Posts from the “ihub” Category

Improving death certification standards during the pandemic – George Fernie

Posted on October 19, 2021

Our Medical Reviewer, George Fernie, explains how our Death Certification Review Service (DCRS) has helped the national response to the pandemic by advising doctors on the accurate recording of deaths.

In many respects, this year’s annual report has been difficult to write. It has felt slightly uncomfortable to be looking to celebrate how the Death Certification Review Service (DCRS) has been supporting the pandemic, when the reality is that we’re helping to improve the accurate recording of deaths which we sincerely wished had never needed to be reported.

However, one thing that we shouldn’t shy away from is the importance of DCRS in being able to support the response to the pandemic in meaningful ways.

It has been vital that death certificates have been completed correctly and that doctors have been given the proper advice to know how to record COVID-19, especially when there can be a range of other co-morbidities that may have impacted on an individual’s death. The evidence tells us that we’ve risen to the challenge and carried out our task effectively for the service.

The importance of improvements

DCRS sits within Healthcare Improvement Scotland. As a consequence, it’s right that improvement is at the heart of what our service does.

I’m proud to say that DCRS has seen sustained year-on-year improvement in the quality and accuracy of Medical Certificates of Cause of Death (MCCDs), and the progress achieved appears to have been maintained as we start to exit the worst of this unpredicted virus.

We continue to meet our legislative requirements to improve the quality and accuracy of MCCDs, giving the public confidence in the death registration process in Scotland; to inform public health information about causes of death in Scotland, supporting consistency in recording that will help resources to be directed to the best areas in a more timely way. In addition, we’ve seen continued improvement in the number of ‘not in order’ certificates across all NHS boards – despite the significant additional pressures placed upon certifying doctors and the team of medical reviewers during the pandemic especially. Moreover, all advance registration applications have been undertaken within 2 hours, which minimises any additional stress that might be caused to loved ones as a consequence of knowing that a review of the paperwork was to be carried out.

These improvements are down to the hard work and dedication of the DCRS team, but also to the doctors across the breadth of the country to show commitment to making sure that death certificates are accurate and meaningful.

Fulfilling our commitments

Each year we set goals for key areas that we wish to improve. Last year was no different, even though we were in the midst of the pandemic.

On top of the goals we set, in July we took the opportunity to reflect on our response to the pandemic and carried out an After Action Review which helped us to be prepared and positively respond to the second wave. We responded well, indeed, we identified why there was a difference between death rates from COVID-19 diagnosed clinically and those where there was a positive polymerase chain reaction (PCR) swab, taking into account a known ‘false-negative’ rate. In addition, we highlighted nosocomial (hospital acquired) infections and successfully used the Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) framework to categorise these. Furthermore, we worked with Scottish Fatalities Injuries Unit (SFIU) and the COVID Death Investigation team (CDIT) to ensure accuracy and promote public reassurance.

Unexpected developments

Although we would not have planned to do so in a pandemic situation, through necessity the service migrated IT systems and relocated staff (although at the moment the full team continue to work from home). Within seven months we have successfully introduced a new electronic case management and telephony system which has allowed the service to work with greater efficiency, in a more focused manner and benefits all stakeholders in the death registration process.

The pandemic and our team

Like the rest of society, the staff of DCRS experienced all the varied consequences of COVID-19 where many of us were tested for the virus, a number contracted the virus and, some like myself, lost a frail family member, all whilst viewing real-time data of the deaths that were occurring in front of us. Whilst this was nothing like the impact on those in the frontline of the NHS, we have had to learn to live very differently in both our personal and professional lives. We were fortunate enough to come through this experience physically unscathed as a team, but are very much aware of the consequences due to our direct knowledge of what had happened.

I cannot thank my team enough for pulling together during an incredibly difficult time where I believe we made a meaningful contribution to the NHS in Scotland – their commitment and sensitivity at a time of national emergency was outstanding.

George Fernie is Senior Medical Reviewer with Healthcare Improvement Scotland.

More information

Read the latest Death Certification Review Service Annual Report.

Categories: COVID-19 blogs, ihub

A week in the life of an improvement advisor – variety and making a difference – Leanne Marshall-Wood

Posted on September 20, 2021

In our latest blog, Leanne Marshall-Wood explains what she enjoys about the role of improvement advisor and what her typical week might look like. She explains how variety, plus making a difference, are at the centre of each working week.

I’m a people person. Without a doubt that’s a vital requirement to be an improvement advisor with Healthcare Improvement Scotland. Building relationships with teams and individuals in NHS boards and Health and Social Care Partnerships (HSCPs) all over Scotland is a key part of what we do. It’s those relationships that become the foundation to bring about the improvements to the care that people receive, whether in NHS or social care settings.

So without a doubt the best thing for me about the job is the amount of different people I get to work with and to see how the building of effective relationships leads to vital changes that make a difference for real people.

My own improvement journey

Where I am now in my career is because of where I started out.

I’ve worked in NHS Scotland since 2009. In fact, I started my career in this organisation as an admin officer in what was then known as the Scottish Patient Safety Programme. The organisation supported and encouraged me to grow and develop. I became a project officer for our organisation’s work to support improvements in primary care, before moving to NHS Greater Glasgow and Clyde to become an improvement coordinator.

So when I saw that Healthcare Improvement Scotland were advertising for an improvement advisor in the Living Well in Communities team, I immediately wanted to apply and go back to where my own improvement journey began!

Making a difference

At the moment I’m working on the Hospital at Home programme, which supports NHS boards and HSCPs across Scotland to develop and deliver Hospital at Home services. This has been a rewarding programme to be part of, as it provides an opportunity for people to be treated in their own home where possible, which is important to people at all times, but especially throughout the COVID-19 pandemic. Knowing that the support your team provides has contributed to the development of Hospital at Home across Scotland gives a real sense of achievement that your working day has made a real difference. It’s great speaking to teams about their services and how they might improve – every single person we work with is so passionate about the role of Hospital at Home and the difference it makes to patients, and its brilliant being able to share that message.

Getting into the detail

There are lots of opportunities to get involved in different things across the Improvement hub (ihub), which is the main part of our organisation where improvement advisors work and where the improvement programmes take place. The ihub is a really friendly directorate, and I’ve met lots of colleagues I don’t normally work with on a day-to-day basis – even since we’ve been working in a much more virtual way as a consequence of the pandemic.

My role is varied – so if that’s something that you like, then this is a great role to have. There isn’t really such a thing as an average week for me!

As an idea of what the role involves, here are some of the activities I’ve been involved in over the past week:

Delivery of online quality improvement training: a priority across Healthcare Improvement Scotland is to ensure as many staff as possible have a foundation level understanding of quality improvement. I am lucky enough to be part of the group that are delivering this training to a wide range of staff across the organisation.
Hospital at Home: A large part of my week has been spent meeting with the teams who are developing and delivering Hospital at Home services across NHS Scotland. The format of this varies from team to team, and can be anything from being part of a steering group, facilitating process mapping and stakeholder engagement sessions, or regular catch-ups with teams to discuss progress, any challenges and provide any support I can.
Delivery of a national learning system: one of the key elements of the Hospital at Home work is the delivery of a learning system to share learning, good practice and challenges. This includes planning and hosting networking sessions and drop in sessions, building and facilitating an online community for Hospital at Home teams, developing and sharing resources and planning and recording a series of podcasts. This is one of my favourite parts of my current role.
Developing a national infrastructure for Hospital at Home: this involves providing a measurement toolkit to teams to share activity on services while working with other national organisations to provide a sustainable process for this in the future, and working with colleagues across Scotland to address challenges around workforce, including competency frameworks and training requirements.

All in all, a varied, busy role with a great deal of personal satisfaction at its heart. But most importantly of all, I get to do it in a brilliant team and in an organisation that has always supported me to grow and to improve – I get the chance to improve as well as helping others to improve. It’s a perfect combination.

Leanne Marshall-Wood is an Improvement Advisor with Healthcare Improvement Scotland.

More information

To find out more about Hospital At Home, visit: https://ihub.scot/project-toolkits/hospital-at-home/hospital-at-home/

Categories: ihub

The importance of teamwork and continuous improvement in maternity care – Professor Alan Cameron

Posted on September 17, 2021

To mark World Patient Safety Day, Professor Alan Cameron gives his reflections on safety in maternity care. Alan is Clinical Lead for Obstetrics with Healthcare Improvement Scotland.

In maternity care, safety is all about the safe delivery of a baby and a healthy mother. These cannot be achieved without a team working together effectively. The team involved can consist of midwifery, obstetric and neonatal staff – and, depending on the complexity of a pregnancy, specialist midwives and subspecialists in maternal fetal medicine may also be involved.

A good example of where combined care is needed is when a mum to be has diabetes. Here, input is required from specialist midwives, maternal fetal medicine consultants, diabetic specialist nurses, diabetes consultants and dieticians. All of these staff need to work together to make sure mum and baby are as healthy as possible.

The Essentials of Safe Care

To support teams in maternity services to work together to deliver safe care the SPSP team recently developed the Essentials of Safe Care. This is an evidence-based package of guidance and support designed to enable health care professionals to deliver safe care. Embedding the Essentials of Safe Care provides an opportunity to accelerate the sharing of learning and improvement within and between teams in maternity services.

The importance of continuous improvement

Despite tremendous efforts of all clinical staff who care for pregnant mums and their babies, there are still a small number of families who experience a poor outcome in their pregnancies.

This can be either the devastating loss of a baby after 24 weeks, a stillbirth, or the loss of a newborn baby in the first 28 days of its life, a neonatal death. Also distressing for families is where a baby requires intensive care in a neonatal unit due to complications arising before or during labour. In addition, some mums may require high dependency care following the delivery of their baby. The most common reason for this is post-partum haemorrhage, which is severe blood loss after childbirth.

Although the rates of these complications are thankfully very low there remains a need for all staff involved in maternity care to practice safe care, using a multitude of guidelines and tools developed by SPSP MCQIC and recognised bodies such as the Royal College of Obstetricians and Gynaecologists (RCOG) and Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK).

To support safety in pregnancy and childbirth, Healthcare Improvement Scotland has developed various packages of support using Quality Improvement (QI) to aid staff working in maternity care to reduce the rate of stillbirth and post-partum haemorrhage (PPH). These include resources to help reduce stillbirth and the four stage approach to recognising, responding to and managing PPH.

Although the guidelines and tools have been created specifically for Scotland, we know that they will be of use to maternity care staff across the world. In fact, we already know that our work in Scotland has international interest. To mark World Patient Safety Day and its focus on maternity care, I’d encourage those involved in maternity care across the world to learn from our work and to share it as widely as possible, so that all babies and mothers can benefit.

The work that we do at Healthcare Improvement Scotland is work that I I continue to be very proud of to be part of. We’ve achieved many successes and it’s great to be part of a team with the knowledge and expertise to continue to make more improvements for babies and mothers across Scotland.

Professor Alan Cameron is Clinical Lead for Obstetrics with Healthcare Improvement Scotland.

More information

More examples of the work of SPSP MCQIC and resources to help make maternity care as safe as possible are available on our website: www.ihub.scot/spsp.

Categories: ihub

How quality improvement has supported improvements in maternal and newborn care in Scotland – Angela Cunningham

Posted on September 15, 2021

Angela Cunningham is our Midwifery Clinical Lead for our organisation. Angela has practised as a midwife for over 38 years in both Scotland and England. In this blog Angela explains how quality improvement has supported real changes for mothers and babies in Scotland.

When I first entered the world of midwifery as a student in 1981 it was accepted that things didn’t always go as planned. It was a high risk area of work, we did our best but sometimes things just went wrong!

Now, 38 years later, I was delighted when I heard that ‘safe maternal and newborn care’ was going to be the theme of the World Health Organisation (WHO) patient safety day on 17 September 2021. It really made my year. I know that may sound strange, however, improved safety and care are what I’ve aspired to throughout my midwifery career. Safe and respectful childbirth should be the right of every woman.

Improved outcomes

In Scotland through the Scottish Patient Safety Programme Maternity and Children’s Quality Improvement Collaborative (SPSP MCQIC) we have worked hard to improve outcomes for babies, children and mothers. Our work in the area of stillbirth is recognised as world leading. From the inception of the programme in 2013, MCQIC have supported a national aggregated reduction in the number of stillbirths by 23%. Don’t get me wrong, we still have lots of work to do. However, as the Midwifery Clinical Lead I am really proud to be part of a programme which has helped services make changes which mean more mothers taking their healthy babies home to start a new family.

The introduction of the Scottish Patient Safety Programme gave maternity staff the opportunity to run small tests of change through the Model for Improvement and Plan Do Study Act (PDSA) process. These incremental changes have had a major impact on outcomes, giving staff permission to make changes which have improved outcomes for families across Scotland. Applying Quality Improvement (QI) methodology has helped to develop a consistent approach to service delivery at local and national level. It has improved communication between teams and more importantly improved the quality of the care and advice given to women and families. When I speak to frontline staff I feel humble when they tell me stories of how QI is working in practice, how they are using it and the improved outcomes for women and families.

Engaging with the clinical community

When we started out on this quality improvement journey I asked myself how are we going to engage with the clinical community? How would they feel and would they be overwhelmed by what we were trying to achieve? The answer was and still is “one mother, one baby, one family” at a time. This is the message we delivered. Individual staff members in maternity services could see how they could make a difference and they have risen to the occasion.

Safety is paramount in maternity services. Across the world too many women and babies are still dying in pregnancy and childbirth. Many of those dying in pregnancy and childbirth are only children themselves. We all have a responsibility to do everything we can to keep them all safe. Highlighting this on 17 September is another step in the right direction. We are all still on this journey together.

Fast paced and making a difference

Working in Healthcare Improvement Scotland is fast-paced and exciting. I’m part of the team that supports continuous improvement and re-design services for the better in healthcare settings. My training with patients and clinicians gave me transferable skills in negotiation and communication so I can engage in discussions with the same clinicians I am working with now. The training, coaching and mentoring support that I have received since I started has been invaluable and it has helped me become more confident in my role. If you want to work in a fast-paced and exciting team where you can make a huge difference in improving healthcare services, becoming an improvement advisor is the first step towards that goal.

Angela Cunningham is our Midwifery Clinical Lead.

More information

More examples of the work of SPSP MCQIC and resources to help make maternity care as safe as possible are available on our website: www.ihub.scot.

Categories: ihub

A day in the life of an improvement advisor – Adeline Tan

Posted on September 13, 2021

Improvement advisors play an important role in raising the standard of health and social care. Here, Improvement Advisor Adeline Tan gives us an insight into a typical day.

As an Improvement Advisor working in the Primary Care Improvement Portfolio, I have responsibility for the Scottish Patient Safety Programme Medicines and Dentistry programmes. I also help improve Anticipatory Care Planning across Scotland. Working with senior leadership teams in NHS health boards and nationally with clinicians, administrators and patient representatives, I look at the gaps in the service and how to improve them using a Quality Improvement (QI) structured approach. A lot of this work is about creating the environment for change, developing the ideas for actions that will lead to improvement and enable local health and social care systems to develop the capacity and capability to implement improvement ideas.

From physio to facilitator – and beyond

My background is in physiotherapy and I am a registered musculoskeletal physiotherapist with over 20 years of clinical experience in Singapore and Scotland across acute and primary care settings. I wanted to be able to make an impact on programme management in national improvement programmes so I made the transition to a Quality Improvement Facilitator in NHS Lothian working in adverse events, primary care and acute care before joining Healthcare Improvement Scotland. Coming from a clinical perspective and having worked across secondary, primary care and private sector in both Singapore and UK, I have a deep understanding of the clinical landscape. The relationship skills I’m trained in are transferable from interacting with patients to interacting with clinicians. This enhances my work as an improvement advisor when building networks. Completing the NHS Education for Scotland’s Scottish Improvement Foundation Skills (SIFS) Programme and Scottish Improvement Leader (ScIL) Programme, gave me the QI technical skills and leadership skills to enable me to work as an improvement advisor.

No two days the same – especially in lockdown

My work day and week varies. No two days are the same. I can be engaging with internal staff like our communications team or with external partners from Scottish Government, social care and Health Boards. I might be working with my team on project management for programme planning one day and then delivering and facilitating face to face learning sessions to external partners and their teams the next. I have to be quick in responding to the fast changing needs of Primary Care services. I used to travel all over Scotland to support and facilitate learning workshops before the lockdown, but that had changed to virtual learning workshops since.

During lockdown, I had to rapidly develop my IT skills to allow us to move into the virtual working as well as delivering our improvement support to the healthcare teams in Primary Care. That meant training in virtual facilitation to support my colleagues and the healthcare teams. Planning a virtual facilitation session consists of communicating and negotiating with all internal and external staff involved and lots of practice with my project team to get it working seamlessly. During learning sessions, I use skills like QI technical tools like Driver Diagrams, process mapping and fishbone diagram and Liberating Structure facilitation tools as a form of communication with the participants to make them fun and interactive.

The aspect of my job that I thrive in is interacting with different clinicians and management staff to develop programmes. I also enjoy coaching and mentoring people from NHS or third sector organisations on quality improvement methodology.

Fast paced and making a difference

Adeline Tan is an Improvement Advisor in Primary Care Improvement Portfolio.

More information

Find out more about our Primary Care improvement work: https://ihub.scot/improvement-programmes/primary-care/

Categories: ihub

Keeping sight of what’s important – Scott Hamilton

Posted on September 7, 2021

Prior to the pandemic, Scott Hamilton, Improvement Advisor with our Acute Care Portfolio, had perfect vision. A year and a half later and everything has changed. Scott explains how a routine eye test indicated an untreatable condition.

I used to pride myself on my 20/20 vision – even boasted about how far I could see.

My training is as a nurse and I stepped back to the NHS frontline to support the efforts during the first wave of the COVID-19 pandemic. I returned to Healthcare Improvement Scotland in late June 2020 and to homeworking for the first time in my career. Having worked on a COVID-19 ward I realised that my unhealthy lifestyle was putting me at risk if I contracted the virus. I was overweight and very inactive. This had been exacerbated by homeworking and the stresses of the pandemic in general. In January 2021 I took action. I started eating better and in March, for the first time in a long time, I started running. Now I can run…a long way!

In May this year I went for my 2-yearly eye test. I knew my sight had deteriorated during lockdown and I routinely felt exhausted with the ‘screen time’ and my eyes felt really heavy. Little did I expect that I would be diagnosed with early onset age related macular degeneration and to be told that it has no cure!

Macular degeneration – the facts

Every day, around 300 people are diagnosed with macular disease. It’s the biggest cause of sight loss in the UK. Macular disease is cruel and isolating. It steals your sight, your independence, and your ability to do the things you love.

And yet, despite the devastating impact of macular disease, little is known about its causes and there is still no cure. Today, more and more people are being diagnosed with macular disease. In fact, the number of people living with the condition is set to double in the next 20 years. It is set to be the next major public health crisis — far more people with macular disease than dementia.

How does this affect me?

At the moment I can still see. However, low and bright light situations are really difficult and don’t ask me to read what’s on the menu if I don’t have my glasses! Psychologically it’s challenging knowing that over time I am going to significantly lose my central vision. It really brings it home how much you can take your ability to see for granted. I joined the Macular Society after doing a Google search to find out more information – their support and information have been tremendous.

At the moment it’s all about small adjustments and doing all I can to slow the progression. This means that my healthy living needs to become a permanent fixture as good nutrition, blood pressure control and regular exercise can have an effect on how quickly the disease progresses.

Practically, it means doing a weekly test monitoring for any significant deterioration with an Amsler grid that’s stuck to our oven, using my glasses with their blue light filter and edge to edge prescription, being more aware of using my sunglasses (ironic in Scotland!) and managing my screen time in general. I should probably also mention that my wife, Elaine, reads the restaurant menus for me!

The future

There is only one way to beat Macular Disease for good. More research must be funded, until we find a cure, or find treatments that stop it in its tracks.

In June Elaine (personal coach as well as my wife!) talked me into doing the Scottish Half Marathon after doing 10k…at a stroll! When I looked on the Half Marathon website I realised I could raise some money for the Macular Society whilst achieving something I didn’t think would be possible back in January. The pandemic has hit charities hard and the money they have available to fund critical research has been hit hard. They have difficult decisions to make over the next few years. The Macular Society have promised that any money I raise will go straight into their research funds.

I am excited to be doing the Scottish Half Marathon on the 19^th of September 2021. I am the fittest I have ever been in my life but most of all…I love running!

Scott Hamilton is an Improvement Advisor with the Acute Care Portfolio of our ihub.

More information

You can support Scott on his JustGiving page

More information from Macular Society

Categories: COVID-19 blogs, ihub

Move to improve – Benjamin McElwee

Posted on September 6, 2021

In our latest blog, Benjamin McElwee explains how the varied role of being an improvement advisor with Healthcare Improvement Scotland has allowed him to improve health and social care in a wide range of ways.

When 90% of healthcare interactions begin and end in primary care, it is a setting with tremendous opportunities for improving population health and delivering on the early intervention and prevention agenda. This is what drew me to the role of improvement advisor in the ihub in the first place.

Before I joined Healthcare Improvement Scotland’s ihub, I worked in the third sector first as a care provider and then in a range of national roles influencing policy and practice. Whilst working for a mental health charity, I had the opportunity to engage more directly with clinicians and care providers and became particularly interested in the ways to affect practice change at the point of care.

I graduated from the Scottish Improvement Leader Programme whilst still working in the third sector, which enhanced my understanding of and passion for quality improvement. The ihub seemed a natural place to further develop and apply these skills.

A varied role where you can bring your strengths

Working within the ihub’s Primary Care Improvement Portfolio, I had the opportunity to support a variety of work across the whole breadth of health and social care in Scotland. I’ve supported a network of people involved in the redesign of primary care services in their local area to share learning and explore solutions to common challenges. I’ve helped GP practices to triage tasks and navigate people accessing care so they are seen by the right person at the right time in the right place. Working in partnership with colleagues at NHS Education for Scotland (NES), I developed a faculty of professionals (mostly clinical) with expertise in primary care to provide subject matter expertise and support the delivery of the Primary Care Improvement Portfolio’s work. I’ve also worked with the Royal College of General Practitioners, Scottish Government and NES to co-ordinate the primary care learning system and the delivery of webinars and resources.

Applying and developing a range of skills to a multitude of topics

During my time with the primary care team my work touched on a diverse range of topics including person-centred care planning, different approaches to supporting long-term conditions, telehealth and remote monitoring, medicines in primary care and whole systems approaches.

As well as the variety of topics, the role provides ample opportunities to develop a portfolio of skills beyond quality improvement. This could be through facilitating workshops with clinicians, running focus groups, interviewing people accessing care, engaging with other organisations to collaborate, developing business cases for new pieces of work or supporting the development and delivery of communication strategies.

Due to COVID-19, I also saw the adaptability of colleagues, as the organisation temporarily reconfigured itself to provide more responsive support to the system. During this time I supported the use of a video consulting service within primary care and maternity services, engaging directly with administrative, clinical and support staff to do so.

Improving from the inside as well as the outside

Working within the ihub also provides the opportunity to use quality improvement tools to support internal work both within the portfolio and across the organisation, with a variety of groups looking at internal improvement in areas such as organisational culture, digital ways of working, health and wellbeing, and internal processes. It offers the chance to work with people with a wealth of experience within the organisation, people who have quite often worked across multiple different parts of Healthcare Improvement Scotland, thus exposing you to different working styles, views, capabilities and expertise that can support your development.

Indeed, it is through the generosity of colleagues sharing their experience, expertise and insights that I was able to develop within the primary care team to take on a new role with the Value Management Collaborative as a Senior Improvement Advisor.

For anyone looking to make a difference to health and care in Scotland whilst also developing professionally, a role as an improvement advisor could be for you.

Benjamin McElwee is an Improvement Advisor within our Primary Care Improvement Portfolio.

More information

Find out more about our Primary Care improvement work: https://ihub.scot/improvement-programmes/primary-care/

Categories: COVID-19 blogs, ihub

Learning from real life: How the pandemic can help workforce planning in future – Karen Mackenzie

Posted on August 24, 2021

Having the right people in the right place at the right time lies at the heart of workforce planning. But how does that work when the NHS is faced with a pandemic? Karen Mackenzie, Assistant Programme Advisor with Healthcare Improvement Scotland’s Healthcare Staffing Programme, tells us how colleagues in one territorial boards have coped – and how the experience of COVID-19 can help shape future workforce planning ahead of legislation due to be enacted next year.

The COVID-19 pandemic has been transformative for all of us. Many of us have found ourselves in situations we’d never imagined, doing things we’d never dreamed of. Nowhere is this truer than in the NHS, where staff who may not have worked on the frontline for years have suddenly found themselves volunteering to be front and centre when it comes to tackling COVID – and helping to prevent its spread.

When I started my new role as an Assistant Programme Advisor with the Healthcare Staffing Programme (HSP) in August 2020, our team had started to re-group after being redeployed to work in the first phase of the pandemic. It was an exciting time to join my nursing and midwifery colleagues as they worked to support territorial boards with remobilisation and recovery. Reconnecting with our NHS colleagues to learn from the challenges they faced was going to inform our objectives for the year ahead. But then the second phase of the pandemic descended on us and it was once again “all hands on deck”. Health and care services were faced with the parallel demands of COVID-19 care and the urgent roll out of the vaccination programme. Having heard about these challenges from frontline colleagues, I volunteered to provide enhanced support to vaccination programme staffing with NHS Western Isles.

All hands on deck

My clinical background is as an Allied Health Professional (AHP), but even with my knowledge of workload and workforce planning, I was anxious about whether I would be able to offer the right level of support to nursing colleagues given the pressures of vaccination targets.

Working with clinical staff, senior nurses, Public Health Scotland colleagues, clinic schedule coordinators, health intelligence colleagues and the local Quality Improvement coordinator, I began to learn about the landscape in which we were having to plan vaccinations. Something that immediately jumped out at me was the multiprofessional nature of the vaccination staffing effort, and the importance of professional judgement and clinical voice when staffing new services. I saw so many AHPs, from paramedics and podiatrists to dietitians and speech and language therapists, working to support the vaccination effort while also trying to maintain their own services.

Nationally, the pandemic response has highlighted how staffing affects healthcare quality and staff wellbeing across health and social care. In keeping with the principles of the Health and Care Staffing (Scotland) Act 2019, and ahead of its enactment, NHS Boards have to have systems in place to ensure professional advice has been provided at the right level in relation to staffing. Where decisions are made contrary to such advice, associated risks should be identified, recorded and any required mitigation put in place.

With this principle in mind, I worked with my vaccination programme colleagues to map out the current vaccination clinic process, highlighting key staffing risks to allow us to prioritise staffing and workload improvements. For example, observing workflow at vaccination clinics and joining the morning safety huddle helped me to understand the key staffing issues that were impacting patient safety and staff wellbeing. The mapping process helped to identify simple changes to rostering processes that helped to improve the skill mix and effective use of staff during their allocated shift times. Overall the changes were well received by the vaccination staff on the ground as they felt more engaged in staffing discussions and their concerns about patient safety and staff wellbeing were heard. The increased governance and flexibility gave the staff more ownership of their workload and helped to make the best use of their time. Importantly, the changes also protected rest break times and safe working hours to maintain staff wellbeing.

What we can learn

My experience and that of many of my colleagues is that the pandemic has demonstrated that multi-professional collaboration and improvement are possible in the most challenging of circumstances. However, as we move towards what is, hopefully, the beginning of the end, it has also highlighted the need for AHPs to have a consistent way to capture their workloads and to use reliable workload information to plan their services and workforce. This is where my team at Healthcare Improvement Scotland comes in. We support the upskilling of a range of professions in workload measurement to help ensure that their services are safely staffed for high quality care. Now we want to use the learning from COVID-19 to help AHPs prepare for the delayed enactment of the Health and Care Staffing (Scotland) Act 2019. We want to help AHPs understand the importance of knowing their available workforce and identifying gaps in their required workforce, and to explore practical, low data burden solutions to workload and workforce measurement.

Taking a closer look at staffing beyond the nursing and midwifery workforce helps to put health and social Care services in a stronger position for the new legislation, ensuring that services are “safe to start” each day. It also helps them prepare, post-COVID, for whatever happens next.

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

More information

Visit our website for more information on the Healthcare Staffing Programme.

Categories: COVID-19 blogs, ihub

Reflections of a Caldicott Guardian – George Fernie

Posted on July 28, 2021

Many people will know the term Caldicott Guardian but perhaps not quite know what it means. In our latest blog, George Fernie, Senior Medical Reviewer with our organisation, outlines the role and what it means for respecting the rights of patients.

The term Caldicott Guardian is one that many people will have heard of, but perhaps not entirely know what it means or where it comes from. Even within my own organisation, Healthcare Improvement Scotland, I’m likely known as our Senior Medical Reviewer, working largely on our Death Certification responsibilities, but many may not know how the role of Caldicott Guardian is vital in protecting the rights of patients.

What the role is and where it came from

So, let’s answer that question right up front. The generally accepted definition of what constitutes the role of the Caldicott Guardian is set out within the UK Caldicott Guardian’s Manual. It describes the role as:

“… a senior person within a health or social care organisation who makes sure that the personal information about those who use its services is used legally, ethically and appropriately, and that confidentiality is maintained. Caldicott Guardians should be able to provide leadership and informed guidance on complex matters involving confidentiality and information sharing”. Caldicott Guardians

The term is named after Dame Fiona Caldicott who died earlier this year having worked with some distinction as an NHS psychiatrist. The Government Review of Patient-Identifiable Information, chaired by Dame Fiona Caldicott, which reported in December 1997, recommended that “a senior person, preferably a health professional, should be nominated in each health organisation to act as a guardian, responsible for safeguarding the confidentiality of patient information.” At that time, the report also set out principles for determining when confidential information might be used and when it should not. These six Caldicott principles have since helped Caldicott Guardians to make balanced judgements for their organisations, with a seventh being added in 2013 and an eighth in 2020.

From law graduate to legal guardian

Describing the role of Caldicott Guardian is easier to explain, however, than the journey I took to become one!

In Healthcare Improvement Scotland, the role of Caldicott Guardian has been devolved to me because of my long-term interest in medical law and ethics. Although I started my professional career as a ‘proper doctor’ by being a general practitioner, I discovered something even better in forensic and legal medicine. Having commenced work as a medicolegal adviser in 1996, I then had a complete mental aberration by going to law school where I graduated Bachelor of Laws at the University of Strathclyde, in addition to already having a Masters in Law & Ethics in Medicine from the University of Glasgow.

A further opportunity to combine law, ethics and healthcare arose when I was appointed the first Senior Medical Reviewer for Scotland in 2013, which is a statutory role conferred by the Certification of Death (Scotland) Act 2011. The reform of death certification had been a long-term aim of mine when I was the inaugural Registrar and third President of the Faculty of Forensic and Legal Medicine. Scottish Government took the enlightened decision to base the Death Certification Review Service in an independent NHS quality improvement organisation, Healthcare Improvement Scotland. This has allowed me to provide an additional contribution to other organisational workstreams, making use of my knowledge in information governance and the 17 years of practical skills I had gained in supporting doctors in the UK, South Africa and the Republic of Ireland as a medicolegal adviser.

The role of guardian at Healthcare Improvement Scotland

At Healthcare Improvement Scotland, the Caldicott Guardian works as part of a team within the Information Governance Group. In 2021, I was nominated as the Scottish representative on the United Kingdom’s Caldicott Guardian Council (UKCGC). The areas in which the Caldicott Guardian is expected to influence include: strategy and governance; confidentiality and data protection expertise; internal information processing, and information sharing.

It is quite a responsibility to be a Caldicott Guardian, as well as being a great honour. I’m fortunate to work within an organisation that places significant value on the role and its importance for protecting the rights of patients. When I’m asked what I enjoy most about being a Caldicott Guardian, the answers are actually pretty straightforward. It is facilitating the access of people to records to which they are entitled, helping avoid the release of information which is considered confidential and utilising the immense amount of data we possess within our diverse organisation to improve the health and social care of the patients of Scotland.

George Fernie is Senior Medical Reviewer with Healthcare Improvement Scotland.

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Clinical guideline is a crucial stage in treating Long COVID – Professor Tom Evans

Posted on July 6, 2021

Professor Tom Evans is an infectious disease specialist working with Glasgow University and a member of the development group responsible for the Long COVID guideline. Tom reflects on the year that’s been and the importance of sharing knowledge in diagnosing and treating Long COVID.

We have been living with COVID-19 for over a year, and it has affected everyone world-wide in at least one way or another. For some of us, this means the loss of a loved one. Now there is finally real hope for a reduction in deaths and severe disease caused by the infection with the introduction of effective vaccines and better treatment.

However, for some who experience even relatively mild COVID-19, their recovery can be very prolonged and they continue to experience a wide variety of symptoms – including a new condition of post-COVID-19 syndrome, also known as Long COVID.

My own experiences of managing patients with post-COVID-19 syndrome reflects very much the published studies of this condition. They all have experienced a range of persistent symptoms – fatigue is almost universal, as well as intermittent fast heart rates and an inability to focus, often referred to as ‘brain fog’. Many of these patients are still unable to work many months after their initial acute illness. They are frustrated by poor appreciation by some medical staff of the nature of the ongoing symptoms after acute COVID-19, of having multiple referrals to emergency departments or individual specialists, and in a lack of effective therapy.

When do you know you have Long COVID?

But what exactly is Long COVID?

Long COVID is when a patient continues to experience or develops new disabling symptoms for months after the initial infection. These can involve just about any organ system of the human body. Extreme fatigue is commonly reported in addition to:

breathlessness
an intermittent racing pulse
loss of concentration (brain fog)
fevers, and
abdominal pain.

Many patients also report that these symptoms can come and go. Such a diverse range of symptoms for Long COVID presents a real challenge to general practitioners: is this continuing infection? what investigations are required? who is the best specialist to whom I should refer?

Post-COVID-19 syndrome – what’s in a name?

Because of the growing realisation that these persistent symptoms were proving quite common, it was clear there was a need for a national guideline to set out a definition of the condition, to identify the evidence base for any investigations and treatment, and to develop a framework for services that might be required.

A unique collaboration was formed between Healthcare Improvement Scotland, the National Institute for Health and care Excellence (NICE) and the Royal College of General Practitioners, to develop a guideline that could be used across the UK. As an infectious disease specialist, I was asked to be a member of the oversight committee, to provide a definition of the condition, and to set out the questions that the guideline needed to address. This was a real challenge – the knowledge base for Long COVID was very limited and there was no accepted definition or indeed name for the syndrome. Given the large range of symptoms reported and that we wished to make clear this was quite distinct from the symptoms from the acute phase of the infection, we settled on ‘Post-COVID-19 Syndrome’, with a definite diagnosis at 12 weeks after the initial infection.

Patient groups and the media have continued to use Long COVID – I don’t feel there is any problem with this. We are used to there being ‘medical’ names for conditions as well as more common terms used by the public – doctors will call glandular fever ‘infectious mononucleosis’, but the important point is that we are talking about the same thing. Having a definition is incredibly important – this will allow every consultation with patients who have Post-COVID-19 syndrome to be captured by computerised data systems so that we can build up an accurate picture of its prevalence, the spectrum of symptoms experienced and risk factors for its development.

The guideline development team worked incredibly hard and at a fast pace to gather all available evidence in order to produce a document that could be used as quickly as possible. Specialists from across the UK were involved, as well as patients who had experienced the condition. A real challenge for developing the Long COVID guideline was the dearth of good evidence – this is such a recent illness that there was not much high quality research available. However, the final guideline incorporated all that was known at this time and sets out some concrete advice on diagnosis, investigations and management.

A “Living” Guideline

The developers very much realised that the guideline will continue to be modified over time as more evidence accrues – what we refer to as a ‘living’ guideline. But it is a welcome beginning that provides a solid start in recognising and defining the condition, and providing valuable evidence-based recommendations for clinicians caring for Long COVID patients.

As we continue to look at the new evidence in order to help guide future versions of the guideline, it’s important that healthcare professionals and those affected by Long COVID are familiar with what we currently know about the guideline and the best way to diagnose and treat it. Knowledge and the sharing of that knowledge will be crucial to improving the lives of those with the condition.

Professor Tom Evans is an infectious disease specialist working with Glasgow University and a member of the development group responsible for the Long COVID guideline.

More information

Visit the SIGN website to read our Long COVID guideline.

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