Posts from the “Uncategorized” Category

Let’s make Scotland the best place to grow old – addressing frailty and improving care in older life – Dr Lara Mitchell

Posted on March 21, 2023

Frailty can have a significant impact on a person’s life, removing them from the comforts of their own home, their community and their family, while also causing strain on the NHS. Healthcare Improvement Scotland runs a national improvement collaborative that aims to improve identification and support for people living with frailty. Our National Clinical Lead for Frailty, Dr Lara Mitchell, shares her thoughts on what we can do to improve care in older life.

Right now, we are making decisions that will affect our future, older selves. We may not know it, but things we do today will affect how we grow old, what choices we are able to make and how we live. As we age, many of us may become frail, at least to some degree – whether it’s through a loss of mobility, a fall, confusion, or the worsening of an existing condition like dementia. As a result, frailty reduces our mental and physical resilience to bounce back from acute events, which in turn can have a profound effect on our later years.

Having worked as a consultant in Medicine for the Elderly for 20 years, and now in my role as National Clinical Lead for Frailty with Healthcare Improvement Scotland, I have seen first-hand the impact that frailty can have on a person’s life. I believe that if we take a proactive approach to frailty, making sure that people can make informed choices and promoting their sense of agency to make active decisions about their care, we will be able to not only improve peoples’ lives and alleviate some of the pressures currently placed on the NHS, but also make Scotland the best place in which to grow old.

What is frailty and why does it matter?

I think it is important to firstly understand what frailty is not. It is not age and it is not a disability, and that is an important distinction to make. Instead, it is the marriage of a person’s age-related decline with their physiological reserve. While frailty is not inevitable, its impact cannot be underestimated – 50% of people over the age of 85 will live with frailty, while 10% of those over the age of 65 are already frail. It is, however, potentially reversible, especially in the early stages, which is why it is so important that as clinicians in Scotland we look towards identifying frailty as early as possible, and then work with our patients to prevent it from developing further.

When people become frail there can be a loss of control and a feeling that things often happen ‘to them’ such as care packages or a hospital admission. We need to pay attention to our older adults, giving them a sense of control and dignity in the care they receive. On a recent trip to Sweden I learnt of a term that I think encapsulates this – arsrika – which means ‘rich in years’. This concept represents the richness of experience and knowledge that comes in later life, without the loss of dignity, which is really at the core of what we are hoping to achieve.

What are we doing about it?

We are making great strides in identifying the early signs of frailty, which is essential when it comes to addressing its main causes and working towards early intervention and prevention. As clinicians, we have a selection of tools available to us when it comes to assessing frailty. There is the electronic frailty index, which is used in primary care and which is a great signpost for general practitioners about which of their patients are likely to become frail. This is then further contextualised by the clinical frailty scale, a Canadian tool used in both primary and secondary care, to help identify whether the frailty is mild, moderate or severe. Then of course, there is the Comprehensive Geriatric Assessment (CGA), a holistic and evidence-based assessment of a person’s medical, functional, social and psychological needs. This involves a host of professionals assessing the patient to establish what can be done to help, what their needs are and most of all, which involves the patient and their family in the process. It’s a whole-team approach looking at a range of interventions all of which are aimed at improving a person’s life, often in significant and remarkable ways.

At Healthcare Improvement Scotland we are really excited to draw on the learning from our community and acute care programmes of work – we’ve co-designed an improvement change package, which is integrated in approach, spanning health and social care. This package of best practice will form the basis for the ihub Frailty Improvement and Implementation Programme launching in spring 2023, which will provide an opportunity for teams across acute hospitals, health and social care partnerships and primary care to be part of a national improvement and implementation programme. The aim of this is for people living with, or at risk of, frailty to experience improved access to person-centred, co-ordinated health and social care.

What can we do to improve right now?

If we truly want to make sustainable changes for the better of older people, we need to create an environment where we can continually evolve and improve and I believe that this starts and ends with understanding what is important to our patients. I know from my own experience that people are unique and have their own set of priorities, but the one thing that I see come up again and again is that people want to stay at home and want to be with their families. It is only by being attuned to this and listening to our patient’s needs, will we be able to make interventions that have a positive and significant impact on their lives.

Continuous improvement is like exercise, we know it’s good for us, but we need to commit to making it happen. Given current pressures within the NHS this seems like an almost impossible task especially during the challenges of winter. However, if we value and use the strengths in our talented multi-disciplinary teams we can improve patient care and satisfaction, our culture, staff engagement and service quality. Let’s work together to make healthcare better for our future selves.

Dr Lara Mitchell has been a Consultant in Medicine for the Elderly for 20 years and is the current National Clinical Frailty Lead for Healthcare Improvement Scotland.

More information

We are currently accepting applications to join the Focus on Frailty programme until Friday 28 April 2023 at 17.00.

Visit our website to find out more and to apply.

Categories: Uncategorized

The importance of integration for equity and choice in end-of-life experience – Ruth Glassborow

Posted on March 6, 2023

In many ways, the desire to pass our final moments at home is a basic human need. But the reality of making it happen is more complicated. To coincide with Chartered Institute of Housing Scotland’s Housing Festival 2023, Ruth Glassborow, Director of Improvement for Healthcare Improvement Scotland, discusses the need for integration between services to ensure that end-of-life care is delivered effectively for everyone who desires it.

End of life is unavoidable for us all – and although death is often called the great leveller, what has become increasingly clear over recent years is the growing body of evidence around inequalities at end of life, especially with regard to our basic human need to experience our end-of-life journey at home, hopefully surrounded by family and loved ones.

Further, being able to safely care for people at home not only meets the wishes of the people we care for; it also aids us in reducing the significant pressures on our acute hospitals.

When we think of good end-of-life care at home, most of us are aware of the importance of health and social care staff who have the time and skills to support people in their home environment. However, it also requires adequate housing and differences in the quality of peoples housing environment can make a big difference on the both the viability and quality of end-of-life care at home. Imagine you live on the 19th floor of a tower block where the lift is broken and you can’t afford to turn the heating on in the day time, let alone pay the electricity bills attached to the equipment you need to receive care at home. This will inevitably impact on the viability of you receiving end-of-life care at home.

Integration and collaboration

The work of the Dying in the Margins study by the University of Glasgow examines the barriers to, and experiences of, home dying for people experiencing poverty and deprivation in the UK. The images and stories really drive home how important housing conditions are at any time of a person’s life, but particularly at end of life when certain adaptations are required.

Hearing and seeing the practical barriers that people are experiencing has left a lasting impact on my understanding of the importance of this issue.Their work has helped me to realise that, if we want a good end-of-life to be equally available to all, we must pay more attention to integration and collaborative working between health, care and housing.

So, building on the insights provided through Dying in the Margins, Healthcare Improvement Scotland is currently progressing work to better understand the impact of socio-economic status on access to palliative care in the home and to understand whether people living in the most deprived areas of Scotland are able to die in their homes. We will then ensure this evidence informs collaborative working between health, care and housing colleagues to enable individuals to receive end-of-life care at home, no matter where they live.

It is important to highlight that we are not starting from scratch here, there is already much positive work to build on including many great examples of where housing, health and care have collaborated to enhance patient outcomes.

For example, the Housing and Dementia Practice Framework which was co-developed and co-designed by Healthcare Improvement Scotland, Chartered Institute for Housing, Alzheimer Scotland, and people with lived and living experience; assists housing organisations to improve what they are doing to support people living with dementia and their carers.

Another example is testing embedding community link workers within deep-end GP practices in Scotland to support people to live well through strengthening connections between community resources, including housing and primary care.

And then there are all the excellent housing support services that work in effective partnership with local health and care services to enable people to live as independently as possible in the community.

More work for us to do

So we know housing, health and care services can collaborate effectively in helping to improve the lives of people, and improve their access to care. However, there is more work for us to do together if we are to ensure there is equality and choice in how everyone chooses to pass their final moments. No-one should be prevented from dying at home surrounded by their family and loved ones because they live on the 19th floor of a tower block with a broken lift or because they can’t afford the electricity bill attached to the equipment they need to die at home. But we won’t get to this vision of equality without greater collaboration and integration will help us to achieve this important goal.

Ruth Glassborow is Director of Improvement for Healthcare Improvement Scotland.

More information

For more information, visit the ihub website

Categories: Uncategorized

Giving the best advice to help cancer patients in Scotland – Heather Dalrymple

Posted on February 22, 2023

Heather Dalrymple is the National Clinical Lead for Cancer Medicines at Healthcare Improvement Scotland. Having worked as a Lead Cancer pharmacist, she’s now part of the National Cancer Medicines Advisory Group (NCMAG) team helping to improve national access to cancer medicines across the country.

Cancer is something which, sadly, will affect us all in one way or another. One in two of us will get a cancer diagnosis during our lifetimes, and although we can reduce our own chances of getting some cancers, there’s still a possibility that we or our close family members or friends will get a cancer diagnosis.

I know how difficult this can be. Almost six years ago, I lost my dad to mesothelioma, a type of cancer that is caused by asbestos exposure and develops in the lining of the lungs. He was treated in the hospital where I worked, which made it even harder.

At that time, there weren’t many treatment options available for mesothelioma patients, and unfortunately the chemotherapy he received did not help control his disease, and gave him terrible side effects. But now there is evidence available for new treatments with immunotherapy offering improved outcomes with reduced side effects for some patients, showing that improvements in treatment options are developing all the time for many cancers

A passion and a privilege

I spent the majority of my career working as a cancer specialist pharmacist in NHS Lothian before moving to Healthcare Improvement Scotland in May 2022.

I developed my passion for the field of cancer care whilst working as a haematology specialist pharmacist, before becoming lead pharmacist for cancer services in the Edinburgh Cancer Centre. It’s an area where there are constant improvements in the treatments than we can offer patients. In my working lifetime, the treatment options available have multiplied exponentially and outcomes for many cancers have really improved.

It has been a privilege to have been involved in shaping the development of cancer pharmacy services throughout my career, and ensuring that we can safely deliver effective Systemic AntiCancer Treatment (SACT) options for cancer patients.

The cancer community comes together

At the start of the COVID-19 pandemic I was a founding member of the COVID-19 National Cancer Medicines Advisory Group (COVID-19 NCMAG). This group, formed in response to the pandemic, was really successful in uniting cancer specialists to consider how we might best continue to deliver Systemic Anti-Cancer Treatment (SACT) to cancer patients whilst reducing risk of COVID infection in this vulnerable patient group and reducing the pressures on the service.

In a very short space of time 30 proposals were reviewed – and 20 introduced into practice. The group was extremely successful in delivering a ‘Once for Scotland’ approach for patients at a time of huge uncertainty and is something I’m proud to have been a part of.

The development of the National Cancer Medicines Advisory Group (NCMAG)

The success of the COVID-19 NCMAG in delivering national advice, led to a business case being made to Scottish Government with the aim of establishing a programme which would support equitable access to safe and effective off-label and off-patent uses of cancer medicines. This was successful and the NCMAG business as usual programme was established during 2021.

Prior to NCMAG being established, there was no consistency in decision making for cancer medicines which fell into the categories of being off-label –where a medicine is used outwith its licence and off-patent – where the patent for the medicine has expired and alternative versions are available. Off-patent and off-label uses of medicines are outside the remit of the medicines work carried out by our colleagues in the Healthcare Improvement Scotland’s Scottish Medicines Consortium (SMC). SMC review new medicines that have received a licence from the Medicines and Healthcare products Regulatory Agency (MHRA – the licensing body for the UK) and new formulations of, and new ways to use, established medicines.

How NCMAG works

NCMAG is clinically driven, which means cancer specialists from across Scotland can submit proposals for treatments that they believe will provide benefits to cancer patients. By giving ‘Once for Scotland’ advice, NCMAG aims to minimise duplication of work across the country and reduce variation in access. The NCMAG team provides the necessary expertise to undertake full clinical and health economic review and is made up of health services researchers, pharmacists and a health economist supported by a project management team. The team use their expertise to find and review all available clinical and health economic data associated with the proposed use. This means that the quality of the review is more robust than local processes are able to offer.

NCMAG works with key stakeholders including patient groups and public partners. The NCMAG council, which makes the decisions, is made up of experts, including medical and pharmacy specialists in cancer care, a cancer service manager finance and public partners, which ensures there are appropriate levels of expertise in the decision making process. This provides assurances that the decisions we make take into account both clinical and cost-effectiveness issues alongside the voices of patient groups.

Positive outcomes for patients with cancer

NCMAG opened for business on 1 April 2022. The NCMAG council meets quarterly, and the team can review two or three proposals each time. The first council review of a proposal took place in June 2022, and a total of five decisions were made in 2022, four of which were positive. This is great news for cancer patients in Scotland.

One of the latest decisions the council have made is particularly noteworthy it is abiraterone plus prednisolone as a new treatment option for patients with high risk early prostate cancer. The patent for abiraterone expired during 2022 meaning more cost-effective generic alternatives have become available, so its use in this indication is both off-label and off-patent. Abiraterone has been shown to both delay progression and improve overall survival in this patient group, giving patients with prostate cancer a new treatment option which is simple to take in a tablet form and will give them valuable extra time with family and friends.

Future work of the NCMAG

Looking to the future, the team are working closely with the Scottish Cancer Network as they develop National Clinical Management pathways and identify more off-label treatments that clinicians would like to be included as treatment options for patients.

We’ve also have had some initial discussions with the University of Strathclyde to explore research opportunities and consider how we can evaluate the impact of medicines made available through the NCMAG process.

We have four deadlines in 2023 for new proposals and have already received four proposals, so I think we will continue to be busy throughout 2023 and beyond. Two of the proposals are new treatment options for mesothelioma patients, which is something I am personally happy to see.

During my long career in cancer care, I’ve seen massive improvements in the medicines we can deliver and also the way we can do it. There is currently a national drive and enthusiasm to try and do more things ’Once for Scotland’ for cancer care and the work of NCMAG plays an important part in this. It’s a privilege doing this – working in cancer care gives you a reassurance that what you are doing brings improvements for cancer patients.

Heather Dalrymple is the National Clinical Lead for Cancer Medicines at Healthcare Improvement Scotland.

More information

For more information on the work of NCMAG, visit the Healthcare Improvement Scotland website.

Categories: Uncategorized

Engaging with families is the key to learning from adverse events – Moira Manson

Posted on February 15, 2023

Every time an adverse event occurs, it has the potential to leave a significant and lasting impact. No one expects themselves, or their loved one, to be placed at the risk of harm while in a healthcare setting and healthcare professionals work tirelessly to provide high standards of care for their patients, yet sadly adverse events can happen from time to time. Adverse events can happen for a variety of reasons, such as environmental or human factors, like understaffing or sheer exhaustion experienced by staff. And while these events can’t be eradicated entirely, what we can and must do is learn from each incident through a constructive review process. To do this, we are working with NHS boards and healthcare professionals across Scotland to standardise our approach to adverse events by revising the existing framework and ensuring that those involved in a review are treated with care and empathy, and, above all, that actions are put in place to reduce the risk of the incident reoccurring.

The main issue currently facing NHS boards when it comes to adverse event reviews is a lack of standardised approach based on best practice. As we work with healthcare practitioners to establish what this should look like, we keep seeing two key themes – that listening to patients and their families is essential if we want to understand what went wrong, and that clear, empathetic communication is fundamental if we want to provide them with the support they need as they move through what is unquestionably, an incredibly challenging time.

Pull quote: "We must ensure that people are at the heart of each adverse event review, engaging with them from the outset"

Understanding what patients, families and carers need

As a review takes place following an adverse event, the feedback from the majority of those involved is that they do not want to use the review to apportion blame. What they want is to receive an apology, understand what happened and get reassurance that it should not happen again. To do this, we must ensure that people are at the heart of each review, engaging with them from the outset. It is only by working with and listening to patients, families and carers that we can glean invaluable information that can inform the actions we put in place to prevent adverse events from reoccurring.

Pull quote: "Every time an adverse event occurs, it has the potential to leave a significant and lasting impact".

As part of our work with medical professionals across Scotland, we are also learning that families and carers want greater clarity. Many feedback that the reports they receive upon the completion of a review is very clinical, full of medical jargon that can be difficult to understand. It can be easy for medical professionals to hone in on the technicalities and the science involved, forgetting that families of those involved are looking for compassion and a clear, straightforward explanation that will help them understand what happened and support them in coming to terms with it.

Going forward

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.

Pull quote: "We must listen to our patients, their families and carers - that much is clear"

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 promoting a single point of contact for families to keep them engaged in review process.

Moira Manson is a Senior Reviewer at Healthcare Improvement Scotland.

More information

Listen to our recent podcast episode on adverse events.

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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 and influence 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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