Posts from the “Uncategorized” Category

The changing nature of regulating private healthcare – Kevin Freeman-Ferguson

Posted on November 24, 2022

As we emerge from the COVID-19 pandemic and the NHS continues its uphill battle towards recovery, private clinics are becoming an option for patients across Scotland and the industry is constantly growing and developing to meet demand. As the regulator for private healthcare, Kevin Freeman-Ferguson, our Head of Service Review, gives his thoughts on how the industry is changing and what the next couple of years have in store.

Looking towards the future

As the regulator of private healthcare in Scotland, we are always looking towards the future – not only do we have to be aware of all the current developments in the industry, but we also need to be a step ahead in order to make sure that services are providing high quality care and have systems, processes and procedures in place to keep patients safe at all times. Private healthcare is constantly changing – just like other commercial sectors, it adapts to market forces to offer new services whenever it identifies an unmet need. For example, the unprecedented demand on the NHS caused by the COVID-19 pandemic has led to private care providers offering new services to patients waiting to see specialists, with a growing number aimed at people who are looking for a diagnosis of neurodiversity, such as autism, ADHD, dyspraxia and others, as well as mental health services.

Regulating private healthcare is paramount to patient safety – we have inspected over 500 private clinics across Scotland, from those offering cosmetic treatments, through to private dentistry, health screening services, private psychiatric hospitals and hospices, among others. Our inspections and their reports ensure that patients who turn to these services, due to NHS waiting lists or because they have private health insurance, or for other reasons, are being seen by the best professionals, who keep their safety and wellbeing front and centre.

Similarly, we are also noticing that the way people are using independent healthcare is changing, as well as those choosing to have health insurance and paying a monthly fee, there is a growing number opting to pay for a single operation or treatment in the independent sector. To me, this demonstrates that we as a whole continue to rely on the NHS, but will occasionally seek out particular treatments, like a specific surgical procedure or a consultation with a psychiatrist.

New challenges

These changes mean that as a regulator of independent healthcare, we are busier than ever. Many of the services that we inspect are providing specialist or emergent treatments and procedures. This means that in order to regulate them and to ensure that our inspections are thorough, we need to obtain a wide range of additional clinical input to support our work. We are tackling this by tapping into the full range of clinical expertise available within Healthcare Improvement Scotland, as well as developing a drawing on clinical experts from outside of our own organisation.

The last couple of years has also seen a rise in healthcare being offered online, which brings with it a unique range of challenges, such as ensuring that people are protected, when in many cases, care is provided on the basis of a clinical questionnaire that relies on the honesty and transparency of the patient filling it in. While this will be reviewed by a prescriber, it is unlikely they will have a face-to-face consultation with a healthcare professional. While this can be done well, the system is easy to manipulate if good controls are not in place. We also must make sure that aspects of the service that are carried out by computers, like identity checks and the algorithms that support diagnosis, are clinically sound and working as expected. I am happy to say that this is a challenge that we are working to rise to, through our collaboration with other regulators, as well as the providers in the sector to develop good practice.

Interestingly, while the COVID-19 pandemic has had a significant impact on how patients are using independent healthcare services, it hasn’t really impacted the way in which we carry out our inspections. To ensure that a provider follows the necessary guidelines and prioritises patient safety, we still need to physically attend the site.

Future developments

As we look ahead to the next couple of years, the biggest regulatory change will be the addition of pharmacists and pharmacy professionals to the definition of an independent clinic, which will close a small regulation gap if a pharmacy professional is working from somewhere other than a registered pharmacy giving us the powers we need to continue keeping patients safe. We will also continue working with our Scottish Government colleagues on modernising the regulatory framework so that is it better equipped to deal with services that do not engage with us or who are intent on evading regulation. Fortunately, due to how closely we work with Scottish Government, we are always well prepared for any changes, especially as more often than not, we consult on them and support with information where we can.

Kevin Freeman-Ferguson is the Head of Service Review at Healthcare Improvement Scotland.

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Ensuring accurate death certificates helps provide clarity to loved ones at a distressing time – Dr George Fernie

Posted on October 19, 2022

The work of our Death Certification and Review Service (DCRS) has a direct impact on the people who have experienced the death of a loved one, helping to provide answers and clarity to aid the bereavement process. Dr George Fernie, our Senior Medical Reviewer, explains the benefits to the public of the work of DCRS.

The death of a loved one can be a distressing and complicated time for family and friends. No matter how prepared you might be for an individual’s passing, there is always so much to do, a great deal to process and so many questions that loved ones seek answers to.

The death certificate is that all-important legal document, written by the treating doctor, and provides clarity as to the cause of death. If the deceased had other health conditions or a series of medical events leading up to their death, an accurate certificate can provide answers that can help people process what has happened.

DCRS – the vital service behind the scenes

The Death Certification Review Service (DCRS) fulfils a vital role that happens largely behind the scenes – a function that most families and friends of people who have died will be completely unaware of. In a way, that’s a very good thing. We always aim to be as unobtrusive as possible, so that we don’t affect burial or cremation plans.

In essence, our role is to ensure that death certificates are completed accurately by checking a random sample of certificates before they are issued, providing advice to doctors who have questions about how to complete a certificate, and helping ensure accurate data of information on public health and the main causes of mortality in Scotland. Moreover, we work with both junior and experienced doctors to provide training and opportunities for them to learn and improve; thus ensuring that more and more families are clear on the cause of death of their loved one.

Standard of accuracy continues to improve

As we publish our latest annual report for 2021/22, we’re delighted to say that the standard of accuracy in how doctors are completing death certificates continues to improve. The monthly percentage of randomly-selected death certificates found to be ‘not in order’ – meaning that we have requested changes or clarification – has seen a sustained improvement each year to a current median of 21.5%. Of the certificates we deemed were ‘not in order’, 48% were due to the cause of death being too vague. ‘Too vague’ can mean failing to specify the location and type of cancers or strokes. This information gives consistency in recording causes of death in Scotland that will help resources to be directed to where they best need to be. Administrative errors like spelling mistakes, use of abbreviations and failing to sign the certificate, were other reasons for DCRS asking for improvements to the certificate which was issued.

But doctors also get in touch with us for advice, and we’re available to them 365 days a year, which is especially important for particular faith groups. In 2021/22, we dealt with 2,279 calls. The majority of calls (81.8%) were from doctors seeking clinical advice on how to represent a death on a death certificate.

Repatriation and deaths abroad

We’re also responsible for approving burial or cremation in Scotland of people who have died abroad and want to be repatriated to Scotland.

In 2021/22, the service received 84 repatriation requests. All were approved. One family requested a post mortem which was also granted.

Review requests from the public

Members of the public can request a review of a death certificate, as well as registrars being able to refer a death certificate to DCRS service for review if they feel the certificate is not accurate.

We will then carry out a Level 2 more detailed review, if the death has not previously been reviewed by us, or the death has not already been reported to the Procurator Fiscal. Last year we carried out 13 such reviews, of which 6 were found to require a change and 3 required reporting to the Procurator Fiscal. One was declined as the death had previously been considered by the Procurator Fiscal.

Potential challenges ahead

Year on year we have seen the amount of time within which our reviews take place getting shorter and we are aware this winter period, with greater pressure on the NHS, completing reviews as quickly may be challenging. In 2021/22, our average time to complete a level 1 review was less than 4 hours, however 217 reviews took longer than our agreed 8 hours timescale, with 187 due to difficulties reaching the certifying doctor to carry out the review. Deaths cannot be registered until DCRS complete the review and delays in death certificates being issued, can impact on burial or cremation plans. We will do all that we can over the coming months to minimise the disruption to loved ones at an already difficult time.

The year ahead

Over the year ahead we will continue to look to improve the service we provide. By doing this, we know that families and loved ones across Scotland can get greater certainty around the cause of death of their loved one; thus aiding the grieving process and providing a key answer to a question that so often accompanies death.

Read the latest DCRS Annual Report for 2021/22.

George Fernie is a Senior Medical Reviewer at Healthcare Improvement Scotland.

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Timely and sensitive engagement with bereaved families and carers after the death of a child is of utmost importance – Dr Alison Rennie

Posted on October 17, 2022

Dr Alison Rennie, Clinical Lead for the National Hub for Reviewing and Learning from the Deaths of Children and Young People, reflects on what we’ve learned during the first year of implementing new guidance and processes for child death reviews and how engaging with bereaved families is at the heart of every review. The National Hub is a collaboration between Healthcare Improvement Scotland and the Care Inspectorate.

In my time as a children’s doctor I have had the privilege of caring for children with many diseases and conditions, and I’ve seen innovative developments in medical care. I have also experienced the death of many children, so I am all too aware of Scotland’s unfortunate ranking in having amongst the highest child mortality rates in Western Europe.

Each death stays with you, and having supported bereaved families and carers following the death of their child, I recognise the importance of timely and sensitive engagement at such a sad time is vital.

I’m proud to be the National Clinical Lead for the National Hub, a collaboration between Healthcare Improvement Scotland and the Care Inspectorate. The National Hub seeks to address the child mortality rate by supporting the health and social care system in Scotland to reduce avoidable deaths of children and young people. This will be achieved by reviewing and learning from every death of live born children up to the date of their 18th birthday, or 26th birthday for those who had been receiving care at the time of their death. This learning will help with the redesign of pathways and services and will be used to recommend legislative change.

Year 1 of death review implementation

The National Hub started sharing national data on the deaths of every child in Scotland from 1 October 2021. Along with our implementation leads in each NHS board area and their local authority partners, we have worked over the past year to embed quality child death review processes and governance and share learning to promote the spread of positive change.

What we learned from bereaved families

Alongside our work with implementation leads and other national agencies involved in child deaths, including among others the Scottish Ambulance Service (SAS), Police Scotland and the Crown Office and Procurator Fiscal Service (COPFS), we also consulted parents and family members whose child had died. Working with our charitable partners, Children’s Hospices Across Scotland (CHAS), Child Bereavement UK and Sands, the stillbirth and neonatal death charity, we produced a report in June 2022: When a child dies: Learning from the experiences of bereaved families and carers.

The report highlighted the vital importance of the need to learn from child deaths and to keep the voices of families and carers at the forefront in order to gain invaluable insights into the life and care of their child, and acknowledge where improvements must be made to reduce preventable deaths.

We found through our research that while the levels of support received by families varied considerably across Scotland, examples of excellent, compassionate care were also present. The report gave a voice to families and carers, and the important role that clear and consistent communication has when it comes to ensuring that families understand the review process and feel properly supported throughout.

The report made eight recommendations to NHS boards, local authorities, public protection committees, third sector organisations and the National Hub to help improve the review process for families and carers. One recommendation that can bring significant positive impact for bereaved people is identifying a key contact for the family before, during and after the review process to ensure that the interests of families and carers are represented throughout. While levels of support for families varied a lot across the country, examples of excellent care were also highlighted.

How we can make a difference

With the findings we now have, we are working with our partners to produce national information that explains child death reviews and the role of the key contact in supporting families and carers following the death of a child. We’ll produce the information in more than one format to make it as widely accessible as possible and it will be distributed throughout Scotland, with extra local advice in some areas.
We’ll continue to refine processes, governance and engagement in each health board area and share learning as we strive to continually change and improve.

We want to thank everyone who has been involved in the programme to ensure the successful launch of the National Hub and implementation of our national guidance over the past year. In particular we want to thank those bereaved parents, carers and family members who helped us understand what it’s been like for them following the death of their child or children, and show us what we can do to help families feel more supported in the future.

While we can’t prevent all deaths, we hope the work of the National Hub and those involved in child death reviews will lead to a reduction in the child mortality rate over time, and will deliver a more appropriate and meaningful support for families whose child has died. I am confident change will come.

Dr Alison Rennie is a Consultant Paediatrician and Clinical Director of Community Paediatrics in NHS Greater Glasgow and Clyde with a special interest in children with complex disability. Her background of working with vulnerable families, and her experience in significant case reviews led to her interest in understanding and learning from deaths in childhood. She is seconded to Healthcare Improvement Scotland as national clinical lead for the National Hub for Reviewing and Learning from Child Deaths.

On Twitter, follow @AlisonRennie7 and the National Hub at @online_his using #CDRNationalHub.

Find out more

Read our guidance and report, and download resources at https://www.healthcareimprovementscotland.org/CDRNationalHub

You can also get in touch with the National Hub team at his.cdrnationalhub@nhs.scot

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How being an AHP lead me to helping others to meaningfully engage – Sarah Bowyer

Posted on October 14, 2022

The career journey of an Allied Health Professional has no definitive map, according to the experience of Sarah Bowyer, Engagement Officer in Healthcare improvement Scotland’s Community Engagement directorate.

“Don’t forget – academic qualifications aren’t everything. You’ll need to be interested in science and food and people’s lifestyles. You’ll need excellent communication skills and be able to explain complex things simply.”

This is the advice the NHS careers website offers about the role I started out my working life in – dietitian. But in truth, it’s the latter point that could apply to the whole of my varied career. Helping others to be all they can be, rather than setting my sights on reaching a particular position or role, has been my aim in my working life. In fact when my career began with my state registration as a dietitian, over 30 years ago, many of the jobs I have since enjoyed were not even in existence– and that includes my current position as Engagement Officer in Healthcare improvement Scotland’s Community Engagement directorate.

How did I get here?

Over the years, I’ve enjoyed working on fixed term contracts around the UK, across the public, private and third sectors. These have mainly been in the NHS but others have been in education, and have focused on nutrition in primary care, public health and health inequalities in communities.

I’ve worked in Scotland over the last 14 years, where my work has been less about my interest in science and food, and more on those people oriented skills, refined during my past dietetic roles, which look at the complexities of ‘People, Health and Place’.

I started in a public health dietetic role with NHS Highland, which looked at a community development approach to health and wellbeing. This led me to carry out research focusing on the involvement of people (both patients and staff) in improving rural health services, and this work led me to come across the Scottish Health Council (relaunched as Healthcare Improvement Scotland – Community Engagement in April 2020).

I’m now working as part of the Healthcare Improvement Scotland – Community Engagement directorate, where we look to get people involved in developing and delivering health and social care services.

Bringing skills to Healthcare Improvement Scotland

My role is to deliver the work of Healthcare Improvement Scotland in the NHS Highland health board area. As a dietitian, my practice and skills need to meet the 15 standards of proficiency, governed by the Health and Care Professions Council.

These standards guide how I do my work today. Some may seem obvious, such as the ability to communicate effectively, or be able to practise in a non-discriminatory manner, but other, more specific ones are key to my role with Healthcare Improvement Scotland.

As a practitioner, my natural style has always been about the people, using a ‘with and for’ rather than an ‘at and to’ approach. For example, when supporting someone with a therapeutic diet, my thinking is that the person knows what works best for them, and they will have useful information from their lived experiences to share.

Another example is my role in developing, establishing, and maintaining links with local NHS, integration authorities, patient and public networks, helping with local communications plans to make sure we have the maximum impact possible, and give effective support to the other bodies/organisations.

These actions all tie in with standard 9, ability to work appropriately with others, which I have managed to do with different groups, of different ages, of different types, in different areas, during my 30 plus year career.

Where to next?

As NHS Scotland recovers following the COVID-19 Pandemic, two things jump out at me for my Engagement Officer role – community engagement and providing inclusive person-centred public services.

As a registered Allied Healthcare Professional (AHP), my work helps me play my part in the Scottish AHP Public Health Strategic Framework Implementation Plan, for Scotland’s AHPs to be leaders in public health improvement. I feel well placed to be a part of this work.

Sarah Bowyer is a Community Engagement Officer based in the Highland Community Engagement Office.

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Ensuring everyone has access to good quality mental health services this World Mental Health Day – Rachel King

Posted on October 7, 2022

Our mental health needs attention and care to allow us to feel well and manage our day to day lives.

We know that if we are struggling, we should ask for help, we also know that just because mental health problems aren’t visible, it doesn’t mean they aren’t real. This year, to support World Mental Health Day, we have spoken with Rachel King, our mental health lead, about our ongoing work to ensure that everyone across Scotland has access to good quality mental health services.

1 in 4 people will experience mental health struggles at some point in their lives – a massive number of people who will need either some support at one point in their life, or ongoing, life-long mental health support. It is essential that as the general public continues to gain a better understanding of mental health struggles, the health service continues improving and developing, offering support to people whenever they need it, wherever they are in the country. As the improvement agency for health services in Scotland, we are currently working on four different mental health programmes that help to solve specific issues faced by the health service or members of the public accessing it.

Pull quote graphic. Text reads: "1 in 4 people will experience mental health struggles at some point in their lives"

Scottish Patient Safety Programme Mental Health

The Scottish Patient Safety Programme (SPSP) is a national quality improvement programme that aims to improve the safety and reliability of care and reduce harm. The mental health work supports NHS boards to ensure that everyone in adult mental health inpatient settings experiences safe and high quality care, with their unique needs placed at the centre of care delivery. As part of this work, we are striving towards reducing incidents of restraint and seclusion, while also working with boards to create conditions for improvement within their teams and implementing the ‘From Observation to Intervention’ national guidance.

Since launching the mental health programme, we have achieved some significant milestones, such as a 57% reduction in restraint, a 70% reduction in the number of patients who self-harm, and a 78% reduction in the rates of violence on inpatient wards.

As this programme goes on, we hope to achieve even greater results and continue to improve the experience of mental health inpatients across Scotland.

Pull quote graphic. Text reads: "We have achieved a 70% reduction in the number of patients who self-harm in inpatient settings"

Personality Disorder Programme

The Personality Disorder Improvement Programme (PDIP) is one of our most recent pieces of work, launching in January 2022. While still in its early stages, the overall aim of the programme is to better understand the care currently provided to people with a diagnosis of personality disorder, which will in turn help to identify the areas that could benefit from improvement and then to develop proposals to deliver those improvements.

One of the main goals of this programme is to provide opportunities for care providers to learn together, sharing their experiences and knowledge. To date, we have hosted three webinars and one workshop, with over 1,385 people registering to date and over 550 people attending. Another of the programme’s aims is to better understand the current state of personality disorder care and identify the key opportunities for improving services. It will also enable us to make high-level recommendations about what would need to be in place to deliver these improvements.

The main approach for the gathering of information is virtual visits with NHS boards and Health and Social Care Partnerships (HSCPs). From June–August 2022, the PDIP team has been in active discussions with 11 of the 14 NHS boards and representatives from each of the HSCPs. We have commissioned the Scottish Recovery Network and Voices of Experience (VOX) to undertake a programme of engagement of people with lived experience of personality disorder, as their input would be invaluable.

Early Intervention in Psychosis (EIP)

The Early Intervention in Psychosis (EIP) programme supports the redesign and continuous improvement of healthcare services across Scotland, keeping people with lived experience of psychosis, families and carers at the heart of this work.

Pull quote graphic. Text reads: "The programme keeps people with lived experience at the heart of its work.

Currently in its second phase, the programme supports two pathfinder sites, NHS Dumfries and Galloway and NHS Tayside, while they prototype and test new models of early intervention services. The models are now live and they will provide easier access to services, evidence-based person-centred care and treatment, and an increased likelihood of getting well and staying well to people experiencing first episode psychosis.

In addition to supporting pathfinder sites, the EIP national programme is engaging with stakeholders, collecting and analysing service-level data emerging from pathfinder sites, and sharing learning through national network events, newsletters and case studies. At the end of this phase, the programme will produce an implementation guide to be used by health boards across Scotland who are considering setting up an EIP service locally.

Mental Health and Substance Use Programme

Studies have shown there are clear links between mental health and substance use. People who present with both often experience difficulty in accessing services and appropriate treatment. The aim of the Mental Health and Substance Use programme is to redesign care pathways to improve quality of care, access to treatment and health outcomes for those with mental health and substance use support needs.

Pull quote graphic. Text reads: "studies have shown clear links between mental health and substance use"

We are currently involved in ongoing work in NHS Tayside to develop and test an integrated approach to mental health and substance use. We are also working with NHS Grampian and NHS Greater Glasgow & Clyde to bring this work to the areas, with plans to work with NHS Lothian and NHS Lanarkshire in the near future. Measures of success will include the following phases: discover, define, develop and deliver. Measures of success will include improved and fair access to health and care services, reduction in harm arising from unmet needs in relation to mental health and substance use, and the extent to which individuals experience a person-centred, integrated service based on needs.

Our end goal for all of this work is to improve the care received by people affected by mental health conditions, making sure they can access the help they need quickly and efficiently, regardless of their geographical location.

Rachel King is the portfolio lead for the mental health work at Healthcare Improvement Scotland.

More information

Find out more about our work at the links below:

Scottish Patient Safety Programme Mental Health

Personality Disorder Programme

Early Intervention in Psychosis (EIP)

Mental Health and Substance Use Programme

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Helping ensure excellence prevents the mistakes of the past – Gareth Bourhill

Posted on August 18, 2022

Having lost his mum in the Vale of Leven c-difficile outbreak of 2007-8, Gareth Bourhill was determined to prevent other families having to experience the same thing. Now a patient representative on Healthcare Improvement Scotland’s recently relaunched Excellence in Care Programme Board, he tells us why team work and communication are key to good quality care for all.

Just before Christmas 2007, my mum, Janet Fitzsimmons, was admitted to the Vale of Leven Hospital. She was diabetic and had a blood sugar issue. It had happened before, and we expected her home after a few days when her blood sugar levels were back to normal. But this time it was different and she contracted horrific diarrhoea. Doctors couldn’t find a cause or a suitable treatment and within 24 hours she was put in isolation. She had contracted clostridium difficile (C. diff).

While she came very close to passing away over those few days, she made a limited recovery. She died eight months later, on 9 August 2008 aged 69, one of the youngest victim of the Vale of Leven outbreak.

The story of my mum’s final illness has been summarised and reported on in the many documents and reports at the C.diff public inquiry. Police Scotland carried out a criminal investigation and I spent two full days with police officers in my home, writing down every single word, date, time, things about my mother’s care, confirming on hospital ward drawings exactly what bed she was in and for how long as she moved from ward to ward.

Helping ensure the past doesn’t happen in the future

After all this, after everything my mum went through, that we as a family went through, you might wonder why I wanted to get involved with Excellence in Care, with anything to do with the healthcare system.

Well, quite simply I lost someone who was important to me. Like my fellow public reps on the Excellence in Care programme board, I could have easily walked away and continued my family life as best I could after the conclusion of the public inquiry and the publication of Lord MacLean’s report in November 2014.

But, like my fellow reps, the knowledge I gained from the infection outbreak to publication of that report, I knew that until all 75 of the report recommendations were addressed and executed within all areas of NHS Scotland, a similar or indeed worse occurrence wasn’t just likely, it was likely to be a certainty.

What is Excellence in Care?

Excellence in Care is about the patient, their family and health care staff working together as a team for a positive outcome and experience for all. Ultimately that leads to less complaints and better outcomes for all.

My colleagues on the programme board have to keep reminding me that these things are what they call the “Fundamentals of Care”. Being a consultant electrical engineer, I go into engineering mode and call them the basic skills or foundation skills, but we’re all talking about the same things here. There’s no point in having a stunning looking skyscraper if you don’t get the foundations of the building right. Even if they are out of sight, out of mind buried in the ground, the building will eventually fall over.

When I started as an apprentice electrician in 1981 my new boss said to me: “Gareth, you are now an apprentice electrician, please don’t ever do anything while at work that will cause any embarrassment to your family or the good name and reputation of this firm”. To me that philosophy is also very much part of the fundamentals of Excellence in Care.

At the end of each shift, can you honestly say that the work you carried out, or were responsible for, was in line with your professional training and experience and protocols? If everyone does that, the outcome for patients will be better, family representatives will see that, there will be fewer complaints and far less chance of another Vale of Leven C.diff outbreak happening again.

Excellence in Care is very much part of every minute, every hour and every shift a health care professional works.

Gareth Bourhill is a public representative on the programme board of Excellence in Care, a programme led by Healthcare Improvement Scotland.

More information

To find out more about Excellence in Care, visit: the Healthcare Improvement Scotland website.

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A cosmetic procedure should be aesthetically pleasing, but it must also be safe – Natalie Graham

Posted on July 13, 2022

Natalie credits her work for Healthcare Improvement Scotland, the regulator of private healthcare clinics, with shielding her from getting cosmetic treatments that, while cheap, were provided by people whose knowledge and training was unclear. She is now on a mission to help others understand what is and isn’t safe when it comes to private healthcare.

Understanding what is, and isn’t, safe

All of us have heard stories of cosmetic procedures gone horribly wrong – lip fillers that look awful, face muscles that get affected if an injection wasn’t done properly. But this didn’t put me off when I first looked into getting a cosmetic procedure done. Back then, I was influenced by two factors – the price and how close the provider was to where I live in West Lothian. This attitude quickly changed when I began my role with Healthcare Improvement Scotland within the team responsible for regulating private healthcare (clinics, hospitals and hospices that are not part of the NHS). Now, the most important factor in my decision-making is whether the clinic is registered with us, which means that their staff will be appropriately qualified and the clinic inspected and their reports published online.

I now have my aesthetic work done at a registered clinic in Glasgow. It is vital that clinics are regulated to ensure that they meet the standards of care set out in Scotland.

Regulated and safe, vs unregulated and careless

It was during my first my first appointment with my current clinic – which was a consultation only – that I noticed the stark difference between regulated and unregulated clinics In the course of the appointment, I felt that not only was I given great advice about what would work for me specifically, but that the clinicians wanted to make sure that I was getting the procedures for the right reasons. I felt that they were subtly checking to see if I was doing this for myself, that I understood what the process entailed and that I wasn’t affected by body dysmorphia. This was very different from the non-regulated clinics that I attend in the past, where I felt that the practitioners were only interested in taking my money and that frequently, they would have more than one patient in at the same time, which meant I didn’t receive their undivided attention, which naturally increased the scope for error.

Learning from experience

While I now have the assurance that I am in the hands of certified healthcare professionals, this is often not the case for many people. Since talking about my work to my friends, I have been approached by numerous people, asking me for advice about aesthetic procedures and specific clinics, to see if I knew about them and if they were registered with Healthcare Improvement Scotland. It highlighted to me just how important it is that young people – and all those considering cosmetic procedures – know what to look for in a clinic and how to guarantee that they will be safe and taken care of. For many of the people I have spoken to, the first step when it comes to researching a clinic for treatments is to check if they are registered with us. Everything else, like location and price, comes after.

There is of course still the risk that young people especially could be swayed by lower prices offered by unregistered clinics, or if they market their treatments in ‘bundles’. I always say that while the price might seem lower, the quality of care may be worse as well and should there be a medical emergency, many of the clinics that are not registered may not be able to help. Similarly, if something does go wrong, there is no one to complain or flag your concerns to, whereas for an clinics registered with Healthcare Improvement Scotland, not only do you have that safety net to fall back on, but you can actually check a clinic’s previous reports to see how well they did and if any concerns were raised during inspection or if any complaints have been investigated and upheld.

Getting a cosmetic treatment is a personal choice – everyone’s reasons are totally unique to them. What all people considering aesthetic work must do is prioritise their personal safety and wellbeing, and the best way to do this is in the hands of a trained and registered clinic.

Natalie Graham is 26 and an administrative officer with Healthcare Improvement Scotland’s independent healthcare team.

More information

For more information on regulated clinics, and to view our register of regulated clinics, visit our website.

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How we engage with patients and their families is key to care improvements – Lynsey Cleland

Posted on June 22, 2022

Placing patients and families at the heart of everything we do is key to improving Scotland’s healthcare, says Lynsey Cleland, Director of Quality Assurance at Healthcare Improvement Scotland.

As we look at the recovery of our health and care services following the COVID-19 pandemic, we are beginning to look towards the future and what quality patient care should look like going forward. The more we look, the more we see that the key to our improvement is patients and their families – without their feedback and their involvement we will miss a vital opportunity which can help us succeed in our mission of delivering outstanding care to everyone in Scotland.

Two important reports

In the course of the last few months, our organisation carried out two pieces of work looking at incredibly challenging areas of healthcare – adverse event reviews (an adverse event is when something happens while care is being delivered which could have, or has resulted in, harm to people) and the experiences of families and carers who lost a child. Both of these areas have a profound emotional impact on those involved, lasting years, if not entire lifetimes. Despite these pieces of work focusing on different areas of healthcare, they set out to establish similar objectives – what did those with lived experience of these events need from their health service? What was truly important to them? What could health providers, local authorities and the third sector do to make a difference and improve?

Listening and empathy

Two themes emerged – listening to patients and their families is essential if we want to understand what went wrong, and that clear, empathetic, human communication was fundamental if we wanted to provide patients and families with the support they need as they move through what is unquestionably, an incredibly challenging time. Both studies talked about examples of patients and families experiencing extraordinary levels of care and consideration across NHS Scotland, with healthcare professionals really tuning into their needs, listening to their experiences and showcasing demonstrable learnings. However, both studies also showed that approaches to reviews, for adverse events and child deaths alike, were inconsistent and didn’t always take account of individual patient and family needs. Families and patients highlighted that in order to benefit from a review process, they needed to understand exactly what the purpose of the review was, how they can contribute and be safe in the knowledge that their emotions will be taken into consideration.

For example, the National Hub for Reviewing and Learning from the Deaths of Children and Young People set up by the Scottish Government and overseen by us and the Care Inspectorate to review and learn from the deaths of all children and young people in Scotland up to age 18, or 26 if receiving continuing care or aftercare, at the time of their death, found in its found in its consultation of bereaved families and carers that following a harrowing event like the death of a child, many families and carers were often unable to digest the information given to them and would benefit from having a review at a later stage. On the other hand, the adverse event reviews study found that some reviews were not timely enough, with those affected saying that they understood that NHS services were under significant pressure and that they would benefit from a timeline, or updates when delays had to happen.

Unprecedented numbers

So, what can we do going forward? We must listen to our patients, their families and carers – that much is clear. We already know that NHS boards across Scotland are paying attention – an unprecedented number of healthcare professionals has expressed interest in receiving compassionate communications training, while examples of outstanding care are reported by patients across the board. It is also paramount that we never forget that people are at the heart of everything we do and that their needs should be placed at the centre of how we shape and improve our health services. Community engagement is a core part of what we do at Healthcare Improvement Scotland, working with the NHS, our partners and patients to make sure that real human experiences and opinions shape national policy. From the recent findings of our work, it is clear that this collaboration is now more vital than ever and that we focus our efforts on three key elements – listening, learning and improving. We will continue to play a key role in ensuring this happens, through producing national information for families, as well as instituting a single point of contact for families to keep them engaged in review process.

Lynsey Cleland is Director of Quality Assurance for Healthcare Improvement Scotland.

More information

Read ‘When a child dies: Learning from the experiences of bereaved families and carers on the Healthcare Improvement Scotland website.

Access the study on the British Medical Journal website.

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Personal pronouns and why you should start sharing yours today – Rosie Tyler-Greig

Posted on June 13, 2022

Thumbnail image of author: Rosie Tyler-Greig

As part of our celebration of Pride month, Rosie Tyler-Greig, our Equality and Diversity Officer, has spoken with our internal Pride Network for LGBT+ identifying staff and allies, to explore the importance of personal pronouns and why we should all start sharing them in our working environment. We would like to thank Rosie and everyone who took part by contributing their thoughts and reflections.

We use personal pronouns every single day – when talking about ourselves, about our colleagues, friends, families and strangers. Yet, how often do most of us actively think about other people’s pronouns or even our own? How many of us state our pronouns in our email signatures, or say them out loud when introducing ourselves? Do many of us understand why doing so is actually important? Since pronouns can be particularly important for members of the LGBT+ community, we have spoken with our Pride Network to get their thoughts on some of these questions. Members also offered ideas that could help Healthcare Improvement Scotland be an even more inclusive environment.

Pull quote image: "How many of us state our pronouns in our email signatures or say them out loud when introducing ourselves?”

Personal pronouns = identity

The first thing to understand is that personal pronouns impact everyone – whether you have never questioned your birth gender (so are cis-gender) or realised your gender is different to the one assigned (so are trans). We have all, at one point or another, come across unfamiliar or uncommon names, or names that could belong to different genders. In a situation like this, you may take special care to pronounce or spell a name correctly. Our pronouns are as much a part of our identity as our name – we use them throughout the day when talking about ourselves and those around us, so it is only natural that by using the right pronouns we are being respectful of someone’s individuality and identity.

Stating your pronouns = safe space

Using a person’s preferred pronoun is a sign of respect for them as an individual. Sharing your own, regardless of your gender or how ‘obvious’ your pronoun is, is an active step towards creating a safe space for everyone around you. This is because doing so normalises something that may be ‘less obvious’ and take bravery for someone else.

Pull quote image: “Using a person’s preferred pronouns is a sign of respect”

Our gender is at the core of who we are. Calling someone by the wrong pronoun feels the same as using the wrong name – it can invalidate who they are and undermine trust. It would be hard to feel safe expressing opinions or needs in any environment where people consistently called you the wrong name.

Asking questions = curious respect

All that said, what can we do to respect pronouns? Being respectful of others is a huge part of any healthy work environment and at one point or another, all of us will worry about accidentally offending or upsetting someone. If you find yourself unsure about someone’s pronouns, the easiest thing to do is just ask! Asking the question and learning in the process is so much better than making assumptions, or even worse, avoiding someone entirely because you are worried about saying the wrong thing. Similarly, if you find yourself making a mistake, apologise and move on just like you would if you mispronounced a name. There is no need to make it into a big issue.

Practice = perfect

Sometimes we may need to remind ourselves of the pronoun a person uses. Non-binary pronouns, they/them, seem to be an area people trip up at more often. Some people have assumed – incorrectly – that using ‘they/them’ in the singular is grammatically incorrect. Imagine someone, who you don’t know has left behind their phone. You would automatically say ‘they forgot their phone’. If you’re talking about an appointment with a clinician you haven’t met before, you’d say ‘I’m going to see them to ask them about…’ If you don’t know someone’s gender, you may just use ‘they’ until you get clarity. If you still find yourself tripping up, then practice – tell anecdotes about people using they/them pronouns, talk about your friends who identify as they/them when they aren’t around. Eventually, this will come more naturally.

Pull quote image: “Some people have assumed – incorrectly – that using ‘they/them’ in the singular is grammatically incorrect”

Next steps

We hope this article has clarified the important role that personal pronouns have. So how can you help make our communications more inclusive? Start by adding your personal pronouns to your email signature and stating them whenever you introduce yourself to someone new. For example, ‘Hi, I’m [name], my pronouns are [pronouns] and I [job]’

This shows that you are taking responsibility and sharing your knowledge. In turn, this takes some pressure off the LGBT+ community, who are so often expected to do the teaching. And remember – mistakes do happen, the key is that you learn from them!

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

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Leaving the NHS doesn’t mean the caring ends – Linda Gunn

Posted on June 6, 2022

Linda Gunn is a volunteer Public Partner with Healthcare Improvement Scotland. Following her retirement from the NHS after 42 years, Linda still wanted to play her part in helping others and saw the role with our organisation as a perfect way to keep making a difference.

The NHS has been through a most difficult time in the last few years, in all its forms of healthcare delivery and in the education of new healthcare workers.

Even though I had retired from working in dental care, I felt I still had something to offer and that my experience might be helpful to another part of the NHS. Initially I thought I would be able to help in the response to COVID-19, but I was open to different challenges.

An initial web-based search for volunteering roles in the NHS brought up Healthcare Improvement Scotland (HIS) and the name caught my attention, as my own motivation for volunteering would be to improve care. I felt, from that moment on, a new, interesting and enlightening world opened up for me.

I applied to Healthcare Improvement Scotland to become volunteer, otherwise known as a Public Partner, at the beginning of 2022, so it is still early days. Since then I have undertaken a comprehensive induction programme and completed an online module on Health Technology Assessment – more of that later.

Meaningful involvement

It does not matter whether we, as patients or carers, have to use the NHS regularly or not. Having the reassurance that it is available to us is one thing, but having the comfort of knowing that we will be treated in the best way by the right healthcare staff who are well trained and professional is, I think, the most important thing to us. This scrutiny of the service in its many forms is what being a Public Partner allows me to be a part of and to contribute to.

As a Public Partner, I have found myself involved in major projects such as the quality assurance of Healthcare Improvement Scotland itself and quick questionnaires such as those of the citizen’s panel.

Pull quote graphic: "As a Public Partner, I have found myself involved in major projects such as the quality assurance of Healthcare Improvement Scotland itself and quick questionnaires such as those of the citizen’s panel."

was not sure which area I wanted to focus on but when I joined HIS, the Scottish Medicines Consortium (SMC) – another part of Healthcare Improvement Scotland – was looking for a new Public Partner. I joined SMC in February as one of three Public Partners. We are full voting members of the SMC Committee, and as members of the public, we use our judgement on the value of a new medicine to NHS Scotland. This has been so interesting and a completely new subject for me, so there has been a huge amount to learn, although we are fully supported by the SMC Public Involvement Team.

I was not sure which area I wanted to focus on but when I joined HIS, the Scottish Medicines Consortium (SMC) – another part of Healthcare Improvement Scotland – was looking for a new Public Partner. I joined SMC in February as one of three Public Partners. We are full voting members of the SMC Committee, and as members of the public, we use our judgement on the value of a new medicine to NHS Scotland. This has been so interesting and a completely new subject for me, so there has been a huge amount to learn, although we are fully supported by the SMC Public Involvement Team.

Healthcare Improvement Scotland offers a variety of activities which Public Partners can become involved in, because everything that happens in the NHS can be enhanced by including the opinions of those who use the service; the public.

It is clear that much of this is new to me but from the start everyone in Healthcare Improvement Scotland have been so helpful and patient to ensure I understand. As well as talking me through things, an online module was provided through the University of Glasgow which I completed over a few days.

There was a bit of anxiety when I did the ‘tests’ but once I realised I could go back and revise, that helped – after all, it was more about me learning than achieving a score or pass mark.

Astonished and grateful

While I was totally unaware of the processes involved in how new medicines get approved in Scotland, I am both astonished and grateful that when SMC look at new medicines they take into account patients’ views, the views of their families, the experts and clinicians’ views, cost-effectiveness, and as a Public Partner, my opinions. It is such an incredible, sensitive, caring process which is in place to ensure the patients get the best treatment. I feel very honoured to be part of it.

Pull quote graphic: "My passion for volunteering is a big part of my life and I’m always trying to find other opportunities to help."

There was a bit of anxiety when I did the ‘tests’ but once I realised I could go back and revise, that helped – after all, it was more about me learning than achieving a score or pass mark.

New opportunities

New opportunities to volunteer within Healthcare Improvement Scotland come up regularly but I don’t feel I need to contribute to everything, and no-one puts pressure on me. The trouble is, it’s all so interesting it’s hard to say ‘no’.

I am also hugely aware that everyone in the organisation appreciates my time and recognises that I am a volunteer.

I said I wanted to continue to contribute and I still wanted a challenge and to continue to learn. I have learned so much in the last few months and my thoughts and opinions have been appreciated and respected. It is gratifying to see how such an organisation works for the people in Scotland, so that they continue to receive the best care delivered by professionals at their highest professional standards.

Anyone can contribute and have their own opinions valued, and you don’t need to have an NHS background.

Linda Gunn previously worked in dental education in the NHS in Scotland is a Public Partner with healthcare Improvement Scotland.

Call to action – find out more about being a Public Partner at Healthcare Improvement Scotland and the work of the Scottish Medicines Consortium.

Find out more about the role of a SMC Public Partner.
As part of a rolling Public Partner recruitment programme, SMC will be recruiting another new Public Partner later this year. To find out more please email his.smcpublicinvolvement@nhs.scot
Find out more about Volunteers’ Week 2022. This is the 38^th Volunteers’ Week, with the focus this year on saying thank you to those who give up their time to help others. Find out more on social media, using the hashtag #VolunteersWeekScot

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