Posts from the “COVID-19 blogs” Category

Listening to understand: learning from an unpaid carer – Alan Bigham

Posted on December 10, 2020

As part of the Scotland-wide Carers Wellbeing Campaign, Alan Bigham, Senior Programme Manager with Healthcare Improvement Scotland’s Transformational Redesign Team, reflects on his own role caring for his father.

Something that’s still fresh in my mind from when my mother was still alive, is my dad showing me something from one of the Sunday papers, an article about ‘carers’.

“This is me now for mum,” he told me.

Now, it’s me for him.

Our awareness of what caring is, and what we mean by carers and unpaid carers can vary and changes over time. It can lead to assumptions being made if we are not clear in our language. Even those of us who are in a caring role, to any extent, may not always grasp what the role is.

I live an hour away from my dad and although I visit regularly, a year ago I would not have considered myself a carer because I’m not there all the time. This year has changed that quite significantly.

On the same week my brother’s family returned to Australia, my Dad became very unwell, deteriorating physically and mentally over a number of weeks. The system didn’t ‘kick in’ and I had to become a full time carer. This happened during a period of planned leave for me, but for those four days I got an insight into what a day might look like for an unpaid full-time carer. I managed to arrange care for when I returned to work, but I returned from leave more exhausted than I was when I had finished.

Sadly, Dad’s condition deteriorated and he was hospitalised. It was only then that his needs were assessed and at the discharge process that the right level of care was put in place. Did this now mean I was no longer a carer? No, I am. It has just changed what the extent of my role was – something it took me time to realise.

**Alan’s Dad with Alan’s niece Cora and nephew Callum**

Making the time for care – and self-care

For those of us working in Healthcare Improvement Scotland and the wider NHS, person centred care is a strategic priority. But what do you do when the person doesn’t want the care? Whether it was social or health-related, if you value the individual and believe in their right to self-determine, where does this leave you when they refuse everything until a crisis situation occurs?

The feelings of failure and guilt are difficult to shift. I’ve learned this is not uncommon. The same feelings also transfer to work, where the impact of a caring role, even remotely as I am now, affects your ability to focus and concentrate, to balance being responsive to the person you care for against what you are employed to do.

Fortunately I’ve found my managers to be extremely understanding and flexible, as are colleagues across Healthcare Improvement Scotland. But – and this takes me back to the point about assumptions, both my own and those of other people – it was only when I described what was happening on a daily and weekly basis that I really articulated what I needed both for the person I care for and my own wellbeing. ‘Protected lunchtimes’ if you will.

Only this week, someone referred to me as a carer. What they reflected back to me was that the time I was setting aside for a lunch break, to prepare and eat lunch, get some exercise and make that vital call to my father wasn’t just a lunch break. It was a break for caring too. No wonder the 30-60 minutes set aside for this wasn’t working. The calls alone are typically 30-60 minutes. My work calendar is now populated with ‘lunch and carer time’ each day.

Golden opportunity to hear – and improve

If you have a caring role you should consider what your needs are. As a good friend has often said to me, “You can’t pour from an empty cup”. We can each know what we do, but much of it is unseen by others, including the mental and emotional toll. The cup needs to be refilled and you and those around you will know best how to do that.

We have an opportunity in Healthcare Improvement Scotland to listen, really listen, to each other and to the people we work with so that changes can be made and people are supported before crisis point. That means some really tough questions about policy and practice, as well as considering what ‘managerial discretion’ really means in policies – what it could limit just as much as what it can and does achieve.

We are in a privileged position to be seeing and understanding the experience of unpaid carers. We have a golden opportunity to consider how we hear those voices now and what that means for what we do, what we produce and how it is implemented and evaluated in the health and social care system.

By listening to others, truly listening, we can identify and challenge our own assumptions that we might not even be aware of. Sometimes it’s just being listened to that can make all the difference.

Alan Bigham is a Senior Programme Manager with Healthcare Improvement Scotland’s Transformational Redesign Team.

Further information:

If you or someone you know would benefit from support as a carer you can contact Care Information Scotland online or phone 0800 011 3200 to find out about support available.

Phone lines are open Monday to Friday 9.00am to 5.00pm.

Categories: COVID-19 blogs

Take action to benefit from the Act – Karen Mackenzie

Posted on November 17, 2020

Think that that email about workforce planning and legislation doesn’t apply to you as an Allied Health Professional? As part of Healthcare Improvement Scotland’s Healthcare Staffing Programme, Karen Mackenzie advises holding fire with the delete button.

How many times a day do you hit the delete button if you think an email isn’t for you? In my busy clinical role as a NHS Scotland Speech and Language Therapist, I’d often skim over emails that dropped in to my inbox with the words “legislation”, “workload” and “workforce planning” in the subject field. Surely that information was for managers or executives? My experience was that clinicians on the ground didn’t have any involvement in workload and workforce planning.

In 2019 I attended a Royal College of Speech and Language Therapists (RSCLT) Scotland Hub event that completely changed my perspective…and stopped me hitting that delete key. As a clinician with 14 years of experience in a range of settings where Allied Health Professional (AHP) services often struggled to meet service demand with a limited resource, the Health and Care Staffing Act (Scotland) 2019 got my attention. And like many of my colleagues, I had a lot of questions. What do I need to know? How is this going to affect my team’s day to day work? Can we get any support with this?

Not just for nurses

For a start, I found out that this legislation is not just for nurses. It applies to all Health and Social Care staff groups. What’s more, the Common Staffing Method and General Duties enshrined within the Act could change the face of AHP workload and workforce planning, helping us ensure that we have the right people in the right place at the right time to deliver safe, high quality person centred care.

While the Act does not impose minimum staffing levels, all NHS Scotland Health Boards will have a legal duty to ensure that they implement the General Duties of the Act. For AHPs, this means several things. First of all, our professional judgement matters when it comes to making decisions about staffing numbers and skill mix. As clinical leads for our services, we can help shape vital decisions around staffing. And even if you’re not the lead, your thoughts matter when it comes to workload and safe staffing. Every team should have a process that allows them to decide on a daily basis whether their service is “safe to start” based on available staff. That way, the impact of staffing numbers and skill mix on quality of care will be made clearer. Furthermore, when clinical staff identify risks associated with reduced staffing levels, there will be clear, easily accessible processes for mitigating and escalating these risks.

From deleting to developing resources

I’m now an Assistant Programme Advisor with Healthcare Improvement Scotland’s Healthcare Staffing Programme. I’ve come a long way from hitting the delete button. I work in partnership with people from a range of health and social care professions to help them understand what they need to do to get ready for the enactment of the legislation. The team I’m part of also develops tools and education resources to help our stakeholders measure and plan their workloads and capture the quality of patient care and staff wellbeing.

We’re talking to everyone from AHPs to care home staff, and in the current pandemic we have supported teams with simple solutions to real time staffing assessment. For example, our team members worked with our stakeholders and the Scottish Government to develop simple Safety Huddle and Professional Judgement templates that can be used in a variety of settings, including care homes, to assess real time staffing and risk on a daily basis. Over 1000 Care Homes across Scotland registered to use the safety huddle template. We collaborated with our colleagues at NES Digital to further develop the Care Homes Safety Huddle into a digital resource on Turas. We also work with Workforce Leads from NHS Scotland boards to ensure that they have the right knowledge, skills and training to support Health and Social Care staff to embed the duties of the Act. The clinical voice of a wider range of professionals is a welcome addition to the support we offer and the resources that we develop.

So the next time you see an email with the words “legislation”, “workload” and “workforce planning” in the subject field, don’t just hit delete. It could hold the key to making your team safer, stronger and ready for anything.

Karen Mackenzie is an Assistant Programme Advisor with Healthcare Improvement Scotland’s Healthcare Staffing Programme.

Find out more

Check out our webpages on the Healthcare Improvement Scotland website

Speak with the Workforce Lead for your NHS Board area for information and suggestions on how you can get involved.

Categories: COVID-19 blogs

Patients benefit from moving vital work to a virtual space – Daniel Cairns

Posted on November 4, 2020

When the pandemic arrived, routine decisions on the status for Scotland of newly licensed medicines were paused. Daniel Cairns of Myeloma UK, Scottish Cancer Coalition’s representative on the SMC Public Involvement Network (PIN) Advisory Group, explains how moving one of Healthcare Improvement Scotland’s biggest and most complex meetings into a virtual space, allowing vital decisions to be made, has been welcomed by patients.

Access to new medicines is a vital part of a cancer patient’s journey. As a patient advocate, I represent patient views, insight and experience on new medicines, and help to feed that insight into the work of the Scottish Medicines Consortium (SMC) as they look to make recommendations for newly licensed medicines, including those for cancer patients.

Cancer medicines are a large part of the work for the SMC. When the pandemic arrived, it was understandable that parts of the SMC process had to pause as Healthcare Improvement Scotland helped to tackle the challenges posed by the pandemic.

Whilst we were all disappointed for patients, we were not surprised that the work of SMC was paused, since a large part of both the committee membership and SMC staff is made up of healthcare professionals who were needed elsewhere to help with the pandemic.

With continued uncertainty as to when face-to-face meetings will be able to begin again, I was heartened to hear that SMC had found a way to restart its confidential meetings by moving them online.

The benefits of moving SMC online

It feels like every organisation in the country has been given a crash course in online working. With that in mind, a virtual meeting format was almost expected to be rolled out for SMC, and the Scottish Cancer Coalition is very happy that this has happened. The work of SMC is vital in enabling patients in Scotland to access potentially lifesaving new treatments and extending access to existing treatments.

We are pleased that the work of the SMC has now fully resumed and are keen to work in constructive ways to help develop new ways of working which minimise any delays in access to new medicines due to the pandemic. I have been involved in informing some of this work through my participation in the SMC PIN Advisory Group.

Running smoothly

Between its pause and restart we were kept informed on the situation by both the SMC Public Involvement Team and the Scottish Government.

I recently took part in one of the first virtual Patient and Clinician Engagement (PACE) meetings, followed by the second ever virtual SMC Committee meeting in September. There was plenty of preparation given before each meeting. When we were notified of the PACE and SMC committee meetings, there was a helpful briefing detailing what to expect from the virtual meeting, together with some virtual meeting etiquette.

Alongside this, the Public Involvement Team were always on hand and happy to meet virtually to discuss any questions that I had. This was useful for me preparing for my first meeting.

Both the meetings I attended ran smoothly. There were no significant technical issues. The chair of the committee meeting was in good control over the virtual platform, allowing ample opportunity for patient organisations to contribute to the discussions around the appraisal.

The meetings were relaxed and easy to follow, with clear instructions from the SMC team. All of the attendees were courteous and we were given plenty of breaks to refresh our coffees and continue with each section of the meeting.

Could virtual meetings be the future?

I think virtual meetings certainly have a place in the future of the SMC. This kind of meeting is good for Patient Organisations who are based more remotely. It is also especially significant for PACE/SMC meetings when a patient organisation nominates a patient or carer to attend and speak about their own experience. Cancer patients have to take each day as it comes depending on how their illness or treatment is affecting them. It would be a huge advantage for patients to be able to contribute from the comfort of their own home instead of journeying in to attend a meeting in person.

That being said, the pandemic has had an impact on the third sector with many patient organisations restructuring due to huge losses in fundraising. Unfortunately, this may impact on the ability of some patient organisations to participate in health technology assessments.

As new treatments are such a vital part of myeloma patients’ outcomes, we remain committed to working with the SMC and the Scottish Cancer Coalition to ensure that these new treatments are delivered to patients.

Clearly, a great deal of hard work and dedication from the SMC team has gone into finding an innovative solution to the problems raised by the pandemic. The virtual meetings have so far been a success and it is brilliant for patients that the work of the SMC is continuing.

Daniel Cairns is Patient Advocacy & Policy Officer with Myeloma UK, a member of the Scottish Cancer Coalition and a member of SMC’s PIN Advisory Group which sits within Healthcare Improvement Scotland.

More information

Find out more about the SMC

Categories: COVID-19 blogs

Taking a vital meeting from actual to virtual – Lindsay Lockhart

Posted on November 2, 2020

How do you take a complex committee meeting and make it work online? Scottish Medicines Consortium’s Public Involvement Advisor Lindsay Lockhart explains how they successfully took one of Healthcare Improvement Scotland’s biggest and most vital meetings virtual.

So you think you’re pretty good at managing virtual gatherings – team meetings, drinks with friends, quiz nights with the family. But then you’re asked to get involved in setting up a really complex, really important committee meeting. Cue a sharp intake of breath.

Meeting the need

The Scottish Medicines Consortium (SMC) monthly committee meetings are the centrepiece of our work – and one of the largest, most complex and vital meetings in Healthcare Improvement Scotland. They’re the moment when everything comes together, in one large room, with lots of different stakeholders present, and complex decisions are made by committee members on whether medicines should be accepted for use in NHSScotland.

Well, that’s the way it used to be. Then COVID-19 happened. In March 2020, with agreement from Scottish Government, some of the work Healthcare Improvement Scotland does was put on pause. For SMC, that meant all our meetings, including the New Drugs Committee (NDC), Patient and Clinician Engagement (PACE) meetings and SMC Committee meetings, were suspended. Many of the SMC team were redeployed to working on frontline NHS services. By May, while many of SMC’s pharmacists and clinical staff were still needed elsewhere in NHSScotland, we started to plan our business recovery, something that was vitally important to ensure any further delay on decision-making and patient access to new medicines was minimised.

It quickly became obvious that we couldn’t meet in person for the foreseeable future. Urgent work had to be done to reinstate SMC’s meetings securely and professionally, avoiding reputational risk. We had to get this right for all stakeholders – committee members, patient groups, public partners, industry representatives, and members of the public.

A new role to help roll out a solution

Stepping out of my day job (and comfort zone) as SMC’s Public Involvement Advisor, where my role is to ensure the voices of patients and carers are heard as part of the assessment of new medicines, I became part of a small team with Ailsa Brown, our Lead Health Economist, and Rosie Murray, our Admin Manager. We undertook a rapid review of the options and quickly established that NDC and PACE meetings could be held virtually with Microsoft Teams.

To make this work, the staff who organise and assist at these meetings and liaise with external stakeholders had to become ‘technical hosts’ almost overnight. The speed with which we all learned how to manage meetings in this way was impressive. After a ‘mock’ NDC was held to iron out any technical issues, a virtual meetings protocol and etiquette document was produced. Thanks to the commitment of everyone involved, we were able to successfully reinstate NDC and PACE meetings in June and July respectively.

NICE to (virtually) meet you…

Then came the real challenge. The SMC Committee with its various complexities – confidentiality of information, public gallery, closed sessions with no public or external attendees, private voting by ballot – demanded more research … and quickly. Working with NHS National Services Scotland (NSS), it was established that the current roll out of MS Teams across Healthcare Improvement Scotland did not, at the time, provide sufficient functionality. While this is likely to change in future, for the short term, another solution was needed.

Through other COVID-19 related work, we knew colleagues in NICE were using the Zoom platform for their health technology assessment committee meetings. They had chosen to take this route long before COVID, following a full option appraisal and two years’ work to introduce virtual meetings for sustainability, cost and environmental reasons. With agreement from the Healthcare Improvement Scotland Executive Team, it was agreed that Zoom was the best option, in the short term, to allow its committee meetings to be reinstated quickly and efficiently. This included support contracted from NICE and their virtual meetings team, which provided us with the benefit of their experience and excellent knowledge.

Early discussions identified key requirements for SMC including licences, dedicated technical/digital support, testing and training for committee members and staff, production of guidelines, slides, corporate visual backdrops and branded meeting communications.

The complexities of committee

We also had to consider amending some processes to match the technology, for example, how committee members could vote in private. With six medicines on average discussed at each meeting, committee members used to cast their vote at the end of discussion for each medicine. With Zoom, this couldn’t be done without moving committee members in and out of a break out room for each individual private vote. The answer was to ask voting members to note their vote for each medicine and then cast their votes for all medicines privately once the public part of the meeting was over.

Slides to complement presentations were introduced. Non-committee members could follow the discussion using the slides instead of receiving a set of redacted Detailed Advice Documents (DADs) for each medicine. More staff were required to manage waiting rooms and break out rooms, and to keep an eye on technological hiccups so they could be quickly resolved. And then…we were ready.

Opening night nerves – and the importance of audience feedback

Our first SMC Committee meeting using this new method took place on Tuesday 4 August. SMC’s reputation – and indeed, that of Healthcare Improvement Scotland – was at the forefront of everyone’s minds so there was an element of ‘opening night nerves’ for all of us. Everyone had their own roles and responsibilities to ensure the meeting went well, and it did.

A debrief highlighted things which the team felt they would do differently for future meetings. Feedback from attendees also helped identify anything else which may have to be reviewed, so it was important to follow up all virtual meetings – NDC, PACE and SMC Committee – with an online survey for all attendees.

Feedback from the first meetings has been very positive, with all participants rating the overall experience of attending virtual meetings as being ‘very good’ or ‘good’. The majority of attendees found the technology ‘very easy’ or ‘easy’ to use and there has been a positive response to slide presentations. Clarity of communication from presenters/speakers has been commented on, with some attendees preferring virtual meetings.

Becoming experts

It’s early days, but they say practice makes perfect. Fortunately our virtual meetings team are fast becoming experts in the technology which will need to be a feature of all our work for some time to come. And with Rosie, Ailsa and I back in our “day” jobs, plans for future meetings are now in the very capable hands of SMC’s Operations Manager, Donna Leith, who has recently returned from maternity leave.

Still, it’s been said that everyone should acquire some new skills during lockdown. I’d like to think I know more now about virtual meeting technology than I did a few months ago … that and how to cut my husband’s hair!

Lindsay Lockhart is a Public Involvement Advisor in Healthcare Improvement Scotland’s Scottish Medicines Consortium (SMC).

More information

Find out more about the SMC

Find out more about SMC’s role in our Evidence Directorate

Categories: COVID-19 blogs

Virtual events: feel the fear and do it anyway – Stuart Donald

Posted on October 26, 2020

The last eight months have seen Healthcare Improvement Scotland’s wealth of events and meetings move from actual to virtual. As someone used to delivering workshops face to face – despite an early fear of speaking in front of large groups – Interim Portfolio Lead for Strategic Planning Stuart Donald offers us some food for thought.

Earlier this year, on my way to deliver a fairly typical workshop in a fairly typical conference room, I started thinking about my early experiences of speaking in front of large groups of people. As I’m sure is the case for most of us, this involved getting up in front of my high school English class and talking for five minutes about whatever generic topic our teacher could think of. Being an awkward, ridiculously self-conscious teenager, it wasn’t the most enjoyable experience I’ve ever had – particularly when it got to the point of panic attacks and vomiting.

If you’d told that kid that twenty odd years later he’d end up speaking to large groups of people for a living and that he’d actually enjoy it and be pretty good at it, he would probably have laughed in your face. Then vomited again.

Cutting a very long story short, over time and with a load of trial and error, the sheer terror of speaking to large groups of people gave way first to an ability to tolerate it, then to enjoying it and ultimately to approaching a level of competence. The nerves and self-doubt never go away, you just find ways to use them positively.

The point is that often the only way to take the fear out of something is to just get on and do it, that way you learn what works – and what doesn’t.

The days of getting a group of people into the same room to discuss, debate, share ideas, collaborate and generally put the world to rights might be a long time returning. For those of us whose work largely revolved around doing exactly that, we’ve had to figure out how we do it in an inclusive, yet physically distant way.

As Healthcare Improvement Scotland is an organisation that’s all about finding out what works well and what can be improved, a small team of us have pulled together learning from across the organisation to help us all get better at collaborating virtually. Here’s some of what we’ve learned.

Accept that it’s not the same as face to face

We’ve all experienced the joy of sitting staring at a blank flipchart while nobody answers the facilitator’s questions. Or the awkward ‘introduce yourself to the rest of the room’ and ‘share an interesting fact about yourself’ ice-breaker. Do we really need to recreate that virtually? I really, REALLY hope not.

Everyone knows the way we work now and in the future is going to change, so we need to adapt and maybe move out of our comfort zones a bit. For example, why do you need to run a virtual workshop ‘live’? Could you get the same, or better, outcomes by setting some sort of challenge to people and giving them a set time to complete it? Naturally there’s going to be risks and benefits to doing that, but that’s true of running something live too – if it’s going to achieve the outcomes you’re working towards, just do it.

Don’t be limited to one way of working. Try things out, keep doing what works, stop doing what doesn’t. By focussing on outcomes and the needs of our participants, we can design effective interventions that work for us.

How will you make sure everyone can participate?

Any time we run any kind of meeting or event we should always be thinking about accessibility. Virtual collaborations are no different. For example, you don’t need to be thinking about physical access to a venue, but you do still need to think about things like how people with sensory impairments can participate.

It’s important to remember that accessibility also means your participants having access to technology and the confidence to use it. As we get more and more used to communicating virtually, we need to make sure we’re not putting up unnecessary technological barriers for our participants as well. For example, do you know if some people might have to join your session using a smartphone rather than a PC or laptop? How does that change the experience for them? What do you need to do to make sure they can still participate?

It’s a team effort

You could certainly try and run a virtual meeting or event yourself, but I wouldn’t recommend it! What if your technology fails, the cat jumps on your keyboard and disconnects you from the session, or a child really must tell you RIGHT NOW all about the episode of Paw Patrol they’ve just watched? Take it from me, these things happen…

There are lots of eventualities and you can’t always prepare for them all, but as a minimum a good virtual session needs a delivery team. This includes someone to lead and facilitate the session, a backup facilitator, someone to monitor the chat box and respond to comments or flag them to the facilitator and someone who can support participants who need any extra help or IT troubleshooting (and potentially, someone who can provide 1-2-1 support throughout to anyone who couldn’t otherwise participate). The bigger the meeting or event, the bigger the delivery team you’ll need. In Healthcare Improvement Scotland we’re very fortunate to have so many talented and helpful colleagues to help deliver virtual meetings and events, so make the most of them.

Share your learning

As with everything we do, we should be seeking feedback and learning to help us improve for next time. Ask your participants, have a debrief amongst your delivery group, be honest with yourself about what worked well, what could have been better, and what you would do differently next time. Then share those insights with everyone else.

I’m not going to lie, I really miss presenting to a room full of people. The thought that it could be six months or more before I get to experience that buzz again is a bit sad. Delivering things virtually is definitely a different thing altogether, but it’s been great to learn about how as an organisation we’ve already started to embrace it, and to help pull what we’ve learned so far into something we can all keep building on.

Stuart Donald is Interim Portfolio Lead for Strategic Planning, within the Transformational Redesign Unit in the ihub

More information

For more information on the work of the Transformational Redesign Unit visit the ihub website.

Categories: COVID-19 blogs

Value of being clear when it comes to cancer treatment – Dr Alastair Lawrie

Posted on October 8, 2020

As we publish guidance on consent for cancer care, Consultant Haematologist Dr Alastair Lawrie tells us how important it is to ensure patients are well informed about their treatment and what it entails – and looks at where the guidance will go next, following on from the COVID-19 pandemic.

It’s May 2020, and I am phoning an elderly patient I’ve known for several years. She has chronic lymphocytic leukaemia, a common, slow-growing blood cancer. She was diagnosed incidentally after having blood samples taken for another issue and has been well until recently. Like many patients, she has been shielding at home and has not left the house since February. Her GP has contacted me highlighting concerns about weight loss and fatigue. They arranged a blood test for her at home, and this shows progression with deterioration in her blood counts. She almost certainly has reached the need for treatment that cannot wait until the COVID-19 pandemic is over.

We chat about her blood tests and condition generally. She is struggling but is clearly terrified of coming to hospital. We had discussed chemotherapy before, and she is particularly worried about the risk of regular intravenous treatments bringing her into contact with others, as well as her risk of infection generally. I explain that temporary approval has been given in Scotland during coronavirus to use a newer, oral chemotherapy treatment to treat her leukaemia. It will also increase her risk of infection, but will greatly reduce her need to leave the house or attend hospital. We have not previously discussed this medication before and she has lots of questions.

Clarity and consent are key

When it comes to cancer treatment, it’s not surprising that patients like the one in this case have a lot of questions. While Systemic Anti-Cancer Therapy (SACT) – chemotherapy – has been widely used for years, it’s still a high risk treatment with a lot of potential side effects. Yet although written consent for chemotherapy is not specifically required by law, it is widely regarded as best practice in support of a full discussion with the patient about the intended benefits and possible risks of a treatment. We know from regular audit of chemotherapy services in Scotland that current practice is good. However, it’s also been identified that there is wide variation in the approaches that individual health boards employ to seek written consent for chemotherapy.

In 2018, the Scottish Cancer Taskforce asked Healthcare Improvement Scotland to review this issue, with the aim of identifying best practice and standardising this across Scotland. A working group comprising medical, nursing and pharmacy representation from across Scotland examined and compared various approaches.

The approach endorsed by the group was to use regimen-specific consent forms. These are already widely in use in England, where a ‘library’ of over 200 custom-designed consent forms for each individual chemotherapy combination or regimen has been created. The forms have been developed by cancer clinicians at Guy’s and St Thomas’ Hospital in London and more recently, this project has been funded and supported nationally by Cancer Research UK. A key aim of this approach to improve consistency and clarity in the communication with patients. This improves shared decision-making, and makes the process of consent more patient-centred. Feedback from patients who have used the forms has been positive.

Focussing on the impact on the individual

Central to the need for clarity and consent is the need to ensure that the discussion and risks are individualised to the patient. One example given of this is the risk of nerve damage from chemotherapy, which may have different implications for a concert pianist, for example, as opposed to other people. In practice, I have found that the new forms help with this, by offering a clearer and more consistent summary of what a particular chemotherapy regimen will involve. This then helps elicit the concerns and questions of particular importance to that patient.

I’m optimistic that the CRUK regimen-specific forms will be a positive step once implemented across Scotland. The coronavirus pandemic has resulted in radical changes to many aspects of clinical work. Remote consultations and paperless working are now moving from an aspiration to the standard of care. These new forms already help with remote consultation and work is already under way to explore creation of electronic consent forms.

A successful outcome

And my patient? Well, she was receptive to discussions about her proposed treatment, both through the phone call with me and a follow-up call with a clinical nurse specialist. An information booklet on the treatment was sent to her by post, together with a consent form specific to that medication. We debated initiating the treatment remotely – a friend agreed to collect the medication – but in the end, she decided to attend clinic for in-person assessment and to receive her first prescription. She responded well, with minimal side-effects and has been treated remotely since then and continues on treatment. For her, and for me as her clinician, the opportunity to discuss the benefits and risks of her proposed treatment, particularly given her nervousness about attending hospital during this unprecedented time, cannot be overstated. To see such discussion and consent formalised for patients across Scotland will, I believe, be a benefit to all.

Dr Alastair Lawrie is a Consultant Haematologist at Aberdeen Royal Infirmary.

More information

Visit the Healthcare Improvement Scotland website to read a news article on this work and to access the latest guidance.

Categories: COVID-19 blogs

Total Recall – Gail goes from her new home back to Homeless – Gail McDonald

Posted on October 6, 2020

While the COVID pandemic has hit everyone hard, for those who are homeless the challenges have been even greater, as Senior Inspector Gail McDonald tells us.

Usually, you take up a secondment expecting you’re going to be working somewhere else for a while and you mentally prepare yourself for the changes. What you don’t expect is what happened to me. After 14 years working in Homeless Health Services, towards the end of last year I was offered a two year secondment with Healthcare Improvement Scotland as a Senior Inspector on the Adult Support and Protection (ASP) Inspection Programme. And I thought that would be it for the next two years.

But after just four months, my old colleagues were unexpectedly seeing my face again as I returned to my substantive post because of the global pandemic. It was certainly something neither me nor my colleagues could ever have predicted!

Making sure the support is there

With my old role as Team Lead for Occupational Therapy and Mental Health Teams already backfilled, there was no obvious place for me to slot into at first, but I was happy to return to the work I love, with many valued colleagues, and I was willing to pick up whatever I needed to. Ultimately, I took on a role as Occupational Therapy and Admin Team Lead and had a role in the service recovery and social distancing planning in the building.

My first days back were a bit odd, trying to deal with the sudden shift from one role to another. But in many ways we were all in the same boat: it was the early days of lockdown so the atmosphere and environment was one of uncertainty, change, but most of all of support. Staff from all teams were really pulling together to ensure the delivery of essential services for homeless people was maintained. There was a focus on mental health care and treatment, urgent General Practitioner services, wound care, needle exchange, sexual health and opiate replacement treatments. The city had already undertaken emergency action to accommodate any individuals who were rough sleeping or in night shelters where isolation and social distancing was not possible, including individuals with no recourse to public funds. This was to ensure people could keep safe and comply with isolation and ‘lockdown’ recommendations. People were primarily accommodated in city centre hotels with food parcels or meals being delivered daily.

The need to maintain contact

In the initial weeks the expectation was that those who were homeless would be disproportionately affected by COVID-19. This population have poorer health, live in more communal-type settings and are arguably less able to follow some of the restrictions of lockdown due to health and social functioning issues. The obvious conclusion, therefore, was that the death rate would be higher. Service delivery planning initially became about reducing and restricting contact for the safety of service users and staff alike, with the exception of the mental health team whose contact remained consistent due to the level of vulnerability of their service users.

However, it soon became clear that the risks of no contact with service users outweighed the risks of COVID- 19. Individuals who are homeless are dealing with a whole variety of issues beyond and arguably more severe than COVID-19. Day centres and visiting supports were closed, so social and community supports were significantly reduced. We had to set up alternatives quickly, ranging from daily visits or phone calls to weekly or a minimum of monthly face to face contact. There was a focus on assertive outreach and those service users who had no phone were issued with pay as you go mobiles. This low cost intervention proved to be hugely valuable to both service users and staff. Service users valued the means to stay in touch and have continued engagement. Health and social care interventions increased due to staff being able to contact them. Even service users who had been typically reluctant to engage with health were open and inviting increased contact – a real indication that the situation was taking its toll on how people were feeling.

Breaking down barriers

In general the situation in relation to COVID-19 strengthened the need and justification for a health service with reduced barriers and an assertive outreach approach. Much of the work was adapted or an extension to what already existed. The addiction service probably experienced the most significant learning curve as they had to work out how to continue to support those undergoing opioid replacement therapy, such as treatment with methadone. For most people, the answer was to give them longer prescriptions and more take home doses, rather than their usual daily dose at a pharmacy. But this was only undertaken after a risk assessment had been carried out. We did, of course, have a lot of service users who went through very hard times due to COVID-19. Some were not allowed back into their accommodation as they were not following lockdown rules. Drug debts increased for some, as there were far fewer opportunities for begging. Treatments for conditions like hepatitis C were suspended. Contact with children was limited and rights to have access reviewed were suspended due to courts not sitting. And, just like the rest of us, there was the sense of increased isolation from family and friends.

There was undoubtedly an increase in homeless presentations over this time, but with registered social landlords not accepting referrals and there being virtually no movement ‘out’ of homelessness into permanent accommodation, a huge block was created in the system. This will impact homeless people for months beyond this initial lockdown, and the demand on all the additional support services is continuing to grow.

A learning experience

While what I’ve seen for individuals affected by homelessness in the past few months has been some of the toughest in my career in the past few years, I’ve also learned a lot. I’ve seen first-hand how service delivery can adapt and evolve in response to a unique situation. I’ve seen a renewed commitment to challenging structured, non-flexible health care delivery. And I’ve seen the willingness and supportive nature of most staff when push comes to shove.

It’s been intense, and it’s taken me a couple of weeks to wind down from, but I’m glad to be back at Healthcare Improvement Scotland and looking forward to putting what I’ve learned to good use in the Adult Support and Protection (ASP) Inspection Programme.

More information

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

Categories: COVID-19 blogs

Devices and data – keeping Scotland connected – Wendy McDougall

Posted on October 2, 2020

During lockdown, those people who were digitally excluded became even more isolated. Wendy McDougall, Engagement Officer in Healthcare Improvement Scotland – Community Engagement explains how her team helped keep people connected.

When the world went into lockdown, our lives moved online – even accessing health and care services was online, along with grocery shopping and only being able to see loved ones through a video call. As a result, the Scottish Government quickly implemented a £5million initiative called Connecting Scotland to get 9,000 vulnerable households online. The idea being that those who are most vulnerable across our communities will be provided with a device or training that enables them to connect with health and care services, as well as other people in their community and family that may be further afield.

There were eight teams working across the country on the Connecting Scotland initiative and our role was to find community venues that could be used for training on how to use digital equipment and distribute the devices, should they be required. We were an important part of a big jigsaw!

To do this, each engagement office across the 14 NHS board areas spent a number of weeks contacting their local third sector and community group networks. This was a great opportunity for me as a new recruit to pick up the phone and, not only introduce myself as the new Engagement Officer for Forth Valley but, more importantly, actively listen to the challenges that are sadly being faced by people living in poverty and the resulting barriers they can face on a daily basis.

Over 60 community groups were contacted in the Forth Valley area alone and we still managed to make a number of new connections ranging from the Church of Scotland to bowling clubs. The conversations had such a positive impact on me, highlighting that organisations and volunteers were willing to do anything within their power to help others. It was so insightful being in a position to witness a strong sense of community spirit and strength in practice.

Another team was responsible for identifying those who were eligible for devices and data. To be eligible households had to be digitally excluded, on low incomes and be at risk of isolation due to the coronavirus pandemic. We were able to link our community groups to these other teams to ensure they could access the resources of the Connecting Scotland initiative.

Once eligible people or organisations who worked directly with eligible people were identified, they were given an internet-enabled device and were linked with a Digital Champion who provides six months of training and support over the phone.

Connecting Scotland has made a significant difference to the lives of thousands of people who were missing out on the benefits of being online. It has enabled them to stay connected to friends and family, be informed and entertained, access health and care services and able to continue learning and working.

In the Falkirk area, a community centre was able to get iPads, Chromebooks and MiFis, – a MiFi taps into mobile phone networks and uses this to create a mini wireless broadband cloud or hotspot. Four of the community centre leaders have been trained as Digital Champions via the Connecting Scotland initiative. The centre was also able to source funding for six further laptops and a printer to start a computer companions Sunday coffee club. This allowed people to be paired up and learn from each other. They also have an IT suite through the week for people to access and get help.

One of the community centre leaders commented that, “Many of our families are living in deprivation with no access to the internet and cannot afford digital equipment. One of our aims is to help bridge the attainment gap by providing the digital equipment needed to access education to local families. Another barrier our individuals are coming up against is lack of training and isolation. They are isolated in their homes or community and unable to use the internet to stay connected. With the equipment and mentoring we aim to create ‘inclusive growth’ online through Connecting Scotland. By tackling these barriers we are encouraging education, upskilling and contributing to the community which aligns with the national framework.”

It was heartening to hear how communities have accessed Connecting Scotland, and have further developed what is on offer in their areas. I heard someone say that digital connectivity is a necessity for modern life, not a luxury. I’m glad that I could be part of a team working towards this vision.

Little did I know that this was only the first phase of the Connecting Scotland initiative.

As local lockdowns are being put in place across the country, Connecting Scotland clearly has an important role to play. An additional £15 million has recently been allocated by Scottish Government. This will help thousands more families who cannot afford to get online, making sure they are not further disadvantaged by providing the necessary hardware, data, and skills they need to get connected.

Wendy McDougall is an Engagement Officer with Healthcare Improvement Scotland – Community Engagement.

More information about the Connecting Scotland initiative.

Categories: COVID-19 blogs

Putting Evidence at the heart of everything we do – Safia Qureshi

Posted on September 10, 2020

Our Evidence Directorate are about to launch a new approach to the way they take on work. Director Safia Qureshi explains her vision for the directorate – and why evidence should lie at the heart of improvement.

Have you ever stopped to wonder how many pieces of advice or guidance, reviews, reports, statements or strategies Healthcare Improvement Scotland has published over the years? It’s the sort of question you might ask yourself if you were coming along for a job interview, which is exactly where I was around about fifteen months ago, gearing up for round one of interviews for the role of Director of Evidence.

The answer is: a lot! Search our website and there’s over 1000 items to choose from, published over the last 10 years. And that doesn’t include the work of the Scottish Antimicrobial Prescribing Group (SAPG), the Scottish Intercollegiate Guidelines Network (SIGN) or the Scottish Medicines Consortium (SMC) which sits on separate sites. Adding these publications in takes our total to well over 2600 – with around 1560 pieces of medicines advice from SMC alone – all of it robust and trusted advice.

That’s a lot of work, covering an enormous range of subjects. How did we decide what to do? How should we decide what to do? Can we make better use of our resources? How do we make best use of our resources to provide the advice and guidance that will best help to shape the decisions made by health and social care organisations as they work to resolve the issues facing the NHS in Scotland?

Building on our strengths

I didn’t get asked about publication numbers at my interview – it’s all a bit of a haze now – but we did talk about the role of Healthcare Improvement Scotland in making sure evidence is at the heart of decision making. As Angela Timoney, the Chair of SIGN, likes to remind us in these days of disparaging experts: “evidence matters – our challenge is to ensure we address the most important issues”.

This is the challenge I’ve set myself – and the teams across our Evidence Directorate: to put evidence at the heart of decision making. There’s been some great work from all the teams in the directorate- SAPG, SIGN, SMC, Scottish Health Technologies Group (SHTG), Standards & Indicators and the Data Measurement and Business Intelligence team (DMBI). Now we’re looking to build on their strengths to ensure we have something even better to offer.

A force for improvement

At present, each team has its own approach to topic selection and prioritisation of work. In practice that means each sets its own timetable for taking on new work, each has its own selection criteria and each its own selection committee. All of these individual approaches are perfectly valid – this is the Evidence Directorate after all, we think very carefully about the right way to do things. But by harnessing all these parts into a whole directorate approach that aligns stakeholders’ needs with our wide range of skills and expertise, we can think strategically about our work programme and maximise the impact of our work. This way, I think we can provide a real force for improvement, something that will make a real difference to NHSScotland.

More than the sum of our parts

With that in mind, from 17 September we will be thinking about our work programme in a completely new way. We will start our move towards a coordinated work programme that aligns more clearly with national and organisational priorities. One multidisciplinary committee will use one process and one set of criteria to agree a coordinated work programme for SIGN, SHTG and Standards & Indicators, with more explicit alignment and support from DMBI, SAPG and SMC. This will help us to use the resources of our directorate in a way that is more responsive to the questions and problems posed by stakeholders. We think it will allow us to provide a more coordinated and flexible response that can call on any or all of the skills and outputs across the directorate. At the same time we’re going to raise the profile of the Evidence Directorate in its own right, as more than a collection of the sum of its parts.

Of course, given the consideration, development and production time of our advice and guidance, it will take a while for our new approach to fully kick in. We’re still committed to delivering all of our existing programme of work, but it’s very exciting to be taking the first steps down a new road.

Safia Qureshi is Director of Evidence for Healthcare Improvement Scotland. Follow her on Twitter @qureshisafia1

More information

Find out more about the new approach

Categories: COVID-19 blogs

Tagged: Evidence

Do the Scottish public know how to use antibiotics wisely? – Jacqui Sneddon

Posted on September 8, 2020

Our Scottish Antimicrobial Prescribing Group (SAPG) have spent the last ten years raising public awareness of the threat antibiotic resistance poses. But is the message getting through? SAPG lead Dr Jacqui Sneddon decided to find out, with help from colleagues in our Community Engagement Directorate.

Since 2010, the Scottish Antimicrobial Prescribing Group (SAPG) have led annual campaigns, centred around European Antibiotic Awareness Day on 18 November. The aim is to communicate messages to healthcare staff, patients and the public about the threat of antimicrobial resistance and the need to use antibiotics wisely to protect them for future generations. Staff in health boards and our Public Partners have supported campaign activities tirelessly across hospital and community settings, including schools, youth groups and even Aberdeen Football Club. We’ve also managed to get our own Brownie badge, thanks to one enterprising SAPG committee member developing an awareness raising project for her Brownie pack. But how do we really know if these messages are reaching the public? Is what we’re doing really influencing people’s behaviour around managing common infections and seeking antibiotics from their GP?

Opportunity knocks…

After attending a Scottish Health Council (now Community Engagement) presentation on Citizens’ Panel surveys back in 2019, it struck me that there may be an opportunity to have a Citizens’ Panel survey on antibiotics.

A Citizens’ Panel is a large, demographically representative group of citizens regularly used to assess public preferences and opinions. The Our Voice Citizens’ Panel was established in 2016 to be nationally representative and currently comprises just under 1,200 members of the public from across all 31 Integration Authorities. Since the panel was established, it has gathered the public’s views on around 20 different health and social care topics and has begun to demonstrate impact on ongoing health and social care policy and practice.

Welcome result

Our survey ran earlier this year, and received a 52% response from panel members, so it’s statistically robust at a Scotland wide level. More importantly, the recently published findings make welcome reading for those of us working on safeguarding antibiotics. The majority of the panel had heard of antibiotic resistance, knew that this means bacteria fail to be killed by antibiotics and that overuse of antibiotics is the main cause of resistance. Most people also knew the difference between bacterial infections that can be serious and viral infections that usually cause coughs and colds.

When it came to seeking help when they or a family member was unwell with a suspected infection, most said they would ask a healthcare professional such as a doctor or pharmacist for advice, or consult a reputable on-line source such as NHS Inform. Over 90% of panel respondents had been prescribed an antibiotic at some time and about 40% had needed a second antibiotic, possibly because the infection was resistant. When it came to using antibiotics, most people would complete the course, would not share antibiotics with others and were not likely to try to purchase antibiotics on-line or when overseas on holiday. Respondents also knew which common infections are likely to get better without antibiotics, with the exception of earache in young children which they incorrectly thought would usually need antibiotic treatment.

Looking to the future

We also wanted to know whether the panel were aware of the campaigns run by SAPG and others on infection-related topics. About half of respondents had seen some of the campaign materials, usually in Health Centres. I was pleased to learn that over half of respondents were aware of the “Pharmacy First” service which provides treatment of common infections via pharmacies, and over one in four respondents had used the service. And as a pharmacist myself it was also good to know that the majority of people would be happy to seek and take advice from a pharmacist.

This survey has been helpful for SAPG and I’m sure it will be of interest to colleagues in other UK nations. We’re hoping the details will help us design public awareness campaigns to save our antibiotics. From the survey results, both reinforcing advice about self-care for common infections and highlighting which infections may require antibiotic treatment so that people can consult their GP or pharmacist for advice when necessary look like avenues we may explore in future. Thanks to the Citizens’ Panel, we’ll now be able to target future campaigns more effectively.

The Our Voice Citizens’ Panel Survey on awareness of antibiotic resistance, appropriate use of antibiotics and related public health campaigns report is available on the Community Engagement website.

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

@jacquisneddons @HISengage @SAPGAbx

More information

Visit the SAPG website

Categories: COVID-19 blogs

Tagged: COVID-19