Pandemic puts person-centred care at the heart of dementia care – Marie Innes

Posted on June 1, 2021

Restrictions imposed as a result of the COVID-19 pandemic brought to light the importance of person-centredness in dementia care. As part of Dementia Awareness Week, Marie Innes of our Focus on Dementia team, explains why delivering care to people in the way that matters most to them is at the heart of Healthcare Improvement Scotland’s relaunched Dementia in Hospitals Collaborative.

The COVID-19 pandemic put many thing on hold for many people, including the range of improvements that health and care professionals across the country were focused on for people with dementia through our organisation’s Dementia in Hospitals Collaborative. As Healthcare Improvement Scotland focuses on restarting this important programme of work, the pandemic has brought lessons that will be important to how the collaborative moves forward – most importantly, the importance of person-centred care.

The collaborative started late in 2019 and was originally scheduled to run until September 2021. The aim was to bring together hospital teams from across Scotland to work on improvements to hospital care for people with dementia, with an overall focus on the prevention and management of stress and distress, plus four other areas of focus.

Along came COVID-19, and the collaborative was paused, not once but twice, during 2020.

But the last year has brought important knowledge that will help aid the next stage of the programme.

Supporting people in the way that matters most to them

Even before the pandemic, Person-Centred Care Planning had been an area that had consistently been highlighted as an area for improvement both by hospital teams themselves, as well as through the findings of our inspections into the care of older people in hospitals.

During the pause, we engaged with a range of stakeholders to find out their key issues around hospital care for people with dementia during the pandemic. One issue that came out consistently was that the restrictions to hospital visiting had caused issues in the way hospital staff were able to engage with families and carers of people with dementia. This made it difficult to find out what was really important to individuals to support a meaningful, person-centred approach to care. In addition, the necessary, stricter, infection control measures that had been put in place, often made it difficult or impossible to support people in the way that mattered most to them. These issues meant that a person-centred approach to care planning for individuals has proved more challenging and was therefore identified as a key focus area for improvement.

The aim of the collaborative in this area is that the hospital care of people with dementia will be informed by a personalised care plan which reflects their strengths, needs, wishes and choices. Moreover, the person-centred approach will support the prevention and management of stress and distress.

Another key feature of the collaborative is that we are working in partnership with the Alzheimer Scotland Dementia Nurse and AHP consultants who are providing local leadership for collaborative teams in their NHS board areas.

Building on the learning from the past

The best programmes focus on learning from the past and building on what we know works well. The Dementia in Hospitals Collaborative does the same, by building on the Specialist Dementia Unit Improvement Programme (SDUIP), a three-year programme that supported four sites to improve the quality of care for people with dementia within Specialist Dementia Units.

The learning from the SDUIP programme also helped inform an online toolkit to support improvements in dementia care in hospital settings. The toolkit is due to be launched on our organisation’s ihub website in summer 2021 to coincide with the restarting of the Dementia in Hospitals programme of work.

Hopes for the future

We are currently identifying new and existing teams who are able to re-engage, with a restart planned for June 2021 and the first Learning Session arranged for late June. We hope that teams will be not only sharing their learning with other collaborative teams through the collaborative activities, but will also be developing plans for scaling up and spreading their improvements within their own NHS board, as well as sharing their learning with the wider hospital communities through the Focus on Dementia Learning System.

The collaborative is a really exciting piece of work with huge potential to make a difference to Person-Centred Care Planning. Through testing new approaches to care planning and sharing with each other, the teams involved in this programme can really help to pull together all of the great work and learning that has been happening over the last few years. I believe that this will make a real difference to the experience of people with dementia and their families.

Marie Innes is an Improvement Advisor with the Focus on Dementia Team at Healthcare Improvement Scotland.

More information

Find out more about our Focus on Dementia work.

Categories: COVID-19 blogs, ihub

Vaccine queen – Tracy Hunter

Posted on May 11, 2021

Although Tracy Hunter trained as a nurse and knows how to give injections, she never imagined when she joined Healthcare Improvement Scotland that she would be supporting a mass vaccination programme – and administering to patients herself. As we celebrate International Day of the Nurse, Tracy, an Assistant Programme Advisor for NMAHP’s Healthcare Staffing Programme tells us the challenges of setting up and running a vaccination programme for NHS Fife – and proves that nurses can turn their hand to just about anything.

When I was first asked to help support the set up and roll out of the COVID vaccination programme for NHS Fife, my first thought was “This is a mammoth task – how on earth am I going to do this?”

Now, over 200,000 vaccinations later, over 62% of Fife’s population have had the vaccine – quite an achievement, and one I’m very proud to have been involved with, given everything we’ve all gone through in the past year. And certainly not bad for someone who started out wanting to be a teacher!

Learning to fly

Nursing wasn’t how I originally saw my life panning out. When I left school, I trained as a teacher, but my heart was always in nursing and wanting to help people. There’s no greater feeling than knowing you have provided the highest quality care to an individual and their families. I feel very privileged to be a nurse and have met and worked alongside so many amazing people.

When the reality of the pandemic began to kick in in March last year, I was on secondment to Healthcare Improvement Scotland’s Healthcare Staffing Programme from my role as a senior charge nurse in adult inpatient services in NHS Fife. Like so many of my colleagues, I was deployed back to my home board to lend a hand to tackling COVID-19, firstly in a senior charge nurse role on a palliative care ward and later through joint care assurance visits with social work colleagues to nursing and care homes.

Seeing the impact the pandemic had, like most people I was delighted when a vaccine finally came in to use. Supporting its set up was quite another thing. In many ways it’s been like flying a plane when you are still trying to build it. That’s a phrase we’ve been using on a daily basis, and it really has been a huge task for everyone involved.

In the wee small hours of the morning…

One of the biggest challenges has been recruitment and management of rosters. Logistically, it was a bit of a headache to start with, and my knowledge of rostering and workforce planning was certainly a benefit in helping set up clinics.

We started out by building a rostering team, and in the early days we were building rosters in the wee small hours – my office actually became my bedroom for a couple of weeks. All the staff have been phenomenal, working excess hours at the drop of a hat to establish clinics. Along the way I’ve tried to be open and honest with the team as we worked alongside all the required agencies to bring the clinics together. I’ve asked the ‘daft lassie’ questions where I needed to, and not been afraid to do so.

Focusing on people, not processing

One of the things that I and the team were determined about when we were setting up clinics is not allowing them to be conveyor belts. I’m passionate about delivering person-centred care, and was keen to make sure every patient was welcomed and time was taken to discuss the vaccine procedure with them. To ensure this approach was being delivered, I’ve taken part in vaccinating people myself a number of times, helping out when teams are busy and need an extra pair of hands. It’s been great chatting to members of the public who in some cases have not been out of their homes for months. I will never forget one elderly gentleman who came in wearing his best suit. He was thrilled to receive his vaccine, so much so we both shared a tear or two. He was so grateful and appreciative of our NHS – you don’t forget things like that.

It’s a feeling shared by staff across the board – the feedback is that they love working in the clinics. So many members of the team work in their own jobs all day then support clinics in the evenings and weekends. I am in constant awe of them.

We’ve been supported in all this by teams from the army, who have helped us in so many ways. Their medical teams have taken part in vaccinating, they’ve helped facilities teams by adapting community clinics and empty shops into vaccination clinics, and they’ve supported the logistics of setting up and running clinics. They have been phenomenal, always sharing what they’ve learned – they’ve become part of the team. And like us, they have particularly enjoyed the regular donations of cakes and steak pies from local bakeries!

Typical day

A typical day for me at the moment is manic – it starts at the crack of dawn and then the day just flies by. It usually consists of rostering workforce (right people, right skills, right place), clinical updates, and educating and training of new recruits, particularly Band 3 healthcare support worker vaccinators – a brand new role developed for the pandemic. There are never two days the same and always some curve ball or other you’re not expecting. On the odd occasion where the clinics have been a little quieter, we’ve been able to offer support to GP practices which is always gratefully welcomed.

There’s still a lot of work to be done, and always room to improve and develop, as with everything, but I am so proud of what we have achieved, 19 vaccination clinics open across Fife and another four mass vaccination clinics. No mean feat given all the sleepless nights! I try to visit each of the clinics on a weekly basis, but it’s becoming harder with there being so many of them. For me personally, this has been a huge learning experience, and as I look forward to returning to work with colleagues in the Healthcare Staffing Programme, I hope we can make real use of everything we’ve all learned during this past year.

Tracy Hunter is an Assistant Programme Advisor for NMAHP’s Healthcare Staffing Programme, part of Healthcare Improvement Scotland

More information

Find out more about the work of our Healthcare Staffing Programme.

Categories: Mental Health

Sticks, stones and stigma – Lauren Redpath

Posted on May 10, 2021

As part of Mental Health Awareness Week, Communications Officer, Lauren Redpath, reflects on the importance of language in how we approach the topic of mental health – and explains what Healthcare Improvement Scotland is doing to deliver improvements to mental health care services.

“Sticks and stones may break my bones but names will never hurt me.”

When I was little, I used to chant this saying in the playground when other kids would poke fun at my curly hair. I remember one of my primary school teachers proudly teaching us the saying as if she believed she was providing us with a fool-proof coping mechanism against name-calling. It wasn’t until I got a bit older – and perhaps less resilient – that it dawned on me that names and labels do hurt and they have an unwelcome way of sticking too.

Bill Clinton once said: “Mental illness is nothing to be ashamed of, but stigma and bias shame us all.” This quote resonates with me on so many levels, but it’s a stark reminder that although we have made significant progress in reducing the stigma surrounding mental health and mental ill-health, we still have a very long way to go in ensuring it has no place in our society. Mental health stigma has existed for decades and the hurtful, inaccurate labels often given to people living with mental health issues are still swirling around – they’ve found a way of sticking.

Progress – but still a way to go

Over the past 10 years, mental health has become less of a taboo subject – we’ve seen more stories in the media and heard more conversations about mental health than ever before. Governments are also making it a priority. Mental health is a key theme in our organisation’s work and we have a broad portfolio of mental health redesign and improvement programmes, plus clinical guidelines to support diagnosis and care. For example, Early Intervention in Psychosis (EIP) is highlighted as a priority in the Scottish Government’s Mental Health Strategy (2017-2027) and Mental Health Transition and Recovery Plan (2020). As a result, they commissioned us to undertake a detailed exploration of current EIP services across Scotland, the findings of which were published in March. Engaging with people with lived experience of psychosis was a key part of this work, with the findings highlighting that stigma prevents people from seeking help early. Stigma doesn’t only present itself as hurtful labels, it’s also a barrier to people seeking help when they need it most.

According to research carried out by See Me in 2019, 79% of people in Scotland think that public perception of mental health problems has improved over the past 10 years. However, 56% of people with a mental health condition have experienced stigma and discrimination and only 55% of us would feel confident challenging mental health stigma if we saw it. Being a glass half-full kind of girl, I like to think the other 45% perhaps don’t feel confident in challenging mental health stigma because they don’t know what it looks like – and not because they’re willing to turn a blind eye as it’s not their problem.

The view from Down Under

Before joining Healthcare Improvement Scotland at the start of 2021, I lived and worked in Melbourne for six years – making the most of that big, round, yellow hot thing in the sky that us Scots only get to experience for one week of the year – if we’re lucky. Ok, ok, maybe that’s a glass half-empty statement but I’m sure you wouldn’t disagree.

I worked for an organisation called SANE Australia – a national mental health charity providing support and advocacy for Australians affected by complex mental health issues such as schizophrenia, bipolar, eating disorders, OCD, complex PTSD and trauma. I managed their StigmaWatch programme which promotes responsible reporting of mental ill-health and suicide in the Australian media. The programme team monitors and responds to reports of inaccurate or inappropriate stigmatising media portrayal of mental ill-health and suicide. They also work with the media to provide constructive feedback and advice on how to responsibly report stories touching on these issues.

Mind your language

Studying journalism at university and choosing a career in communications, it’s no surprise that language and how we communicate with each other fascinates me. Add to that my passion for raising awareness of mental health and breaking down the stereotypes and myths associated with it, working on the StigmaWatch programme couldn’t have been a better fit.

I’m hoping I can now use what I learned in Australia to help our vital communications work around mental health in Healthcare Improvement Scotland. I’m passionate about educating and supporting people and organisations on how to talk about mental health safely and responsibly. The language we use when talking about mental ill-health often plays a big role in keeping stereotypes, myths and stigma alive. But what does stigmatising language look like when talking about mental ill-health? Well, terms you might hear every day such as ‘nutter’, ‘crazy’ ‘lunatic’, ‘psycho’, ‘schizo’ and ‘mental patient’ are not only offensive and hurtful, they’re problematic and sensationalise mental ill-health. The preferred language would be a person is ‘living with’ or ‘has a diagnosis of’ a mental illness. It is also stigmatising to label a person by their mental illness. We shouldn’t refer to someone as a ‘schizophrenic’ – instead we should say, ‘a person has a diagnosis of’ or ‘is living with schizophrenia.’ Think about it this way – we wouldn’t label someone by the type of cancer they have so why should it be any different when someone is living with mental ill-health?

A weapon that keeps people apart

During my time at SANE Australia, I worked closely with many of our peer ambassadors who had lived experience of mental ill-health. While filming a promotional video to explain what StigmaWatch is and does, we asked one of them to tell their story. He turned to look in to the camera and said:

“Stigma is a permanent part of my life. After my diagnosis, many people just left. The negativity just came from decades of misunderstanding – in the media, in medicine. People were afraid. When I was given my diagnosis, it was stigma that told me that I was never going to have a home, I was never going to have a job, I was never going to have a family and I was never going to have a life. It took me 15 years to realise that that is all completely wrong.

“Stigma is a weapon that keeps people apart.” I think if I’d asked him about the sticks and stones saying from my childhood, he would simply have said “the sticks and stones and words just never stop coming – or hurting.”

Lauren Redpath is a Communications Officer for Healthcare Improvement Scotland. In her spare time she sits on the Advisory Group for See Me, Scotland’s programme for tackling mental health stigma and discrimination.

More information

Find out more about our mental health improvement portfolio

For anyone looking for support in a crisis, the Samaritans helpline is 0116 123 and is open 24 hours, 7 days a week.

Rethink Mental Illness offers support and advice for people living with mental illness.
Phone 0300 5000 927 (Monday – Friday, 9.30am to 4pm)

Categories: Mental Health

The four steps to the right Anticipatory Care Plan – Paul Baughan

Posted on April 21, 2021

We’ve launched a new section of our ihub website with information, tools and resources to support Anticipatory Care Planning (ACP), a crucial process which ensures that the right things are done in the future for each person, should their health change. Dr Paul Baughan, clinical lead with our Primary Care team explains why this ACP is so important and the various stages to enable the right outcome for patients.

The longer I work in general practice, the more I realise that there are many different ways to treat people who have exactly the same medical condition. Priorities for care vary considerably between individuals, and if we do not stop to ask “What matters to you?” then we can actually cause harm – even when following the latest evidence-based guideline.

Spending time with someone to explore treatment and care options that are right for them – in the context of their current state of health, their social situation, and the various priorities in their life – is critically important. It can ensure that the right things are done in the future for that person, should their health change. Things such as the type of medicines to use during an exacerbation or sudden deterioration, the people who should be contacted to help with decision making, and how the person would like to receive care if staying at home is becoming more difficult. These preferences can be written down, kept with the person, documented in their clinical notes, and shared with other people who need to know. Many people call this approach ‘Anticipatory Care Planning’.

***Diagram: The 4 steps of successful Anticipatory Care Planning***

There are four crucial steps to a successful ACP, which forms the basis of the new Healthcare Improvement Scotland ACP toolkit. Each of these steps is important to ensure that we do the right thing for the person we are caring for. We know that harm can be caused if we jump straight in at Step 3 (documenting a care plan), without the important preparation and planning, or having first engaged in meaningful conversations with the right people.

As a GP, as well as the Clinical Lead for Primary Care with Healthcare Improvement Scotland, let me explain how I’ve been using the four stages and how they help me to ensure that the right care plan is created for everyone.

Step 1: Preparation and Planning

The first step, Preparation and Planning, involves identifying who you will be having an ACP discussion with, then preparing yourself and the person for that conversation.

I do this by finding out as much as I can about the person before meeting with them. I ask myself the following questions: What is their current state of health? What have other professionals and specialists said or written in their notes? Is there anyone who normally supports this person with decision-making? What is their social situation? What realistic options are there for future treatment and care?

It is also important that I prepare the person with whom I will be speaking, check that they are happy to have this type of conversation, and ask whether there is anyone else who should be involved in these discussions (For example, a family member or power of attorney).

Step 2: Meaningful Conversations

The conversation between the health or care professional and the individual, as well as those important to them, is at the heart of ACP.

I find the REDMAP framework, developed by Dr Kirsty Boyd, Reader in Palliative Care at University of Edinburgh, a helpful structure to follow.

It’s important to allow appropriate time for these discussions, and this can be a challenge in general practice. I will often hold these important conversations over a number of different appointments over several weeks. This allows the person and their family time to think about things before we agree an action plan that is right for them.

Step 3: Documentation and Sharing

Once a plan has been made, it is important that it is shared with all those who need to know. After all, it might be needed in the middle of the night when the practice is closed. The best way that we have to share this information between health professionals is through the Key Information Summary (KIS). However, information can only be added to KIS through GP practice clinical systems. For those unable to access this, there is now a web-based Essential ACP Online Tool to document aspects of the ACP. This can be securely shared with the individual or the GP practice. Work is progressing with a digital version of ReSPECT, and ultimately I look forward to a time when we have a single citizen-held electronic health and care record. One within which my patients can enter their own information about ‘What matters to me’, and that can be supplemented with information from all the health or social care staff who are involved in providing care.

Step 4: Regular Review

People may change their mind about their priorities for care as their health or social situation changes. What matters to someone in six months’ time may be very different from now. That is why it’s important that ACP information is regularly reviewed and kept up to date.

33% of the Scottish population have something entered within their KIS. Not all of these will incorporate an anticipatory care plan, however it does present me and my primary care colleagues with a logistical challenge to keep them up to date. Healthcare Improvement Scotland with RCGP and Scottish Government has recently published pragmatic guidance and top tips for reviewing and updating KIS. An important aspect of this guidance is exploring the resources (people and time) that are available and ensuring that the extended multidisciplinary team is involved in these reviews. This requires preparation and planning, which of course brings us back to Step 1.

So whether, like me, you are working in general practice, or are based in another part of our health and social care system, anticipatory care planning is important. It is not a one-off activity to be ticked-off and completed, but instead is a process that requires preparation and planning, meaningful conversations, documentation and sharing and regular review.

Paul Baughan is a GP and the Clinical lead with Healthcare Improvement Scotland’s Primary Care Team.

More information

Visit http://ihub.scot/acp for all the resources mentioned here and share with us your learning about ACP by emailing: his.pcpteam@nhs.scot.

Categories: COVID-19 blogs

Getting on board – what it’s like to be a non-executive director – Rhona Hotchkiss

Posted on April 9, 2021

What’s it like being a non-executive director on the board of Healthcare Improvement Scotland? As we recruit for a new board member, Rhona Hotchkiss explains the route she took to becoming a non-executive director and the qualities you need for the role.

Sometimes life takes unusual turns that you can’t possibly foresee. Way back in 2004, after I spent a year as an Interim Director of NHS Quality Improvement Scotland (NHS QIS) – the predecessor organisation to Healthcare Improvement Scotland (HIS) – I left the NHS, seemingly for good, and went into management consultancy. I had no notion then that I would be back 15 years later as a non-executive director, nor of the path my career would take to get me here!

Scotland to Australia and then back again

But it all started way before HIS and way before QIS! I started my working life as a nurse, training with Argyll & Clyde Health Board, as it was then, and after qualifying went on to train and work in ITU. I went to Australia for 6 months on a working holiday visa, during which time I did agency nursing to keep myself fed and clothed, and the rest of the time generally scrounged off some Australian midwives that I’d become friendly with when they had previously come to Scotland to train.

Fast forward many years after my return from Australia, and life has taken more twists. It’s 1998 and I’m an advisor in Nursing and Quality at Scottish Government going on to become the first Director of the new Nursing and Midwifery Practice Development Unit for Scotland, NMPDU or ‘NUMPTY’ as it was affectionately known. After 2 years, NMPDU was one of the organisations that came together to form NHS QIS and then eventually became HIS. In a way, change and development was becoming quite normal.

Time for more change

By then I’d been working in the NHS for 25 years and it was time to try something entirely different, so I opted to join a consultancy firm. It was comprised of good people working to a very high standard, but, although I stayed for almost 5 years, it wasn’t for me. I missed the sense of unity and purpose, the feeling of service that the public sector had brought and, in a move that surprised many who knew me, I joined the Scottish Prison Service as a Deputy Governor. After being Deputy Governor at Barlinnie and then Shotts, I went on to be Governor of Dumfries (just the prison, not the entire town!) then to Cornton Vale, where I also project managed the reprovision of the women’s prison estate and finally to HMP Greenock, from where I retired in 2019. I could write a book! Well actually, I have, but I can’t get anyone to publish it.

One week after retiring and I was back in the NHS as a Non-Executive Director at Healthcare Improvement Scotland – saying ‘hello’ to at least 15 very familiar – and much aged – faces, while my own of course had barely changed!

The volume of evolution

As someone who had worked for QIS, HIS does and doesn’t feel like the same organisation. The volume of evolution and outright change has been huge. The direction the organisation has taken, and the size it has grown to, are sometimes surprising to me and at other times feel more organic. Having at least a passing familiarity with the organisation pre-HIS has been useful, as has retaining some understanding of the environment it operates within – but much more useful has been the whole 40 years I’ve spent working in or close to the public sector – at all levels – from very junior to very senior. Of course, running a prison is very different to being with HIS, but people are the same wherever you work: their concerns, their issues, their brilliant and their not so brilliant moments, and I feel every step of my 40-year working life has contributed in some way to the person I am and what I bring to the non-exec director role.

Being a non-executive Director is never dull. I’m as prone as the next person to letting my concentration wander during long meetings and, of course, some things interest me more than others – but that’s true wherever you work. I think there is both a qualitative and quantitative difference between a national public board like HIS and a territorial NHS board. Different issues, different pressures, and yes a different workload. I’ve been surprised by how well the non-executive team of directors get on and how our backgrounds and skills complement each other.

The main qualities required to be a board member

I think the main qualities a non-executive director requires are curiosity and a willingness to learn. If you’re already feeling jaded, then this isn’t for you, because the political machinations that determine how the NHS runs can feel a bit ‘groundhog day’ at times, particularly when you’ve been around the public sector as long as I have. But seeing real progress being made more than compensates for that.

You have to be able to probe and ask questions in a constructive way and you have to be brave enough – or stupid enough – to do that when no-one around you seems to have any issue with what is being said or presented. Everyone wants to operate in a supportive environment, and you have to play your part in creating that at board level – that means valuing the contribution of others, even when you don’t agree or can’t see their point; understanding that the process by which a governing board will reach a collective stance may not always result in what would be seen as a perfect outcome in your book.

Finally, I think being able to read critically is a vital skill. There’s a lot of material to plough through at times and having the wisdom to realise what can be skimmed, what has to be looked at forensically and what just doesn’t hang together properly and needs to be questioned further, is vital.

If you want to contribute to the NHS, if you have a broad base of experience, and if you can operate in a collegiate way, being a non-executive director might just be right for you.

Rhona Hotchkiss is a non-executive director on the Board of Healthcare Improvement Scotland.

More information

Find out more about this role and apply online now.

Categories: COVID-19 blogs

Prison pilot scheme proves its worth during pandemic – Dr Steve Conroy

Posted on April 7, 2021

COVID-19 has created new challenges for the delivery of treatment and care to individuals with a drug problem within the prison population. Dr Steve Conroy tells us how the rapid rollout of a successful pilot scheme involving Healthcare Improvement Scotland has helped both prisoners recovering from addiction and the staff who are there to treat them.

Treating opiate addiction takes time. The most frequently prescribed treatments (opiate agonist therapy, or OAT) need to be taken every day, and it’s estimated that there are 1800 people in prison in Scotland who need it. Every day, each individual will be taken to and from a dispensing area by Scottish Prison Service staff and have their medication supervised by at least two NHS staff. That’s around 12,500 contacts between patients, the clinicians who treat them and the prison staff whose role is to facilitate that treatment every week.

In HMP Shotts where I work, over 170 of the 545 people in custody are prescribed OAT. That amounts to 63,145 interactions with them across the space of a year simply to administer their medicine. That’s a lot of time on the part of both staff and prisoners that might be better spent on work which can support them to recover from addiction in other ways. It’s also time that could be spent supporting other prisoners with other vital rehabilitation work. Throw a pandemic into the mix, where physical distance and constant cleaning of contact surfaces is vital, and those timeframes increase even further.

A vital decision

Generally, the OAT of choice is methadone, with far fewer patients on oral buprenorphine products. Buprenorphine, although a very valuable medicine in treating addictions, comes with many problems in the prisons, where it can be used as currency – creating problems with diversion, bullying and coercion. But it’s used because methadone is not a suitable treatment for all patients. Thanks to a decision taken by the Scottish Medicines Consortium in August 2019, there is now an alternative to daily treatment.

Buvidal is a form of buprenorphine which is a longer acting treatment and can be given monthly or weekly through a slow-release injection compared to daily doses of oral forms. When given within a framework of medical, social and psychological treatment, it may enable patients to focus on recovery and returning to normal daily routines without the daily visits to a pharmacy to receive treatment.

Time for change

Following the SMC’s decision, Healthcare Improvement Scotland’s Prisoner Healthcare team, with whom I work closely, began looking at a pilot scheme for the medicine in prisons. A business case was approved by Scottish Government in January 2020. But as the COVID-19 pandemic progressed, it became clear that the reasons to support the pilot became even more compelling and the team was asked to scale up their proposals.

Under our revised plan, all prisoners with at least six months left to serve of their sentence would be transferred to the new form of buprenorphine during the pandemic, provided patients gave consent to switch treatment.

As well as supporting social distancing measures, our proposals also meant, in theory, that staff and patients alike would have more time to spend on other activities which could support recovery from drug addiction – within the parameters afforded by COVID-19 restrictions. While it’s too early for data to confirm this, logic tells us that if we only see someone twice in 28 days rather than 28 times, staff and prisoners will have more time to spend on other things. In addition, the reduction in the quantity of controlled drugs being used prisons would help to reduce the potential for their use as currency, and improve overall safety.

To support the move to the prescription of this slow release form of buprenorphine in prisons, the team engaged with clinicians with experience of prescribing the medicine at local, national and international level in order to develop guidance. Crucially, given how the pandemic affected supply chains, we also worked closely with the pharmaceutical company to ensure there was sufficient stock of the product to meet requirements.

Game changer

The decision to move to slow-release buprenorphine has been widely welcomed by prison staff and those receiving treatment alike. People have described it to me as “a game changer”, “nothing but good” and “the way forward”. In HMP Shotts, we have only had two people choosing to come off the treatment and going back to their previous medication. Those I’ve prescribed it to have said they feel better generally, enjoy the clarity of thought and really appreciate not having to wait in the daily “methadone queue”. Prison staff, meanwhile, have said that they have noticed a marked improvement in the general condition of people prescribed this medication. It’s incredibly satisfying to have worked with colleagues at Healthcare Improvement Scotland to have delivered a simple and effective change that has made such a difference to people’s lives.

Dr Steve Conroy is Lead Medical Practitioner in NHS Lanarkshire’s Addictions Community Prescribing Service.

Categories: COVID-19 blogs

Early Intervention for psychosis in the time of COVID-19 – Dr Suzy Clark

Posted on March 31, 2021

As we publish a new report on the importance of early intervention in psychosis, our clinical lead for this work, Dr Suzy Clark, outlines how those with psychosis have been helped under the COVID-19 restrictions and how our new report will benefit people with psychosis across the country.

Psychosis was already on the increase when the pandemic arrived, but there have been noticeably more new presentations of psychosis since last March of 2020. Approximately 1,600 people in Scotland experience a first episode of psychosis each year, and since March 2020 data from NHS Greater Glasgow & Clyde’s ESTEEM service, where I am the consultant clinical psychologist, showed a 20-25% increase in caseload.

It’s easy to see how the events of the last year can have affected people profoundly. Many people have had important life transitions, such as leaving home to go to university, thwarted. Social networks are diminished and people miss their peer group contact and there is a lack of structure to their day. Moreover, with the restrictions in place, it has at times taken longer for people to get referred and the psychosis is often more severe by the time they do.

Impact of COVID-19 on Early Intervention Services

For an Early Intervention Service to be required to be socially distanced – and not to have face to face contact – is the antithesis of how it would normally operate. But this was a necessary requirement as we all dealt with the first wave of the pandemic.

Accessibility and engagement, getting alongside the person with psychosis for a coffee or a walk or to help with housing, are key aspects to the early stages of intervention All of this has been much more difficult during COVID-19. Many of the interventions the service would routinely offer such as group meetings, family events for carers, face-to-face contact with clinicians, were discontinued. Staff were sent home abruptly and a rota provided cover in the office. At ESTEEM, we lost our clinical rooms to support new Mental Health Assessment units and clinical work was focused on contact with people with acute psychosis and at risk of admission.

Fortunately the service had been piloting digital delivery and the pace of this work then accelerated. Clinicians adapted quickly to the use of Near Me and learnt to share documents and still hold team discussions online.

Learning to cope

Many people with psychosis surprised themselves with how well they coped during lockdown, finding the skills they had learnt to help with their mental health also helped with general wellbeing, such as regular fresh air and exercise, planning your day in chunks of time and not giving yourself a hard time if you are not that productive.

For others, it has been a very difficult time. People with psychosis missed the face-to-face contact, but recognised the need for remote working; some also reported benefits, for example, fitting sessions around work commitments and being more able to talk about difficult things at a distance.

Getting back up and running

Gradually, more routine work was remobilised. Supervision structures, Behavioural Family Therapy, Family & Friends support groups, and psychological therapy restarted online in the summer of 2020 and are continuing to work well. There were some inevitable hiccups with the technology, but gradual improvements to functionality has helped enormously. Attendance has been good: staff, those with psychosis and their carers appreciate the opportunity to connect online.

Raising the standard across Scotland

During the pandemic, Healthcare Improvement Scotland produced a new report outlining how early intervention in psychosis can be delivered in urban, semi-urban and rural communities, tailored to local context.

The report found that there is significant variation across Scotland in the provision of care and treatment for people with first episode psychosis. Moreover, people who experience delays in initial access to services are more likely to have contact with out of hours, crisis or emergency services.

It’s our hope that this report will help NHS boards to understand how best to establish and run services in order to provide the best care to people at the very earliest opportunity. We are extremely grateful to the people with lived-experience of psychosis who contributed to this work.

Looking to the future

Looking forward, I’m confident that the new report will help to improve services across the country. Digital technology will no doubt continue to play a role in delivering care. I believe digital service delivery is here to stay- although I anticipate a blended approach going forward. Being in the room with a highly distressed person to help them feel less alone will never be replaced.

As for the future, at ESTEEM we’re planning to introduce walking groups and cycling groups for the spring of 2021 and I think we will all take forward a renewed appreciation of the value of social connections for well-being and recovery. Let’s hope that the difficult time that everyone has been through creates a more energised space for delivering effective care, especially for people with psychosis

.Dr Suzy Clark is Consultant Clinical Psychologist Clinical Lead at Healthcare Improvement Scotland and Consultant Clinical Psychologist in the ESTEEM Early Intervention Service at NHS Greater Glasgow & Clyde.

More information

Visit the Healthcare Improvement Scotland website for more information on this report.

Categories: COVID-19 blogs

Being part of something bigger – Volunteering in the Covid-19 Vaccination Programme – Janice Malone

Posted on March 15, 2021

Our Volunteering in NHSScotland programme helps make volunteering in the NHS a safe, supportive and positive experience for all volunteers. But with access to hospitals limited during the COVID-19 pandemic and many volunteers in the shielding category, what volunteering opportunities are there in the NHS right now? For many, it’s being a vaccination programme volunteer, as Janice Malone, our Volunteering Programme Manager, tells us.

What do you think of when you think of a volunteer? The word conjures up all kinds of images in my head. At Healthcare Improvement Scotland in the Volunteering in NHSScotland Programme it means many things – from mealtime volunteers and way-finders who help direct people around hospitals to play volunteers in children’s wards. The Volunteering Programme exists to support the development of safe, sustainable and person centred volunteering across NHSScotland.

As details of vaccines for COVID-19 began to filter through in late 2020, it was clear to me that volunteers could play a significant role in supporting the rollout of the vaccine programme. Not only that, but by involving volunteers in such a significant milestone in the route out of the pandemic, it would allow communities to be empowered and feel they are contributing to something bigger. I was glad to discover that others thought the same.

Making connections

I began to make connections with the relevant people and departments within Scottish Government, who were considering a proposal from the British Red Cross on the creation of a National Volunteer Co-ordination Hub. The Hub offers all NHS boards in Scotland a flexible approach to the mobilisation and deployment of volunteers to vaccination centres. They are able to draw on the 20,000 plus volunteers across Scotland who signed up to support the response to the pandemic through the Ready Scotland campaign, and offer a range of support based on the needs of NHS boards.

The speed at which the Hub has developed and begun to deploy volunteers has been rapid, and in my view, is testament to the partnership approach between Scottish Government, British Red Cross and NHSScotland. So far, approximately 1300 volunteers have provided thousands of hours of support to vaccination centres in roles like queue marshalling to ensure social distancing or meeting and greeting patients to explain how the vaccination centre operates. But much more important than just the number of volunteers is the impact these volunteers who gifted their time to NHSScotland and the vaccination programme have made. They provide much-needed reassurance and crucial human connection for people, many of whom feel frightened and are vulnerable after a year of such turbulence.

Critical friend

An interesting development has been our role as a conduit for two-way communications between NHSScotland volunteering structures and the National Volunteer Co-ordination Hub. We have been able to provide real-time feedback on the plans for the Hub, create a process for staff to raise questions or concerns and respond to them. The volunteering programme acts as a critical friend to the Hub ensuring that NHSScotland policy and best practice for volunteering works cohesively with what is an emergency response situation. For the most part, the feedback has been hugely positive, with patients commenting on the friendly welcomes they have been given by volunteers and how smooth the whole process has been.

This is a fast paced and challenging piece of work, which is likely to last long beyond the initial emergency response phase that we are currently in. We will continue to work with our partners in the National Volunteer Co-ordination Hub in the months to come and support the transition from emergency response to a business as usual approach when the time comes.

I have been passionate about volunteering for more years than I care to remember and I have no doubt of the positive impact that volunteering has on individuals, communities and on the wider society. The devastation and turmoil wreaked by this pandemic has been harrowing, but one thing I hold dear is seeing the kindness of individuals and communities who step up and volunteer to help. I am full of hope and optimism that the benefits and the impact of volunteering will be much more widely recognised across all sectors in our society than they have been in the past.

Janice Malone is the Programme Manager for the Volunteering in NHSScotland programme.

More information

You can keep up to date with the latest guidance on Volunteering during Covid-19 on our website.

Categories: COVID-19 blogs

What it’s like to support inspections to help keep care homes safe during COVID-19 – Agnes Chirozvi

Posted on March 10, 2021

Agnes Chirozvi is a new inspector with the Quality Assurance Directorate of Healthcare Improvement Scotland. Working with the Care Inspectorate on their inspection of care homes, Agnes shares her story of how she became an inspector and what it’s like to go into care homes during the pandemic, whilst ensuring safety for residents and staff, as well as the inspection teams themselves.

When the COVID-19 pandemic broke out I was working as a scrub nurse for a private company working in trauma and orthopaedics operating theatres in a major NHS hospital in Scotland. Although I loved working in trauma and orthopaedics, fixing the broken bones and making people whole again, there was something missing.

Earlier in my career I was in a nursing management role for nearly seven years. I realised that I missed the partnership working and quality assurance aspects of the job, including my focus on infection prevention and control (IPC). This is what inspired me to join Healthcare Improvement Scotland as an inspector in mid-November 2020. I was excited to know that I would help to make a huge difference in people’s lives through driving safety to improve the quality of their lives. I knew Healthcare Improvement Scotland was exactly where I was meant to be.

Building relationships virtually in a new role

On my first day with Healthcare Improvement Scotland it felt a bit strange to be sitting in my home in front of a computer by myself, and not going to an office full of people which I had done before. It felt like a huge contrast to my nursing career and I had all sorts of mixed emotions. But in my second week I was able to get out into the field, shadowing two Care Inspectorate inspectors and one Healthcare Improvement Scotland inspector as part of my supervised induction into my new role. I was excited to meet these experts in the flesh and felt privileged to be able to tap into their vast knowledge.

At the end of January this year, I was ready to take part in my first care home inspection, alongside colleagues from the Care Inspectorate. Since then, I have represented Healthcare Improvement Scotland on eight inspections. My first four months as an inspector have been an exciting time in my life as the learning never ends.

The challenges of carrying out inspections during the pandemic

The Care Inspectorate is the lead agency for the inspection of care homes across Scotland – at the start of the pandemic, the Scottish Government asked Healthcare Improvement Scotland to provide additional support to the IPC dimension of their work, with our joining them for about 30% of their inspections. Since May of last year, Healthcare Improvement Scotland inspectors have supported over 300 inspections of care homes across the country.

Many of the care homes we have visited have been dealing with outbreaks of COVID-19, so taking extra precautions to keep risks at a minimum was and is an absolute priority. One of the main challenges of carrying out inspections during the pandemic are the complexities of trying to achieve safety for myself, my colleagues, care home staff and the residents.

We take appropriate Personal Protective Equipment (PPE) with us on visits and wear it for each activity we carry out and afterwards, immediately remove our PPE and clean our hands. Inspectors have to carry out a self-administered COVID-19 Lateral Flow Device Test twice a week and before each inspection. If a test is positive, the inspector is taken off an inspection and replaced by someone who is negative. On arrival at a care home, we have our temperature checked as this could be an indication of the onset of symptoms of the virus. We also change into scrubs that can be washed at high temperatures and reverse this process at the end of the inspection. Throughout the inspection, we socially distance from colleagues, care home staff and residents. We also wash our hands in between activities and apply alcohol rub to ensure our hands are clean before and after applying gloves. This can be taxing, but we are all conscious of how it is important it is for individual safety and good public health – and it is no more than we are expecting from the staff working within the care homes we are visiting.

Infection prevention and control

A key difference between a hospital and a care home is that the latter are people’s homes – a place where they should be and should feel safe, comfortable and at home.

As a Healthcare Improvement Scotland inspector, my primary role is to determine whether the infection control practices in place support a safe environment for residents and for staff. We use a standard inspection tool to guide this process, based on the most up to date national guidance available. Our assessments include cleanliness of the physical environment; furnishings and equipment; observation of staff practices; and checking of audits, systems and processes. Speaking with care home staff also provides an invaluable insight into each care home’s understanding of IPC and its use of current national guidance. As inspectors our job is to help keep people safe – and so where we can offer advice and guidance to staff on how to improve IPC we always seek to do so.

It is extremely fulfilling to be part of such an important process and to be a member of a very committed team. By working in partnership with our colleagues from the Care Inspectorate, Healthcare Improvement Scotland staff have made an important contribution to our national COVID-19 response – and we will continue to play our part in helping to keep people safe as the social care sector looks to re-mobilise, recover and re-design.

Agnes Chirozvi is an inspector with Healthcare Improvement Scotland.

Categories: COVID-19 blogs, Inspections and Reviews

How hospital inspections are aiding our national COVID-19 response – Ann Gow

Posted on February 17, 2021

As Healthcare Improvement Scotland’s programme of hospital inspections begins to focus exclusively on COVID-19, Ann Gow, our Deputy Chief Executive, outlines the role that inspections have in the pandemic response, and the role that the new focused inspections will have in helping to keep people safe.

During the pandemic, inspections by Healthcare Improvement Scotland have had an important role to play in ensuring that staff, residents in care homes and patients stay safe from harm. By providing objectivity to help hospitals and prisons, care homes and services know where to tighten up and improve key practices, we’ve been able to give assurances both publicly and to NHS boards and services that they are doing all they can to respond effectively to the virus.

During the first lockdown of March 2020, we paused our inspection programmes for hospital cleanliness, care of older people, and our inspections of independent clinics, hospitals and hospices. But as we came out of the first lockdown we resumed inspections, making sure that they were focused on ensuring that people were being kept safe from the virus. Our inspections team produced a new methodology in record time that combined the cleanliness and care of older people inspections, and our inspections of independent services focused in on ensuring that where treatments were being provided they were being done safely and following national guidance on COVID-19 to help stem the spread of the virus. As issues arose with the rate of infections in care homes, our inspectors have also joined the Care Inspectorate inspection teams to bring our expertise in the transmission of infections to bear to help keep older people and staff safe.

Being sensitive to pressures in the system

This, of course, has put our inspection teams firmly on the frontline. It has also meant that they have had to be sensitive to the ongoing vital work that care teams have been undertaking to save lives and to bring people through the worst of the virus.

Inspections are very much about conversation as well as observation. We can’t gather the necessary evidence we need without detailed discussions with healthcare professionals about how they undertake their work. Therefore, carrying out inspections during the pandemic – when services can be stretched – is an ongoing delicate balance to ensure that at a time when staff are busier than ever, we ensure that our work helps to enhance and improve the amazing work that NHS boards are doing.

Shifting our focus

In the past few weeks our inspection focus changed again, and in a highly important way. Inspections of acute NHS hospitals will now focus specifically on how hospitals are ensuring that they help prevent the spread of the virus. We’ve used the current HAI standards produced by our organisation, alongside national COVID-19 guidance, to create a focused methodology that will help staff to make improvements in key areas.

Moreover, hospital staff don’t have to wait to see the final report to know what to improve; they get feedback there and then, so that they can immediately begin to put changes in place. It gives NHS boards the assurance that they are doing the right thing, as well as giving them the information they need to make vital improvements to prevent the spread. In addition, the final reports are published so that the general public have access to this information also.

Our organisation cannot thank our inspectors and our inspection teams enough for the crucial work they are undertaking on the frontline as part of Scotland’s national response. We’re also indebted to NHS boards and services for their support and engagement which allows us to help them to improve.

Ann Gow is Deputy Chief Executive of Healthcare Improvement Scotland and Director of Nursing, Midwifery＆ Allied Health Professionals

More information

Visit the Healthcare Improvement Scotland website to read the first COVID-19 focused inspection report.

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