Posts from the “Uncategorized” Category

Pregnancy and newborn screening standards: helping women make informed choices – Surindra Maharaj

Posted on July 10, 2018

The Pregnancy and Newborn Screening Standards have been revised, at the request of National Services Division (NSD) of NHS National Services Scotland and Scottish Government, and are now out for an 8 week consultation period. During this time we are eager to obtain as much feedback as we can to ensure the final standards are fit for purpose. By updating the standards we are ensuring there is a consistent and equitable service across Scotland. The aim of the standards is to improve the screening service for pregnancy and newborn screening, which aims to allow women to make informed choices about their health and the health of their baby. The pregnancy and newborn screening programme differs to others in that it is essentially five screening…

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Regulation works: How registration of independent clinics works to improve care – Karen Beattie

Posted on July 5, 2018

Although a record number of over 50,000 people throughout the UK opted to undertake cosmetic procedures in the UK in 2017, it’s interesting to note that until relatively recently, clinics which provide private treatments unavailable on the NHS, remain one of the least regulated areas of healthcare. Our organisation has many parts all pulling towards the same purpose – to make care better within the NHS, social care and the independent healthcare sector. Since April 2017, when it became a legal requirement for independent clinics to register with us, we have been leading the way in regulating independent healthcare to help clinics provide a safe experience for consumers. Throughout this time, we have worked with over 200 clinics across Scotland to proactively set measures…

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Biological medicines: a framework for safety and consistency – Mandy Mackintosh

Posted on June 12, 2018

Biological medicines have revolutionised patient treatment by offering new and effective treatments for a range of conditions. Derived from living cells or organisms, biological medicines differ from generic medicines and are highly complex in their structure. A biosimilar medicine is a biological medicine that is similar to another biological medicine that is already available. The biosimilar medicine must demonstrate that it is similar to the original product and does not have any meaningful quality, safety or efficacy differences. Eight of the top 10 medicines by expenditure used in the hospital setting in Scotland in the year to 31 March 2017 were biological medicines such as adalimumab, etanercept, and infliximab for a range of conditions including, autoimmune diseases, cancer and enzyme deficiencies. “Biological medicines have…

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Using local medicine data to improve care nationally – Laura McIver

Posted on June 7, 2018

NHSScotland spends £1.65bn on prescription medicines each year and the burden of harm relating to medicines is well reported. We know that learning from past harm can support improvements in future care, but currently Scotland doesn’t have a systematic way to analyse all adverse events on a national level to identify potential learning. “We were asked to explore whether aggregating local data on a national level would be possible. If possible, would identifying learning and opportunities for improvement result in safer use of medicines, as well as strengthening our current approach to learning nationally from adverse events?” Therefore, we led a project in collaboration with colleagues across NHS boards, Scottish Government, the Care Inspectorate and independent healthcare colleagues to gather data on all adverse…

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What is the ‘political paradox of rationing’ and can it be avoided? – Richard Norris

Posted on May 30, 2018

In my last blog (Do we spend too much money on medicines in Scotland?19.11.2017) I looked at the issue of whether we get the right balance in spending on healthcare treatments (assuming there is one). I suggested that whilst it is in everyone’s interest to have a transparent, open and fair system for allocating healthcare resources, this was very difficult to achieve in practice. One problem I mentioned was the issue of what is known as ‘the political paradox of rationing’ and whether this can be resolved. The ‘political paradox of rationing’ is a phrase that was coined to describe the outcome of efforts made in the 1990s by the state of Oregon in the USA to make publicly transparent decisions about what treatments…

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The right words are crucial to empower patients and the public – Karen Graham

Posted on May 17, 2018

Karen Graham We know there are huge benefits to patients, the public and health and care services if people are at the heart of the care they receive.

To achieve this, one element that is crucial is the importance of finding and using the right words that help build a meaningful connection between people and their care givers.

SIGN, part of Healthcare Improvement Scotland, produces guidelines for health and care professionals in Scotland on the best treatments that are available for a range of conditions, including asthma, heart disease, various forms of cancer, ADHD and a number of mental health conditions.

“For some time we have understood to the need to ensure patients and the public understand the guidelines. And since 2007 we’ve placed increasing importance on producing accessible patient-friendly versions of our advice that help inform people about their own condition and the care options open to them.”

Recently, we produced information for people living with Coronary Heart Disease (CHD) or who are at risk of CHD. Our information sought to inform people about their condition and empower them to take responsibility for aspects of their health.

Here are a couple of quotes from people living with CHD about the information we provided:

“I’ve never seen this kind of thing and it helped me understand. I’m at high risk of a heart attack so I’m really clear about what I can do now to be a bit healthier. It’s quite hard to eat the right things and get your exercise but this is realistic and gives helpful tips. My GP makes me feel like I’m to blame, but this explains things well.”

“After reading this I felt I would be more in control of my health. It has everything you need to know. I think this is really good information so you can then chat to your GP about it all. The style it is written in helps people to feel in control and you’re not getting told what to do.”

Patient versions of guidelines can act as a discussion aid to promote shared decision-making. Whether a person has autism or is being treated for a heart condition, people want to know that they have all the necessary information to make decisions about their care. Without support from accessible and reliable health information, it’s almost impossible for people to understand and take part in shared decision-making.

In 2016 we produced an advice booklet for children and young people on assessment and treatments for autism, a lifelong condition causing difficulties with social and communication skills and behaviour.

We heard from young people with autism to make sure their views were reflected in the advice. We visited schools and spoke to young people about their experiences of living with autism. They also told us it was the first time they had ever been asked what they thought!

“We’ve now produced around 30 patient-friendly versions of our guidelines and we continue to learn how to communicate effectively using words that patients, service users and members of the public understand and relate to. It’s a two-way process: we learn from the people we involve in our work and they learn to take control of their condition. In essence, they empower us to help to empower them.”

The more patient versions of guidelines we produce the more it becomes apparent just how important it is that the advice is understood by everyone involved. Health and care professionals increasingly request copies of these booklets for their clinics and patient groups order them for their information packs.

I would like to say a big Thank You to all those who take the time to tell us exactly what they think, who let us know what it’s like to be them and help us to connect meaningfully. Together we’re shifting the focus of care from what is done to patients, to what happens in collaboration with them – with meaningful words at the heart of the bridges we build.

To read our patient-friendly advice on a range of conditions, visit our website www.sign.ac.uk.

Karen Graham is Public Involvement Advisor at the Scottish Intercollegiate Guidelines Network (SIGN), part of Healthcare Improvement Scotland.

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Safeguarding antibiotics to preserve their use for future generations – Dr Andrew Seaton

Posted on May 15, 2018

20180514 SAPG chair Andrew Seaton Antimicrobial resistance and drug resistant infections are major public health issues which are already complicating treatment for many patients and posing significant threats to the future of healthcare. To address this growing global problem we must ensure that we ‘take good care’ of our available antibiotics through good antimicrobial stewardship.

Healthcare Improvement Scotland has a key role to play in establishing strong antimicrobial stewardship through the Scottish Antimicrobial Prescribing Group (SAPG). Established in 2008, SAPG works in collaboration with regional board Antimicrobial Management Teams (AMTs) and clinicians from a range of specialties across hospital and community settings. Together, we have made great progress in improving use of antibiotics and promoting optimal safe care of patients with infection.

About 80% of antibiotics are used in the community and the commonest reason for an antibiotic prescription is for a suspected respiratory tract (throat, ear or chest) infection. Many such infections are caused by viruses or are otherwise self-limiting so do not require antibiotic therapy. We continue to work with and support primary care teams in the recognition and management of those situations where symptomatic measures should be promoted over an antibiotic prescription.

“This collaborative work has paid off, with a 3.1% reduction in total antibiotic use between 2012 and 2016 and an 11.1% reduction specifically in primary care, the lowest point since 2004.”

In 2016, 29.0% of the population received at least one antibiotic prescription in primary care which was the lowest proportion since data became available in 2010.

SAPG’s work isn’t just about reducing antibiotic prescribing, it’s about improving prescribing to ensure better outcomes for patients and to minimise harm to individuals and wider society. A key measure of quality prescribing is choice of antibiotic following recommendations in local guidelines. In 2016, first line recommended antibiotics – the initial recommended treatment – accounted for 81.5% of antibiotic use in primary care, suggesting GPs and other prescribers are following local guidelines. In hospitals, improved use of antibiotics has had a significant and sustained impact on reducing Clostridium difficile in our most vulnerable patients. We have also been successful in introducing good practice recommendations for some of our most challenging infections and establishing safety monitoring processes for our most complex antibiotics.

“Antibiotic stewardship is everyone’s business and we all have our part to play.”

It is important that patients and the public are supported in their understanding of the difference between when an antibiotic is needed and when and how they should practice self-care. We take part in European Antibiotic Awareness Day (EAAD) every November to raise professional and public awareness of the problem of antimicrobial resistance/drug resistant infections and what everyone can do to use antibiotics more wisely. We also support the Antibiotic Guardian campaign developed by Public Health England, which encourages everyone to make a pledge about how they can personally help to make better use of antibiotics. To date over 2600 people (mainly healthcare workers) across Scotland have become Antibiotic Guardians. We aim to increase public participation in this programme through posters and leaflets in community pharmacies during EAAD. We also promote community pharmacies as the ‘first port of call’ for anyone with symptoms of infection for advice on symptom relief and whether they need to consult their GP.

Our current and future work is closely aligned with the Chief Medical Officer’s vision of Realising Realistic Medicine, the aim being to reduce harm, waste and variation in antibiotic prescribing practice and to develop individualised treatment for patients wherever possible. This includes clinical decision support tools available at the point of care to inform individual patient treatment decisions, national antimicrobial Quality Indicators and metrics to drive improvement in prescribing practice and Penicillin allergy review to develop a simple, easy to use algorithm within hospitals to support de-labelling of patients without a true allergy. One success we have had in this area is with our Antimicrobial Companion app, which gives practitioners quick and easy access to clinical guidance and supports decision making on antibiotic prescribing. Registered as a medical device with the Medicines and Healthcare products Regulatory Agency (MHRA), the app was developed in partnership with NHS Education for Scotland (NES) and with the input of clinicians from hospital and primary care practices across Scotland.

Although we have made progress, there is still much work to do to protect our population from antimicrobial resistance and drug resistant infections and to preserve our precious antibiotics for future generations. Our collaborative way of working, which has yielded these results, will continue to be central to everything we do.

Dr Andrew Seaton is the chair of SAPG and Infectious Diseases Consultant/AMT Lead at NHS Greater Glasgow and Clyde.

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