Do the Scottish public know how to use antibiotics wisely? – Jacqui Sneddon

Posted on September 8, 2020

Our Scottish Antimicrobial Prescribing Group (SAPG) have spent the last ten years raising public awareness of the threat antibiotic resistance poses. But is the message getting through? SAPG lead Dr Jacqui Sneddon decided to find out, with help from colleagues in our Community Engagement Directorate.

Since 2010, the Scottish Antimicrobial Prescribing Group (SAPG) have led annual campaigns, centred around European Antibiotic Awareness Day on 18 November. The aim is to communicate messages to healthcare staff, patients and the public about the threat of antimicrobial resistance and the need to use antibiotics wisely to protect them for future generations. Staff in health boards and our Public Partners have supported campaign activities tirelessly across hospital and community settings, including schools, youth groups and even Aberdeen Football Club. We’ve also managed to get our own Brownie badge, thanks to one enterprising SAPG committee member developing an awareness raising project for her Brownie pack. But how do we really know if these messages are reaching the public? Is what we’re doing really influencing people’s behaviour around managing common infections and seeking antibiotics from their GP?

Opportunity knocks…

After attending a Scottish Health Council (now Community Engagement) presentation on Citizens’ Panel surveys back in 2019, it struck me that there may be an opportunity to have a Citizens’ Panel survey on antibiotics.

A Citizens’ Panel is a large, demographically representative group of citizens regularly used to assess public preferences and opinions. The Our Voice Citizens’ Panel was established in 2016 to be nationally representative and currently comprises just under 1,200 members of the public from across all 31 Integration Authorities. Since the panel was established, it has gathered the public’s views on around 20 different health and social care topics and has begun to demonstrate impact on ongoing health and social care policy and practice.

Welcome result

Our survey ran earlier this year, and received a 52% response from panel members, so it’s statistically robust at a Scotland wide level. More importantly, the recently published findings make welcome reading for those of us working on safeguarding antibiotics. The majority of the panel had heard of antibiotic resistance, knew that this means bacteria fail to be killed by antibiotics and that overuse of antibiotics is the main cause of resistance. Most people also knew the difference between bacterial infections that can be serious and viral infections that usually cause coughs and colds.

When it came to seeking help when they or a family member was unwell with a suspected infection, most said they would ask a healthcare professional such as a doctor or pharmacist for advice, or consult a reputable on-line source such as NHS Inform. Over 90% of panel respondents had been prescribed an antibiotic at some time and about 40% had needed a second antibiotic, possibly because the infection was resistant. When it came to using antibiotics, most people would complete the course, would not share antibiotics with others and were not likely to try to purchase antibiotics on-line or when overseas on holiday. Respondents also knew which common infections are likely to get better without antibiotics, with the exception of earache in young children which they incorrectly thought would usually need antibiotic treatment.

Looking to the future

We also wanted to know whether the panel were aware of the campaigns run by SAPG and others on infection-related topics. About half of respondents had seen some of the campaign materials, usually in Health Centres. I was pleased to learn that over half of respondents were aware of the “Pharmacy First” service which provides treatment of common infections via pharmacies, and over one in four respondents had used the service. And as a pharmacist myself it was also good to know that the majority of people would be happy to seek and take advice from a pharmacist.

This survey has been helpful for SAPG and I’m sure it will be of interest to colleagues in other UK nations. We’re hoping the details will help us design public awareness campaigns to save our antibiotics. From the survey results, both reinforcing advice about self-care for common infections and highlighting which infections may require antibiotic treatment so that people can consult their GP or pharmacist for advice when necessary look like avenues we may explore in future. Thanks to the Citizens’ Panel, we’ll now be able to target future campaigns more effectively.

The Our Voice Citizens’ Panel Survey on awareness of antibiotic resistance, appropriate use of antibiotics and related public health campaigns report is available on the Community Engagement website.

Jacqui Sneddon is Scottish Antimicrobial Prescribing Group (SAPG) lead with Healthcare Improvement Scotland.

@jacquisneddons @HISengage @SAPGAbx

More information

Visit the SAPG website

Categories: COVID-19 blogs

Tagged: COVID-19

A helping hand to be treated at home – Shirley MacKenzie

Posted on September 2, 2020

Shirley MacKenzie’s mother, Agnes, was able to spend her final months in her own house, thanks to Hospital at Home. Here, Shirley tells us in her own words how much it meant that her mum was able to have her final wish of a peaceful death at home.

My mum Agnes was diagnosed with aggressive B cell lymphoma in June 2019 and she completed her treatment in November of that year.

Over the winter, mum kept in reasonable health, joining in with family occasions and seeing friends. Then COVID-19 changed everything and she became a shielded patient.

Fortunately she was able to maintain independent living, with her family visiting her in the garden and bringing her groceries. We were so lucky with the good weather which made the isolation easier. We were also very lucky to be able to use video technology, and she used this to keep in contact with us daily as well as with the family abroad.

In mid-June she became more unwell, developing extreme tiredness, breathlessness and back discomfort. Because she was became worse over a few days, we contacted the Beatson who directed her to her GP. Mum was reluctant to go to hospital so her GP said he would contact the Hospital at Home service operating in NHS Lanarkshire.

Same day service

A nurse from Hospital at Home came out to visit her the same day. She carried out an assessment, observations and blood tests. Later that morning, a hospital consultant came to the house, retook her history and examined her. The consultant then explained to mum that her very high calcium level, which was related to her underlying disease, was contributing to the deterioration in her symptoms. She said that she could provide some treatment that might offer some improvement to mum’s current symptoms. She then liaised with the specialists at the Beatson about what, if any, additional treatment might help mum’s underlying condition, as well as looking at community resources to provide aids that could help her maintain a safe home environment. These were delivered later that same day.

Later on in the day of her first contact with Hospital at Home, my mum was given intravenous fluids. The following day she received intravenous medicine to help lower the high calcium. At all times, the service’s staff were very professional, helpful, sympathetic and considerate of her wishes. Their communication and explanations to my mother and our family were excellent.

A final wish fulfilled

Initially, my mum picked up a bit following this treatment and a few days later the Hospital at Home service discharged her to the care of her GP and McMillan Nursing Services.

However, she deteriorated quickly in the end and died peacefully at home, being cared for by her family. Her wishes were to be cared for in her own home and to die there, if this was possible. If it had not been for The Hospital at Home services, social services, her GP, and the support of the family, I don’t think this would have been as comfortable or indeed possible to achieve.

Throughout her contact with the service, my mum was aware that the treatment offered was for symptom control and that her disease was progressing. She was comfortable and less anxious in her own familiar surroundings than she would have been in a hospital ward and said she felt more in control. It allowed her to continue to have her family around her – an important consideration for her, especially in recent times.

More information

Visit the Hospital at Home section of the ihub website.

Categories: COVID-19 blogs

Tagged: COVID-19

Ensuring that radiation in healthcare is used as safely as possible – Alastair McGown

Posted on August 28, 2020

We used to think of radiation as being a highly dangerous substance and thoughts of historical international disasters would possibly spring to mind. As an invisible and powerful force, it can certainly be harmful when not handled correctly, but there are many benefits to its use in healthcare, and it plays a vital role in diagnosis and treatment. Most people will know of someone who has had an x-ray and some of use will know someone who has gone through radiotherapy. These are common healthcare procedures that most of us will consider safe and effective. Regulation of the use of radiation is about making something that is already very safe into something that’s extremely safe.

Safety is at the heart of what we do

But how do we know these procedures are safe and that we’re protecting patients from the potential harms of radiation? That’s where the IR(M)ER inspectors come in! IR(M)ER stands for Ionising Radiation (Medical Exposure) Regulations, and it’s our job to ensure that ionising radiation for medical exposure is as safe as practicable across both the NHS and private healthcare in Scotland.

In this role we work for Healthcare Improvement Scotland to inspect services throughout Scotland, but we carry out these regulatory duties on behalf of the Scottish Government. IRMER regulations cover the UK, so whether we are in Scotland or other parts of the UK we are all inspecting to the same regulations. We work together to drive consistency where possible. The UK safety standards are based on international standards and countries all over Europe and globally have agreed to implement these into their regulations. A recent international review of how the UK manages radiation safety was undertaken by the International Atomic Energy Agency. As part of that review we had to demonstrate how we were fulfilling our international obligations as a regulator. This was a unique experience and offered a chance to meet regulators from all over the UK. The reviewer that looked at our work was from Sweden. We were delighted with the outcome from the visit and will use the results to continually improve how we deliver our work.

A rare and unique role in healthcare

This type of role requires a lot of specialised training and on the job experience. For me, it’s a fantastic opportunity that’s also enjoyable and rewarding, plus I get to learn from other bodies like Public Health England and to develop relationships with colleagues in other countries. We work alongside radiologists and radiographers around the country to ensure that they have all the safety measures in place. These include rigorous controls to make sure that when ionising radiation is used it is appropriate to do so and as safe as possible.

I’ve been inspecting for over a decade, and have experienced a variety of receptions when I arrive on site. Inspecting in IRMER has been really enjoyable. Every department we’ve visited has been extremely welcoming to us, and have made every inspection a pleasant and rewarding experience.

My role, alongside fellow inspectors, is to ensure that each provider complies with the regulations, and to support and encourage compliance where necessary. We do this through inspections, responding to notifications of incidents and through engagement with national groups.

What we’ve found is that there is a true focus on improvement, and any recommendations are for the safe use of ionising radiation are accepted with a commitment to implement them. We have had the opportunity to see at first hand the different type of equipment and the truly remarkable work that’s undertaken. Everyone we visit has a passion for their work, and safety and improvement is always a priority.

Training is vital

The regulation of IRMER is a very important area of work, and requires us to have sound, specialist working knowledge of diagnostics, nuclear medicine and radiography. These include x-rays, nuclear medicine, CT scanning and mammography.

Before I started undertaking IR(ME)R inspections, I had to complete a robust training programme. The main part of this was a fantastic week delivered by Public Health England (PHE) experts, who carry out this training for regulators across the UK. We learnt about the various aspects of ionising radiation and its use in medicine, as well as the regulation and monitoring of it. It’s really beneficial to learn alongside regulators from all over the UK. We can also call on the support of colleagues from PHE and the CQC whenever it’s required.

It’s been a fascinating but steep learning curve to understand such a highly specialised area of work. However, the learning is never finished. In the same way that we’re always expecting providers to improve, we endeavour to do the same. It’s satisfying to know that the work that we all do together helps to keep patients safe, enabling them to be protected from the harms of radiation, and instead to receive only the benefits.

Alastair McGown is a Senior Inspector with Healthcare Improvement Scotland

More information

To find out more visit the Healthcare Improvement Scotland website

Categories: Inspections and Reviews

Tagged: Inspections, Quality Assurance

Rich tea and sympathy – Julie Davidson

Posted on August 18, 2020

While the pandemic has kept us apart, we’ve still found ways to be together when it matters most. As part of our Community Engagement Directorate’s virtual visiting scoping exercise to gather information about how hospital patients and their families stayed in touch when visits weren’t possible, Julie Davidson, a Community Engagement Officer in Dumfries and Galloway, reflects on how she’s learned to value technology when it comes to staying in touch.

There’s nothing better than a chat over a cup of tea and a biscuit. That bit of time between arriving at a meeting and the meeting starting, where you’re making brew and rummaging through the biscuit tin for something good to dunk in it, that’s when you find out the important stuff. It’s when you get to know what’s really going on, get to know your colleagues better and find out how things are with them. But sometimes when you have to make a 140 mile round trip just to get to the tea, the biscuits and the meeting, you do start to wonder if there’s sometimes an easier way of doing things, as much as the effort to travel all those miles is appreciated by workmates and stakeholders alike.

Face to face vs virtual meetings

Back before we had heard of COVID-19, I remember how excited/nervous/curious I was about the possibilities of using NHS Near Me, a video platform which was in many ways a forerunner to things like MS Teams. One day when I realised I wouldn’t make it back from Stranraer to a meeting in Dumfries, NHS Near Me was suggested. I had lots of thoughts about using it. Would I able to contribute as normal? Would my colleagues forget I was there? Turns out it was fantastic. I felt fully involved, and from then on used it when I couldn’t make meetings due to time and distance. It helped me stay connected and attend several meetings in one day. It saved me a day out of the office! Yet I did miss the long drives which helped me gather my thoughts. I missed catching up face to face with colleagues. Can anything beat face to face contact and the interaction it allows?

Well, almost. There’s certainly a lot things it can make easier. Using Near Me worked so well for me, I started thinking it would be great to attend GP appointments this way. Little did I know how prescient that thought was! Near Me has now been used with patients and service users throughout this pandemic, helping people attend GP and hospital appointments from the comfort of their own home. This has been particularly helpful in a rural area like ours, where people rely on public transport, as in our experience, healthcare is often provided in Glasgow or Edinburgh. Now it can be provided in your own front room.

The value of visiting virtually

I support NHS Dumfries and Galloway volunteer peer support group sessions, which have continued through MS Teams during lockdown. Recently we’ve heard emotional stories from NHS volunteers about the impact not being able to visit is having on hospital patients and their loved ones. From having a family member in hospital during this time myself, I know first-hand just how important it is to stay in touch. Technology has provided us with the means to do so. People are Zooming, Facetiming, Whatsapping, Teaming. We’re visiting virtually.

Using technology in this way has been eye opening, and the possibilities are endless. Virtual visiting means it’s now possible for someone at the other end of the country, or indeed the other side of the world, to visit a loved one in hospital without all the stress of travelling and anxiety that you won’t get there at the right time. Now that we are starting to come out the other side of lockdown, will these trends continue? For me, there’s nothing like a face to face catch up, but no one ever said you couldn’t have a cuppa and a catch up virtually. Just watch out for biscuit crumbs on your tablet!

Julie Davidson is an Engagement Officer in Dumfries and Galloway

More information

To find out more about virtual visiting and contribute to Community Engagement’s scoping exercise, go to their website:

https://www.hisengage.scot/equipping-professionals/virtual-visiting/

Categories: COVID-19 blogs

Tagged: COVID-19

The need for speed (and safety) – Rickie O’Connell

Posted on August 13, 2020

In the midst of the COVID pandemic, urgent treatment for cancer patients has continued. As part of our Off-label Cancer Medicines programme, Senior Pharmacist Rickie O’Connell tells us how a two-year test and development programme became a vital part of the response to ensuring patients received the care they needed while staying safe.

In November when I first went on secondment from my regular job as a pharmaceutical analyst with the Scottish Medicines Consortium to be a senior pharmacist for the Medical Directorate’s Off-label Cancer Medicines (OLCM) programme, I knew the work would be challenging. The programme had two years funding to develop and test an approach for improving national consistency in the use of cancer medicines in a way that is different to that described in their licence. I was looking forward to a tough but interesting couple of years. I never imagined we’d be pedal to the metal, trying to put guidance in place so people with cancer could be treated more safely in a pandemic situation.

Responding to the crisis

Patients receiving treatment for cancer were initially considered a vulnerable group for developing severe COVID-19. Not unnaturally, patients and clinical teams therefore wanted, and still want, treatment options that require fewer hospital visits, have fewer serious side effects or that can be taken orally at home rather than in hospital.

Clinical leaders within the OLCM group identified the need for a national governance group to help prevent local medicine governance systems becoming overwhelmed with requests for less familiar treatments which could meet patient’s preferences to avoid hospital visits. Such changes, if carried out at a local level, would likely result in duplication of effort at a time when the health and care system was focused on tackling COVID-19, and could result in inconsistencies in treatments available to people with cancer across Scotland.

A new project for our team

Our OLCM programme team was just four months in to our project at the time, but following this advice we were deployed to work on COVID-19 National Cancer Medicines Advisory Group (NCMAG) to help address this challenge. Like many teams in Healthcare Improvement Scotland, our team has skills in evidence review and project management, as well as links with cancer clinical teams across Scotland, so we were well placed to help.

Things moved rapidly once the group was set up. Within weeks we had all the processes and support tools in place so that clinicians could submit proposals for treatments not routinely available, we could prioritise the work and produce the guidance. We also quickly got all the key players in place, including representatives from regional cancer networks and NHSScotland National Procurement, to ensure there were sufficient supplies of the medicines the group were supporting for use, and also ways to get our advice out to those who needed it. Once issued, the advice would mean that patients could have ready access to cancer treatment options that were not previously routinely available, and with fewer hospital trips.

Going at 90 miles per hour

The benefits of this national approach were quickly acknowledged by practicing clinicians and our team received many proposals in a very short time. Fortunately, our colleagues within the wider Medicines and Pharmacy team and colleagues from Scottish Medicines Consortium kindly supported us through the heaviest workload.

From April to July, the team has been working at a pace I didn’t think was possible. The original aim of our OLCM programme was to produce up to 10 pieces of advice in two years. So far we have produced 21 pieces of advice in four months. It’s not been easy, but knowing the advice we’re producing is benefitting those who need it most makes the effort and long hours worthwhile.

Adapting to changing circumstance

Looking back, the few months have seen a lot of things change. Like most of you, I’m no longer office based, and have swapped the Glasgow commute to working from home. I even have a noisy new colleague – my daughter, Úna, turned one during lockdown and her birthday was a busy day of back to back video calls. Since then she has developed new hobbies of heckling and cyber-attacking daddy during work meetings – the broadband router now hangs high up on the wall out of the reach of her tiny fingers.

And I was right about the secondment. It has been challenging. But I’m glad our team have had the opportunity to contribute, with our individual skill sets, to the care of cancer patients during this uncertain time.

Rickie O’Connell is a Senior Clinical Pharmacist with the Off-label Cancer Medicines Programme and Area Drug and Therapeutics Committee Collaborative

More information

You can find more information about COVID-19 National Cancer Medicines Advisory Group on the Scottish Government website

Categories: COVID-19 blogs

Tagged: COVID-19

Our antimicrobial prescribing team – a big impact for a small team – Jacqui Sneddon

Posted on August 6, 2020

Although the COVID-19 pandemic is still with us, many parts of the NHS in Scotland are keeping their focus on the virus while restarting work that had to be paused. Jacqui Sneddon reflects on the work of the Scottish Antimicrobial Prescribing Group as part of the pandemic response and looks at the way forward.

The impact of the COVID-19 pandemic brought challenges and opportunities for the Scottish Antimicrobial Prescribing Group (SAPG).

Our group works with NHS boards across health and care settings in Scotland to safeguard antibiotics against the global threat of antimicrobial resistance. When both the group’s committee and project group meetings were paused, it meant that that routine work for the group was also suspended.

We’re a small and agile team of just three employees, including me, plus one day per week from our Chair, Dr Andrew Seaton from NHS Greater Glasgow and Clyde, but with a committee of national experts and clinical staff from across Scotland, as well as several project steering groups.

Initially I was seconded to support first the Medicines and Pharmacy team within Healthcare Improvement Scotland (of which SAPG is a part), and then to NHS Lothian to support the ICU pharmacy service. Marion Pirie, our team’s Project Officer, took on part-time work with NHS 24 supporting staff training by role playing real-life patient calls.

Meanwhile, Lesley Cooper, our Health Service Researcher, devoted her time to finalising evidence reviews for two of our projects – penicillin allergy de-labelling and use of antibiotics towards the end of life – which have now been submitted for publication. There was also time to write up our findings from global health partnership work we’d just recently completed with two hospitals in Ghana for future publication.

The issue of COVID-19 and antibiotics

But we couldn’t entirely take our eye off COVID-19.

The pandemic meant that we needed to be sure that use of antibiotics was still appropriate and that clinicians had the information they needed.

Literature reports of overuse of antibiotics in other countries led to SAPG producing advice to support antimicrobial teams in NHS boards to maintain stewardship of antibiotics in hospitals and care homes.

We recognised an opportunity and need to explore the impact of COVID-19 on hospital antibiotic prescribing, given emerging data form China and other parts of the UK, so SAPG led a point-prevalence survey audit examining epidemiological, clinical and prescribing data from eight boards. Data were captured from over 800 patients with suspected or proven COVID-19 across 15 acute hospitals (about one third of all hospitalised patients with COVID-19 in Scotland at the time) during the last 10 days in April. The study generated a huge amount of data that Lesley and colleagues in Public Health Scotland analysed and this provided reassurance that antibiotic use in Scotland was compliant with local guidelines, with lower use in COVID-19 patients than reported elsewhere. Thankfully there was no increased use of broad spectrum antibiotics that drive resistance although the emerging problem of secondary bacterial infections in critical care was observed. One paper has been submitted for publication focused on the epidemiology of antibiotic prescribing in COVID-19 and a second on management of suspected respiratory infections in the context of COVID-19 is underway.

Emerging from lockdown

As we gradually emerge from lockdown, SAPG work has restarted with our first virtual committee meeting recently attended by 32 members. On the agenda as well as the hospital audit data was a discussion of data on GP practice antibiotic prescribing during COVID-19, and hearing about the challenges that antimicrobial teams had faced. All of this information will allow us to continue to learn and will inform the SAPG work programme to ensure the NHS in Scotland continues to use antimicrobials optimally to preserve antibiotics for future generations.

We then turned our attention to our project groups on penicillin allergy and end-of-life antibiotics, to finalise outputs and agree plans for implementation as well as publications on our project development processes. We’re now working with our SAPG Public Partners to produce a patient version of recommendations for use of antibiotics towards the end of life to support patients and their families in shared decision making.

As I reflect on the lessons of the pandemic and the way forward for the group, it strikes me just how much COVID-19 has brought people together – we see that in society, but also within organisations like our own. Our team is contributing to cross-organisational work on older peoples’ systems and primary care where our experience of working with care homes, and with GP Practices will help to inform and support future priorities. 2020 marked 12 years since SAPG was formed and since I joined the organisation. We’ve achieved so much by working in partnership with health and care professionals across the country. Although it’s been a difficult year for everyone, we can only look forward, to continue the fight against antimicrobial resistance, and to face whatever new challenges lie ahead.

Jacqui Sneddon is Scottish Antimicrobial Prescribing Group (SAPG) lead with Healthcare Improvement Scotland.

@jacquisneddons @SAPGAbx

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19

Innovative communication: working, thinking and engaging differently in Shetland – Camille Brizell

Posted on July 28, 2020

COVID-19 has meant that for most of us, virtual meetings and other remote communication tools have now become the new normal. But for our colleagues in remote communities, these tools have long played an important role in their day to day work.

As Community Engagement launches its “Engaging Differently” web content and resources Camille Brizell, our Engagement Officer in Shetland, explains how finding different ways to engage has long been just part of the job.

As an organisation we’re all adapting and getting used to different ways of working just now. However, video conferencing or communicating through email with colleagues might still seem a bit odd if you’re used to just walking over to their desk and asking them face to face. But in the Local Engagement Office that I work in, that’s been the norm for years. If I wanted to ask Vicky, our team administrator for something, it would be quite a journey for me to walk over to her desk – it’s 210 miles away in Aberdeen! Just popping over to Vicky’s desk would involve crossing the North Sea from my desk in Lerwick. Quite a feat!

Yet distance has never stopped our team from working closely. We’re used to being innovative in how we do things and have always planned ahead. After all, just travelling from one part of Shetland to another can require a lot of planning. The area is approximately 100 miles long from north to south and has 16 inhabited islands, some of which can only be reached by ferry. To get to some of our outer islands it takes two ferries. Then you have to factor in the weather – if you do manage to get to the place that you’re going to for a meeting, will you be able to get home again?

As you can imagine being able to adapt and use different approaches, including the use of technology, has certainly helped to maintain links, especially when the weather has been poor.

Now that everyone is rethinking the way they communicate with others, we’re hoping that our experience here in Shetland, as well as the experiences of others across health and social care, can help support the Community Engagement Directorate’s “Engaging Differently” work.

Engaging differently – one size doesn’t fit all

“Engaging Differently” is a set of web content and resources that does exactly what it says on the tin – it looks at the different ways that we can adapt what we do so that community engagement remains not just possible, but also meaningful, even if it is from a distance. In my role as an Engagement Officer, I’ve always used a range of approaches to involve different audiences. I’ve found that no two communities are alike and no two people are alike; what works for one community or person may not work for another. In her recent blog for Gypsy / Traveller History Month, my colleague Gillian Ventura, who works in Lanarkshire, told us about how important it is to build relationships and trust in order to get communities to engage.

As Engagement Officers, we explore every possibility to support and encourage different communities to engage. We can then understand their needs and provide support for them to make sure that their opinions are heard by our health and social care colleagues.

Engagement might sound complex and in need of some grand solutions. Add in the factor of the pandemic and associated lockdown and it seems even more complex. Technology like MS Teams is helpful when we can’t meet in person but sometimes the solution is much simpler than that and you can make use of what you already have around you.

It’s good to talk

During the pandemic I’ve been supporting work around NHS Shetland’s Respiratory Care Unit. One piece of work was to develop written information for the family and friends of patients being admitted to the Respiratory Care Unit.

Under normal circumstances, we’d gather a small working group together and share printed drafts of information leaflets for discussion. During lockdown, however, this just wasn’t physically possible. While I was able to gather some feedback through emails, there was one member of the public on the group who didn’t have access to the internet. There wasn’t time to post the draft leaflet to her so we did the whole thing by phone. Every time I think back to this moment, I have a vision of this lady sitting by the phone, writing out the text of the information leaflet word for word as I read it out to her. We were on the phone for a good number of hours over a weekend as the leaflet was needed urgently. For me, it’s important to remain open to using different approaches and keeping in mind traditional methods just as much as new technology. The opinions of those who don’t use computers, conference calls and instant chat messaging on a daily basis are just as important as the opinions of those who do. We need to remember that. Often just a chat with someone on the phone has a lot of value when it comes to finding out how they feel about the healthcare that they’re receiving.

Opportunities

With everything that’s happened over the last few months, it’s strange now to think that before COVID- 19 it was often just me dialling in to a meeting on the mainland via video conference or telephone and I was the only one who was constantly thinking about a plan B if the technology failed. Now, everyone has to find new ways to communicate effectively.

COVID-19 has created many challenges for all of us when it comes to engaging with people, but it is also an opportunity for us to be optimistic. Here in the north, we’ve always risen to the challenges that being so remote and far away from each other has presented; the pandemic has proved that this is something we can all do and it may even have provided us with more effective ways of working. Even though we now need to keep our distance from each other, we have found that by engaging differently, we can overcome any barriers to communication and ensure that we can continue to provide essential support to our communities throughout these challenging times.

Camille Brizell is a Community Engagement Officer in our Community Engagement Directorate’s Shetland Office.

More information

You can find out more about Engaging Differently on the Community Engagement website

Categories: COVID-19 blogs

How small things make big differences – Andrea’s story

Posted on July 21, 2020

During the COVID-19 pandemic, a lot of the day-to-day things we take for granted have stopped. Returning to work as an Occupational Therapist in mental health services, Associate Improvement Advisor Andrea Boyd noticed that in a time of big challenges, it was often the little things that mattered.

It’s often the small things that mean the most in times of uncertainty. The everyday, ordinary things. The things you normally never notice, the things that you never miss until they’re not there.

Over the past few months I’ve noticed the absence of a lot of these small things and the difference they can make. A hug. A shared meal. A comforting pat on the arm. They all mean a lot.

**Andrea on ward dressed in PPE and Andrea with family**

Going back to work on wards

In my normal job, I split my time between working as an Associate Improvement Advisor in the ihub’s mental health improvement team, and working as a Senior Occupational Therapist (OT) at NHS Ayrshire & Arran. The focus of my ihub work is improving observation practice in mental health services, which is part of the Scottish Patient Safety Programme. I’ve built up a network of national improvement leads and I was looking forward to starting full time hours within the ihub from 1 April. But then everything changed.

As part of Healthcare Improvement Scotland’s national response to COVID-19, I returned to work as an Occupational Therapist at Woodland View, NHS Ayrshire & Arran’s acute mental health facility and community hospital at Ayrshire Central Hospital. I worked three days a week in older adult mental health wards, one day in acute adult mental health wards and one day a week in the community role I’ve continued to undertake.

The impact of COVID-19

My community role as an Occupational Therapist has often been to act as a reassuring voice. I check patients’ symptoms and give advice on remedial actions they can take. During lockdown, the way I’d normally work has had to change, although, surprisingly, this was sometimes for the better.

For example, lockdown meant I was only able to make urgent visits to my community-based patients. However, as I kept in touch with them weekly on the phone, I ended up being in contact with them more regularly than I would in pre-COVID times. Some of my patients have been shielding and have particularly appreciated being in contact with me on this more regular basis.

Physical barriers can impede recovery

Working on the wards at Woodland View was, of course, a different story. Because of COVID, we’ve been aiming to reduce footfall in wards and make sure people get home as soon as possible.

The most challenging aspect has been to treat patients with complex mental health needs while wearing PPE. Some of our work involves working with patients in physically close situations, such as the kitchen, so we have to be careful to maintain a physical distance as much as possible, and to wear the correct PPE. It makes it a bit more difficult to get to know new staff and patients, and it affects building therapeutic relationships. Older adults in particular find it difficult to hear you through your mask.

Meal times in particular have been more isolated than usual as patients are eating alone in their rooms, rather than socially. Visitors have not been allowed inside the building, and while we facilitated some patient visits at ground floor windows, this lack of social contact has been hard for all of us.

Finding the positives

On the positive side, COVID has meant that we take every opportunity to get out in the fresh air, either for a staff break or with patients, where we can remove our PPE. There is a beautiful woodland walk on the hospital grounds.

Within the hospital foyer, Bramble Café is a bustling hub for coffee and cakes. When they removed the indoor tables and chairs and put out notices reminding us of the potential threat of COVID, the atmosphere changed. Thankfully, the tables and chairs are back now and I realise how much I missed them! It’s a small change, but it illustrates a bigger point about how much we all take for granted.

A piece of cake

One small thing we have been able to bring some cheer to the wards is to bake cakes for staff – we created ‘cake Friday’ to keep up team spirits. I do find not being able to hug anyone quite difficult, so giving out cakes is like sharing cuddles on paper plates. As a bonus, my youngest daughter has started baking with me at home – it’s something we enjoy together.

Next steps

I’m now back at Healthcare Improvement Scotland to start the work I should have begun in April, and I’m really looking forward to re-joining my colleagues in the ihub’s mental health improvement team. I’m particularly excited about a new video and case study the team have produced as part of our Improving Observation Practice programme, which gives an insight into how NHS Tayside improved the lives of mental health service users and staff through changes to their observation practice.

But my time back on the ward and in the community will stay with me. When we become overwhelmed with information and daily updates on the number of COVID-related deaths, we need to focus on the positives and what we can do, rather than what we can’t. And we should always remember that it’s the little things that count.

Andrea Boyd is an Associate Improvement Advisor who specialises in mental health within Healthcare Improvement Scotland’s ihub.

More information

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

Categories: COVID-19 blogs

How inspection can lead to positive outcomes for people who require health and social care – Sharon Walker

Posted on July 14, 2020

We’re currently recruiting for new inspectors. In our latest blog, Sharon Walker explains what it’s like to know that you help to improve care and safety for patients

The primary goal of inspection is to promote high quality health and care services for the people of Scotland. As a senior inspector with Healthcare Improvement Scotland, I’m able to help make improvements happen by using a variety of tools to assess the strengths and weaknesses in a service or organisation.

The importance of relationships

Inspection is about team work. Inspection programmes are often planned in advance to identify what works well in an area, what isn’t working well and what is needed to achieve national drivers for optimum health and wellbeing across Scotland. The inspection teams are made of a variety of skills – some of us are nurses, some have worked as allied health professionals and others have enhanced knowledge of medicine, quality assurance and improvement methodology. By tapping into these skills, we are far more likely to help services to achieve high quality sustainable health and social care.

From experience, to help affect change it’s better to work with services – hierarchical domination usually ends in mistrust. It takes time to build these relationships and to find the right way to bring people with you on the journey to realise improvements. Listening to what works well in the service and what doesn’t helps to establish trust; it’s a two-way process whereby strategies can be openly discussed and agreed. Moreover, offering the right support at the right time helps services to improve outcomes for people.

It’s this engagement with care providers and the public that I like best. Meeting staff on the front line delivering care, talking to people receiving care about their experiences gives me a sense of achievement, knowing that I have included the most essential people in the inspection process.

Then there’s the report! This is the step that pulls all the evidence together in a relatively short summary – it’s an area which requires careful consideration to ensure key evidence of the inspection findings are included. After all, this is the part that demonstrates how good the service is and what needs to improve.

Sadly, some services do not always provide satisfactory levels of care despite targeted support – outcomes for people accessing care can at times be poor and require immediate interventions. Being able to understand the governance which supports the inspection methodology allows us to take the necessary steps to mitigate risks in services and find a way forward that is right for the service to improve and to keep patients safe. It’s important for us to report our findings accurately and clearly, so that the public can fully understand a services’ strength, plus where and how it needs to improve.

Partnership working and getting the balance right

As a senior inspector, I am predominantly involved in partnership working with other bodies such as the Care Inspectorate and Her Majesties Inspectorate of Constabulary in Scotland (HMICS) to carry out joint inspections of services provided across Scotland. As a result, I have developed my knowledge of joint inspection methodology and legislation which supports this aspect of quality assurance.

For example, the programme I am supporting at the moment is Adult Support and Protection, other joint programmes I have supported are services for Children and Young People and Adults.

The joint approach to inspection requires the team to consider the operational strengths and challenges associated with delivering health and social care, alongside knowledge of strategic commissioning and decommissioning of resources, plus the challenges associated with achieving equality – particularly in hard to reach areas and communities which have co-morbidities and higher crime rates.

Planning is essential. Being involved in the planning of inspections for me is important as I can help influence how my skills can be best used to gather evidence from inspections.

Once a nurse, always a nurse

Over the years, I have developed my experience of quality assurance and improvement, but occasionally I still feel like I am wearing two hats. Before I was an inspector, I was and still am a registered nurse, and this background helps me to strike the right balance between nursing and helping to bring about improvement. I am fortunate to have operational and strategic leadership experience which allows me to focus on specific aspects of inspection methodology such as quality of staffing, safe delivery of care and leadership and management. My colleagues in the Care Inspectorate and HMICS bring additional skills, all of which help to ensure inspections are carried out effectively.

As an inspector, I have travelled to some of the most beautiful parts of Scotland and met some truly amazing people who work tirelessly to bring about change. It’s hugely rewarding to add to what they do and to work with them to improve the quality of care.

Sharon Walker is a senior inspector with Healthcare Improvement Scotland

We’re currently recruiting for new inspectors, to find out more and to apply, visit: https://apply.jobs.scot.nhs.uk/displayjob.aspx?jobid=26459

Categories: COVID-19 blogs

The role of health and care inspector – varied and satisfying – Catriona Hutcheson

Posted on July 14, 2020

We’re currently recruiting for new inspectors. In our latest blog, Catriona Hutcheson explains the diversity and satisfaction she gets from the role.

For most people, there is not a standard route to becoming an inspector for health and care services.

For me, I’d spent 15 years as an occupational therapist in mental health before making the change. Over that time, I’d developed a keen interest in how the quality of services offered to people could be improved for those who received them. I became increasingly keen to put this to good use. When an opportunity arose to work as a visiting commissioner with the Mental Welfare Commission I jumped at the chance.

It was a challenging but exciting role where I learned about regulation and quality assurance in a wider context. I started exploring the role of quality assurance in improving health and social care services and learnt about the work of Healthcare improvement Scotland. This is when I realised that I wanted to be an inspector. I always had a passion for driving improvement, and I realised that inspections are an important tool in achieving this. Not only do we identify where improvement is needed, but we recognise and share good practice examples so others can learn from them.

What it means to be an inspector

The word inspector carries many connotations with it relating to things like restaurants and even of course the police, and with those connotations come many stereotypical images of stern faces and clipboards and an officious tick-box manner. One thing is for sure, if that had been what the role is, I would not have been attracted to and I would not have stayed here for six years.

I’ve found working for a national organisation to be very exciting. I enjoy the flexible working arrangements and opportunities to work from home if required. We are expected to deliver on nationwide programmes of inspection, so there are a lot of opportunities to travel around Scotland and gain new experiences, as well as develop wider working networks with staff from different partnerships.

For me, the very best thing about being an inspector is when you see the quality assurance process contribute to improved services for people who access them. I recently led a team from different quality assurance organisations in a review of a health and social care partnership we had previously inspected. It is one of the highlights of my career to see first-hand the improvements that were made, and to be part of recognising the hard work that had been done to achieve them. This is one of the most satisfying and rewarding aspects of the job. Like all health professionals, my reason for doing my job is to help people when they need us.

Working with Healthcare Improvement Scotland

When I joined Healthcare Improvement Scotland, the biggest challenge was adjusting to the wide scope of the role, but I soon realised that we each bring different skills and experiences and it those that enable us to be valuable members of the quality assurance team.

I joined a multi-agency team which inspected health and social care partnerships, alongside colleagues from the Care Inspectorate and Audit Scotland. Our inspection role in this area was large and a little daunting at first. We went through a process of analysing data and intelligence about the partnership, before heading on site to read files, meet with people who access services and hear about their experiences, both the good and the bad. Then we spent time with staff from the partnership, meeting with staff of all grades, and specialisms, including the senior managers and chief executives. At the end of the process we produced a report. The primary purpose for our reports was to help the partnership improve services for people who use them.

A diverse and ever-changing role

The inspector role is constantly evolving and there are always opportunities to work in new and different areas of our work.

The highlight of my time with Healthcare Improvement Scotland has been my recent engagement in the IRMER (Ionising Radiation (Medical Exposure) Regulations) inspections. Radiology and radiography are highly-specialised areas of work in healthcare. The regulated inspections of these areas required intense training. I’ve enjoyed the challenge and satisfaction of these inspections. This is an element of the job that I love.

I have also been part of a team led by HM Inspectorate of prisons inspecting a prison. My focus was of course on the provision of healthcare for the prisoners. I really enjoyed this experience as it is such a unique environment in which to deliver healthcare. I was also involved in the first ever review of community mental health services across an entire NHS board, where I was able to draw on my experience of working in frontline mental health services to contribute to this pioneering piece of work. I’ve also shadowed colleagues as they complete regulatory inspections of independent healthcare clinics. These inspections are different, because they are private businesses and the evaluations in the report will influence people when they chose the clinic they wish to go to.

If you’re looking for a job that is rewarding, challenging and diverse, and where you get the opportunity to travel, then becoming an inspector is a great career move. You’ll learn and grow, and feel that you play a key role in helping to ensure that people get the best care no matter where and how it is delivered across Scotland.

Catriona Hutcheson is a senior inspector with Healthcare Improvement Scotland

We’re currently recruiting for new inspectors, to find out more and to apply, visit: https://apply.jobs.scot.nhs.uk/displayjob.aspx?jobid=26459

Categories: COVID-19 blogs