Posts from the “COVID-19 blogs” Category

Our antimicrobial prescribing team – a big impact for a small team – Jacqui Sneddon

Posted on August 6, 2020

Although the COVID-19 pandemic is still with us, many parts of the NHS in Scotland are keeping their focus on the virus while restarting work that had to be paused. Jacqui Sneddon reflects on the work of the Scottish Antimicrobial Prescribing Group as part of the pandemic response and looks at the way forward.

The impact of the COVID-19 pandemic brought challenges and opportunities for the Scottish Antimicrobial Prescribing Group (SAPG).

Our group works with NHS boards across health and care settings in Scotland to safeguard antibiotics against the global threat of antimicrobial resistance. When both the group’s committee and project group meetings were paused, it meant that that routine work for the group was also suspended.

We’re a small and agile team of just three employees, including me, plus one day per week from our Chair, Dr Andrew Seaton from NHS Greater Glasgow and Clyde, but with a committee of national experts and clinical staff from across Scotland, as well as several project steering groups.

Initially I was seconded to support first the Medicines and Pharmacy team within Healthcare Improvement Scotland (of which SAPG is a part), and then to NHS Lothian to support the ICU pharmacy service. Marion Pirie, our team’s Project Officer, took on part-time work with NHS 24 supporting staff training by role playing real-life patient calls.

Meanwhile, Lesley Cooper, our Health Service Researcher, devoted her time to finalising evidence reviews for two of our projects – penicillin allergy de-labelling and use of antibiotics towards the end of life – which have now been submitted for publication. There was also time to write up our findings from global health partnership work we’d just recently completed with two hospitals in Ghana for future publication.

The issue of COVID-19 and antibiotics

But we couldn’t entirely take our eye off COVID-19.

The pandemic meant that we needed to be sure that use of antibiotics was still appropriate and that clinicians had the information they needed.

Literature reports of overuse of antibiotics in other countries led to SAPG producing advice to support antimicrobial teams in NHS boards to maintain stewardship of antibiotics in hospitals and care homes.

We recognised an opportunity and need to explore the impact of COVID-19 on hospital antibiotic prescribing, given emerging data form China and other parts of the UK, so SAPG led a point-prevalence survey audit examining epidemiological, clinical and prescribing data from eight boards. Data were captured from over 800 patients with suspected or proven COVID-19 across 15 acute hospitals (about one third of all hospitalised patients with COVID-19 in Scotland at the time) during the last 10 days in April. The study generated a huge amount of data that Lesley and colleagues in Public Health Scotland analysed and this provided reassurance that antibiotic use in Scotland was compliant with local guidelines, with lower use in COVID-19 patients than reported elsewhere. Thankfully there was no increased use of broad spectrum antibiotics that drive resistance although the emerging problem of secondary bacterial infections in critical care was observed. One paper has been submitted for publication focused on the epidemiology of antibiotic prescribing in COVID-19 and a second on management of suspected respiratory infections in the context of COVID-19 is underway.

Emerging from lockdown

As we gradually emerge from lockdown, SAPG work has restarted with our first virtual committee meeting recently attended by 32 members. On the agenda as well as the hospital audit data was a discussion of data on GP practice antibiotic prescribing during COVID-19, and hearing about the challenges that antimicrobial teams had faced. All of this information will allow us to continue to learn and will inform the SAPG work programme to ensure the NHS in Scotland continues to use antimicrobials optimally to preserve antibiotics for future generations.

We then turned our attention to our project groups on penicillin allergy and end-of-life antibiotics, to finalise outputs and agree plans for implementation as well as publications on our project development processes. We’re now working with our SAPG Public Partners to produce a patient version of recommendations for use of antibiotics towards the end of life to support patients and their families in shared decision making.

As I reflect on the lessons of the pandemic and the way forward for the group, it strikes me just how much COVID-19 has brought people together – we see that in society, but also within organisations like our own. Our team is contributing to cross-organisational work on older peoples’ systems and primary care where our experience of working with care homes, and with GP Practices will help to inform and support future priorities. 2020 marked 12 years since SAPG was formed and since I joined the organisation. We’ve achieved so much by working in partnership with health and care professionals across the country. Although it’s been a difficult year for everyone, we can only look forward, to continue the fight against antimicrobial resistance, and to face whatever new challenges lie ahead.

Jacqui Sneddon is Scottish Antimicrobial Prescribing Group (SAPG) lead with Healthcare Improvement Scotland.

@jacquisneddons @SAPGAbx

More information

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19

Innovative communication: working, thinking and engaging differently in Shetland – Camille Brizell

Posted on July 28, 2020

COVID-19 has meant that for most of us, virtual meetings and other remote communication tools have now become the new normal. But for our colleagues in remote communities, these tools have long played an important role in their day to day work.

As Community Engagement launches its “Engaging Differently” web content and resources Camille Brizell, our Engagement Officer in Shetland, explains how finding different ways to engage has long been just part of the job.

As an organisation we’re all adapting and getting used to different ways of working just now. However, video conferencing or communicating through email with colleagues might still seem a bit odd if you’re used to just walking over to their desk and asking them face to face. But in the Local Engagement Office that I work in, that’s been the norm for years. If I wanted to ask Vicky, our team administrator for something, it would be quite a journey for me to walk over to her desk – it’s 210 miles away in Aberdeen! Just popping over to Vicky’s desk would involve crossing the North Sea from my desk in Lerwick. Quite a feat!

Yet distance has never stopped our team from working closely. We’re used to being innovative in how we do things and have always planned ahead. After all, just travelling from one part of Shetland to another can require a lot of planning. The area is approximately 100 miles long from north to south and has 16 inhabited islands, some of which can only be reached by ferry. To get to some of our outer islands it takes two ferries. Then you have to factor in the weather – if you do manage to get to the place that you’re going to for a meeting, will you be able to get home again?

As you can imagine being able to adapt and use different approaches, including the use of technology, has certainly helped to maintain links, especially when the weather has been poor.

Now that everyone is rethinking the way they communicate with others, we’re hoping that our experience here in Shetland, as well as the experiences of others across health and social care, can help support the Community Engagement Directorate’s “Engaging Differently” work.

Engaging differently – one size doesn’t fit all

“Engaging Differently” is a set of web content and resources that does exactly what it says on the tin – it looks at the different ways that we can adapt what we do so that community engagement remains not just possible, but also meaningful, even if it is from a distance. In my role as an Engagement Officer, I’ve always used a range of approaches to involve different audiences. I’ve found that no two communities are alike and no two people are alike; what works for one community or person may not work for another. In her recent blog for Gypsy / Traveller History Month, my colleague Gillian Ventura, who works in Lanarkshire, told us about how important it is to build relationships and trust in order to get communities to engage.

As Engagement Officers, we explore every possibility to support and encourage different communities to engage. We can then understand their needs and provide support for them to make sure that their opinions are heard by our health and social care colleagues.

Engagement might sound complex and in need of some grand solutions. Add in the factor of the pandemic and associated lockdown and it seems even more complex. Technology like MS Teams is helpful when we can’t meet in person but sometimes the solution is much simpler than that and you can make use of what you already have around you.

It’s good to talk

During the pandemic I’ve been supporting work around NHS Shetland’s Respiratory Care Unit. One piece of work was to develop written information for the family and friends of patients being admitted to the Respiratory Care Unit.

Under normal circumstances, we’d gather a small working group together and share printed drafts of information leaflets for discussion. During lockdown, however, this just wasn’t physically possible. While I was able to gather some feedback through emails, there was one member of the public on the group who didn’t have access to the internet. There wasn’t time to post the draft leaflet to her so we did the whole thing by phone. Every time I think back to this moment, I have a vision of this lady sitting by the phone, writing out the text of the information leaflet word for word as I read it out to her. We were on the phone for a good number of hours over a weekend as the leaflet was needed urgently. For me, it’s important to remain open to using different approaches and keeping in mind traditional methods just as much as new technology. The opinions of those who don’t use computers, conference calls and instant chat messaging on a daily basis are just as important as the opinions of those who do. We need to remember that. Often just a chat with someone on the phone has a lot of value when it comes to finding out how they feel about the healthcare that they’re receiving.

Opportunities

With everything that’s happened over the last few months, it’s strange now to think that before COVID- 19 it was often just me dialling in to a meeting on the mainland via video conference or telephone and I was the only one who was constantly thinking about a plan B if the technology failed. Now, everyone has to find new ways to communicate effectively.

COVID-19 has created many challenges for all of us when it comes to engaging with people, but it is also an opportunity for us to be optimistic. Here in the north, we’ve always risen to the challenges that being so remote and far away from each other has presented; the pandemic has proved that this is something we can all do and it may even have provided us with more effective ways of working. Even though we now need to keep our distance from each other, we have found that by engaging differently, we can overcome any barriers to communication and ensure that we can continue to provide essential support to our communities throughout these challenging times.

Camille Brizell is a Community Engagement Officer in our Community Engagement Directorate’s Shetland Office.

More information

You can find out more about Engaging Differently on the Community Engagement website

Categories: COVID-19 blogs

How small things make big differences – Andrea’s story

Posted on July 21, 2020

During the COVID-19 pandemic, a lot of the day-to-day things we take for granted have stopped. Returning to work as an Occupational Therapist in mental health services, Associate Improvement Advisor Andrea Boyd noticed that in a time of big challenges, it was often the little things that mattered.

It’s often the small things that mean the most in times of uncertainty. The everyday, ordinary things. The things you normally never notice, the things that you never miss until they’re not there.

Over the past few months I’ve noticed the absence of a lot of these small things and the difference they can make. A hug. A shared meal. A comforting pat on the arm. They all mean a lot.

**Andrea on ward dressed in PPE and Andrea with family**

Going back to work on wards

In my normal job, I split my time between working as an Associate Improvement Advisor in the ihub’s mental health improvement team, and working as a Senior Occupational Therapist (OT) at NHS Ayrshire & Arran. The focus of my ihub work is improving observation practice in mental health services, which is part of the Scottish Patient Safety Programme. I’ve built up a network of national improvement leads and I was looking forward to starting full time hours within the ihub from 1 April. But then everything changed.

As part of Healthcare Improvement Scotland’s national response to COVID-19, I returned to work as an Occupational Therapist at Woodland View, NHS Ayrshire & Arran’s acute mental health facility and community hospital at Ayrshire Central Hospital. I worked three days a week in older adult mental health wards, one day in acute adult mental health wards and one day a week in the community role I’ve continued to undertake.

The impact of COVID-19

My community role as an Occupational Therapist has often been to act as a reassuring voice. I check patients’ symptoms and give advice on remedial actions they can take. During lockdown, the way I’d normally work has had to change, although, surprisingly, this was sometimes for the better.

For example, lockdown meant I was only able to make urgent visits to my community-based patients. However, as I kept in touch with them weekly on the phone, I ended up being in contact with them more regularly than I would in pre-COVID times. Some of my patients have been shielding and have particularly appreciated being in contact with me on this more regular basis.

Physical barriers can impede recovery

Working on the wards at Woodland View was, of course, a different story. Because of COVID, we’ve been aiming to reduce footfall in wards and make sure people get home as soon as possible.

The most challenging aspect has been to treat patients with complex mental health needs while wearing PPE. Some of our work involves working with patients in physically close situations, such as the kitchen, so we have to be careful to maintain a physical distance as much as possible, and to wear the correct PPE. It makes it a bit more difficult to get to know new staff and patients, and it affects building therapeutic relationships. Older adults in particular find it difficult to hear you through your mask.

Meal times in particular have been more isolated than usual as patients are eating alone in their rooms, rather than socially. Visitors have not been allowed inside the building, and while we facilitated some patient visits at ground floor windows, this lack of social contact has been hard for all of us.

Finding the positives

On the positive side, COVID has meant that we take every opportunity to get out in the fresh air, either for a staff break or with patients, where we can remove our PPE. There is a beautiful woodland walk on the hospital grounds.

Within the hospital foyer, Bramble Café is a bustling hub for coffee and cakes. When they removed the indoor tables and chairs and put out notices reminding us of the potential threat of COVID, the atmosphere changed. Thankfully, the tables and chairs are back now and I realise how much I missed them! It’s a small change, but it illustrates a bigger point about how much we all take for granted.

A piece of cake

One small thing we have been able to bring some cheer to the wards is to bake cakes for staff – we created ‘cake Friday’ to keep up team spirits. I do find not being able to hug anyone quite difficult, so giving out cakes is like sharing cuddles on paper plates. As a bonus, my youngest daughter has started baking with me at home – it’s something we enjoy together.

Next steps

I’m now back at Healthcare Improvement Scotland to start the work I should have begun in April, and I’m really looking forward to re-joining my colleagues in the ihub’s mental health improvement team. I’m particularly excited about a new video and case study the team have produced as part of our Improving Observation Practice programme, which gives an insight into how NHS Tayside improved the lives of mental health service users and staff through changes to their observation practice.

But my time back on the ward and in the community will stay with me. When we become overwhelmed with information and daily updates on the number of COVID-related deaths, we need to focus on the positives and what we can do, rather than what we can’t. And we should always remember that it’s the little things that count.

Andrea Boyd is an Associate Improvement Advisor who specialises in mental health within Healthcare Improvement Scotland’s ihub.

More information

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

How inspection can lead to positive outcomes for people who require health and social care – Sharon Walker

Posted on July 14, 2020

We’re currently recruiting for new inspectors. In our latest blog, Sharon Walker explains what it’s like to know that you help to improve care and safety for patients

The primary goal of inspection is to promote high quality health and care services for the people of Scotland. As a senior inspector with Healthcare Improvement Scotland, I’m able to help make improvements happen by using a variety of tools to assess the strengths and weaknesses in a service or organisation.

The importance of relationships

Inspection is about team work. Inspection programmes are often planned in advance to identify what works well in an area, what isn’t working well and what is needed to achieve national drivers for optimum health and wellbeing across Scotland. The inspection teams are made of a variety of skills – some of us are nurses, some have worked as allied health professionals and others have enhanced knowledge of medicine, quality assurance and improvement methodology. By tapping into these skills, we are far more likely to help services to achieve high quality sustainable health and social care.

From experience, to help affect change it’s better to work with services – hierarchical domination usually ends in mistrust. It takes time to build these relationships and to find the right way to bring people with you on the journey to realise improvements. Listening to what works well in the service and what doesn’t helps to establish trust; it’s a two-way process whereby strategies can be openly discussed and agreed. Moreover, offering the right support at the right time helps services to improve outcomes for people.

It’s this engagement with care providers and the public that I like best. Meeting staff on the front line delivering care, talking to people receiving care about their experiences gives me a sense of achievement, knowing that I have included the most essential people in the inspection process.

Then there’s the report! This is the step that pulls all the evidence together in a relatively short summary – it’s an area which requires careful consideration to ensure key evidence of the inspection findings are included. After all, this is the part that demonstrates how good the service is and what needs to improve.

Sadly, some services do not always provide satisfactory levels of care despite targeted support – outcomes for people accessing care can at times be poor and require immediate interventions. Being able to understand the governance which supports the inspection methodology allows us to take the necessary steps to mitigate risks in services and find a way forward that is right for the service to improve and to keep patients safe. It’s important for us to report our findings accurately and clearly, so that the public can fully understand a services’ strength, plus where and how it needs to improve.

Partnership working and getting the balance right

As a senior inspector, I am predominantly involved in partnership working with other bodies such as the Care Inspectorate and Her Majesties Inspectorate of Constabulary in Scotland (HMICS) to carry out joint inspections of services provided across Scotland. As a result, I have developed my knowledge of joint inspection methodology and legislation which supports this aspect of quality assurance.

For example, the programme I am supporting at the moment is Adult Support and Protection, other joint programmes I have supported are services for Children and Young People and Adults.

The joint approach to inspection requires the team to consider the operational strengths and challenges associated with delivering health and social care, alongside knowledge of strategic commissioning and decommissioning of resources, plus the challenges associated with achieving equality – particularly in hard to reach areas and communities which have co-morbidities and higher crime rates.

Planning is essential. Being involved in the planning of inspections for me is important as I can help influence how my skills can be best used to gather evidence from inspections.

Once a nurse, always a nurse

Over the years, I have developed my experience of quality assurance and improvement, but occasionally I still feel like I am wearing two hats. Before I was an inspector, I was and still am a registered nurse, and this background helps me to strike the right balance between nursing and helping to bring about improvement. I am fortunate to have operational and strategic leadership experience which allows me to focus on specific aspects of inspection methodology such as quality of staffing, safe delivery of care and leadership and management. My colleagues in the Care Inspectorate and HMICS bring additional skills, all of which help to ensure inspections are carried out effectively.

As an inspector, I have travelled to some of the most beautiful parts of Scotland and met some truly amazing people who work tirelessly to bring about change. It’s hugely rewarding to add to what they do and to work with them to improve the quality of care.

Sharon Walker is a senior inspector with Healthcare Improvement Scotland

We’re currently recruiting for new inspectors, to find out more and to apply, visit: https://apply.jobs.scot.nhs.uk/displayjob.aspx?jobid=26459

Categories: COVID-19 blogs

The role of health and care inspector – varied and satisfying – Catriona Hutcheson

Posted on July 14, 2020

We’re currently recruiting for new inspectors. In our latest blog, Catriona Hutcheson explains the diversity and satisfaction she gets from the role.

For most people, there is not a standard route to becoming an inspector for health and care services.

For me, I’d spent 15 years as an occupational therapist in mental health before making the change. Over that time, I’d developed a keen interest in how the quality of services offered to people could be improved for those who received them. I became increasingly keen to put this to good use. When an opportunity arose to work as a visiting commissioner with the Mental Welfare Commission I jumped at the chance.

It was a challenging but exciting role where I learned about regulation and quality assurance in a wider context. I started exploring the role of quality assurance in improving health and social care services and learnt about the work of Healthcare improvement Scotland. This is when I realised that I wanted to be an inspector. I always had a passion for driving improvement, and I realised that inspections are an important tool in achieving this. Not only do we identify where improvement is needed, but we recognise and share good practice examples so others can learn from them.

What it means to be an inspector

The word inspector carries many connotations with it relating to things like restaurants and even of course the police, and with those connotations come many stereotypical images of stern faces and clipboards and an officious tick-box manner. One thing is for sure, if that had been what the role is, I would not have been attracted to and I would not have stayed here for six years.

I’ve found working for a national organisation to be very exciting. I enjoy the flexible working arrangements and opportunities to work from home if required. We are expected to deliver on nationwide programmes of inspection, so there are a lot of opportunities to travel around Scotland and gain new experiences, as well as develop wider working networks with staff from different partnerships.

For me, the very best thing about being an inspector is when you see the quality assurance process contribute to improved services for people who access them. I recently led a team from different quality assurance organisations in a review of a health and social care partnership we had previously inspected. It is one of the highlights of my career to see first-hand the improvements that were made, and to be part of recognising the hard work that had been done to achieve them. This is one of the most satisfying and rewarding aspects of the job. Like all health professionals, my reason for doing my job is to help people when they need us.

Working with Healthcare Improvement Scotland

When I joined Healthcare Improvement Scotland, the biggest challenge was adjusting to the wide scope of the role, but I soon realised that we each bring different skills and experiences and it those that enable us to be valuable members of the quality assurance team.

I joined a multi-agency team which inspected health and social care partnerships, alongside colleagues from the Care Inspectorate and Audit Scotland. Our inspection role in this area was large and a little daunting at first. We went through a process of analysing data and intelligence about the partnership, before heading on site to read files, meet with people who access services and hear about their experiences, both the good and the bad. Then we spent time with staff from the partnership, meeting with staff of all grades, and specialisms, including the senior managers and chief executives. At the end of the process we produced a report. The primary purpose for our reports was to help the partnership improve services for people who use them.

A diverse and ever-changing role

The inspector role is constantly evolving and there are always opportunities to work in new and different areas of our work.

The highlight of my time with Healthcare Improvement Scotland has been my recent engagement in the IRMER (Ionising Radiation (Medical Exposure) Regulations) inspections. Radiology and radiography are highly-specialised areas of work in healthcare. The regulated inspections of these areas required intense training. I’ve enjoyed the challenge and satisfaction of these inspections. This is an element of the job that I love.

I have also been part of a team led by HM Inspectorate of prisons inspecting a prison. My focus was of course on the provision of healthcare for the prisoners. I really enjoyed this experience as it is such a unique environment in which to deliver healthcare. I was also involved in the first ever review of community mental health services across an entire NHS board, where I was able to draw on my experience of working in frontline mental health services to contribute to this pioneering piece of work. I’ve also shadowed colleagues as they complete regulatory inspections of independent healthcare clinics. These inspections are different, because they are private businesses and the evaluations in the report will influence people when they chose the clinic they wish to go to.

If you’re looking for a job that is rewarding, challenging and diverse, and where you get the opportunity to travel, then becoming an inspector is a great career move. You’ll learn and grow, and feel that you play a key role in helping to ensure that people get the best care no matter where and how it is delivered across Scotland.

Catriona Hutcheson is a senior inspector with Healthcare Improvement Scotland

We’re currently recruiting for new inspectors, to find out more and to apply, visit: https://apply.jobs.scot.nhs.uk/displayjob.aspx?jobid=26459

Categories: COVID-19 blogs

From making meals to buying them: Volunteering during COVID-19

Posted on July 8, 2020

Supporting people lies at the heart of our Community Engagement Directorate, and for many of our staff, that’s true both inside and outside their working hours. Here, Admin Officer Susan McLaren tells us how her role volunteering with older people has changed during the current pandemic – and why she now recognises the importance of the humble chocolate teacake.

Helping hand

Before I started working as a volunteer, I had no idea of the importance of chocolate teacakes in Scottish society. To me, they were just another biscuit – the one I get offered with a cup of tea each time I give blood. Now I know differently.

Eighteen months ago, when teacakes were the furthest thing from my mind, I started volunteering as a meal maker for a charity called Food Train. In my day job for Healthcare Improvement Scotland’s Community Engagement Directorate, I support my team to engage with people across Scotland and get them involved in health and social care. Community matters to me, and that doesn’t change when I stop working, which is part of the reason I volunteered. As a meal maker, I was paired with an older person in the community called Helen and cooked a nutritious (and hopefully tasty) meal for her once a week.

“In my day job for Healthcare Improvement Scotland’s Community Engagement Directorate, I support my team to engage with people across Scotland and get them involved in health and social care. Community matters to me, and that doesn’t change when I stop working, which is part of the reason I volunteered.”

Then the virus hit and lockdown happened. I quickly realised that Food Train would have a lot of extra demand for their shopping service but may be experiencing a reduction in numbers of their regular volunteers. They’ve been going since 1995 and recently celebrated their 25^th anniversary, but have never experienced anything like this. A quick phone call and I was approved to help with the supermarket shopping service. Now I and a team of four or five volunteers are up and out with the lark three days a week to do shopping for about 140 vulnerable people in my community – all before I start the day job.

Simplicity is the key to shopping for others

When I first started the shopping role I was a bit unsure what to expect, but the co-ordinator for my supermarket shopping was really welcoming and explained in detail how it all works. As with the best things in life, simplicity is key. I am given the shopping list, do the shopping, pop it into crates (that have been sanitised, of course) and it’s then delivered by volunteer drivers throughout West Lothian.

Of course, it’s not always straightforward, especially when things aren’t avaiIable. I now understand the dilemma facing supermarket staff doing the pick for online shoppers – to substitute or not to substitute, that is the question! Luckily all the volunteers are willing to help with suggestions on this – it’s real team work. The one that did stump us for a while, though, was those chocolate teacakes. We had so many shopping lists given to us that contained them that when the factory at Uddingston closed and the shelves were bare we really struggled – I’m sure there were a few disappointed faces when the deliveries arrived. Apparently nothing beats a chocolate teacake with a cuppa! Fortunately production started back within a few weeks and we were once again able to meet the demand – phew!

Making a difference

Volunteering means an early start for me, shopping from 7-8 am (and that is after walking the dog) but the shop is usually quiet at that time and I also get to scope out all the bargains. I feel glad I’m able to help out someone who might be anxious about how they will manage if they can’t get out to shop for themselves. And as volunteers, the people we help have left us in no doubt just how much what we’re doing is appreciated. I recently received a note from one older person we’ve helped which read: “I was so worried about my food and shopping before you called me. Nobody could help me and I’m on my own. Not only do your volunteers shop for me but their wee visits really cheer me up. Wish they could visit every day”.

We’ve also had lovely surprised like a request on one shopping list for a box of chocolates for the Food Train helpers. This was lovely and totally unexpected but really brought it home how much this means. As one grateful daughter said “Knowing you can support my elderly mum is such a relief to me, you are all wonderful”. It’s very satisfying to know that my little bit of volunteering is making such a difference to other people’s lives.

“As volunteers, the people we help have left us in no doubt just how much what we’re doing is appreciated. I recently received a note from one older person we’ve helped which read: ‘I was so worried about my food and shopping before you called me. Nobody could help me and I’m on my own. Not only do your volunteers shop for me but their wee visits really cheer me up. Wish they could visit every day‘.”

Once COVID-19 is over and we’re all living in whatever the new normal will be, I like to think I’ll still be there with my shopping trolley, hunting out those teacakes. Whatever happens, I expect to still be making my weekly visits to Helen bringing her a tasty meal and having a bit of chat as well – it’s as important to her as it is to me. We’ve seen fantastic examples of community spirit during the pandemic lockdown and I look forward to seeing so much of it, not just in my day job, but by all of us, every day, all year round. It will be so important to help us all recover.

More information

You can find out more about the work of Food Train or Mealmakers on their websites: https://www.thefoodtrain.co.uk/ and http://www.mealmakers.org.uk/

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19

Long journey for travellers to have their voices heard

Posted on June 29, 2020

Community engagement is about everyone in Scotland having a right to take part in decisions about their health and wellbeing. But for some groups this is harder than for others. As part of Gypsy Traveller History Month, Community Engagement Officer Gillian Ventura tells us how important it is for this resilient community to have their voices heard.

Lockdown has been hard for everyone. Staying home, staying safe, doing your bit. It’s a struggle being cooped up when you’re in house with a garden. Imagine doing it when you can’t get things delivered to the place where you live. Imagine doing it when you’re part of a community where family is everything, but you can’t be within two metres of loved ones whose home you could touch if you just stretched out your hand. Imagine doing it when the land your home sits on is no guarantee of permanent residency.

As family and kinship are central to Gypsy / Traveller culture, the reality of lockdown has been particularly challenging. It can be difficult to maintain a two metre distance in a pitch which requires space for at least two caravans to accommodate one family.

“Due to discrimination, many Gypsy / Travellers won’t challenge the system anymore as they feel nothing is really going to change for their community. This means there’s little point in me knocking on doors on a site and asking them about their healthcare and what matters to them. The first step is building a relationship. And that takes time.”

Yet lockdown has simply highlighted the many struggles and inequalities that this community face. Helping to get those struggles voiced at the highest levels is part of my job as one of Healthcare Improvement Scotland’s Community Engagement Officers.

Taking time to engage

There are around 20,000 Gypsy / Travellers living in Scotland. Among them are groups as diverse as Romany Gypsies, Scottish Gypsies / Travellers, Irish Travellers and European Roma. Some will have arrived in the UK as asylum seekers and refugees, fleeing persecution. They all consider travelling and a nomadic identity as an important part of their traditional and contemporary culture. Recognised in law as a distinct ethnic group, they also have the worst health outcomes of any ethnic group, primarily due to poverty and discrimination.

Due to discrimination, many Gypsy / Travellers won’t challenge the system anymore as they feel nothing is really going to change for their community. This means there’s little point in me knocking on doors on a site and asking them about their healthcare and what matters to them. The first step is building a relationship. And that takes time.

I’ve been working with the Travelling community at the Swinhill site in Larkhall for two years now, supporting the work of NHS Lanarkshire’s Keep Well Team, nurses Heather Craig and Sandra Kelly. Gypsy / Travellers face a range of health problems at an earlier age than the general population and it’s important to reach them so they can get the right healthcare and support. They typically live 10 – 12 years less than “settled” people. They have higher rates of anxiety and depression and their suicide rate is six times higher than the general population – this increases to seven times for young Traveller men. Infant mortality is three times higher. Around 42% of Gypsy / Travellers are affected by a long-term condition, compared to 18% of the general population. People from Gypsy / Traveller backgrounds also engage later with health services and can often experience barriers accessing primary care as a result of living in unauthorised areas or moving frequently, having low levels of literacy and experiencing discriminatory attitudes.

“The input of the community and their leaders is vital to this work. There are some strong community leaders among the Gypsy / Travellers, and they play central roles in the Travelling Community Network at local, regional and national level.”

The key to engaging the community has been the site manager, Roy Overend. Roy has been at the site since 2003, and thanks to the great relationships he’s built up with the residents and the Gypsy / Traveller community in Lanarkshire, he’s helped us engage with them and understand the complexities of their community. The on the ground work done by Heather and Sandra has also been vital: by carrying out health checks, monitoring blood pressure, diabetes, addressing issues with mental health and wellbeing etc, they have built a rapport with the community. At first it was just the women from the site that went along, now the guys are coming as well. They all see the benefits and the advice they get opens the door for me to be able to do work around things like Realistic Medicine and What Matters to You.

What matters to them

Through the What Matters To You work, we found that the main issue for the community was accessing primary care services, in particular getting registered with a GP service when they are travelling, which is part of their culture. This work was shared with the Travelling Community Network and also with Scottish Government, to help raise the profile of the issues that matter to the community. Through this, we’re linked in to the Improving the Lives of Scotland’s Gypsy/Travellers (2019-21) action plan, launched by Scottish Government at the end of last year. The five key priorities are: provide more and better accommodation, improve access to public services, better incomes in and out of work, tackle racism and discrimination and improve Gypsy / Traveller representation.

The input of the community and their leaders is vital to this work. There are some strong community leaders among the Gypsy / Travellers, and they play central roles in the Travelling Community Network at local, regional and national level. One lady from the community within Lanarkshire assisted the Scottish Government Person Centred Care Team to develop GP Registration Cards. The Keep Well team worked with the community to promote the cards within Lanarkshire and the wider partners working with Gypsy Travellers.

The Blue GP Registration Cards are a pocket sized card promoting the right to register at GP practices. I’ve been encouraging their use by the community, asking them to keep a card in their pocket or bag so wherever they are, they know they can access GP services. Helping improve healthcare here is all about teamwork, and it doesn’t matter that people don’t know which organisation we’re from or who we work for. It’s about working together to ensure the community gets the health and social care support they need. We’re simply the people who can help them do that.

What matters to me

But this is not a quick job. Gypsy / Travellers enjoy and are proud of how they live – it’s the discrimination and lack of respect and resource that they get annoyed about the most. This lack of understanding from “settled” people can make it harder to engage with them – why should this time be any different? Yet building relationships, persevering, and, most importantly, understanding their culture will, over time, pay off, ensuring better health and social care not just for them but for everyone using local healthcare systems. At a time when Gypsy / Traveller culture is being compromised due to lack of site provision, it’s important to me that their voices are heard.

Gillian Ventura is a Community Engagement Officer with Healthcare Improvement Scotland

More information

Find out more about the Improving the Lives of Scotland’s Gypsy/Travellers (2019-21) action plan

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19

How the COVID-19 infodemic is changing the way we look at evidence

Posted on June 24, 2020

When COVID-19 struck, Scottish Intercollegiate Guidelines Network (SIGN) had an obligation to support healthcare professionals in Scotland with contextualised guidance on the diagnosis and treatment of a new and emerging disease. Angela Timoney, Chair of SIGN, explains the challenge of developing evidence-based guidance with very little high-quality evidence.

The scale and pace of the COVID-19 pandemic has presented numerous challenges to healthcare professionals. It has also presented a new type of problem for people who seek to aid health and care professionals by making sense of evidence. The so-called infodemic is almost a virus in its own right – the endless circulation of information and misinformation from many different sources and experts causing hope and confusion on an almost daily basis, and spreading with great speed through social media and 24-hour news. In fact, the World Health Organization has said that the infodemic around COVID-19 is almost as dangerous as the pandemic itself.

“The so-called infodemic is almost a virus in its own right – the endless circulation of information and misinformation from many different sources and experts causing hope and confusion on an almost daily basis, and spreading with great speed through social media and 24-hour news. In fact, the World Health Organization has said that the infodemic around COVID-19 is almost as dangerous as the pandemic itself.”

Some steady voices, including the Centre for Evidence-based Medicine and Cochrane, have helped filter this information overload, and Healthcare Improvement Scotland’s Evidence Directorateis providing expertise in evaluating evidence and highlighting the most reliable sources. Internationally, SIGN has been involved in a COVID-19 taskforce as part of Guidelines International Network to reduce duplication of effort. There’s lots of information – but is there evidence?

The need to adapt

Indeed, there is plenty of evidence – it comes thick and fast. But it’s not the robust evidence we need for clinical guidance. We like large, randomised controlled trials; currently, most evidence related to COVID-19 is retrospective and observational at best. It’s fast-moving, incomplete and often from populations that don’t always match with ours. This rapid pace of change means that, even with the best of intentions, outdated clinical guidance can actually do more harm than good.

Over the past 27 years, SIGN has developed an international reputation in producing highly regarded clinical guidelines. We have worked to a robust methodology during this time, but quickly realised that the lack of high-quality evidence related to COVID-19 wouldn’t fit this mould. Uncomfortable as it was, we had to adapt to ensure that our contribution would be meaningful and timely.

Initially, we worked with the National Institute for Health and Care Excellence (NICE) to learn from their development of rapid ‘living’ guidelines within one week. We also collaborated with the University of Glasgow to develop a rapid review to support colleagues in general practice.

“Over the past 27 years, SIGN has developed an international reputation in producing highly regarded clinical guidelines. We have worked to a robust methodology during this time, but quickly realised that the lack of high-quality evidence related to COVID-19 wouldn’t fit this mould. Uncomfortable as it was, we had to adapt to ensure that our contribution would be meaningful and timely.”

We are also supporting the Scottish Government’s COVID-19 Clinical Guidance Cell, a large multidisciplinary group acting on behalf of the Chief Medical Officer, Dr Gregor Smith, to develop rapid, high-quality guidance. Dr Smith recently acknowledged our role: “your willingness to collaborate has resulted in a process that is responsive to clinicians’ need for guidance. It will also ensure that Scotland’s clinical guidance will continue to be highly regarded, and provide our healthcare professionals with much needed support.”

Learning for the future

There’s a common word in all of this: ‘rapid’. In a short space of time, we’ve learned a great deal that we can apply to future guideline development, while retaining our reputation. It is easy to state that we must not ignore the good in search of the perfect, but in the middle of the storm the real challenge was determining not if it was good but ‘good enough’. History will determine if we got that balance right, but it feels that we have and this is reflected in feedback from others.

We’ve seen how guidance can be developed more quickly and without physical meetings, and we’ve also seen how our methodology remains valid; it is still necessary to have debate among multidisciplinary healthcare professionals and involvement from patient and public involvement groups and representatives.

Whether it is producing rapid guidelines, pinpointing where more research is needed or highlighting the most reliable resources, SIGN’s role in Scotland’s response to COVID-19 is vital –by sticking to our founding principles and robust methodology, we aim to continue to be a guiding light for healthcare professionals in Scotland throughout the crisis. We look forward to finding ways that we can take this knowledge and experience to benefit other areas of our work in the future.

Angela Timoney is Chair of Scottish Intercollegiate Guidelines Network (SIGN)

More information

Weekly updates on SIGN’s work throughout the pandemic can be found on the Healthcare Improvement Scotland website.

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19

(Not going) Out for Pride – Rosie’s story

Posted on June 17, 2020

Pride Month is about being out and proud. But while COVID-19 means we’ve all been spending more time inside, the LGBT+ community aren’t going to let a pandemic stop them celebrating, as our Equality and Diversity Advisor Rosie Tyler-Greig tells us.

June is Pride Month, when LGBT+ communities around the world celebrate the diversity and influence of LGBT+ people. Local organisers fill the month with events, headlined by Pride marches – loud, proud and colourful parades of LGBT+ people, our allies and our flags. We take over the streets for a few hours then spill into events and venues which centre and celebrate our love, our rights and the amazing versatility of glitter.

Pride started in New York in 1970 and spread round the world, arriving in Scotland in 1995. Each Pride marks the years following the Stonewall riots – three nights of unrest in June 1969, when LGBT+ people resisted arrest and victimisation during police raids on the Manhattan gay bar, the Stonewall Inn.

“Pride events not only celebrate the diversity of LGBT+ lives, but have raised awareness about issues facing the LGBT+ community”

From that inaugural moment of visibility and demand for equality, Pride events have not only celebrated the diversity of LGBT+ lives but have also raised political awareness about issues facing the LGBT+ community. They have kept a steady beat as the country has woken to LGBT rights – sexual decriminalisation in 2001, equal marriage in time for Christmas 2014, commitments to gender recognition for trans people last year.

Pride however looks a lot different this year. There is no flamboyance on our streets. Placard art projects are paused until Pride ’21. Celebrations have moved online, virtually re-imagined. For those who can get online, there has been an impressive offering of creative, educational and therapeutic spaces for LGBT+ people. With loneliness a particularly acute issue for LGBT+ communities, groups and organisations have had to adapt quickly to maintain that vital connection.

“When I go to the big Pride events, I’m genuinely proud. I know why I’m there. I really mean it when I raise my placard or wave a flag. And that doesn’t change when I join in from my sofa at home instead.”

***Rosie celebrating Pride Month at home***

I’ve enjoyed seeing more virtual events appear and being able to attend things I may not otherwise have got to. I’ve been reminded that it’s the connection we build and the conversations we have all year round that actually make each Pride an event. As a bi woman, the friendships I’ve made and the smaller year-round events I’ve attended have raised my awareness and given me a sense of having an identity to celebrate. I’ve also learned about my fellow community members and how to be an ally. When I go to the big Pride events, I’m genuinely proud. I know why I’m there. I really mean it when I raise my placard or wave a flag. And that doesn’t change when I join in from my sofa at home instead.

There will be future Pride parades. But in these locked-down times, my intention has become to nurture my pride by continuing to connect and learn with the LGBT+ community and improve my knowledge and support of LGBT+ lives, especially at the intersection of other identities. As Phyll Opoku-Gyimah from UK Black Pride says, ‘we have not achieved equality until every LGBT person, of every colour and background, is able to enjoy equality within our community and outside of it’.

The next time Pride is a physical event, flags and sparkle will make sincere statements about my identity and ally-ship. And in the meantime, I’ll tune in to the multitude of other ways to fly the Pride flag.

You can found out more about Pride events during June on Pink News’ Pride for All webpage Year-round events for the LGBT+ community in Scotland can be found on LGBT Health’s What’s on webpage

Rosie Tyler-Greig is an Equality and Diversity Advisor with Healthcare Improvement Scotland.

More information

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19

Transitioning from quality improvement to a COVID-19 ward – Scott’s story

Posted on June 15, 2020

Scott Hamilton, Associate Improvement Advisor, was deployed back to the frontline as a nurse on a COVID-19 ward. He describes what it’s been like to manage the fear, connect with family and appreciate the many things that nurses do to make a difference.

On 17 February this year, I joined Healthcare Improvement Scotland’s Acute Care Improvement Portfolio as an Associate Improvement Advisor. Having completed the Scottish Improvement Leader Programme, I was excited to get stuck into my new improvement role at a national level.

Then, just a few weeks in, COVID-19 happened.

I’ve got over 20 years’ clinical nursing experience, from working in acute admissions at the front door to focusing on practice development, quality improvement and clinical teaching within older peoples’ care. I thought I’d seen plenty of what life throws at the NHS. I remember the SARS and flu outbreaks in recent years, but both now seem like a storm in a teacup compared to this. It is astonishing to see the speed with which this virus affects people, particularly the elderly.

Mentally, emotionally and physically demanding

Once the scale of the problem became clear, I was keen to go back to my previous team at the Royal Alexandra Hospital (RAH) in Paisley to help. Very quickly the ward I was on, ward five, became a designated COVID-19 unit.

The past 12 weeks have been the hardest challenge of my career.

When our first COVID-19 patient came in, my colleagues and I were anxious about what to expect. We were – and are – learning new ways of working in a new environment, all at speed and on the hoof. And it is demanding work. We’re dealing with situations we wouldn’t have thought possible. For example, in usual circumstances, we would be looking for oxygen saturation levels of 96-100%, but now we are accepting lower levels like 88-94% or occasionally even lower. Patients seem to do OK on that and it blows your mind as a clinician. But it is taxing mentally, emotionally and physically. We have to concentrate constantly on keeping ourselves safe by following the guidance on how to don and doff personal protective equipment (PPE) and keep it in place. The frequent hand washing is causing me some skin problems, and 12-hour shifts are something I’ve not experienced since 2008.

“I’ve got over 20 years’ clinical nursing experience, from working in acute admissions at the front door to focusing on practice development, quality improvement and clinical teaching within older peoples’ care. I thought I’d seen plenty of what life throws at the NHS. I remember the SARS and flu outbreaks in recent years, but both now seem like a storm in a teacup compared to this.”

New rules

Thanks to previous work by the Scottish Patient Safety Programme (SPSP), we are used to using the National Early Warning Score (NEWS) to help identify deterioration in patients. The system remains invaluable in clinical settings. However, In COVID-19 patients it is more about how the patient looks at a particular time based on their NEWS score. There is no broad standard for everyone – it is much more focused on goal setting and getting the right parameters for each individual’s care. We need to maintain existing standards and guidance and develop a complementary new rulebook for COVID-19 patients, because it’s so different.

Teamwork is outstanding

There is one thing that has remained very much the same, though – the teamwork. I work in a multidisciplinary team including nurses, student nurses, consultants, junior doctors, physios and occupational therapists. Thanks to a combination of strong leadership, teamwork, compassion and camaraderie, we’ve become tight and slick! Everyone has an essential role in dealing with COVID-19 patients, whether we are helping them overcome viral fatigue, connecting them with loved ones using technology (usually tablets) or treating various complications that they may be dealing with. The team is phenomenal – they are my NHS heroes.

This experience has shown us that when the motivation is there, amazing things can happen in a short space of time. There has been no adoption curve – everybody is moving in the same direction at the same time. It’s amazing what we can do. Frontline staff have been supported to be innovative and creative and the whole team has been able to contribute. I think we’ll need to re-scope the landscape – for example, treatment for older people looks different now. There has been so much invaluable learning and the NHS has done a tremendous job, now we need to keep sharing and spreading that learning.

“Everyone in my team has an essential role in dealing with COVID-19 patients, whether we are helping them overcome viral fatigue, connecting them with loved ones using technology or treating various complications that they may be dealing with. The team is phenomenal – they are my NHS heroes.”

Connecting with others

My wife Elaine, who is also a nurse, usually works in Practice Development however, due to the pandemic she has returned to work in the Queen Elizabeth University Hospital Intensive Care Unit. We’re working different shifts so we make the most of the one day a week when we can spend time together as a family, along with our three children.

Usually, you could describe our life as “pedal to the metal”, week in and week out. Lockdown has led us to reflect on what’s important in life and we have been spending our family time playing board games and walking outdoors together. We appreciate that time together a lot more now.

My two boys both had birthdays during lockdown. Our youngest, Matthew, turned 10 and had a virtual party on Zoom. Using the internet has been essential to connect all of us, not just with each other but with the wider world so we can do things we took for granted before. For example, both my mother in law and sister in law have both used NHS NearMe for medical consultations. For me, it’s meant I can learn from my Healthcare Improvement Scotland colleagues through a webinars that share learning from those using the service. It’s been interesting to see these things from both sides.

This experience has made my introduction to Healthcare Improvement Scotland interesting, to say the least I can’t wait to get back to that role, but I would not change the experience. I’m so proud to be a nurse. The leadership, teamwork, connecting patients and their families – it’s all the little things that nurses do that make a difference to patients, families and the whole NHS team.

Scott Hamilton is an Associate Improvement Advisor with the ihub’s Acute Care team.

More information

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19