’s the idea that – as beds become available or extra beds are added by care home owners – a small number could be allocated for palliative care, step up or step down care, but while ensuring residential need is being properly met. 

“We are preparing to take these proposals for public consultation, along with the modelling we will be basing our planning around. We have also identified facilities which either currently contribute to the intermediate care bed-base right now or which could over coming years, and which we want to discuss with the local communities. 

“It’s very important that everyone is aware of the public consultation taking place from April 14 2023 until July 7 2023, and that they are encouraged and supported to have their say.” 

Dumfries and Galloway Health and Social Care Partnership Chief Officer Julie White has also voiced the call for everyone to participate in the consultation, and to help promote the opportunity to others. 

Ms White said: “The contribution everyone has made to the development of this work through the engagement activity has been invaluable. 

“It’s vitally important that everyone now has the opportunity to review and understand what has emerged from this work, and has the opportunity to provide their response. 

“A core principle of Dumfries and Galloway Health and Social Care Partnership is to deliver services right into the heart of communities, and so it was heartening that this was reflected very prominently in what people were saying. 

“I’d encourage everyone to note how they can participate in the consultation process, to take part, and to help others to do the same.” 

A calendar of in-person engagement events has been scheduled between 21 April 2023 and 7 July 2023, and this is set out as follows: 

21 April at 3.00pm to 7.00pm – Lockerbie Town Hall  

24 April at 3.00pm to 7.00pm – Virtual  

27 April at 3.00pm to 7.00pm – Castle Douglas Town Hall  

03 May at 12 pm to 2 pm – St Ninian’s Centre, Isle of Whithorn 

03 May at 3 pm – 6 pm – Whithorn, venue TBC 

05 May at 3.00pm to 7.00pm – The Usual Place, Dumfries  

16 May at 3.00pm to 7.00pm – Moffat Town Hall  

22 May at 1.30pm to 5.30pm – Thornhill Community Centre  

24 May at 3.00pm to 7.00pm – Buccleuch Centre, Langholm  

29 May at 3.00pm to 7.00pm – Parish Church, Kirkcudbright  

01 June at 3.00pm to 7.00pm – Richard Greenhow Centre, Gretna  

06 June at 3.00pm to 7.00pm – McMillan Hall, Newton Stewart  

09 June at 3.00pm to 7.00pm – Dalbeattie Town Hall  

12 June at 3.00pm to 7.00pm – Corner House Hotel, Annan  

22 June at 3.00pm to 7.00pm – Sanquhar Community Centre  

03 July at 3.00pm to 7.00pm – Stranraer Millennium Centre 

Anyone who requires assistance to attend or who wishes to attend the virtual meeting on 24 April is asked to email dg.spcp@nhs.scot 

Information on events is hosted on a dedicated web-page, which will also host all the consultation materials and the consultation document itself. 

The web-page is www.dghscp.co.uk/rcrp-consultation 

The consultation document can be completed online, can be completed in person at any of the events, or taken away and returned by July 7 2023 by emailing to dgcommunications@nhs.scot or by post to Communications Team, DGRI, A75, Cargenbridge, DG2 8RX. 

Partnership calls for questions on a challenging year 

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Annual Review Postponed
Unfortunately we have been made aware of a technical issue that has resulted in any questions submitted prior to 23 January 2023 not arriving in our mailbox.
The IJB has decided to postpone the Annual Review to enable people to submit their questions.
If you submitted a question prior to 23 January 2023, please resubmit your question.
We will be recording the answers at a later date.
Thank you for your patience.
 

DUMFRIES and Galloway Health and Social Care Partnership senior managers are ready to take questions on its performance in 2021-2022, following the publication of its latest Annual Review.  

The Review, covering the year from April 2021 to March 2022, praises health and social care staff for their work fighting the second year of the COVID-19 pandemic – and highlights many pressures which continue to this day. Senior management will discuss the review and answer questions in an online meeting later this month. Questions can be sent in by visiting https://dghscp.co.uk/performance-and-data/annual-review/ 

David Rowland is the Director of Strategic Planning and Transformation for the HSCP, and he says: “The Annual Review is how the Partnership is held to account. The Scottish government has set nine health and wellbeing objectives for every region in the country, and we have to hold ourselves to them and report how well we are doing.  

“2021-2022 has been a very tough year for Dumfries and Galloway, and health and social care have been under unprecedented pressure – pressure that continues to this day. The Review recognises areas where we have done well, and areas where we have not yet met our ambitions and aspirations. It also talks about the change and innovation that has happened over the year, a lot of it driven by the pandemic, and how that has improved services for people in the region. 

“The Partnership is accountable to the people of Dumfries and Galloway. Anyone can ask senior management a question about the Partnership’s performance at the meeting this month, and get an answer in public.” 

A panel of senior managers from Dumfries and Galloway Council and NHS Dumfries and Galloway, including Partnership Chief Officer Julie White, DGC Chief Social Work Officer Lillian Cringles, Partnership Chief Finance Officer Katy Kerr, Integration Joint Board Chair Laura Douglas, and IJB Vice-Chair Andy McFarlane will discuss the review’s findings in an online meeting on 25th January.  

All questions are welcome – anyone in the region, including Partnership staff, can send in a question for the panel by visiting https://dghscp.co.uk/performance-and-data/annual-review/ A video and transcript of the meeting will be published shortly after the meeting finishes.  

The Review is available now online at https://dghscp.co.uk/performance-and-data/annual-review/ and highlights some of the partnership’s achievements. Alcohol and drug treatments are promptly available, and most people say they are able to look after their own health – Dumfries and Galloway is significantly ahead of the Scottish average in both areas. The region also has some of the most successful vaccination programmes in the UK, both for COVID-19 and for other diseases. 

However, rising demand for health and social care, together with staff shortages, put a heavy burden on the people working across the Partnership. Waiting lists have grown, and in some cases planned care and operations have been delayed.  

Support for unpaid Carers has been a priority with the opening of the new Carers Centre at Dumfries and Galloway Royal Infirmary. The Partnership has also been working on making care more accessible and more efficient, through projects such as Home Teams for coordinating care delivered at home, Care Call to provide rapid assistance to vulnerable people at home, and the Single Access Point for reaching all health and social care services across the region. 

The Annual Performance Report is available at https://dghscp.co.uk/performance-and-data/annual-review/  An Easy Read version is also available for anyone who has difficulty reading.  

Unprecedented pressures

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Massive pressures faced by region's health and social care

UNPRECEDENTED pressures are being faced by the region’s health and social care system – in line with the rest of Scotland, and the UK as a whole.
Julie White is Chief Officer of Dumfries and Galloway Health and Social Care Partnership, and she said: “The pressures are now greater than seen during the peak of the COVID pandemic.
“They are being driven by a combination of factors, including very high rates of flu and other respiratory illness currently circulating within communities – resulting in high numbers of vulnerable people requiring immediate medical care.
“The health and social care system is also supporting many older and vulnerable individuals who have multiple, complex needs that have been exacerbated by the pandemic.
“We are having to make day by day decisions on our capacity to deliver planned surgery. This is distressing for patients who receive late notice cancellation but reflects the prioritisation of those with the most immediate and pressing need.
“Similarly, we are exploring options to facilitate the accelerated discharge of patients. Currently, a very significant proportion of hospital staff are supporting patients who no longer have a need for further medical treatment or rehabilitation.
“It is essential that we do everything we can to return these individuals home or to a homely setting in order that we are able to provide the support to those most unwell patients – where immediate help can potentially be life-saving.
“We are appreciative of all support in this, particularly from all families and the thousands of Carers who already contribute so much to the sustainability of health and social care delivery.
“If you are able to think of ways in which you can support a loved one to get home from hospital now they have no further medical need to be there, please do get in touch with them and their clinicians.
“At this very challenging time, our priority has to be to minimise the risk of harm to individuals.
“Today, well over 100 people are in hospital beds whose needs could be better met at home or in a homely setting, important operations are being cancelled and our Emergency Departments are under significant strain. Our GP practices, mental health teams and community-based health and social care teams are also experiencing unprecedented demands.
“To be clear, the primary consideration here is not facilities or equipment, but having the necessary volumes of staffing who have the skill and capacity to provide treatment and care to those in most urgent need.
“At this time, difficult decisions will need to be taken to ensure our staff can help meet the most urgent need and to ensure that our hospital has the capacity to deal with the next emergency attendance.
“We will keep you informed of this position and the difficult decisions which need to be taken to deal with this unprecedented level of pressure. It is likely that these pressures will persist in line with the traditional flu season and we are unlikely to see significant improvement for some weeks.”