Posts from the “COVID-19 blogs” Category

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

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