A rainbow in the middle of the storm: Laura’s story

Posted on May 5, 2020

We’re continuing to tell the story of how Healthcare Improvement Scotland staff are helping in the fight against COVID-19. Today, to mark International Day of the Midwife, Healthcare Staffing Programme’s Laura Boyce tells us how deployment back to a maternity unit has provided a glimmer of hope in the middle of the pandemic.

The joyous moment a baby is born and a family grown is a wonderful experience. As a midwife, I’ve been privileged to see so many of these moments during my career. It’s what makes my job special.

My background is in intrapartum care (high risk labour and birth, including maternity operating theatres). Although I’ve been on secondment from my role at Crosshouse Hospital’s Ayrshire Maternity Unit since June 2018, first with Scottish Government and now with Healthcare Improvement Scotland, returning there to help during the pandemic feels like going home in many ways.

“Maternity services can always be a bit unpredictable, with peaks and troughs of activity. We always say there can be an element of predictable unpredictability about it! COVID-19 has, of course, made things just that little bit more unpredictable”

During my secondment I’ve been on regular ‘Keep in Touch’ days to maintain my clinical competency, and a lot of the care, policies and guidance are very similar to when I worked there full time. The biggest challenge has been getting to know all the new faces and working out who is doing what role. Oh, and the nightshift feeling…yuk! I haven’t missed that feeling.

Maternity services can always be a bit unpredictable, with peaks and troughs of activity. We always say there can be an element of predictable unpredictability about it! COVID-19 has, of course, made things just that little bit more unpredictable, but we’ve currently got good staff levels as all additional roles have been paused to allow a focus on frontline care giving, and a streamlined service is provided for routine clinics. Obviously there are some areas more affected by staff isolating or shielding than others, but the service is working well to redeploy and continually review.

**Laura on the ward before the COVID-19 outbreak – the personalised scrub cap has had to be swapped for a disposable one under PPE guidance.**

“A new baby is a huge family affair and it’s sad to see the impact COVID-19 is having on what is a wonderful time for women and their families. Yet I can honestly say the general public have been very supportive and understanding of why these measures have been implemented. And oddly, this situation does have a benefit: mums are getting precious uninterrupted time with their newborns, something they don’t always get in today’s busy modern world.”

The pandemic has, of course, affected our “business as usual”. Women are attending triage, initial assessment and for induction of labour alone, as there is currently no visiting due to COVID-19 regulations. However, they are still supported and encouraged to have a symptom-free birth partner with them for labour and delivery. I think some women are obviously nervous about attending or having hospital stays alone, but the staff are trying their utmost to provide that extra emotional support for them and make their journey as stress-free as possible.

There are other downsides to the current situation, as siblings and grandparents aren’t getting to visit their new families. But technology is a wonderful thing and we’re actively encouraging people to keep in touch. A new baby is a huge family affair and it’s sad to see the impact COVID-19 is having on what is a wonderful time for women and their families. Yet I can honestly say the general public have been very supportive and understanding of why these measures have been implemented. And oddly, this situation does have a benefit: mums are getting precious uninterrupted time with their newborns, something they don’t always get in today’s busy modern world.

“The best thing about going back to the labour ward is that it’s reignited that passion inside me that started my professional journey all those years ago. Watching women become mothers, and couples become families, is an exceptionally privileged opportunity. For me, it’s my little rainbow in the current storm.”

There are obviously some new challenges to overcome for staff, too, and providing care whilst wrestling to seamlessly master the donning and doffing of PPE has been a challenge – the scrub cap I’m wearing in the picture here is my personalised one; we’re all having to use disposal ones instead just now. Yet the teamwork has been truly nothing short of exceptional. Those special moments when you see that new family come together for the first time are what gets us through the tough times, too. The best thing about going back to the labour ward is that it’s reignited that passion inside me that started my professional journey all those years ago. Watching women become mothers, and couples become families, is an exceptionally privileged opportunity. For me, it’s my little rainbow in the current storm.

More information

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19

Answering the call – by making one: Paula’s story

Posted on April 30, 2020

When Standards and Indicators’ Paula O’Brien volunteered to help support the training of new call handlers for NHS24, she had no idea she’d end up with a sore throat…and an alter ego!

“Can I speak to John?” the voice asked.

I started to feel a bit panicky.

“He’s not feeling well,” I said, fidgeting with the phone.

“If you could let me speak to him, please. We just need to ask him a few things,” said the person at the other end.

I counted to 10 in my head. I’m still not sure why I did what I did next, looking back.

“It’s John here,” I said, putting on a much deeper voice.

The voice at the other end of the phone asked me a few more questions. I kept on for a bit, being ‘John’. Then I thought, ‘What am I doing?’

After a while, I went back to my normal voice.

What did I get out of it? A sore throat. What did the voice, the person at the other end of the phone get out of it? Well, apart from amusement at my efforts pretending to be John, hopefully in some small way I’ve helped them prepare to answer one of the many calls that NHS24 will be receiving during the COVID-19 pandemic.

***Paula volunteered to help support the training of new call handlers for NHS24***

Volunteering to help support the training of new call handlers for NHS24, by posing as a patient with real symptoms for test calls, is a world away from my job working as an admin officer for the Standards and Indicators team in Healthcare Improvement Scotland. But in a previous life I worked in a call centre environment. As my partner, Alan, is a care home nurse and my sister, Karen, a mental health nurse, I also felt I wanted to do something to help, no matter how small or big.

“As my partner, Alan, is a care home nurse and my sister, Karen, a mental health nurse, I also felt I wanted to do something to help, no matter how small or big.”

The volume of calls NHS24 is receiving has risen quite significantly due to COVID–19, and they’ve had to quickly recruit around 300 new call handlers. By volunteering to help support the training of these new call handlers, I’ve been able to help NHS24 in two ways. Firstly, having people like me involved means they don’t have to take experienced call handlers from the ‘live’ environment to train new staff. Secondly, by taking on the role of a patient caller, I’m helping to support the training of those additional staff.

Training for the role of a patient caller took place through a conference call with our contact at NHS24, someone that others in Healthcare Improvement Scotland will be familiar with – our former Equality and Diversity Advisor, Mario Medina. Mario ran through the processes and gave us the opportunity to ask any questions to help us prepare for our new roles as patient callers. We always have a point of contact, like Mario, to refer to if we’re unsure of anything. These contacts also give feedback via email about how much our help is appreciated and how well we are doing regarding the support training of new staff.

Being a patient caller in the training programme basically involves using scripted scenarios and demographics. There’s usually two demographics (patient details such as name and address) and four scenarios, two of which have an “end point” where the call handler advises on care at home, and two of which are ILTs, Immediate Life Threats requiring ambulance dispatch. My role is not to score, rate or make comments on how the trainee has done, it’s to follow the scenario to the end. During each call I make, I hope that the trainee call handler gets it right and I root for them each time. It sounds strange, but you can actually feel a smile through the phone – I could just tell the trainee who had to listen to me pretending to be ‘John’ was amused. On another call, an ILT one, the trainee asked, “How do you get into the house?”, needing to know so they could direct the ambulance crew when they got there. I misheard this as “How did you get into the house?”, to which I replied quite indignantly “Through the front door! I live here with my mum!” Only when the trainee repeated the question did I realise my mistake, and again a smile was shared across the phone.

I normally get up to three shifts a week, half a day for each shift – these can be morning, afternoon or evening. I select the most suitable shifts dependent on other workloads and home life and I then get provided with a rota and patient details for those shifts. I’ve been supplied with a work mobile for the training, as we have to continually call the training centre during our shift, alternating scenarios as we go. My preference has been to do either morning or afternoon shifts – Alan works nightshift in a care home. Luckily he is a deep sleeper so up to now my work as a trainer has not encroached on our routine and seems to fit in with it nicely.

“Carrying out this work not only helps NHS24 in a small way but is also keeps me busy and keeps my mind off worrying about my loved ones. I speak to both Alan and my sister regularly about their experiences of working during this pandemic. Volunteering in this way helps benefit my mental wellbeing in a positive way, and I’m glad of the opportunity to help during this difficult time.”

I do hope – and certainly feel – that I am making a difference by assisting with the training of new call handlers. Despite the ‘John’ incident, I try not to get emotionally attached to my patient character as I’m focussed on how the trainee must be feeling and how anxious some of them must be. I concentrate on ensuring I give them all the information they need to seek clinical advice from a colleague and complete the call in the correct way.

Carrying out this work not only helps NHS24 in a small way but is also keeps me busy and keeps my mind off worrying about my loved ones. I speak to both Alan and my sister regularly about their experiences of working during this pandemic. Volunteering in this way helps benefit my mental wellbeing in a positive way, and I’m glad of the opportunity to help during this difficult time. As part of a team of people from across Healthcare Improvement Scotland that have stepped up and volunteered to help support the training of call handlers, and as part of our wider team of colleagues across the organisation who are all helping fight this virus in their own way, I’d like to say thank you – you all make me really proud!

Paula O’Brien is a member of the Standards and Indicators team in Healthcare Improvement Scotland.

More information

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19

How to build a hospital in under three weeks – Ann’s story

Posted on April 28, 2020

On 29 March, our NMAHP Director, Ann Gow, temporarily stepped away from her Healthcare Improvement Scotland role and into the unknown as Nurse Director for the new NHS Louisa Jordan hospital at the Scottish Events Campus (SEC) in Glasgow. She tells us about the challenges of setting up a fully-functioning hospital in just three weeks – and how the staff, work programmes and culture of our organisation have helped.

Around three weeks ago, I started a job unlike any other I’ve ever had. It wasn’t planned, I didn’t apply for it. There was no lengthy application form to fill or nerve wracking interview process to go through. It’s the kind of job I never imagined I’d be asked to do, not even in my wildest dreams. If anyone had ever suggested to me I’d be helping set up a hospital in a conference centre more used to JLS than NHS, and have just three weeks to do it, I’d have thought they were joking.

But now here we are. In the middle of a global pandemic that has made us all change the way we think about how we work and live our lives, we’ve set up the NHS Louisa Jordan at the SEC. And I couldn’t be prouder of all those who’ve contributed to it.

I was asked to help by Scotland’s Chief Nursing Officer Fiona McQueen, who chairs the Louisa Jordan’s Governance Board. With the full support of our chief executive and chair, I agreed to step away for a short time from Healthcare Improvement Scotland and help establish the new hospital.

A new job but with similar responsibilities

As nurse director, I’m part of the strategic executive team reporting to the Scottish Government’s Governance Board and have lead responsibility for nursing on the site. This responsibility includes levels of nurse staffing, systems to support provision of safe, effective and person-centred nursing care, patient safety, quality and learning and infection prevention and control. Although I’ve been a nurse director previously, and was chief nurse in acute services at NHS Greater Glasgow and Clyde before I joined Healthcare Improvement Scotland, this has been very different from any role that I’ve done before. Yet the core principles of nursing care and the needs of patients and staff remain the same, and my years in public health have been useful for working in a hospital focused on an infectious disease.

There are similarities to my regular job: I provide strategic nursing advice at executive level, I’ve helped build a great nursing team with a myriad of skills, and made sure we apply all the principles of quality, patient safety, healthcare acquired infection and governance that we in Healthcare Improvement Scotland apply within the NHS system. Our culture of teamwork and trust is one that I’ve applied here in the Louisa Jordan, too. Our organisation has also provided support for improvement, learning, project management, HR and AHP leadership as NHS Louisa Jordan has been established.

“Working at such a pace has been very full on. The whole team have worked 12 hour days with no time off for the past three weeks. Yet the feeling that we were making a contribution, and the great team spirit not just with NHS staff but with construction contractors, architects and the SEC staff, has made it easy.”

Team spirit and learning from each other

Working at such a pace has been very full on. The whole team have worked 12 hour days with no time off for the past three weeks. Yet the feeling that we were making a contribution, and the great team spirit not just with NHS staff but with construction contractors, architects and the SEC staff, has made it easy. The build took two weeks from start to finish and it was amazing to watch the conference centre transform. The contract and procurement teams worked really closely with the clinical people on site to make sure it was fit for purpose in a very short period of time. The saddest thing for the whole team has been knowing we are planning an environment where patients will have little contact with their families and that staff in PPE need to find ways of comforting and building relationships with each other and patients when their faces are largely covered. We’ve learned from NHS Greater Glasgow and Clyde’s experiences and will be using donated iPads so patients can have virtual visiting with families.

We’ve also been learning from the experiences of colleagues at the other temporary hospitals across the UK, and have weekly calls with staff at the NHS Nightingale in London. Colleagues at the Dragon’s Heart Hospital (Ysbyty Calon Y Ddraig) in Cardiff have been helping us develop a learning and evaluation system which our Evidence and ihub colleagues are supporting and sharing to help other Scottish sites.

Putting a learning culture at the heart of Louisa Jordan

Probably the most important learning tools we have though are our nursing staff. Many of them have already been caring for patients with COVID-19. Most are experienced, so induction has focused on the areas that are different from the norm, whether due to the environment or the disease. The operational multi-disciplinary teams are deployed from NHS boards and most are currently working or recently retired. Many of the staff helping with the set-up phase stepped in from retirement or from organisations like ours, NHS National Services Scotland and Scottish Government at very short notice and are hugely experienced – we really couldn’t have got to where we are without them.

**Nurse Director Ann Gow in the newly built NHS Louisa Jordan Hospital**

All staff coming on site have volunteered to be there and have been massively enthusiastic. To help build these teams in such a short space of time, we’ve used Healthcare Improvement Scotland’s quality management system approach. This has helped place a learning culture at the heart of what we do, and really helped gel teams together. There has been a can-do attitude and mutual support from everyone on site right from the start. Operational staff coming in for induction have picked up on and are continuing this culture.

Now the hospital is operationally ready, , it will provide beds for patients who require ‘ward care’ as either a step down from ICU or where ICU isn’t necessary. These patients may need oxygen and care for around 5-7 days in the first instance. We’ve also got 90 beds which can be used for critical care if needed.

“In many ways, my experience at Louisa Jordan has reinforced the importance of the work we do at Healthcare Improvement Scotland. There’s a lot of learning I’m hoping to bring back with me, too, around the speed of change and the focus on teamwork, as well as the need to have ongoing connections with the system in which we work.”

The safety net we hope we won’t need

NHS Louisa Jordan is here as a safety net. We hope we don’t need to be used, as it would indicate that the volume of people with the disease was greater than the current system could cope with. But if we’re needed, we can step in to make sure patients and staff are well cared for.

In many ways, my experience at Louisa Jordan has reinforced the importance of the work we do at Healthcare Improvement Scotland. There’s a lot of learning I’m hoping to bring back with me, too, around the speed of change and the focus on teamwork, as well as the need to have ongoing connections with the system in which we work. The relationships that have been built here will I’m sure endure and make working across our various organisations easier in future.

I’m really proud to be a part of what will hopefully be a once in a lifetime experience. On site we’ve all been really focused and driven by providing somewhere that would be a good environment to care for very distressed patients and a good environment for staff to work in. I’m pleased that I can use skills to “do my bit”, but still feel in awe of the others on the front line who are working in hospitals, the community and care homes every day. I‘m also proud to be doing this on behalf of Healthcare Improvement Scotland. Since the start of the COVID-19 outbreak, our organisation has played a key role in supporting the NHS battle to combat this virus, refocusing what we do and offering support to the system. This has been invaluable to me working at the Louisa Jordan, and the spirit of cooperation that has been shown by our staff with their health and social care colleagues only enhances our reputation.

Ann Gow is NMAHP Director with Healthcare Improvement Scotland and Nurse Director with NHS Louisa Jordan hospital.

More information

Visit the Healthcare Improvement Scotland website for information on our response to COVID-19.

Categories: COVID-19 blogs

Tagged: COVID-19

Being aware of your unborn baby’s movements can save your baby’s life – Anna Todd

Posted on February 26, 2020

I’ve had three pregnancies and I have two children. But I see myself as having three: Rosie, Alice and my son, Scott, who was unable to survive birth.

Every year we celebrate Scott’s birthday. Five years on and it’s still emotional for us all. We take a wreath in the shape of a boat to his grave and we release balloons. We celebrate who he might have become and what he might be doing now.

But in many ways, Scott does live on and not just in our hearts. Our losing Scott helped save another life: his little sister Alice, who is now three. I like to think he’s saving other lives too as I work with various organisations to help spread the word about the importance of mums-to-be paying attention to their baby’s movements in the womb.

“The loss is indescribable. So much hope and expectancy, which grew alongside our baby growing in the womb, were all taken in the blink of an eye. The sense of profound loss was horrendous.”

My first child Rosie was born in 2011. After a textbook pregnancy I found myself whisked into theatre at Wishaw General, my baby in distress. Rosie was eventually born as healthy as can be. I however needed physio, treatment for an abscess and counselling for post-natal depression – all within a year and a half after giving birth.

By 2014, the trauma of Rosie’s birth behind me, we were ready to extend our family. Again there were no issues during the pregnancy itself, but complications arose during birth, caused by what’s known as an incompetent cervix. The condition affects 1 in 100 pregnancies and means that the body can’t hold the baby anymore. Scott was delivered stillborn.

The loss is indescribable. So much hope and expectancy, which grew alongside our baby growing in the womb, were all taken in the blink of an eye. The sense of profound loss was horrendous.

The care from staff at Wishaw General Hospital after we lost Scott was extraordinary. The bereavement care available to me and my husband Stuart allowed us both to find a way to move on. Everything in the care I received was tailored to me. I was treated like a person and nothing was too much to help us come to terms with our loss.

The counselling did its work and a year later we were both amazed that we wanted to try again. I became pregnant at the start of 2016.

After what happened to Scott, the pregnancy was naturally an anxious one. During my baby shower at 34 weeks, I was suddenly aware the baby had stopped moving. With the loss of Scott, I was acutely tuned in to how my body felt and knew something wasn’t right. Over the next 48 hours, movements were sporadic and I was in and out of hospital as the baby was monitored. It was my acute awareness of how my baby was feeling that saved her life. The hospital staff listened to me and they were receptive to my needs and concerns. After it was discovered that the baby’s blood pressure was dangerously low, an emergency Caesarean brought baby Alice into the world. At 4lb 14 ounces, Alice needed a lot of help after birth, but now she’s as healthy, amazing and troublesome as any three year old!

While the number of stillbirths has reduced in recent years, in Scotland four babies a week are stillborn. I’m delighted the Scottish Government’s Stillbirth Group have launched a new campaign to raise awareness of the three key ways expectant mums can potentially lower their risk of this happening to them. Being aware of foetal movements is one of those ways, along with sleeping on your side and stopping smoking.

“If I had one piece of advice, it would be for mothers to trust their instincts and their sense of their own body. Your baby talks to you through movement, so be prepared to listen. You could save your baby’s life.”

I’m so happy that the importance of being tuned to baby’s movements in the womb is getting the national importance that it deserves through this campaign and the work of the Scottish Patient Safety Programme’s Maternity Care Programme. Since Alice was born I’ve found myself working at times with SANDS Charity (Stillbirth and Neonatal Death Society) as a befriender to help others through the trauma of stillbirth, I’ve spoken at the Royal College of Physicians to help develop a bereavement pathway, and I’ve spoken at midwifery conferences. It all helps with the permanent sense of loss to know that others might learn and benefit, that losing Scott may be helping to save others.

If I had one piece of advice, it would be for mothers to trust their instincts and their sense of their own body. Your baby talks to you through movement, so be prepared to listen. You could save your baby’s life.

Anna Todd is a mother of three and a befriender with the SANDS Trust.

For information on work to prevent stillbirth in Scotland, visit:

SPSP Maternity Care Programme: ihub.scot

Advice on preventing stillbirth

Categories: ihub

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

Full ESTEEM ahead for those who experience psychosis – Jonathan O’Reilly

Posted on January 9, 2020

“I no longer see psychosis as a catastrophe…I’ve been able to accept my diagnosis and not let it define me or my trajectory.”

These words were spoken at the first meeting of our Early Intervention in Psychosis Improvement Network (EIPIN) by Michael who has personal experience of psychosis.

With vulnerability and openness, Michael – and Stephanie, who also had experience of psychosis – brought to life for those attending the meeting what the experience is like, the recovery journey, and the impact and importance of early intervention.

Michael’s words of acceptance and hope had particular resonance for those attending the network meeting, as this is the very outcome we are striving to achieve for everyone who experiences psychosis in Scotland.

What is psychosis?

“Treating psychosis in the early stages can reduce the amount of time a patient needs to spend in hospital, reduce relapses, and leads to more effective and long lasting outcomes.”

Psychosis is characterised by hallucinations, delusions and disturbed thinking. It can cause considerable distress and disability for people affected, and for their families or carers. It’s estimated that there are approximately 1,600 new cases of psychosis in Scotland each year. Psychotic disorders can be extremely debilitating and it’s vital that those experiencing psychosis are treated quickly and effectively. Treating psychosis in the early stages can reduce the amount of time a patient needs to spend in hospital, reduce relapses, and leads to more effective and long lasting outcomes. Research from previous work in Scotland has shown improved outcomes when using a specially-designed model (called ESTEEM), compared to a more generic model, as inpatient stays can be significantly reduced, sometimes by up to 55%.

How the network came about

In the summer of 2019, Scottish Government published the action plan, Our Vision to Improve Early Intervention in Psychosis in Scotland, affirming their commitment to action 26 of the Mental Health Strategy, to improve access to services for those experiencing psychosis.

The Early Intervention in Psychosis Improvement Network is part of Healthcare Improvement Scotland’s Mental Health Improvement Portfolio of work.

By establishing and launching the network with the first meeting, Scotland took its first step in achieving those actions and mobilising a network consisting of health and social care, education sector, third sector, individuals with lived experience and carers.

The first EIPIN meeting was hosted by Healthcare Improvement Scotland with over 100 people from across Scotland in attendance. The aim of the meeting was to raise awareness of the importance of Early Intervention in Psychosis, the current evidence base for treatment, and how that evidence is currently being applied in the ESTEEM service in Glasgow (a community mental health service for people between 16-35 years, who appear to be experiencing their first episode of psychosis). Most importantly, the network will look at the positive impact of early intervention services on people’s lives.

Partnership working to drive improvements in care

“This work will ensure people presenting for the first time with psychosis anywhere in Scotland get access to effective care and treatment, with a focus on early intervention and recovery.”

A crucial part of this programme of work has been to recruit NHS Forth Valley and NHS Highland and their associated Health and Social Care Partnerships (HSCPs) to better understand the current provision of EIP services, what’s required to improve services, consider how data can be best collected and optimised, and determine what a good service for people experiencing psychosis looks like for service providers and service users.

I’m delighted to be involved in this important work. The work will ensure people presenting for the first time with psychosis anywhere in Scotland get access to effective care and treatment, with a focus on early intervention and recovery.

The success of the network launch – and the enthusiasm of all those who have stepped forward to be involved – has put us all on a strong footing to deliver improvements and recommendations to change the future for so many people experiencing psychosis in our communities.

Jonathan O’Reilly is an Improvement Advisor within the Mental Health Portfolio of Healthcare Improvement Scotland

More information

To learn more about the EIPIN and how we are progressing the action plan visit ihub.scot or on Twitter @spsp_mh. Get involved in the conversation on social media by following the hashtag #EIPScot.

Categories: ihub, Mental Health

Expertise and evidence will always have value – Professor Angela Timoney

Posted on January 7, 2020

“The people of this country have had enough of experts”
Michael Gove, 3 June 2016

It is a little galling after years of studying and honing your craft to be told that your expertise is not required. To be fair to Michael Gove, he claimed that he was interrupted and that he intended to qualify his statement to explain that he was speaking in regard to economists. However, I am not sure the health economists working with us in Healthcare Improvement Scotland (HIS) will think this qualification makes it better.

So I believe we have not had enough of experts. In SIGN (which is part of HIS) we rely on our multidisciplinary teams to use their expertise to critically appraise the literature and come to a considered judgement in order to inform practice. Where I have some sympathy for the quote is where we have relied on experts making statements not based on evidence who expect to be listened to simply because of their years of experience. That is precisely why we need evidence-based guidelines.

“The problem with evidence, of course, is that it is of variable quality. It may be conflicting. It may not even answer the precise question that we in Scotland consider needs to be addressed.”

The problem with evidence, of course, is that it is of variable quality. It may be conflicting. It may not even answer the precise question that we in Scotland consider needs to be addressed. This is why we need our experts, our clinicians with expertise and our patients with expertise who live with the condition to work together and apply considered judgement. Considered judgement is just one point in the process of guideline development, but one I think should not be forgotten. The phrase itself makes it clear this is a judgement, it may change if the evidence were to change or it may not apply in a particular circumstance. But unless a judgement is made then it is really difficult for practitioners and patients to act with confidence.

SIGN has a long and proud history of providing recommendations for practice in NHSScotland and for leading rigorous guideline development in the international community. For example, two members of the SIGN team recently presented our work, on asthma, on involving patients and on guidelines methodology, to an international conference in Australia.

“SIGN has a long and proud history of providing recommendations for practice in NHSScotland and for leading rigorous guideline development in the international community.”

I think our patient information booklets enable Realistic Medicine. Each guideline has a booklet for patients describing to them what is advised for their condition and enabling a meaningful conversation about their diagnosis treatment and care: “If the guideline says this, what does this mean for me..?”

I am pleased to be Chair of SIGN, I think it is a fantastic team and I want to ensure that the clinicians and patients in NHSScotland recognise this gem. Clinical practice in Scotland is not that different from the rest of the UK or our European and American colleagues but isn’t it reassuring to know that we have guidelines based on evidence which applies to the context of practice for NHSScotland?

So, Michael … This country has not has enough of experts, it needs expert assessment of evidence to address variation, bring new evidence to the forefront and support patients, their families and practitioners in their practise.

Professor Angela Timoney is Chair of the Scottish Intercollegiate Guidelines Network (SIGN), part of Healthcare Improvement Scotland.

More information

Visit the SIGN website to read our evidence based guidelines for NHSScotland.

Categories: SIGN