Posts from the “COVID-19 blogs” Category

Let’s continue the conversation on health inequalities and improvement – James Battye

Posted on June 8, 2021

Equality is important. As a publicly funded organisation, Healthcare Improvement Scotland has legal duties to take action to address the inequalities that exist in Scotland. We must also be able evidence how we have met our duties in everything that we do. So how do we make sure it underlies our work? Associate Improvement Advisor James Battye give us his thoughts.

Since joining Healthcare Improvement Scotland’s ihub, health inequalities and what to do about them has been a key theme of my work. Given what we know about health inequalities in Scotland, keeping a constant focus on this is absolutely essential.

I won’t pretend that weaving this into my own day to day role as an Associate Improvement Advisor has been easy. I’ve spent a good chunk of my time doing a bit of head scratching and wondering whether I am on the right track.

For example – did I get that Equality Impact Assessment (EQIA) right? What will I do with it now?

Sessions like the equity knowledge café session organised by our Evidence and Evaluation for Improvement (EEvIT) team have been really helpful in clarifying my thinking, and left me keen to keep exploring the question of what we can do to address health inequalities in our work.

Health inequality and quality improvement

Towards the end of 2020, with the help of Zoom/Teams I had the opportunity to attend the Institute for Healthcare Improvement (IHI) Forum.

Health inequality was a key theme of the forum. Keynote speakers included Roseanne Haggerty, CEO of Community Solutions, a charity whose mission is to end chronic homelessness in the US and Patrisse Cullors, a social activist and co-creator of Black Lives Matter. In addition, among the sixty or so breakout sessions there were a good few dedicated to improvement and inequalities.

For me, two questions stand out when I think about health inequalities and quality improvement: firstly, what can health and social care systems do to support and sustain a culture of improvement and redesign around health inequality? And secondly, how do we measure the effect improvement or redesign has had on health inequalities themselves?

Supporting a culture of improvement and redesign around health inequalities

One theme emerged early on during presentations and this was the importance of a strong values base along staff at all levels which incorporated addressing inequality.

This was particularly evident in the United States in relation to Black Lives Matter. The movement has prompted health and social care professionals to examine their practice and consider whether they were doing all they could to end the racial disparities which exist within the U.S.

In the examples shared during the forum, health and social care professionals said they felt empowered to take action as tackling inequality was part of their job. They also said they felt supported by their leadership teams to take action. On the face of it this seemed be a key factor in mobilising a health and social care system to introduce changes which aim to reduce inequalities.

Considering Scotland, I think we have some of the right building blocks in place. For example there’s our own work on Quality Management Systems in which leadership and shared values are a key part. We also have the NHS Scotland’s 2020 workforce vision which includes a focus on providing more equitable access to healthcare.

However, I’m sure we’ll all agree that there’s much more to do.

Measuring the impact of initiatives to address health inequalities

When it came to how health and social care professionals measured the impact of initiatives which sought to tackle health inequalities things were a little less clear cut. Presenters admitted that often they just didn’t have the data – e.g. on demographics, income or something else – and they needed to put their efforts into improving what data they could gather. In fact, the content of the presentations was similar to many of the conversations we had as part of EEvIT’s knowledge café on equity.

Initially I was left a little disappointed by the Forum. I didn’t get that golden nugget that I was hoping might show me the way in relation to my own day job. But on reflection I actually found this encouraging: many improvers across health and social care are at the same point as us. We want to collectively address health inequalities, but we are not always sure what we can do and we are not sure how to measure it.

What can Healthcare Improvement Scotland do to address inequalities?

For me the IHI Forum helped underline why internal initiatives like the inequalities and equity knowledge café session organised by EEvIT are so important. They provide the space for us to share what we know and what we don’t.

It has also prompted me to more actively consider inequalities throughout the entirety of an improvement programme. Not only am I going to ensure that the EQIA is as thorough as possible but I am also going to revisit it frequently – meaning that if I didn’t get it right the first time I can always change and adapt it.

James Battye is an Associate Improvement Advisor in ihub’s Maternity and Children Collaborative

More information

Find out more about the work of our Evidence and Evaluation for Improvement Team.

Categories: COVID-19 blogs, ihub

Pandemic puts person-centred care at the heart of dementia care – Marie Innes

Posted on June 1, 2021

Restrictions imposed as a result of the COVID-19 pandemic brought to light the importance of person-centredness in dementia care. As part of Dementia Awareness Week, Marie Innes of our Focus on Dementia team, explains why delivering care to people in the way that matters most to them is at the heart of Healthcare Improvement Scotland’s relaunched Dementia in Hospitals Collaborative.

The COVID-19 pandemic put many thing on hold for many people, including the range of improvements that health and care professionals across the country were focused on for people with dementia through our organisation’s Dementia in Hospitals Collaborative. As Healthcare Improvement Scotland focuses on restarting this important programme of work, the pandemic has brought lessons that will be important to how the collaborative moves forward – most importantly, the importance of person-centred care.

The collaborative started late in 2019 and was originally scheduled to run until September 2021. The aim was to bring together hospital teams from across Scotland to work on improvements to hospital care for people with dementia, with an overall focus on the prevention and management of stress and distress, plus four other areas of focus.

Along came COVID-19, and the collaborative was paused, not once but twice, during 2020.

But the last year has brought important knowledge that will help aid the next stage of the programme.

Supporting people in the way that matters most to them

Even before the pandemic, Person-Centred Care Planning had been an area that had consistently been highlighted as an area for improvement both by hospital teams themselves, as well as through the findings of our inspections into the care of older people in hospitals.

During the pause, we engaged with a range of stakeholders to find out their key issues around hospital care for people with dementia during the pandemic. One issue that came out consistently was that the restrictions to hospital visiting had caused issues in the way hospital staff were able to engage with families and carers of people with dementia. This made it difficult to find out what was really important to individuals to support a meaningful, person-centred approach to care. In addition, the necessary, stricter, infection control measures that had been put in place, often made it difficult or impossible to support people in the way that mattered most to them. These issues meant that a person-centred approach to care planning for individuals has proved more challenging and was therefore identified as a key focus area for improvement.

The aim of the collaborative in this area is that the hospital care of people with dementia will be informed by a personalised care plan which reflects their strengths, needs, wishes and choices. Moreover, the person-centred approach will support the prevention and management of stress and distress.

Another key feature of the collaborative is that we are working in partnership with the Alzheimer Scotland Dementia Nurse and AHP consultants who are providing local leadership for collaborative teams in their NHS board areas.

Building on the learning from the past

The best programmes focus on learning from the past and building on what we know works well. The Dementia in Hospitals Collaborative does the same, by building on the Specialist Dementia Unit Improvement Programme (SDUIP), a three-year programme that supported four sites to improve the quality of care for people with dementia within Specialist Dementia Units.

The learning from the SDUIP programme also helped inform an online toolkit to support improvements in dementia care in hospital settings. The toolkit is due to be launched on our organisation’s ihub website in summer 2021 to coincide with the restarting of the Dementia in Hospitals programme of work.

Hopes for the future

We are currently identifying new and existing teams who are able to re-engage, with a restart planned for June 2021 and the first Learning Session arranged for late June. We hope that teams will be not only sharing their learning with other collaborative teams through the collaborative activities, but will also be developing plans for scaling up and spreading their improvements within their own NHS board, as well as sharing their learning with the wider hospital communities through the Focus on Dementia Learning System.

The collaborative is a really exciting piece of work with huge potential to make a difference to Person-Centred Care Planning. Through testing new approaches to care planning and sharing with each other, the teams involved in this programme can really help to pull together all of the great work and learning that has been happening over the last few years. I believe that this will make a real difference to the experience of people with dementia and their families.

Marie Innes is an Improvement Advisor with the Focus on Dementia Team at Healthcare Improvement Scotland.

More information

Find out more about our Focus on Dementia work.

Categories: COVID-19 blogs, ihub

The four steps to the right Anticipatory Care Plan – Paul Baughan

Posted on April 21, 2021

We’ve launched a new section of our ihub website with information, tools and resources to support Anticipatory Care Planning (ACP), a crucial process which ensures that the right things are done in the future for each person, should their health change. Dr Paul Baughan, clinical lead with our Primary Care team explains why this ACP is so important and the various stages to enable the right outcome for patients.

The longer I work in general practice, the more I realise that there are many different ways to treat people who have exactly the same medical condition. Priorities for care vary considerably between individuals, and if we do not stop to ask “What matters to you?” then we can actually cause harm – even when following the latest evidence-based guideline.

Spending time with someone to explore treatment and care options that are right for them – in the context of their current state of health, their social situation, and the various priorities in their life – is critically important. It can ensure that the right things are done in the future for that person, should their health change. Things such as the type of medicines to use during an exacerbation or sudden deterioration, the people who should be contacted to help with decision making, and how the person would like to receive care if staying at home is becoming more difficult. These preferences can be written down, kept with the person, documented in their clinical notes, and shared with other people who need to know. Many people call this approach ‘Anticipatory Care Planning’.

***Diagram: The 4 steps of successful Anticipatory Care Planning***

There are four crucial steps to a successful ACP, which forms the basis of the new Healthcare Improvement Scotland ACP toolkit. Each of these steps is important to ensure that we do the right thing for the person we are caring for. We know that harm can be caused if we jump straight in at Step 3 (documenting a care plan), without the important preparation and planning, or having first engaged in meaningful conversations with the right people.

As a GP, as well as the Clinical Lead for Primary Care with Healthcare Improvement Scotland, let me explain how I’ve been using the four stages and how they help me to ensure that the right care plan is created for everyone.

Step 1: Preparation and Planning

The first step, Preparation and Planning, involves identifying who you will be having an ACP discussion with, then preparing yourself and the person for that conversation.

I do this by finding out as much as I can about the person before meeting with them. I ask myself the following questions: What is their current state of health? What have other professionals and specialists said or written in their notes? Is there anyone who normally supports this person with decision-making? What is their social situation? What realistic options are there for future treatment and care?

It is also important that I prepare the person with whom I will be speaking, check that they are happy to have this type of conversation, and ask whether there is anyone else who should be involved in these discussions (For example, a family member or power of attorney).

Step 2: Meaningful Conversations

The conversation between the health or care professional and the individual, as well as those important to them, is at the heart of ACP.

I find the REDMAP framework, developed by Dr Kirsty Boyd, Reader in Palliative Care at University of Edinburgh, a helpful structure to follow.

It’s important to allow appropriate time for these discussions, and this can be a challenge in general practice. I will often hold these important conversations over a number of different appointments over several weeks. This allows the person and their family time to think about things before we agree an action plan that is right for them.

Step 3: Documentation and Sharing

Once a plan has been made, it is important that it is shared with all those who need to know. After all, it might be needed in the middle of the night when the practice is closed. The best way that we have to share this information between health professionals is through the Key Information Summary (KIS). However, information can only be added to KIS through GP practice clinical systems. For those unable to access this, there is now a web-based Essential ACP Online Tool to document aspects of the ACP. This can be securely shared with the individual or the GP practice. Work is progressing with a digital version of ReSPECT, and ultimately I look forward to a time when we have a single citizen-held electronic health and care record. One within which my patients can enter their own information about ‘What matters to me’, and that can be supplemented with information from all the health or social care staff who are involved in providing care.

Step 4: Regular Review

People may change their mind about their priorities for care as their health or social situation changes. What matters to someone in six months’ time may be very different from now. That is why it’s important that ACP information is regularly reviewed and kept up to date.

33% of the Scottish population have something entered within their KIS. Not all of these will incorporate an anticipatory care plan, however it does present me and my primary care colleagues with a logistical challenge to keep them up to date. Healthcare Improvement Scotland with RCGP and Scottish Government has recently published pragmatic guidance and top tips for reviewing and updating KIS. An important aspect of this guidance is exploring the resources (people and time) that are available and ensuring that the extended multidisciplinary team is involved in these reviews. This requires preparation and planning, which of course brings us back to Step 1.

So whether, like me, you are working in general practice, or are based in another part of our health and social care system, anticipatory care planning is important. It is not a one-off activity to be ticked-off and completed, but instead is a process that requires preparation and planning, meaningful conversations, documentation and sharing and regular review.

Paul Baughan is a GP and the Clinical lead with Healthcare Improvement Scotland’s Primary Care Team.

More information

Visit http://ihub.scot/acp for all the resources mentioned here and share with us your learning about ACP by emailing: his.pcpteam@nhs.scot.

Categories: COVID-19 blogs

Getting on board – what it’s like to be a non-executive director – Rhona Hotchkiss

Posted on April 9, 2021

What’s it like being a non-executive director on the board of Healthcare Improvement Scotland? As we recruit for a new board member, Rhona Hotchkiss explains the route she took to becoming a non-executive director and the qualities you need for the role.

Sometimes life takes unusual turns that you can’t possibly foresee. Way back in 2004, after I spent a year as an Interim Director of NHS Quality Improvement Scotland (NHS QIS) – the predecessor organisation to Healthcare Improvement Scotland (HIS) – I left the NHS, seemingly for good, and went into management consultancy. I had no notion then that I would be back 15 years later as a non-executive director, nor of the path my career would take to get me here!

Scotland to Australia and then back again

But it all started way before HIS and way before QIS! I started my working life as a nurse, training with Argyll & Clyde Health Board, as it was then, and after qualifying went on to train and work in ITU. I went to Australia for 6 months on a working holiday visa, during which time I did agency nursing to keep myself fed and clothed, and the rest of the time generally scrounged off some Australian midwives that I’d become friendly with when they had previously come to Scotland to train.

Fast forward many years after my return from Australia, and life has taken more twists. It’s 1998 and I’m an advisor in Nursing and Quality at Scottish Government going on to become the first Director of the new Nursing and Midwifery Practice Development Unit for Scotland, NMPDU or ‘NUMPTY’ as it was affectionately known. After 2 years, NMPDU was one of the organisations that came together to form NHS QIS and then eventually became HIS. In a way, change and development was becoming quite normal.

Time for more change

By then I’d been working in the NHS for 25 years and it was time to try something entirely different, so I opted to join a consultancy firm. It was comprised of good people working to a very high standard, but, although I stayed for almost 5 years, it wasn’t for me. I missed the sense of unity and purpose, the feeling of service that the public sector had brought and, in a move that surprised many who knew me, I joined the Scottish Prison Service as a Deputy Governor. After being Deputy Governor at Barlinnie and then Shotts, I went on to be Governor of Dumfries (just the prison, not the entire town!) then to Cornton Vale, where I also project managed the reprovision of the women’s prison estate and finally to HMP Greenock, from where I retired in 2019. I could write a book! Well actually, I have, but I can’t get anyone to publish it.

One week after retiring and I was back in the NHS as a Non-Executive Director at Healthcare Improvement Scotland – saying ‘hello’ to at least 15 very familiar – and much aged – faces, while my own of course had barely changed!

The volume of evolution

As someone who had worked for QIS, HIS does and doesn’t feel like the same organisation. The volume of evolution and outright change has been huge. The direction the organisation has taken, and the size it has grown to, are sometimes surprising to me and at other times feel more organic. Having at least a passing familiarity with the organisation pre-HIS has been useful, as has retaining some understanding of the environment it operates within – but much more useful has been the whole 40 years I’ve spent working in or close to the public sector – at all levels – from very junior to very senior. Of course, running a prison is very different to being with HIS, but people are the same wherever you work: their concerns, their issues, their brilliant and their not so brilliant moments, and I feel every step of my 40-year working life has contributed in some way to the person I am and what I bring to the non-exec director role.

Being a non-executive Director is never dull. I’m as prone as the next person to letting my concentration wander during long meetings and, of course, some things interest me more than others – but that’s true wherever you work. I think there is both a qualitative and quantitative difference between a national public board like HIS and a territorial NHS board. Different issues, different pressures, and yes a different workload. I’ve been surprised by how well the non-executive team of directors get on and how our backgrounds and skills complement each other.

The main qualities required to be a board member

I think the main qualities a non-executive director requires are curiosity and a willingness to learn. If you’re already feeling jaded, then this isn’t for you, because the political machinations that determine how the NHS runs can feel a bit ‘groundhog day’ at times, particularly when you’ve been around the public sector as long as I have. But seeing real progress being made more than compensates for that.

You have to be able to probe and ask questions in a constructive way and you have to be brave enough – or stupid enough – to do that when no-one around you seems to have any issue with what is being said or presented. Everyone wants to operate in a supportive environment, and you have to play your part in creating that at board level – that means valuing the contribution of others, even when you don’t agree or can’t see their point; understanding that the process by which a governing board will reach a collective stance may not always result in what would be seen as a perfect outcome in your book.

Finally, I think being able to read critically is a vital skill. There’s a lot of material to plough through at times and having the wisdom to realise what can be skimmed, what has to be looked at forensically and what just doesn’t hang together properly and needs to be questioned further, is vital.

If you want to contribute to the NHS, if you have a broad base of experience, and if you can operate in a collegiate way, being a non-executive director might just be right for you.

Rhona Hotchkiss is a non-executive director on the Board of Healthcare Improvement Scotland.

More information

Find out more about this role and apply online now.

Categories: COVID-19 blogs

Prison pilot scheme proves its worth during pandemic – Dr Steve Conroy

Posted on April 7, 2021

COVID-19 has created new challenges for the delivery of treatment and care to individuals with a drug problem within the prison population. Dr Steve Conroy tells us how the rapid rollout of a successful pilot scheme involving Healthcare Improvement Scotland has helped both prisoners recovering from addiction and the staff who are there to treat them.

Treating opiate addiction takes time. The most frequently prescribed treatments (opiate agonist therapy, or OAT) need to be taken every day, and it’s estimated that there are 1800 people in prison in Scotland who need it. Every day, each individual will be taken to and from a dispensing area by Scottish Prison Service staff and have their medication supervised by at least two NHS staff. That’s around 12,500 contacts between patients, the clinicians who treat them and the prison staff whose role is to facilitate that treatment every week.

In HMP Shotts where I work, over 170 of the 545 people in custody are prescribed OAT. That amounts to 63,145 interactions with them across the space of a year simply to administer their medicine. That’s a lot of time on the part of both staff and prisoners that might be better spent on work which can support them to recover from addiction in other ways. It’s also time that could be spent supporting other prisoners with other vital rehabilitation work. Throw a pandemic into the mix, where physical distance and constant cleaning of contact surfaces is vital, and those timeframes increase even further.

A vital decision

Generally, the OAT of choice is methadone, with far fewer patients on oral buprenorphine products. Buprenorphine, although a very valuable medicine in treating addictions, comes with many problems in the prisons, where it can be used as currency – creating problems with diversion, bullying and coercion. But it’s used because methadone is not a suitable treatment for all patients. Thanks to a decision taken by the Scottish Medicines Consortium in August 2019, there is now an alternative to daily treatment.

Buvidal is a form of buprenorphine which is a longer acting treatment and can be given monthly or weekly through a slow-release injection compared to daily doses of oral forms. When given within a framework of medical, social and psychological treatment, it may enable patients to focus on recovery and returning to normal daily routines without the daily visits to a pharmacy to receive treatment.

Time for change

Following the SMC’s decision, Healthcare Improvement Scotland’s Prisoner Healthcare team, with whom I work closely, began looking at a pilot scheme for the medicine in prisons. A business case was approved by Scottish Government in January 2020. But as the COVID-19 pandemic progressed, it became clear that the reasons to support the pilot became even more compelling and the team was asked to scale up their proposals.

Under our revised plan, all prisoners with at least six months left to serve of their sentence would be transferred to the new form of buprenorphine during the pandemic, provided patients gave consent to switch treatment.

As well as supporting social distancing measures, our proposals also meant, in theory, that staff and patients alike would have more time to spend on other activities which could support recovery from drug addiction – within the parameters afforded by COVID-19 restrictions. While it’s too early for data to confirm this, logic tells us that if we only see someone twice in 28 days rather than 28 times, staff and prisoners will have more time to spend on other things. In addition, the reduction in the quantity of controlled drugs being used prisons would help to reduce the potential for their use as currency, and improve overall safety.

To support the move to the prescription of this slow release form of buprenorphine in prisons, the team engaged with clinicians with experience of prescribing the medicine at local, national and international level in order to develop guidance. Crucially, given how the pandemic affected supply chains, we also worked closely with the pharmaceutical company to ensure there was sufficient stock of the product to meet requirements.

Game changer

The decision to move to slow-release buprenorphine has been widely welcomed by prison staff and those receiving treatment alike. People have described it to me as “a game changer”, “nothing but good” and “the way forward”. In HMP Shotts, we have only had two people choosing to come off the treatment and going back to their previous medication. Those I’ve prescribed it to have said they feel better generally, enjoy the clarity of thought and really appreciate not having to wait in the daily “methadone queue”. Prison staff, meanwhile, have said that they have noticed a marked improvement in the general condition of people prescribed this medication. It’s incredibly satisfying to have worked with colleagues at Healthcare Improvement Scotland to have delivered a simple and effective change that has made such a difference to people’s lives.

Dr Steve Conroy is Lead Medical Practitioner in NHS Lanarkshire’s Addictions Community Prescribing Service.

Categories: COVID-19 blogs

Early Intervention for psychosis in the time of COVID-19 – Dr Suzy Clark

Posted on March 31, 2021

As we publish a new report on the importance of early intervention in psychosis, our clinical lead for this work, Dr Suzy Clark, outlines how those with psychosis have been helped under the COVID-19 restrictions and how our new report will benefit people with psychosis across the country.

Psychosis was already on the increase when the pandemic arrived, but there have been noticeably more new presentations of psychosis since last March of 2020. Approximately 1,600 people in Scotland experience a first episode of psychosis each year, and since March 2020 data from NHS Greater Glasgow & Clyde’s ESTEEM service, where I am the consultant clinical psychologist, showed a 20-25% increase in caseload.

It’s easy to see how the events of the last year can have affected people profoundly. Many people have had important life transitions, such as leaving home to go to university, thwarted. Social networks are diminished and people miss their peer group contact and there is a lack of structure to their day. Moreover, with the restrictions in place, it has at times taken longer for people to get referred and the psychosis is often more severe by the time they do.

Impact of COVID-19 on Early Intervention Services

For an Early Intervention Service to be required to be socially distanced – and not to have face to face contact – is the antithesis of how it would normally operate. But this was a necessary requirement as we all dealt with the first wave of the pandemic.

Accessibility and engagement, getting alongside the person with psychosis for a coffee or a walk or to help with housing, are key aspects to the early stages of intervention All of this has been much more difficult during COVID-19. Many of the interventions the service would routinely offer such as group meetings, family events for carers, face-to-face contact with clinicians, were discontinued. Staff were sent home abruptly and a rota provided cover in the office. At ESTEEM, we lost our clinical rooms to support new Mental Health Assessment units and clinical work was focused on contact with people with acute psychosis and at risk of admission.

Fortunately the service had been piloting digital delivery and the pace of this work then accelerated. Clinicians adapted quickly to the use of Near Me and learnt to share documents and still hold team discussions online.

Learning to cope

Many people with psychosis surprised themselves with how well they coped during lockdown, finding the skills they had learnt to help with their mental health also helped with general wellbeing, such as regular fresh air and exercise, planning your day in chunks of time and not giving yourself a hard time if you are not that productive.

For others, it has been a very difficult time. People with psychosis missed the face-to-face contact, but recognised the need for remote working; some also reported benefits, for example, fitting sessions around work commitments and being more able to talk about difficult things at a distance.

Getting back up and running

Gradually, more routine work was remobilised. Supervision structures, Behavioural Family Therapy, Family & Friends support groups, and psychological therapy restarted online in the summer of 2020 and are continuing to work well. There were some inevitable hiccups with the technology, but gradual improvements to functionality has helped enormously. Attendance has been good: staff, those with psychosis and their carers appreciate the opportunity to connect online.

Raising the standard across Scotland

During the pandemic, Healthcare Improvement Scotland produced a new report outlining how early intervention in psychosis can be delivered in urban, semi-urban and rural communities, tailored to local context.

The report found that there is significant variation across Scotland in the provision of care and treatment for people with first episode psychosis. Moreover, people who experience delays in initial access to services are more likely to have contact with out of hours, crisis or emergency services.

It’s our hope that this report will help NHS boards to understand how best to establish and run services in order to provide the best care to people at the very earliest opportunity. We are extremely grateful to the people with lived-experience of psychosis who contributed to this work.

Looking to the future

Looking forward, I’m confident that the new report will help to improve services across the country. Digital technology will no doubt continue to play a role in delivering care. I believe digital service delivery is here to stay- although I anticipate a blended approach going forward. Being in the room with a highly distressed person to help them feel less alone will never be replaced.

As for the future, at ESTEEM we’re planning to introduce walking groups and cycling groups for the spring of 2021 and I think we will all take forward a renewed appreciation of the value of social connections for well-being and recovery. Let’s hope that the difficult time that everyone has been through creates a more energised space for delivering effective care, especially for people with psychosis

.Dr Suzy Clark is Consultant Clinical Psychologist Clinical Lead at Healthcare Improvement Scotland and Consultant Clinical Psychologist in the ESTEEM Early Intervention Service at NHS Greater Glasgow & Clyde.

More information

Visit the Healthcare Improvement Scotland website for more information on this report.

Categories: COVID-19 blogs

Being part of something bigger – Volunteering in the Covid-19 Vaccination Programme – Janice Malone

Posted on March 15, 2021

Our Volunteering in NHSScotland programme helps make volunteering in the NHS a safe, supportive and positive experience for all volunteers. But with access to hospitals limited during the COVID-19 pandemic and many volunteers in the shielding category, what volunteering opportunities are there in the NHS right now? For many, it’s being a vaccination programme volunteer, as Janice Malone, our Volunteering Programme Manager, tells us.

What do you think of when you think of a volunteer? The word conjures up all kinds of images in my head. At Healthcare Improvement Scotland in the Volunteering in NHSScotland Programme it means many things – from mealtime volunteers and way-finders who help direct people around hospitals to play volunteers in children’s wards. The Volunteering Programme exists to support the development of safe, sustainable and person centred volunteering across NHSScotland.

As details of vaccines for COVID-19 began to filter through in late 2020, it was clear to me that volunteers could play a significant role in supporting the rollout of the vaccine programme. Not only that, but by involving volunteers in such a significant milestone in the route out of the pandemic, it would allow communities to be empowered and feel they are contributing to something bigger. I was glad to discover that others thought the same.

Making connections

I began to make connections with the relevant people and departments within Scottish Government, who were considering a proposal from the British Red Cross on the creation of a National Volunteer Co-ordination Hub. The Hub offers all NHS boards in Scotland a flexible approach to the mobilisation and deployment of volunteers to vaccination centres. They are able to draw on the 20,000 plus volunteers across Scotland who signed up to support the response to the pandemic through the Ready Scotland campaign, and offer a range of support based on the needs of NHS boards.

The speed at which the Hub has developed and begun to deploy volunteers has been rapid, and in my view, is testament to the partnership approach between Scottish Government, British Red Cross and NHSScotland. So far, approximately 1300 volunteers have provided thousands of hours of support to vaccination centres in roles like queue marshalling to ensure social distancing or meeting and greeting patients to explain how the vaccination centre operates. But much more important than just the number of volunteers is the impact these volunteers who gifted their time to NHSScotland and the vaccination programme have made. They provide much-needed reassurance and crucial human connection for people, many of whom feel frightened and are vulnerable after a year of such turbulence.

Critical friend

An interesting development has been our role as a conduit for two-way communications between NHSScotland volunteering structures and the National Volunteer Co-ordination Hub. We have been able to provide real-time feedback on the plans for the Hub, create a process for staff to raise questions or concerns and respond to them. The volunteering programme acts as a critical friend to the Hub ensuring that NHSScotland policy and best practice for volunteering works cohesively with what is an emergency response situation. For the most part, the feedback has been hugely positive, with patients commenting on the friendly welcomes they have been given by volunteers and how smooth the whole process has been.

This is a fast paced and challenging piece of work, which is likely to last long beyond the initial emergency response phase that we are currently in. We will continue to work with our partners in the National Volunteer Co-ordination Hub in the months to come and support the transition from emergency response to a business as usual approach when the time comes.

I have been passionate about volunteering for more years than I care to remember and I have no doubt of the positive impact that volunteering has on individuals, communities and on the wider society. The devastation and turmoil wreaked by this pandemic has been harrowing, but one thing I hold dear is seeing the kindness of individuals and communities who step up and volunteer to help. I am full of hope and optimism that the benefits and the impact of volunteering will be much more widely recognised across all sectors in our society than they have been in the past.

Janice Malone is the Programme Manager for the Volunteering in NHSScotland programme.

More information

You can keep up to date with the latest guidance on Volunteering during Covid-19 on our website.

Categories: COVID-19 blogs

What it’s like to support inspections to help keep care homes safe during COVID-19 – Agnes Chirozvi

Posted on March 10, 2021

Agnes Chirozvi is a new inspector with the Quality Assurance Directorate of Healthcare Improvement Scotland. Working with the Care Inspectorate on their inspection of care homes, Agnes shares her story of how she became an inspector and what it’s like to go into care homes during the pandemic, whilst ensuring safety for residents and staff, as well as the inspection teams themselves.

When the COVID-19 pandemic broke out I was working as a scrub nurse for a private company working in trauma and orthopaedics operating theatres in a major NHS hospital in Scotland. Although I loved working in trauma and orthopaedics, fixing the broken bones and making people whole again, there was something missing.

Earlier in my career I was in a nursing management role for nearly seven years. I realised that I missed the partnership working and quality assurance aspects of the job, including my focus on infection prevention and control (IPC). This is what inspired me to join Healthcare Improvement Scotland as an inspector in mid-November 2020. I was excited to know that I would help to make a huge difference in people’s lives through driving safety to improve the quality of their lives. I knew Healthcare Improvement Scotland was exactly where I was meant to be.

Building relationships virtually in a new role

On my first day with Healthcare Improvement Scotland it felt a bit strange to be sitting in my home in front of a computer by myself, and not going to an office full of people which I had done before. It felt like a huge contrast to my nursing career and I had all sorts of mixed emotions. But in my second week I was able to get out into the field, shadowing two Care Inspectorate inspectors and one Healthcare Improvement Scotland inspector as part of my supervised induction into my new role. I was excited to meet these experts in the flesh and felt privileged to be able to tap into their vast knowledge.

At the end of January this year, I was ready to take part in my first care home inspection, alongside colleagues from the Care Inspectorate. Since then, I have represented Healthcare Improvement Scotland on eight inspections. My first four months as an inspector have been an exciting time in my life as the learning never ends.

The challenges of carrying out inspections during the pandemic

The Care Inspectorate is the lead agency for the inspection of care homes across Scotland – at the start of the pandemic, the Scottish Government asked Healthcare Improvement Scotland to provide additional support to the IPC dimension of their work, with our joining them for about 30% of their inspections. Since May of last year, Healthcare Improvement Scotland inspectors have supported over 300 inspections of care homes across the country.

Many of the care homes we have visited have been dealing with outbreaks of COVID-19, so taking extra precautions to keep risks at a minimum was and is an absolute priority. One of the main challenges of carrying out inspections during the pandemic are the complexities of trying to achieve safety for myself, my colleagues, care home staff and the residents.

We take appropriate Personal Protective Equipment (PPE) with us on visits and wear it for each activity we carry out and afterwards, immediately remove our PPE and clean our hands. Inspectors have to carry out a self-administered COVID-19 Lateral Flow Device Test twice a week and before each inspection. If a test is positive, the inspector is taken off an inspection and replaced by someone who is negative. On arrival at a care home, we have our temperature checked as this could be an indication of the onset of symptoms of the virus. We also change into scrubs that can be washed at high temperatures and reverse this process at the end of the inspection. Throughout the inspection, we socially distance from colleagues, care home staff and residents. We also wash our hands in between activities and apply alcohol rub to ensure our hands are clean before and after applying gloves. This can be taxing, but we are all conscious of how it is important it is for individual safety and good public health – and it is no more than we are expecting from the staff working within the care homes we are visiting.

Infection prevention and control

A key difference between a hospital and a care home is that the latter are people’s homes – a place where they should be and should feel safe, comfortable and at home.

As a Healthcare Improvement Scotland inspector, my primary role is to determine whether the infection control practices in place support a safe environment for residents and for staff. We use a standard inspection tool to guide this process, based on the most up to date national guidance available. Our assessments include cleanliness of the physical environment; furnishings and equipment; observation of staff practices; and checking of audits, systems and processes. Speaking with care home staff also provides an invaluable insight into each care home’s understanding of IPC and its use of current national guidance. As inspectors our job is to help keep people safe – and so where we can offer advice and guidance to staff on how to improve IPC we always seek to do so.

It is extremely fulfilling to be part of such an important process and to be a member of a very committed team. By working in partnership with our colleagues from the Care Inspectorate, Healthcare Improvement Scotland staff have made an important contribution to our national COVID-19 response – and we will continue to play our part in helping to keep people safe as the social care sector looks to re-mobilise, recover and re-design.

Agnes Chirozvi is an inspector with Healthcare Improvement Scotland.

Categories: COVID-19 blogs, Inspections and Reviews

Training the AHP workforce of the future – Lynn Flannigan

Posted on January 25, 2021

Placements don’t just provide benefits for students, as Improvement Advisor Lynn Flannigan found out when she and Focus on Dementia colleague Stephen Lithgow supported Healthcare Improvement Scotland’s first ever Allied Health Professional student placements recently.

As a registered Allied Health Professional (AHP), I have a responsibility to support practice-based learning. That didn’t stop me feeling just a little apprehensive when my colleague Stephen Lithgow and I – both of us from our organisation’s Focus on Dementia team – were the first AHPs in the organisation to supervise a project placement for two MSc physiotherapy students.

It had been a long held ambition of June Wylie, our Allied Health Professional (AHP) Lead, that Healthcare Improvement Scotland would support AHP student placements. For the past few years June and a small working group of AHPs in the organisation have been working with Pete Glover from National Educational for Scotland (NES) and Dougie Lachlan Glasgow Caledonian University to bring this into fruition. In October last year, our first two students joined us for a four-week virtual placement.

Learning together

Once they joined us, it was not surprising to find out that our two students, Laura and Shelagh, were just as apprehensive as we were. For them, as physiotherapy students, it was nervousness at being on a placement that wasn’t clinical. For us, it was more about how we could make a placement effective when it was being conducted virtually, as well as how much time it might take on top of the day job. On top of that, for Stephen as an Occupational Therapist, it was whether supervising students from a different profession would work.

To mitigate this, we decided to adopt a 2:2 model of placement so that the two practice educators (Stephen and I) could support each other, and Laura and Shelagh could also support each other. We provided them with a project brief around involving carers in dementia care. The brief specified what outputs were expected and what learning outcomes we hoped to cover. A range of tutorials and interviews with stakeholders were set up in advance for the students which covered topics such as quality improvement methodology, dementia, physiotherapy contribution to dementia and involving carers.

Given the virtual, project-based nature of the placement, we had to give consideration to how Laura and Shelagh could achieve their learning outcomes in order to fulfill University standards. This included subject matter specific teach-back sessions, a case study example, a hypothetical physiotherapy quality improvement project and an evidence summary of their learning.

Making it work

While our initial concern was that trying to support placements virtually would be harder on all of us, in many ways the online technology such as MS Teams provided great benefits. We could link in with Laura and Shelagh daily for short sessions, and they could access a range of staff from across Healthcare Improvement Scotland, wider stakeholder and carers, which gave them a real breadth of experience.

Where we did have a challenge was around the assessment forms, which were still designed for clinical placements. We got round it by creating a case study based on the experience of a person living with dementia during the pandemic, and we built questions around that to help assess Laura and Shelagh’s clinical reasoning. Laura and Shelagh provided us with really positive feedback about how the placement helped them gain an understanding of dementia, physiotherapy interventions, specific issues relating to informal carers for people with dementia, and the QI methodology. We were able to observe their learning develop around quality improvement and how to use tools such as aim statements, driver diagrams and logic models. I think they will take that quality improvement experience with them and incorporate it into their future clinical practice – very few students get that kind of experience.

Everyone’s a winner

From Stephen and I’s perspective, we didn’t feel the placements were too onerous in terms of time, especially as we had so many willing volunteers from across the organisation to help out! For us as practice educators, it also helped support our on-going professional registration, refresh our supervision skills and our subject matter knowledge and skills.

For Healthcare Improvement Scotland more widely, the four weeks we spent working with Laura and Shelagh has tested the concept of student placements within the organisation, and now we plan to expand placement to other AHP groups and nursing colleagues are developing models to support nursing placements. The vision is that all AHPs within the organisation will support student placements and education in some way in future, and we hope to explore other models such as split placements with NHS Boards clinical sites and other national bodies. Providing student placements for AHPs brings so many benefits, including building quality improvement capacity and capability within our future health and social care workforce, raising awareness of non-traditional career pathways for AHPs and enabling AHPs in our organisation to maintain their registration and supervision skills.

It was great to dust off the cobwebs and be supporting students again. It was a very rewarding experience which Stephen and I would fully recommend.

Lynn Flannigan is Improvement Advisor with the Focus on Dementia Team of Healthcare Improvement Scotland.

More information

Visit the ihub website for more information our Focus on Dementia work.

Categories: COVID-19 blogs

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