Posts from the “Uncategorized” Category

Why nursing makes such a difference for us all – Ruth Thompson

Posted on May 12, 2022

Ruth Thompson, Associate Director of Nursing & Midwifery at Healthcare Improvement Scotland, started her nursing career in coronary care, and today celebrates International Nurses Day.

I started my nursing career in Glasgow, training at the Victoria Infirmary. I loved my training, so many of the registered staff were generous of their time and invested in the development of the next generation of nurses, something I try to replicate and support. During my training my biggest struggle was sewing-up my starched lace cap!

As a registered nurse I worked within Coronary Care, where I developed my love of cardiac medicine, Acute and General Medicine, starting as a staff nurse progressing to senior charge nurse, directorate senior nurse manager and then to chief nurse of both Hairmyres Hospital and Monklands Hospital in Lanarkshire.

I then joined Scottish Government as a professional advisor working with the Scottish Executive Nurse Directors to maximise the impact of robust workforce planning on patient safety and quality of care, and to reduce the reliance on supplementary staffing. I joined Healthcare Improvement Scotland in 2019, transitioning the Healthcare Staffing Programme from Scottish Government, before successfully securing the Associate Director of Nursing and Midwifery post.

Caring

During the pandemic I supported several NHS boards. Every day I witnessed nurses going above and beyond, working in new roles, environments, delaying their retirement plans or indeed coming out of retirement to support colleagues and services. All done with a can-do attitude, humour and humility. I also required ED treatment myself, the staff were amazing, kind and caring. Whilst not a surprise to me, I was overwhelmed.

I have been truly blessed to work with many inspirational nurses, who work tirelessly to enhance their own skills and knowledge to improve the care, experience and outcomes for patients.

I don’t think I could have made a better career choice, my experiences whether they made me laugh or cry have been wonderful learning opportunities and shared with fabulous colleagues of many professions.

Unique

For me, nurses are in a unique position to provide the continuum of care across the age spectrum, supporting people to manage their own health and providing that additional support when people are unable to meet their own needs. As a nurse you see people, both patients and their families, at their most vulnerable and the trust placed in you is humbling.

I believe the greatest improvements are those challenges identified and owned by the team; they know their clinical area, the ideas for improvement and then prioritise their improvement programme. Undertaking leadership walk-rounds or “back to the floor days” was a great opportunity for teams to share their successes using the improvement boards and safety crosses and for me to see them in action. Their pride in the improvements made to patient safety and care was palpable.

As a chief nurse, embracing the work of the Scottish Patient Safety Programme (SPSP) we worked tirelessly to move from the traditional ‘bed meeting’ to the hospital safety huddle. Changing the focus from an ED wait for a bed to whole site responsibility for a patient safety issue, using data to understand the blockages in the system and testing new ways of working. This significantly improved the ED quality standard performance and reduced the number of lengthy waits for patients

Impact

The SPSP programme was the foundation stone to improving patient safety and care, this was then strengthened by the Excellence in Care programme which specifically identified the impact of nursing care. None of the quality improvement work can be delivered without having the right number of staff with the right skills at the right time and this is where our Healthcare Staffing Programme supports the delivery of safe, effective care.

Nurses are educated, knowledgeable and skilled practitioners, regulated by the NMC.

I hope that nursing continues to balance the art and the science, both are equally important to patients and their families. I hope to see more nurse-led services. The enhanced and advanced skills of nurses allows patients to be assessed, treated and discharged by nurses, allowing professional relationships to flourish.

Ruth Thompson is Associate Director of Nursing & Midwifery at Healthcare Improvement Scotland.

More information:

The NMAHP directorate (Nurses, Midwives and AHPs) provides professional support and leadership, stimulating improvement in care and collaboration with multidisciplinary teams in HIS and the wider health and care system.

Visit our website for more information.

Categories: Uncategorized

Life on the Board of Healthcare Improvement Scotland – Suzanne Dawson

Posted on March 17, 2022

_{In this video Suzanne Dawson explains the role of Board Member within Healthcare Improvement Scotland}

As Healthcare Improvement Scotland recruits for new Board members, Suzanne Dawson, a Non-Executive Director on our Board, explains the role, how she joined the Board and the importance of diversity and collaboration.

Healthcare Improvement Scotland (HIS) is currently looking to appoint three new Non-Executive Directors to our Board. To many, being on a board may seem like a mysterious role, but they may not be aware that they could be exactly what a board is looking for.

My own journey to the Board

I have been a member of the HIS Board for three years, three of the most turbulent years in the history of the NHS in Scotland.

Before I outline some of my reflections on my role, let me tell you just a little bit about how I got here. Although I had previous board experience, it certainly isn’t a necessary requirement for us, and each of us has to start somewhere. For me, it was as a member of a Further Education College Board.

My professional career was in marketing, primarily in economic development, promoting Scotland in key sectors such as the life sciences, tourism, and the creative industries. Following maternity leave I decided to take a different approach to my working life and set up my own marketing consultancy business. Around the same time, I saw the College Board position advertised and, thinking it would provide me with a great new opportunity to contribute to my local community while gaining new skills and experience which I could bring to my business, I took the jump and applied. I didn’t have any previous board experience and I wasn’t wrong about what I would get from the experience. By the time I left the College at the end of my two terms I recognised just what an important and influential role a board member plays. It certainly wasn’t always easy and with a major estates project happening during my time with the College, there was a whole lot of learning to do.

Board life before and during lockdown

I was appointed to the Board of Healthcare Improvement Scotland a full year before our first COVID-19 lockdown and so was lucky to be able to spend time getting to know my new colleagues face to face. Like now, there were three of us starting around the same time, which was a great support and helped create a collaborative induction process. Like everywhere else, we had to change ways of working in March 2020 and Board business was no different. We adapted very quickly to Board meetings by MS Teams, and it is our intention to take some of the learning from our experience into the future. It is likely that some Committee meetings will continue to be held online, and others will offer hybrid alternatives.

The role of governance committees

Each Board member sits on a couple of governance Committees. In my case I Chair the Committee which is responsible for ensuring public and community engagement across NHS boards and healthcare providers. I also sit on the Quality & Performance and Succession Planning Committees. As Board members it is our role to provide scrutiny, to seek assurance around decisions which are being made and to hold executives to account through effective challenge. Committee work provides a good opportunity to dig deep and ask questions: where’s the evidence for this and are there any gaps in the evidence; what actions are being taken to mitigate risk; how might this proposal impact on patients or local communities; how will we recognise, monitor and evaluate success. These are just some of the questions I have heard asked while I’ve been a Board member.

Diversity makes us stronger

In my experience a strong board is a diverse board. By that I am talking about diversity of thought which goes beyond protected characteristics. Life or community experience which brings a different perspective adds real value to decision making. As our organisation operates across Scotland it is also important for us to fully understand the impact of any proposal across diverse communities, including both rural and urban.

While we can be a diverse Board, with Non-Executive Directors coming from different backgrounds and with a wide range of skills and experience, the key to the Board’s effectiveness is around how we all work together as a team. We are not simply a group of individuals, but are at our best when we work collaboratively, building relationships based on a clear set of values around trust, openness, compassion, dignity, and respect.

Could this role be for you?

If any of what I have said here chimes with you. If you have a real desire to help shape the future of the NHS in Scotland, while broadening your own skills and experience, I would encourage you to apply. You don’t need years of board experience, you just need the commitment to make a difference, to challenge effectively and influence decision making based on your skills, knowledge and experience however that might have been acquired. You have nothing to lose by applying and you, our Board and the people of Scotland have plenty to gain.

Suzanne Dawson is a Non-Executive Director on the Board of Healthcare Improvement Scotland.

More information

Visit the Scottish Government website to apply for this role.

Categories: Uncategorized

The importance of having hope when living with an eating disorder – Ellen Maloney

Posted on January 27, 2022

Healthcare Improvement Scotland have published a new clinical guideline on Eating Disorders. Ellen Maloney, a patient representative on the guideline development group, explains her experience of living with anorexia nervosa and outlines the changes she hopes the new guideline will bring.

I was twelve years old when I first developed anorexia nervosa. I had just started high school and on the surface, everything in my life was going well. I had a group of close friends, I did well academically and had plans to study medicine at university, and I played the harp, performing and competing around the country. Yet I felt constantly overwhelmed and paralysed by anxiety that I had no words for. One day, I simply stopped eating and for the first time, the unbearable anxiety dissipated, and I felt calm.

Managing unbearable feelings

The thing about eating disorders is that they are not about food or eating or weight. Eating disorders are essentially, about managing unbearable feelings. It took years of prolonged hospital admissions before I was able to access therapy that helped me to understand this and find other ways to manage how I felt.

I now volunteer for Beat, the UK’s leading eating disorder charity. My story is not unique: I hear time and time again that access to appropriate treatment is delayed or obstructed because eating disorders are so misunderstood, and professionals focus too much on the symptoms, how much someone is eating or what they weigh. This barrier is highly problematic because we know that a predictor of recovery is early intervention. My hope is that the recommendation in the new guideline produced by SIGN – part of Healthcare Improvement Scotland – for early intervention is implemented as it is not only effective, but it saves lives.

Eating disorders are mental illnesses

A further barrier that many people experience when trying to access treatment, is the focus on symptoms and physical health. Once they reach a certain weight, they are considered “recovered” and support is taken away at a time when it is most needed.

What I hear all the time through my work with Beat and have experienced myself is that this is the hardest stage of recovery. All the coping strategies have been taken away but mentally things can feel very much unchanged. It is acknowledged – for the most part – that weight is only one measure of health in eating disorder treatment, and yet it is too often conflated with recovery. What we found when reviewing the literature for the new guideline is that weight gets conflated with recovery all the time because it is easy to measure, and so terms like recovery and relapse have started to lose meaning because recovery means “weight restored” and “relapse” means “weight loss after treatment”.

There is too little emphasis on the psychological change which is needed for things to be different for the quality of people’s lives to have improved by the time they finish treatment. This has proven to be problematic when writing a clinical guideline on eating disorders as there is no agreed upon definition of recovery. We need more research into this but also more conversations with patients. I had been in treatment for over 10 years before a psychiatrist asked me what I wanted out of my treatment. Maybe recovery would not be so hard to define if patients were engaged more collaboratively with their care.

Language matters

I also think the language used when talking to patients is important but it’s often overlooked. It’s not uncommon to hear stories of people being labelled “treatment resistant” or of being told by clinicians that they will never get better, that their inability to change is because they don’t want it enough – the implication of course being that “wanting to change” should somehow be enough to make that change happen. It doesn’t work like that – and I know that.

My own time in treatment was often a fraught process because the professionals involved in my care so openly expressed frustration as I struggled with change, and I felt blamed and isolated. As it transpired, I was not at all treatment resistant, I needed different treatment. Blaming patients for ineffective treatment must stop. What we know about eating disorders and the treatments we currently use is that not everybody responds in the same way. That should be a time to pause and reflect on the treatment, not a time to dismiss the patient as untreatable.

There is always hope

When I think about the patients I have met at focus groups during my time as an Ambassador for Beat, or through my own time in hospital, I think of people who have struck me as determined, thoughtful, selfless, and caring. Yet they all have stories of medical professionals labelling them as selfish, manipulative, controlling and somehow responsible for their difficulties. These are people who almost always want to get better and yet feel paralysed to a point where the fear of change outweighs the fear of staying the same. For me I began to get well when the balance tipped, and I was more afraid of staying the same than I was of making changes. What the evidence we have looked at shows, is that it doesn’t matter how long someone has been unwell or how many times they have been in and out of treatment, change is possible and there is hope of life beyond an eating disorder.

The guideline development group had long discussions around terminology and it was a deliberate decision to avoid using phrases like “treatment resistant” or language that blames patients in this guideline. My hope is that this will bring about much-needed change in practice and patient experience.

Click here to read the full guideline.

First diagnosed with anorexia at the age of 12, Ellen Maloney spent her teenage years and 20s in and out of treatment. Now in recovery, Ellen uses her platform as an Ambassador for Beat, the UK’s leading eating disorder charity, to channel her passion for both raising awareness and understanding of mental health difficulties and campaigning for easier access to treatment.

Ellen has also written articles about her experiences for Young Women Scotland, American Association for Suicide Prevention, Third Force News, and The Guardian.

Ellen is studying Philosophy and Psychology at the University of Edinburgh, and in her free time can be found translating TED talks or pole dancing.

Categories: SIGN, Uncategorized

Tagged: eating disorder, SIGN

Helping the COVID-19 vaccination effort for Scotland – Bernie McCulloch

Posted on December 20, 2021

When the call went out for vaccinators to aid the national effort to respond to the Omicron variant, many of our staff with clinical experience put their hands in the air to help. One of those volunteers is Bernie McCulloch, Portfolio Lead for Healthcare Improvement Scotland’s Community Care programme. In this blog, Bernie explains what’s involved in being a vaccinator, and how people and healthcare professionals alike are rising to the continued challenge of the pandemic.

When the call went out for volunteers, it made perfect sense to me to become a vaccinator.

Taking my teenage son to get vaccinated I saw at first hand the long queues of people keen to play their part to help themselves and others in the continued pandemic. As a trained nurse, who has worked away from the frontline for a number of years, I instantly felt the moral obligation to dust down my skills and answer the call.

For me, the issue at hand is clear: the more people we can support to get vaccinated – especially in the wake of the Omicron variant in the lead up to the festive period – the better for everyone in Scotland. So I jumped at the opportunity to use my clinical skills and experience in a way that can make a real difference.

Getting the right training to make the right decisions

In my role as a vaccinator, I screen individuals, obtain consent and administer first and second COVID-19 doses, boosters, as well as flu vaccines to those who are eligible. Similar to the COVID-19 vaccine, there are different types of flu vaccines depending on age and medical conditions.

The training to become a vaccinator takes place through extensive and comprehensive online courses and through physically shadowing of other vaccinators. As a trained nurse, I’m able to carry out assessments to determine the appropriate vaccine for people; to support this is the Green Book, which lays out all the side effects and contraindications for all vaccines. In addition, our training covers the legal aspects in relation to consent, how to fill in appropriate documentation and how to correctly handle people’s personal information.

Although the training is thorough, at the vaccination centres there is always support on hand: doctors, nurses, pharmacists and healthcare assistants – so, if you ever have any questions, there are other experts to call upon to help make the right decision for every patient. In addition, daily staff huddles, before the centres open to the public, help to ensure that any changes to national guidance are communicated effectively.

The spirit of togetherness

Aside from the feeling of helping to make a difference, it’s hugely satisfying to have patient contact again and reminds me of what it is that we do in the NHS: caring for people when they need it.

Those who turn up at the vaccination centres all want to be there, which is great to see. Sometimes people are spending hours queuing for the vaccine, but they are all grateful and appreciative to the healthcare workers, the volunteers and to the NHS. As a result, I try to make my interactions as person-centred as possible: thanking them for turning up, for doing the right thing for themselves and others, and for making the effort.

This feeling of us all being in it together also extends to those working at the vaccination centres. There’s a real appetite for everyone to help each other whenever it’s needed.

I’m also encountering people under 50, who are not eligible for the free vaccine, paying privately to get the flu vaccine from their local pharmacy. I think this shows how many people are seeing the benefits of vaccination programmes, and the important role they play in keeping them and other people safe.

The festive season and beyond

I continue to carry out my duties with Healthcare Improvement Scotland alongside shifts as a vaccinator. Over the festive period, I expect to undertake more shifts and in all likelihood into January also. But I’m looking forward to it. I hope that every vaccination that’s carried out takes us all one step closer to coming out of the pandemic, maybe saves a life, while at the same time bringing us all a little bit closer together as a society. If you haven’t been vaccinated yet, please come to one of the centres. We’d be delighted to see you. You’ll be helping yourself and helping everyone else around you too.

Bernie McCulloch is Portfolio Lead for Community Care in Healthcare Improvement Scotland’s ihub.

Categories: Uncategorized

Tagged: COVID-19

Long COVID: The importance of holistic care – Dr Tom Fardon

Posted on December 14, 2021

We have learned a lot about Long COVID and its effects over the past year. In our latest blog, Dr Tom Fardon, Consultant Physician of Respiratory Medicine at NHS Tayside, outlines his own experience with COVID-19 and explains the steps he takes to diagnose and treat patients who may be experiencing long-term effects from the syndrome.

COVID-19 is an unusual illness. The range of symptoms is broad, much more so than the original case definition of early 2020 that included only breathlessness, persistent cough, and fever. The range of severity of illness is equally as wide: some people suffer only mild symptoms of an upper respiratory tract infection; some have no symptoms at all; some develop a rapidly progressive pneumonitis requiring ventilatory support – in wave 1 of the pandemic 20% of people who were admitted to hospital with COVID-19 did not survive.

The unprecedented collaboration between scientists, clinicians, and pharma companies around the world has led to the discovery of a small number of treatments that can, and do, improve outcomes. But, most importantly, we now have safe and effective vaccines that protect against infection, reduce severity of disease, prevent admissions to strained NHS services, and reduce mortality.

The new ‘normal’

For most people COVID-19 affects two weeks of their lives, with a range of flu-like symptoms that are unpleasant, but don’t lead to hospital admission, and they will recover. Most people will take a few weeks to recover their fitness, get back to their normal level of activity, and feel “normal” again. People always ask: “How long until I get back to normal?” Everyone is different. Depending on your previous baseline, the severity of your illness, the length of time laid up resting, and your expectations of recovery, it can be a week, two, perhaps six.

For some people, recovery from the acute illness is only the start of the journey. What we have now come to term Long COVID affects somewhere between 5% and 20% of people who have had the COVID-19 infection. The severity of disease does not seem to predict progression to Long COVID. Indeed most of our critical care COVID-19 survivors have not gone on to develop Long COVID, though their rehabilitation has been long, simply due to the severity of their illness.

Offering a service to people with long lasting symptoms following COVID-19 infection is very challenging. Long COVID is a syndrome for which there is no clear clinical definition; no diagnostic test; large overlap with other diseases and syndromes, some of which are ‘diagnoses of exclusion’; and no mechanistic or pathophysiological pathway. Most hospitals do not have an existing team dedicated to the holistic care of people presenting with the symptoms of Long COVID. The symptoms cross speciality borders: cardiology, respiratory medicine, neurology, rheumatology, dermatology, endocrinology.

Emerging Patterns

In NHS Tayside we followed up our patients from COVID-19 critical care areas after wave 1, and we’ve seen a range of people in our outpatient clinics with Long-COVID symptoms. My experience of seeing people with protracted symptoms following COVID-19 infection has shown me a few emerging patterns.

Speaking to people who have protracted symptoms following COVID-19, there are commonalities in their concerns: is this Long COVID? will it get better? how long will these symptoms last? is there anything I can do to get better? will it get worse? and is this how it’s going to be forever?

Steps to diagnosis

Our first step is to rule out other causes of those symptoms. If someone is breathless following COVID-19, have they developed asthma? If someone has chest pain, is their ECG normal? Just because symptoms started after COVID-19 doesn’t always mean that COVID-19 is responsible. A detailed history often reveals mild symptoms prior to COVID-19, and new things can happen at any time.

Step 2 is to look for modifiable causes of symptoms – deconditioning and weight gain are very often implicated, so a gradual return to an exercise programme, with planned weight loss can be very effective. Addressing any psychological issues is also critical.

Aftercare

Holistic care is vital. There is no clear answer to most of the concerns these people have. We simply don’t understand enough about the Long COVID syndrome to give reliable information about the outlook. In my experience it is uncertainty that scares us: once we’re given the diagnosis, the prognosis, the clear plan, we then have a target, something to aim for, a route to take, and a team to support us.

For people with Long COVID we work in an area of extreme uncertainty. Development of multi-disciplinary teams to help people with this wide range of symptoms, and causes has to be a priority for the next 2 to 5 years.

In NHS Tayside the COVID-19 Assessment Rehabilitation Enablement and Support (CARES) service consists of highly specialised physiotherapists, occupational therapists, psychologists, and secondary care consultants, like me. Our approach is to ensure early screening to look for serious conditions known to complicate COVID-19, such as pulmonary embolus, atrial fibrillation, pericarditis; followed by a personalised patient-centred care plan delivered by the team; and early referral to secondary care if there are concerns over developing complications.

My own experience with Long COVID

I had COVID-19 in April 2020, just before I should have been running the Boston Marathon. I had a dramatic loss in fitness over the 2 weeks of illness, and suffered for over 12 months with daily headaches, earache, tinnitus, sore throat, dizziness. Those symptoms have, with time, settled. I have no explanation for why they happened, why they went away, and even whether they were definitely related to my COVID-19 infection. They certainly created a high level of uncertainty for me and my family, adding to what was already a stressful 2020. But it has helped me to have first-hand experience of the uncertainty that people can experience.

Hope for the future

As we approach 18 months of the pandemic we see more people who do recover and return to normality, but as the restrictions are relaxed and infection rates reach dizzying heights across the country, we will undoubtedly see more people with symptoms of Long COVID. It is therefore vitally important that we have clear guidance on the approach to people who present with symptoms suggestive of Long COVID. As the national guideline continues to develop, it will be a vital place for clinicians and the public to look for reassurance and guidance. Most importantly, it’s important that we don’t miss newly presenting illnesses, and equally important we don’t ignore or downplay the symptoms that people are now presenting with. As we wait for more studies that help us to diagnose and treat, this approach will be crucial.

Dr Tom Fardon is a Consultant Physician in Respiratory Medicine at Ninewells Hospital and Honorary Reader in the University of Dundee

More information

Read our SIGN Guideline: Managing the long-term effects of COVID-19.

Categories: Uncategorized

Tagged: COVID-19

Could you be the next Clinical Lead for our neonatal improvement programme? – Colin Peters

Posted on November 16, 2021

As Colin Peters leaves us as Clinical Lead for our organisation’s neonatal improvement work after five years, in this blog he describes the rewards of the role of clinical lead and how he made the role work alongside his day job.

Interesting, rewarding and enjoyable. After five years as the Neonatal Clinical Lead for Healthcare Improvement Scotland, that’s how I would describe the role. Now that I’ve moved on from the role and I reflect on the time with the organisation’s Scottish Patient Safety Programme, I feel grateful for the tremendous support of the team and the engagement of neonatal teams from around Scotland in order to deliver improvements.

There have been lots of highlights during the five years, but I particularly enjoyed the learning sessions where we had such engagement from everyone involved: nurses, midwives, doctors, improvement advisors and more. Post-it notes and marker pens were the order of the day with roaming microphones and ideas aplenty.

While I’ll miss being in the role, it does mean that there is a fantastic opportunity waiting for someone to take up the mantle of Neonatal Clinical Lead.

The role of the MCQIC Neonatal Clinical Lead

So what does the role of Neonatal Clinical Lead entail? First up, the role is essentially for one day a week, so you undertake the role alongside your clinical duties within your NHS board.

The key responsibility is to provide clinical direction to the neonatal improvement work of the organisation. This includes identifying new areas of work and ensuring that existing areas are up to date. Here it’s important to seek new ideas from around the UK and abroad, as well as draw on recent publications, national guidelines and evidence.

Within the role, you get to visit each NHS board to provide support, share ideas, motivate and inspire. I really enjoyed these as I inevitably came away with a new idea or reflection on something that could be developed.

The importance of collaboration and leadership

Working collaboratively with Midwifery and Obstetric Leads and NHS board teams on measures that sit across the whole MCQIC programme, is a vital part of what the clinical lead will do. In my view, improvement in neonatal outcomes depends on improvements in obstetrics and midwifery. The collaborative work on the Preterm Perinatal Wellbeing Package was a fine example of working across teams to come up with a message for everyone caring for a woman delivering prematurely and her baby.

Leadership is another key element of the role, for example, leading sessions at Scotland-wide meetings. These are really interesting sessions with a fair bit of work involved to put together an engaging presentation / session that leaves the delegates inspired to go back to their NHS boards with ideas and a motivation to improve.

You will also develop and participate in regular webinars. These are now more familiar to us all and although talking to your own screen, hoping that there are people out there, is strange, the responses and conversations are really rewarding.

The Clinical Lead for Neonatal will also contribute to national networks and groups. In my time I’ve worked with the Scottish Perinatal Network, the MANDALS group and Clevermed. Strengthening these relationships have ensured that we’ve been able to take consistent approaches across Scotland and avoided duplication of effort.

I’ve found the support from the project officers to be excellent, and I’ve put many of their ideas into practice. Moreover, the support from the Senior Improvement Advisor has been really helpful. I felt that I wanted to come out with more than just having worked one day a week, so I completed the Scottish Improvement Leader course. The new lead may have some particular area or skill that they want to develop.

Ways of working

I tended to work flexibly, especially in the virtual world which now exists on Teams. Before the pandemic I’d work in Delta House (Glasgow) or Gyle Square (Edinburgh) some days, site visits on other days and at home on some days. Sometimes I’d work whole days, on others it would be broken up across a week trying to average one day a week.

And what advice to my successor as Clinical Lead for Neonatal? There is lots of support from all teams within Healthcare Improvement Scotland, so don’t worry about the practical matters of the job. Enjoy, laugh, and don’t be afraid to voice your opinion. Make the role your own.

Colin Peters is Consultant Neonatologist in Greater Glasgow & Clyde and is the former Clinical Lead for Neonatal for Healthcare Improvement Scotland.

Visit NHSScotland to see the list of current job vacancies.

Categories: Uncategorized

Tagged: impact campaign

Learning from the death of every child – Dr Alison Rennie

Posted on September 28, 2021

From 1 October 2021, Healthcare Improvement Scotland and the Care Inspectorate will be collecting national data on the deaths of every single child in Scotland to age 18, or 26 if receiving continuing care or aftercare. Dr Alison Rennie, Consultant Paediatrician and Clinical Director of Community Paediatrics at NHS Greater Glasgow and Clyde, and the National Clinical Lead for the implementation of the National Hub for Reviewing and Learning from Child Deaths, explains why this work is important and how we will make a difference.

During my 30 year career as a children’s doctor, I have seen children who died from neurological conditions, congenital disorders, prematurity, malignancies, infections, trauma, neglect and abuse. Each one stays with you. I have also witnessed exciting developments in treatments for conditions such a Spinal Muscular Atrophy, once previously universally fatal, and now hopefully curable. However, it is disappointing to note that Scotland still has a higher mortality rate for under 18s than any other Western European country, with over 300 children and young people dying every year. It is estimated that around a quarter of those deaths could be prevented. How can we make a difference? What can we learn and how can we change?

With no national system to support reviews into those deaths or to share national learning, there has been variation across services and across Scotland as to the quality of reviews and even whether reviews are carried out at all.

However, that is all about to change: from 1 October, the health and social care system in Scotland will work collaboratively to reduce avoidable deaths of children and young people by reviewing every death to inform the redesign of pathways and services, or to recommend legislative change. This includes the deaths of all live born children up to the date of their 18th birthday, or 26th birthday for care leavers who are in receipt of aftercare or continuing care at the time of their death.

Where death is inevitable, we aim to improve this process for children, families and carers by learning from quality reviews.

How this work is coordinated

In response to a request from the Scottish Government, Healthcare Improvement Scotland, in collaboration with the Care Inspectorate, set up the National Hub for reviewing and learning from the circumstances surrounding the deaths of all children and young people in Scotland.

The National Hub brings together representatives from across health and social care to develop quality guidance and develop a core data set to help services implement the methodology and to learn from each other’s experiences.

We also established an expert advisory group with representatives from health and social care as well as other agencies such as Police Scotland, the Procurator Fiscal and third sector organisations for their specialist advice around child bereavement.

The National Hub also channels learning from all over the UK to help reduce preventable deaths.

Next steps

We’re working with National Records of Scotland (NRS) to develop a notification system for receiving data regarding the deaths of children and young people and we’ll directly collect national data from health and social care partnerships across Scotland from 1 October. Once we have enough data, the National Hub will assess how the methodology has been adopted nationally and identify important learning about preventable deaths of children and young people. All of this will feed into an annual report to share what we have learned over the previous year. We will highlight areas for change, and recognise aspects of good practice.

I hope that this exciting development is our opportunity to make a change to Scotland’s grim mortality data for children and young people. Can we make Scotland the best country to grow up in and one in which you are less likely to die before adulthood? I am proud to be part of the National Hub and join my many colleagues who will be using the Hub’s guidance to conduct quality reviews, share learning and change outcomes. Through working together in this way, we hope to make a tangible, positive difference to the lives and deaths of children and young people as well as the families and carers surrounding them. They deserve nothing less.

Dr Alison Rennie is a consultant community paediatrician in NHS GGC 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.

Follow Alison @AlisonRennie7 and follow the National Hub at @online_his using #CDRNationalHub

Find out more

Read our guidance, download resources and find out more about our work on the Healthcare Improvement Scotland website.

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

Categories: Uncategorized

Living with Long COVID – Mabli Godden

Posted on December 18, 2020

Ten months ago, Mabli Godden couldn’t imagine how much her life was about to be changed by COVID-19. But now, as one of the many people experiencing the effects of the virus, she is trying to recover, as well as helping Healthcare Improvement Scotland develop the first UK guideline on Long COVID. In our blog, she tells her story. In March of this year I was the most active I have ever been: commuting from Glasgow to Edinburgh daily for work, running two youth arts programmes, cultivating my own arts practice, lifting weights regularly, taking care of an active dog and all the typical things someone in their late twenties and early thirties might do with their lives. But this was all brought to…

Categories: Uncategorized

Safer staffing? Call the midwife! – Laura Boyce

Posted on February 13, 2020

Two years ago I was a senior charge midwife in a busy labour ward.

While labour wards can be joyful places, as parents welcome a new little one into the world, they can also be very intense, stressful places as staff try their very best to make sure birth is a positive, safe experience for both parents and child.

“When the Scottish Government published The Best Start report for maternity and neonatal services, I was excited, enthused and apprehensive.”

Maternity services in Scotland vary hugely not just in relation to geography, but also to the workforce, the location of care delivery and capacity of services. So when the Scottish Government published The Best Start report for maternity and neonatal services in 2017, I was excited and enthused but equally apprehensive.

The key recommendations of Best Start included continuity of carer, putting women and babies at the centre of care, multi-professional working and a new model of neonatal intensive care service.

While midwifery student numbers were receiving substantial investment, I was aware that the experience and expertise of the midwives I was working alongside would be lost just as these younger, less experienced staff were coming into the workplace: almost 40% of midwives were aged in the 50 and over bracket.

Therefore, Best Start was a BIG ask, and I had a LOT of questions.

How will such ambitious recommendations ever be achievable? How can we ensure the staff are confidently skilled in all areas of the pregnancy journey? How can I as a clinical leader support this in a busy, high risk obstetric unit?

When the Government announced in 2018 its intentions to enshrine safe staffing in law, I had even more questions.

What is safe staffing? What would this mean for the staff on the shop floor? How will this impact midwifery care and, wider than that, nursing care?

“The basic aim of the Bill was to provide high quality care by ensuring the right people were in the right place, with the right skills at the right time”

I became engrossed in the new Bill and its progress through parliament. The basic aim of the Bill was to provide high quality care by ensuring the right people were in the right place, with the right skills at the right time to ensure the best health and care outcomes. Throughout my work as a clinical midwife, research midwife and senior midwife, in a variety of boards I’ve come to see these factors as central to the work of not just midwives but to the wider workforce of the NHS. So when a secondment opportunity arose to work as part of the advisory team supporting NHSScotland Boards with the use of workload and workforce planning tools, I went for it.

Initially based in the Chief Nursing Officer’s Directorate before moving to Healthcare Improvement Scotland in 2019, being a programme advisor has allowed me to look closely at the workforce planning processes not just in midwifery, but across a range of healthcare professions. It’s allowed me to explore the wide variation in tools and resources that are used in clinical service. To really understand the basic fundamentals of budgets, planning and service redesign for the best service user experience. To appreciate the positives of good governance and risk assessment. All of these are areas I knew about as a midwife, but can I really say I understood them?

Now, in my role with Healthcare Improvement Scotland, I’m working to answer for others all the questions that I’ve had.

“Supporting boards to understand the demands of the new Safer Staffing legislation and prepare for meeting its requirements as we move towards final enactment, I have been on a rollercoaster of learning and overcoming challenges.”

Supporting boards to understand the demands of the new legislation and prepare for meeting its requirements as we move towards final enactment, I have been on a rollercoaster of learning and overcoming challenges. My role has evolved massively in a short period of time and I now find myself speaking at national events and presenting abstracts for improvement work in this field. I have forged networks and empowered so many wonderful professionals and like-minded individuals who all aspire to that safe, effective and high quality care goal.

How we will monitor and report on the compliance of the legislation is in its infancy, but it’s exciting and uplifting to be a part of something that is shaping healthcare for future generations.

Find out more about the Health and Care (Staffing) (Scotland) Act:

Link to information on the Healthcare Improvement Scotland website.

Link to the Act on the Scottish Parliament website

Contact the mailbox: HCIS.HSP@nhs.net

Laura Boyce is a Programme Advisor with the Healthcare Staffing Programme.

Categories: Uncategorized

Tagged: Healthcare Staffing Programme, safer staffing

The heart of the matter: the need for standards around congenital heart disease – Dr Liza Morton

Posted on October 22, 2019

Since I was 11 days old, my every heartbeat has been dependant on a pacemaker. I was born with complete heart block, an abnormal heart rhythm that means the electrical impulses that control my heartbeat are blocked and do not reach the bottom chambers (ventricles) of my heart.

The surgery I received in 1978 at Glasgow’s Yorkhill Hospital was a world first. Since then, while I’ve lived a very full life, it’s one that’s been reliant on pioneering cardiac treatment. Life as a ‘heart child’ involved countless invasive, painful and often frightening cardiac interventions. By the age of seven I had been fitted with five pacemakers, each by thoracotomy – my ribs were split to gain access to my heart. Early pacemakers were set at a fixed rate, making active play, gym and sports day impossible. They were unreliable and often needing reprogramming. I remember lying still and feeling dizzy as a team of men in white coats armed with a magnet, leads, cold gel, stethoscopes, and electrodes made my heart beat faster, then slower as they learned how to interrogate the pacemaker. I was a medical curiosity, although my team always did their very best to support us. I needed open heart surgery at 13 years old to repair a hole in my heart and around this time I was fitted with a more physiologically responsive, variable rate pacemaker. The challenges don’t end, last summer I was fitted with my 11^th pacemaker involving complex surgery to extract and replace pacing leads.

“By the age of seven I had been fitted with five pacemakers, each by thoracotomy – my ribs were split to gain access to my heart.”

Complex congenital heart disease (CHD) cannot be cured, but due to medical advances a growing number of people are living with a lifelong heart condition. Babies born in the 1940s, had a 20% chance of surviving into adulthood. Today, the chances for a baby born with CHD living that long are 90%. Yet the success story of enhanced detection, medical and surgical advances yields new challenges which healthcare services have not developed to meet. Having overcome significant childhood adversity, many ‘medical orphans’, once celebrated as pioneers of medical advancements, are being let down in adulthood. But with adequate, reliable care many of us can live full lives.

Developing standards to improve services

Healthcare standards offer a means to significantly improve care by engendering trust, safety and patient empowerment. That’s why I’m delighted to be involved with Healthcare Improvement Scotland’s development group to create standards for CHD, and work with them to enable people with this condition to live as normal a life as possible.

Standards are statements relating to levels of performance that people should expect from health services. They are based on evidence relating to effective clinical practice, feasibility and service provision that is responsive to patients’ needs and views. They cover the key issues relating to the provision of safe, effective and person-centred care and treatment.

It’s been a long journey to get to this stage, supported by the cardiologists, nurses and surgeons involved in our specialist care, who witness daily what it means to live with CHD. Given my own experience, and my voluntary work as the Scottish Campaign Manager for The Somerville Foundation (a UK charity supporting adults with CHD), in 2012 I sought to raise awareness of CHD, submitting a petition to The Scottish Public Petitions Committee at the Scottish Parliament asking for healthcare standards and improved care provision, joining Cross Party Groups, asking MSPs to submit parliamentary questions and lobbying through social media.

“It’s vital that healthcare provision for CHD is underpinned by a psychologically-informed approach consistent with recent drives for trauma-informed care and to address adverse childhood experiences.”

The challenges for people with CHD

But what exactly are the issues that people with CHD can face that the standards will look to address?

CHD is the most common congenital anomaly, affecting approximately 1% of babies. A quarter of these babies require medical intervention in the first year of life. Around 20,000 people with CHD currently live in Scotland. Approximately half of this estimated adult population are lost to specialist services, often having been discharged before the need for specialist lifelong care was recognised.

It’s vital that healthcare provision for CHD is underpinned by a psychologically-informed approach consistent with recent drives for trauma-informed care and to address adverse childhood experiences. While medical advances have saved many lives, they can involve invasive procedures which can be frightening, painful and overwhelming. Early separation due to medical care may also impact on attachment to parents. Living with CHD can reach far beyond any medical limitations to affect schooling, employment, finances, discrimination, missing out and issues having and raising a family, to name a few. Perhaps not surprisingly, CHD significantly increases vulnerability to neurodevelopmental issues, depression, anxiety and post-traumatic stress disorder (PTSD) while parental psychological wellbeing can also be affected. Yet these outcomes need not be inevitable. By adopting a psychologically-informed approach to care, these risks could be mitigated, improving wellbeing, physical health, recovery and ultimately reduce costs.

Although I am grateful to the NHS for saving my life, I have experienced multiple life-threatening challenges in my care provision and a lack of understanding about the psychological impact of living with a serious lifelong health condition. At times, living with CHD can seem relentless. Having to fight for appropriate medical care, at your most vulnerable, can feel overwhelming. The challenges don’t end. Many of the challenges we face occur at a local level, for example, when we present to our GPs and emergency care. Standards for local care provision are vital to inform safe, equitable and consistent care. I am far from alone experiencing these challenges.

We should be proud of our NHS as testament of our collective humanity. But having experienced it at its best and worst since my first pacemaker all those years ago, I want to help to make it better. I owe that in return.

More information

Take part in the consultation on the scope of our congenital heart disease standards.

Liza is a Chartered Counselling Psychologist working in private practice and at Strathclyde University. She is actively involved in research and advocacy to promote psychologically informed medicine and improved care for people living with a heart condition from birth. Liza represents patients on the Standards Development Group for CHD for Healthcare Improvement Scotland. You can follow her on Twitter @drlizamorton.

Categories: Uncategorized

Tagged: impact campaign