Unpaid caring: A glimpse of an invisible life – Christine’s Story

Posted on June 10, 2020

It’s Carers Week, and at a time when the work of both paid and unpaid carers is more vital than ever, Christine Sutton, Portfolio Lead for Person Led Care in our Transformational Redesign Unit, shares her experience of caring for her parents.

The theme for this year’s Carers Week is “Making Caring Visible”. It couldn’t be more timely. The current pandemic has brought into sharp focus the needs of unpaid carers. Polls carried for Carers Week identified that an additional 9% of adults in Scotland have become unpaid carers since the outbreak of COVID-19. This is in addition to the 16% who were already providing care and support to friends, neighbours or family members. That’s a total of 1.1 million people. I’ve been one of them, and this is my story.

Daughter and carer

It was our first day of home-working – Wednesday 18 March, if you remember – when I got the call. It was the care agency who looked after my mum. My dad had fallen and was very unsteady on his feet. For the last ten years he has been the main carer for my mum, who was very frail and had dementia. I didn’t wait around. I booked a flight south. That day, I became a full-time carer for both my parents.

“The whole experience has been hugely humbling. I learnt a lot about myself and both my parents and above all about the benefits of being present in each moment. We shared tears and times of laughter.”

My dad was admitted to hospital. It turned out he had pneumonia. A stress filled few days followed. He was tested twice for COVID-19. I felt fortunate that I was able to speak to him on his mobile and visit him once in between the two tests, both of which, thankfully, turned out to be negative. My mum, meanwhile was unaware of the pandemic and had limited understanding about my dad not being at home. This made things easier for me in some respects and it was difficult for my dad to hear, given all the care and support he had given to her over the years.

Fortunately, my dad started to respond to treatment and I was very relieved when I heard he was able to come home. He still needed a lot of support, though. This meant I was now juggling caring full -time for both my parents and negotiating with healthcare services about medication, equipment and advice about ongoing care and treatment. I had decided to cancel the care provision for my mum after my dad’s admission to hospital, concerned to protect my mum’s health as best I could.

I started to get into a routine. However, at the end of March my mum’s health began to get deteriorate. She was eating less and sleeping more. She died at home towards the end of April. Throughout this she remained cheerful and content, a source of comfort to me and my dad.

Humbling experiences and heartfelt kindnesses

The whole experience has been hugely humbling. I learnt a lot about myself and both my parents and above all about the benefits of being present in each moment. We shared tears and times of laughter.

I am very grateful that I was able to be with my mum and dad at this time. I am lucky that I have always had a warm, loving relationship with both my parents. The bond with my mum strengthened in the last weeks of her life. Caring for my dad and hearing more about his experience of caring for my mum gave both of us a deeper appreciation for each other.

I also experienced so much kindness from others. Numerous phone calls, texts and offers of help kept me going. Daily yoga and meditation practice helped to keep me on a half even keel. Knowing that I had the security of a regular salary and the flexibility extended to me by my employer took away one potential source of pressure. So many people – friends from Scotland, my parents’ friends unable to leave their own homes and health and social care staff – expressed the wish that they could do more to support us. This in itself meant so much.

“People do value and gain pleasure, acquire new skills, experiences and knowledge through being unpaid carers. Being an unpaid carer can also take its toll. These two aspects are not mutually exclusive.”

There were still moments when I was at the point between coping and not coping. People do value and gain pleasure, acquire new skills, experiences and knowledge through being unpaid carers. Being an unpaid carer can also take its toll. These two aspects are not mutually exclusive. My dad spoke to me about how much he enjoyed caring for my mum, learnt a lot from doing it and acknowledged that it restricted what he could do and was often exhausting.

The value of carers

I only glimpsed life as an unpaid carer. My dad has now recovered enough to be able to do most things for himself. I don’t know what it is like to care for someone day in day out for an indefinite period, stop doing activities you previously enjoyed, face unemployment or a significant loss of earnings or lose contact with the outside world and become isolated and lonely. These are a just few examples of the many challenges faced by unpaid carers every day.

We all have a part to play in making sure that unpaid carers feel valued and receive the support that they need. Whether that is as colleagues, friends, neighbours or our local communities. I would urge you to reflect on this and think about one way in which you can stand alongside unpaid carers. Those 1.1.million adults, the unpaid carers I mention at the start? You will know some of them. Some of them might not even have told you that they are a carer. If they care for a partner or spouse they may not think of themselves as a carer. Please take the time to talk to them, to show your interest in what they do, offer a listening ear or practical support. You might be able to make all the difference.

You can find out more about Carers Week on their website, https://www.carersweek.org

Christine Sutton is Portfolio Lead for Person Led Care in the Transformational Redesign Unit, part of Healthcare Improvement Scotland.

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19

Scotland’s private clinics – the route map out of COVID-19 restrictions

Posted on June 10, 2020

Nobody in Scotland has been unaffected by the tragedy of the COVID-19 pandemic. Individuals, families, communities and businesses have been rocked by the virus as everyone ensured they played their part in preventing the spread of the virus and saving lives.

At Healthcare Improvement Scotland we are fully aware of the huge challenges the independent healthcare clinics that we regulate have faced as Scottish Government directives meant that their businesses were put on hold.

As we gradually begin to see light at the end of the tunnel in phase 1 of the easing of lockdown restrictions, we fully understand the desire and need for businesses to get back to delivering their services.

But we have a clear and important message to deliver: the sacrifices independent clinic owners have made have helped to save lives, but very little changes within phase 1 of the easing of lockdown restrictions.

“The overriding public health message changed only slightly from ‘stay at home’ to ‘stay at home as much as possible’. All businesses, including private clinics, can play their part by ensuring that people are not unnecessarily exposed to the virus by travel to and from a clinic and through the delivery of treatments that could wait a couple more weeks until we have greater clarity.”

Our helpline for independent healthcare providers has been inundated with questions from providers asking when services can restart and asking us to approve the date that a particular service re-opens. We’ve had to be blunt: it is not possible for us to give a date.

The overriding public health message changed only slightly from ‘stay at home’ to ‘stay at home as much as possible’. All businesses, including private clinics, can play their part by ensuring that people are not unnecessarily exposed to the virus by travel to and from a clinic and through the delivery of treatments that could wait a couple more weeks until we have greater clarity.

A phased approach to easing lockdown restrictions

But what can we say to providers that will be helpful to understand the way forward?

Scottish Government has written to all providers with further detail on what the phased route map means for them. It allows for good clinical decisions to be made and the right care to be given at the right time.

It has always been the case that throughout this crisis the delivery of urgent and essential healthcare can continue both within the NHS and independent services. We provided advice as soon as practicable that this essential and urgent care should continue, but anything that was elective or that could wait should wait. For phase 1, this message remains the same.

As a benchmark, if clinically you decided that there were services that you should stop as a result of the initial lockdown advice, then they probably shouldn’t start again in phase 1. If you are thinking of restarting that service, then the central question to ask yourself is what has changed between lockdown and phase 1 that makes the treatment essential?

It is acknowledged in the route map guidance [link] that there may be treatments or procedures that are not urgent or essential, but that by delaying treatment further it will have a negative impact on patients’ wellbeing. These are highlighted as being able to start again in phase 2.

The importance of sound professional judgement

We know this is not easy. Very complex clinical decisions need to be made for patients in order to balance their need for care, but also the risk to public health. We would fully expect healthcare professionals to show sound clinical judgement on behalf of their patient and the wider society.

This is not about what’s legally right or enforceable, but about doing the right thing.

“We know this is not easy. Very complex clinical decisions need to be made for patients in order to balance their need for care, but also the risk to public health. We would fully expect healthcare professionals to show sound clinical judgement on behalf of their patient and the wider society. This is not about what’s legally right or enforceable, but about doing the right thing.”

It has been said many times that these are unprecedented times and they call for unprecedented actions and decisions – this means that the impact on the health and wellbeing of everyone is impacted by the individual clinical decisions you make that subsequently require your staff and patients to leave their homes.

We can’t thank you enough for the efforts you’ve gone to in order to keep people safe and to save lives at huge cost to your businesses. We’re moving in the right direction, but we would urge you to continue to do what’s right for a little longer and we’ll increase the chances that we all come out of this tragic pandemic together.

Kevin Freeman-Ferguson is Head of Service Review at Healthcare Improvement Scotland

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19

Going home until I can come home – Jane’s story

Posted on June 8, 2020

Returning to work as an ICU nurse has been a rollercoaster of emotions for Internal Improvement Advisor Jane Ross.

I’ve always been fascinated by people, by wellness and illness and helping them get better. It’s what made me want to be a nurse in the first place. It’s also what made me volunteer to go back to an intensive care unit (ICU) to help out during the current pandemic.

It’s been more than 30 years since I became a nurse, and more years than I care to remember since I was on a ward or in an ICU. I’ve seen a lot of things in that time, working in Liverpool, Inverness, Edinburgh and even Cambodia for a while. I still remember wheeling the first patient in Liverpool to have an MRI scan across a busy main road between the Royal Infirmary and the University building where the MRI was kept. But I never imagined in all these years that I would be helping deal with something like COVID-19.

My last full clinical role was working in the Western General Intensive Care Unit (ICU) in Edinburgh. Since then I’ve worked more on the periphery in nursing education and improvement roles. So when the call came for staff with clinical registration to support NHS boards it felt a natural fit to volunteer to be deployed to the Western to help in any way I could.

Getting ready for the frontline

While I was waiting for a start date in ICU, I spent a week helping interview the hundreds of wonderful volunteers that stepped forward to support NHS Lothian. It was a very humbling experience, speaking to so many people from all walks of life who just want to help in any way they could during this extraordinary time.

“While all the pre-learning and support was wonderful, going back to the frontline on day one was initially terrifying. Yet the moment I stepped in through the doors of Ward 20, I felt held and safe.”

Following this, once clinical upskilling sessions were available, I began an orientation process to a clinical role within the ICU itself. I did a lot of online and face-to-face ‘upskilling’ learning sessions to help prepare me – something I’m continuing to do both on shift and off.

While all the pre-learning and support was wonderful, going back to the frontline on day one was initially terrifying. Yet the moment I stepped in through the doors of Ward 20, I felt held and safe. I was one of many ‘returner’ staff with similar feelings, but from the amazing way we were received by everyone on the staff, we were left in no doubt that we were all going to be alright.

A desire to help

I’m part of a band of deployed returners from a range of different areas. Some come from within NHS Lothian itself, others from university and research roles or, like me, from national organisations like HIS. What we all have in common is a background in critical care and a desire to help in any way.

“I’ve been working 12½ hr clinical day shifts, three per week, with a permanent ICU nurse at the bedside in a mentoring capacity. The basic clinical nursing role is very similar to the one I left – nursing care does not really change. What is very different is the complexity of the care and equipment used.”

My role is to support the permanent staff to care for a huge variety of critically ill patients with or suspected of having COVID-19. I’ve been working 12½ hr clinical day shifts, three per week, with a permanent ICU nurse at the bedside in a mentoring capacity. The basic clinical nursing role is very similar to the one I left – nursing care does not really change. What is very different is the complexity of the care and equipment used.

Seeing our organisation’s work in action

During this extraordinary period, the unit has also taken time to clearly lay out the expectations of all roles and responsibilities for the returners and the unit staff to ultimately ensure patient safety. Caring for patients and their family members in these challenging times has been made all the more difficult with the need for full PPE and the lack of patient visitors. Care is orientated to accommodate such restrictions ensuring quality patient care is the absolute priority.

It’s also been wonderful to see how much of the early improvement work that was just beginning when I worked there is now a mainstay of the daily routine, in particular elements of our organisation’s Scottish Patient Safety Programme (SPSP), which is now an integral part of how care is delivered for every patient, every time.

I want to say thank you to Healthcare Improvement Scotland and the staff of Ward 20 for enabling me to be here. I feel so grateful to the Western General ICU for allowing me to work with them and help in some way. If the world was ‘normal’ I don’t think I would have been able to transition quite so easily. But the world isn’t normal, it’s COVID crazy and these unprecedented times have shifted the axis quite dramatically, which is why we returners are welcomed.

The feeling of coming home

Critical care nursing was where I started my nursing career and I’ve always felt privileged and humbled to be part of it. You’re helping patients, their family and your colleagues navigate complex physical and emotional challenges like no other. It has felt, though I am far older and slower, that I have somehow come home. I am remembering what I have always known, that it’s the little things that can make the biggest difference. I am simply offering an extra layer of support for the permanent staff, the patients and family members during this time. The best thing is feeling at the end of the day that I have helped in some small way.

Jane Ross is Internal Improvement Advisor for Healthcare Improvement Scotland

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19

Volunteering in the NHS: who ya gonna call? – Valerie’s story

Posted on June 3, 2020

It’s Volunteers’ Week, and this year has seen more people volunteering to help the NHS than ever, thanks to the COVID-19 pandemic. Here, Community Engagement’s Valerie Breck tells us how they’ve helped NHS boards get the support they – and those volunteering for them – need.

When the COVID-19 pandemic reached Scotland, thousands of people stepped forward and volunteered to support the NHS.

This came from a really good place – a human desire to help those in need – but that overwhelming response left the small volunteer management teams in some NHS boards struggling to cope with the demand.

Who did they call for help? The Volunteering in NHS Scotland Programme, a team based within our new Community Engagement directorate, here at Healthcare Improvement Scotland.

The team consists of two people, Alan Bigham and Lisa Taylor, while I provide management support and oversight.

What do NHS Scotland volunteers do?

In normal times, more than 6,000 people volunteer across NHS Scotland, undertaking a wide variety of roles, from visiting, helping at mealtimes and supporting new mums with breast feeding, to driving people to and from appointments and taking time to listen to them.

No matter what they do, volunteers aim to improve the experience of people in a health and care setting – and they get a lot out of it too, as the case studies on our new Community Engagement website demonstrate.

Along came COVID-19

Since 2011, the team have been working to help NHS boards develop sustainable volunteering programmes; ensuring a safe, supportive and positive experience for the volunteers themselves.

“The success of the programme means it’s always busy. In 2019/20 the team fielded an average of 32 requests for volunteer development support each month. Suddenly, along came COVID-19 and the impact it had was incredible. In March 2020, 75 requests for volunteer development support were received.”

Working with Scottish Government, the National Group for Volunteering in NHSScotland, and local volunteering leads and managers, the team have developed a network of support which shares good practice, innovative ideas, and provides leadership and strategic direction.

The success of the programme means it’s always busy. In 2019/20 the team fielded an average of 32 requests for volunteer development support each month. Suddenly, along came COVID-19 and the impact it had was incredible. In March 2020, 75 requests for volunteer development support were received.

What happened next?

When the impact of COVID-19 became apparent in Scotland the team contacted each NHS board to establish what actions they had taken in their volunteering programmes.

We knew that many of the 6,000 NHS volunteers fell into the ‘at risk’ category, were volunteering in patient-facing roles and relied on public transport, so we had to act quickly to assess what actions health boards were taking to protect volunteers and their families.

Discovering a mix of approaches, we rapidly agreed a series of recommendations with the national group, including assessing those most at risk and reinforcing the need to update risk assessments. From this, all boards either stopped all or some of their volunteering activities or ‘stood down’ the most vulnerable volunteers.

We also planned and delivered a series of webinars to reduce duplication and spread good practice rapidly. The sessions included advice on how to identify volunteers at most risk and shared tools and guidance on managing volunteers in a pandemic.

Recognising that there remained a place for volunteering during the pandemic, we used the learnings from an ongoing improvement project to produce guidance to help speed up the volunteer recruitment process (typically 14 weeks on average) and reduce common delays.

Included in the suite of tools, recommendations and guidance was an online induction module, swiftly developed through a collaboration between NHS Education for Scotland and Healthcare Improvement Scotland’s wider Community Engagement teams.

Reinforcing good practice

Early on in the pandemic, volunteering took on a new perspective in the public eye, as the response to volunteer recruitment campaigns showed.

At the same time, there were suggestions that volunteers could be used in communities in a way that put them at risk; such as driving people to get tested for COVID-19.

Combined, these two things reinforced the need for close reference to the good practice the programme team promotes. Volunteer roles should be developed in partnership, using the Developing Volunteering Toolkit and Checklist. They should be risk-assessed and, perhaps most fundamentally, workforce gaps should be addressed through the recruitment of paid staff.

What happens now?

Some of the existing volunteers are finding new ways to support people and patients through internet, phone and letter writing. They continue to support the people they’ve been involved with – just in a different way.

Boards have developed individual roles for volunteers, such as delivering medicines, taking personal items from families to patients in non COVID-19 wards, and being runners for staff – picking things up from around the hospital and saving them time.

Alongside a reduced core programme (some things clearly had to be paused), Alan is advising Scottish Government on the proposed implementation of Emergency Volunteering Leave (part of the Coronavirus Act 2020) whilst Lisa has been fielding the majority of the advice and support calls.

The next priority is to adapt our planned volunteer engagement activity into something suitable for the socially distanced world we now live in. There remains a risk, perhaps even greater now with demands on volunteer managers, of volunteers feeling unsupported and becoming disengaged.

“Boards have developed individual roles for volunteers, such as delivering medicines, taking personal items from families to patients in non COVID-19 wards, and being runners for staff – picking things up from around the hospital and saving them time.”

Meanwhile, Alan and Lisa continue to keep the Volunteering in NHS Scotland Programme up and running – supporting boards to support thousands of volunteers across the country during one of the most challenging moments in our life time.

Valerie Breck is Engagement and Equalities Policy Manager with Healthcare Improvement Scotland – Community Engagement.

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19

Community engagement is never more important than during a pandemic

Posted on June 1, 2020

The Community Engagement directorate was due to launch at the beginning of April – but then COVID-19 happened. Lynsey Cleland, Director of Community Engagement, explains how they moved the directorate’s whole focus in a different direction, but with people still at the heart of their work.

When the COVID-19 pandemic arrived, it looked like the planned April launch of Healthcare Improvement Scotland – Community Engagement (the new name for the Scottish Health Council) might be forced into quarantine until the pandemic had subsided – all those plans for the launch and the new work programme suddenly having to be put on hold.

In a way, of course, that’s exactly what happened. The launch took place, but much of the work programme for the new directorate was paused. But community engagement is important at all times, no less in a national response to a new and life-threatening virus.

Bringing the new directorate together

Within our directorate we quickly found the importance of our own community. We all had to work together to refocus our attention, we needed to be there for each other, to listen, to seek to understand, and to find a way forward that would be effective for each individual while meeting the increasing and changing needs of the health and care service.

We’ve adapted, we’ve seized opportunities to make a difference, and we’ve worked together in fantastic ways that will serve us well for the future.

Supporting volunteers and the third sector

When the call went out for volunteers to be mobilised to help the health and care service, we knew that our Volunteering in NHSScotland Programme team would be exceptionally busy.

Over the last couple of months, this small team has provided dedicated advice and support to NHS volunteer managers, including reinforcing the duty of care NHS Boards have to volunteers, producing specific guidance for volunteer managers on the recruitment and developing roles of volunteers during the pandemic, and running virtual meetings and webinars to support Boards on a wide range of volunteering issues.

The team have also worked with NHS Education for Scotland to produce an online induction scheme for volunteers which launched in April and is supporting quicker deployment of NHS volunteers.

We’ve also had our own staff both volunteering and deployed across the NHS in Scotland to aid the COVID-19 response, and we’re immensely proud of their efforts. A number of colleagues have been using their skills to help train newly-recruited NHS24 call handlers, while others are providing a range of local support within their communities.

Helping those who are digitally excluded

Our directorate has also been working with Scottish Government, SCVO (Scottish Council for Voluntary Organisation) and other third sector organisations to support the digital inclusion project Connecting Scotland. This project aims to identify individuals who are most vulnerable and digitally excluded across the country and provide them with a device that enables access to the internet to aid their connection with loved ones and with sources of support within their communities. This project has the power to completely transform care and access to information across Scotland.

“We’re beginning a scoping exercise to understand the current demand for virtual visiting across Scotland, taking into account access and equality issues, establish the infrastructure requirements currently available to support virtual visiting, and gather and share good practice on existing virtual visiting approaches. Nationwide, this will help inform virtual visiting services across wards and in-patient facilities.”

To aid this crucial project, we’ve used our network of local connections across Scotland to identify community groups able to provide training and ongoing support to the individuals who receive devices.

Visiting to all hospital wards has been suspended except in end-of-life and other exceptional circumstances – this has meant many patients have no access to family, friends and loved ones throughout their stay in hospital.

Some NHS boards have introduced virtual visiting to assist patients to keep in touch with loved ones, but the picture across Scotland is varied. We’re beginning a scoping exercise to understand the current demand for virtual visiting across Scotland, taking into account access and equality issues, establish the infrastructure requirements currently available to support virtual visiting, and gather and share good practice on existing virtual visiting approaches. Nationwide, this will help inform virtual visiting services across wards and in-patient facilities.

The importance of equality and compassion during the pandemic

Our Public Involvement Unit has supported the development of a range of equality impact assessment including the national shielding programme; person-centred care learning system and virtual visiting, while also compiling a response to the Equalities and Human Rights Committee call for evidence to understand the impact of the pandemic on equalities and human rights.

In addition, we’ve worked with colleagues from our ihub as we capture and promote examples of good practice in person-centred care in the acute sector during COVID-19 restrictions. This work is supporting a learning system to enable staff working in health and social care to learn from each other. This is now being rolled out to include all sectors of health and care service. We will also be working with health and care staff to understand their needs from this learning system; what they would like next from this learning system and what their experiences have been in providing person-centred care during the COVID-19 pandemic.

Our response is varied and meaningful and I can’t thank our team enough for the way they’ve risen to the challenge of COVID-19.

Engagement as we come out of lockdown

Looking to the future as we gradually come out of lockdown, there are certain things that we cannot lose sight of – most importantly, the impact on people and communities of the dramatic changes that we’ve seen this far in the national response.

In many ways, health and care has been transformed during this crisis. As consideration is given to how some of these changes could be taken forward as part of future services, and thought given to what further changes are required to the way services are designed and delivered, it’s imperative that there is meaningful and inclusive engagement with the people and communities using these services.

There is a need to understand how these changes have affected people and communities, including vulnerable and marginalised groups, and ensure that all people’s views shape future service design and delivery. We will therefore be looking to use our local reach and national presence during the next phase of the COVID-response to develop and share good practice to engage differently and support people to get involved in decisions about the services that matter most to them.

“In many ways, health and care has been transformed during this crisis. As consideration is given to how some of these changes could be taken forward as part of future services, and thought given to what further changes are required to the way services are designed and delivered, it’s imperative that there is meaningful and inclusive engagement with the people and communities using these services.”

COVID-19 has transformed life for everyone. Far from being put on hold, HIS Community Engagement is in full swing and I’m proud that it’s already setting out to achieve its goals, even though much of the work programme will be different for the foreseeable future. I’m proud of how the community of our new directorate has responded and I believe we are well placed to provide support to communities and health and care services across Scotland in the months and years to come.

Lynsey Cleland is Director of Healthcare Improvement Scotland – Community Engagement.

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19

COVID-19 response is a family affair – Jacqui’s story

Posted on May 27, 2020

Supporting NHSScotland’s battle against COVID-19 has turned out to be a family affair for Scottish Antimicrobial Prescribing Group (SAPG) lead Jacqui Sneddon.

The COVID-19 pandemic has affected families across the country in lots of different ways. Some of us can’t get to see our loved ones due to social distancing. For others, it’s been about spending much more time together at home than we might ordinarily do.

My family is no different. My husband Andy and I haven’t been able to see our eldest daughter, Nancy, for quite a few weeks now, as she lives with her fiancé. Our younger daughter, Melanie, is living back at home after six years away. On top of that, Nancy, Melanie and I are all working in NHS roles, either helping out on the frontline or helping vital services to continue during this strange and difficult time.

Nancy works in a Mental Health team and they are having to adapt to new ways of delivering services to ensure patient care can be maintained.

For Melanie, a medical student, while her hospital placements have been suspended until August, she was keen support the NHS. She is now working as an NHS24 call handler, dealing with calls on the COVID 111 line. While not a clinical role it has been a valuable opportunity to develop her communication skills and support people worried about their symptoms.

“When I started work at St John’s Hospital, Livingston, back in 1990, I couldn’t have imagined that what I’d learn there would one day result in me leading a national work programme to protect a vital group of medicines.”

My work, meanwhile, has seen me step away from my day to day role as project lead for SAPG and return to a role I last did 18 years ago: clinical pharmacist in an intensive care unit (ICU)

When I started work at St John’s Hospital, Livingston, back in 1990, I couldn’t have imagined that what I’d learn there would one day result in me leading a national work programme to protect a vital group of medicines.

I worked at St John’s for 12 years managing the Aseptic Unit which prepared intravenous antibiotics for patients across the hospital and was also the ICU pharmacist. It was this work that sparked my interest in use of antibiotics. Through multidisciplinary ward rounds in ICU that involved myself and the Consultant Microbiologist, I learned a great deal about appropriate antibiotic use, and the fact that as a group of medicines, antibiotics were at risk of over-use, something which could have significant consequences.

“I’m very conscious of the challenges my daughters are facing in their current working lives … and proud of the fact that our family is helping support NHSScotland’s COVID-19 efforts.”

To prepare for going back to ICU I had to apply for a PVG Disclosure certificate as I only had a basic Disclosure, but there is a rapid process for this. NHS Lothian has a specific training programme for pharmacists returning or moving into critical care practice, and there are some excellent resources from NES and the Royal Pharmaceutical Society.

My role is to support the ICU pharmacist. This involves reviewing patients in both the COVID ICU (done virtually) and the ‘clean’ ICU which involves ward visits as these patients don’t have COVID-19. The principles of the work are similar to my past experience, but now all patient episodes are available online via the Trakcare system which makes it easier to find the information required to review potential medication issues. The rest of the hospital is fairly quiet as currently there is no planned surgery.

While my work with SAPG is far removed from the front line, it’s been useful to see what life is like for my colleagues at St John’s – it’s certainly helped me to refresh my memory and appreciate the challenges they face.

I’m also very conscious of the challenges my daughters are facing in their current working lives. I’m proud of my girls, and the fact that our family is helping support NHSScotland’s COVID-19 efforts, but I do worry that one of us could become ill. It’s also been a bit of an adjustment to go from having no kids at home to having one back full time and the other you just can’t see, but we’re dealing with it as best we can, keeping in touch using FaceTime and our family WhatsApp group. What we’re all really looking forward to is lockdown being lifted so we can finally celebrate Andy’s 60^th birthday together – he hit the milestone back in April, so being able to celebrate as a family will be the icing on the cake.

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

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19

Rolling back the years – June’s story

Posted on May 26, 2020

Retirement loomed for June Wylie, but little did she know that COVID-19 was about to disrupt her final months and give her one last challenge …

At the beginning of this year, as my retirement from my post as Head of Improvement Support with Healthcare Improvement Scotland’s ihub approached, it was understandable that I was in a reflective mood. But at that point in time, I most definitely didn’t foresee my final months being thrown into turmoil by a health pandemic that has disrupted every element of life in Scotland.

Instead, my intended period of handover and winding down turned out to be one of the most stressful, but satisfying periods of my career.

Being involved in establishing NHS Louisa Jordan, a brand new emergency hospital in an exhibition centre, at a furious pace was challenging to say the least. My job was to lead on the planning for the AHP workforce and services including Occupational Therapy, Physiotherapy, Dietetics and Speech and Language Therapy.

“Within Healthcare Improvement Scotland and across our health and care system we have seen the most amazing response to COVID 19, with staff being prepared to rapidly change their routines and practice, and going the extra mile to support service priorities and ensure delivery of essential care. The opportunity to let go of old practices and embrace new and innovate ways of working has never been greater.”

In many ways, this took me back to my roots. I couldn’t have done the work without the support of a whole range of people including AHP Directors from across the west of Scotland. Despite very challenging working conditions, I was impressed by the good nature, willingness to help and the pragmatic ‘can do’ attitude of so many people.

Within Healthcare Improvement Scotland and across our health and care system we have seen the most amazing response to COVID 19, with staff being prepared to rapidly change their routines and practice, and going the extra mile to support service priorities and ensure delivery of essential care. The opportunity to let go of old practices and embrace new and innovate ways of working has never been greater. Now that retirement is here, I will watch with interest how Healthcare Improvement Scotland, and health and social care in general, embrace the opportunity to adopt and adapt to new ways of working.

**A young June Wylie starting out her career as an OT.**

Hospital At home

The COVID-19 response also touched upon a project dear to my heart that was the last piece of work prior to the pandemic: Hospital At Home.

The rapid production of the Guiding Principles on Hospital at Home was exciting and an excellent example of how the range of skills and expertise across our organisation can come together to create a high quality product. The timing for this guidance couldn’t have been better as COVID 19 has brought home the urgent need for us to transform the way we deliver services and truly shift the balance of care.

At last … time for reflection

As I now approach the final days of my professional life, I’m finding some time to ask myself where the past 39 years have gone and how did I get to have the career that I’ve had? How did a wee girl from a small village in the West of Scotland end up working in a range of senior and national roles, including Scottish Government?

I started my career as an Occupational Therapist (OT) in 1981 and worked in Stobhill Hospital in Glasgow before moving to Ayrshire and then Edinburgh in 1985. I spent eighteen years working in NHS Lothian as the Head of Occupational Therapy and then as Divisional Therapist for Medicine before taking on a general management role in Acute Medicine at the Western General. My overarching memories of my time at the Royal Infirmary of Edinburgh (RIE) was that of constant change and adaptation, hospitals were closed and merged, clinical areas were improved as we moved from Nightingale wards to four bed areas and single rooms, and the pressure on hospital beds and delayed discharge just grew and grew. The resilience of staff to deal with daily staffing pressures and constant change never ceased to amaze and impress me. In some ways then, our national response to COVID-19 hasn’t surprised me!

“As I now approach the final days of my professional life, I’m finding some time to ask myself where the past 39 years have gone and how did I get to have the career that I’ve had? How did a wee girl from a small village in the West of Scotland end up working in a range of senior and national roles, including Scottish Government?”

I’ve always thought of myself as a pretty unremarkable OT who just did her job as well as she could, but as I reflect on my career I realise that I was at the forefront of a number of changes and improvements that are now routine practice. I, along with a fellow OT, were the first women to be allowed to job share at the RIE in 1992, a request which required permission from the Board of Directors! We were the first OT department in Scotland to move to seven day working and the first to have Occupational Therapists and Physiotherapists working in the Acute Receiving Units and A&E. Despite the challenges in making some of these changes happen it was the recognition by staff that if services and outcomes for patients could be improved then the change to their own ways of working was worth it.

The importance of people

As I reflect on my career and some of the key milestones the thing that comes to mind the most are the people. The psychology and human dimensions of change have always been an area of interest for me, and even now as I reflect on the next stage of the life I’m drawn to William Bridges work on Transitions and the psychological process we need to go through to adapt and change.

Bridges believes that every new beginning has to start with an ending. The need to let go of old ways of working brings with it uncertainty and anxiety and yet it is only by letting go and ending that we can create new ways of working and beginnings.

His framework resonates with me not just on a personal basis as I end this phase of my career, but also as we enter a new reality for health and social care services.

I am immensely proud to have worked in the organisation for the past seventeen year and from my first day to now I am impressed by the skills and expertise of staff across the organisation and the potential for HIS to play a key role in helping to transform health and social care across Scotland.

So in ending the key learning and reflections from my career, my main piece of advice is to pay attention to people and relationships. Be kind to each other and value the tremendous skills, and expertise we have within our organisation and the tremendous opportunities ahead.

As I enter my own period of transition, I’m looking forward to adapting to a new rhythm of life and simply seeing what comes. I wish you all well and I hope our paths will cross again.

June Wylie has now retired from her post as Head of Improvement Support, Living Well in Communities and Professional Lead Allied Health Professions with Healthcare Improvement Scotland.

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19

Making a difference – with spreadsheets – Katy’s story

Posted on May 20, 2020

When the programme she works on got paused, Excellence in Care’s Katy Haslam wondered what she could do to help NHSScotland combat COVID-19. A lot, as it turns out…

My name is Katy and I love spreadsheets, processes and being busy. So finding out the programme I work on, NMAHP directorate’s Excellence in Care (EiC), was being paused due to the COVID-19 pandemic meant my busy working life as Project Officer, the spreadsheets and the processes were all suddenly gone. What was I going to do now?

The answer came in a team call. Would you like to volunteer to work in our nearest NHS board? I immediately thought: “Yes please!” and then, “But what can someone with no clinical background do to help, really?”

“Would you like to volunteer to work in our nearest NHS board? I immediately thought: ‘Yes please!’ and then, ‘But what can someone with no clinical background do to help, really?'”

Quite a bit, it turns out. I think people forget how much admin sits behind the lovely clinical staff that make up our frontline NHS. And thanks to my colleague Norma Dodds, EiC Lead Nurse for NHS Lothian, I’m now helping out NHS Lothian’s Corporate Nursing division with their workforce planning. It’s a busy task to administrate. Actually, that is a massive understatement. But with my love of spreadsheets and being kept busy, it’s my little corner of heaven for the foreseeable.

I’m supporting Norma with the governance processes involved in recruitment and redeployment of nursing and midwifery staff, including returning staff, students, and volunteers from healthcare partnerships… eesh, I think there are about six routes into NHS Lothian! These processes are required for each of the routes, some have secondment agreements, some have service level agreements and others have pre-employment checks done on appointment. Mapping the different routes into the system helps ensure staff are safe, as they highlight the need for pre-employment checks and what training and PPE are needed for each staff member coming on board. It feels good to be a part of ensuring the steps are clear for the staff recruiting and placing the candidates.

While Norma was waiting for the redeployment processes to be agreed, I was asked to cover a week of annual leave at the Staff Bank. I was trained to use HealthRoster and helped field requests for booking agency staff onto shifts for the Edinburgh Royal Infirmary, Western General Hospital and St John’s. During this time I created a ‘How to…’ guide for their online programme, Allocate. I wanted to help make asking someone to step into this role easier and my love of processes came in helpful here. It was a natural step to take the notes I made during training and type them up, so it wasn’t a huge leap to add screenshots to illustrate the steps for the various tasks the staff there undertake every day.

“I’ve learned that I don’t miss the 22 bus commute to the Gyle in the slightest, but I do miss seeing my lovely Healthcare Improvement Scotland colleagues.”

On the whole I don’t feel I’m doing anything different from my usual role, only that the circle I am working in is smaller. Instead of reaching out to all NHS boards I am working within just the one. Thanks to the EiC programme, the staff names are familiar to me but now I have the opportunity to put faces to them – from a distance of two metres, obviously.

I’ve learned that I don’t miss the 22 bus commute to the Gyle in the slightest, but I do miss seeing my lovely Healthcare Improvement Scotland colleagues. Zoom, MS Teams, Skype, WhatsApp, whatever the means, the times we check in, whether it is the EiC team or the NMAHP directorate, is always filled with anecdotes and information and many giggles. People rise up to challenges and support each other – it’s lovely to see and still feel included while I am redeployed. I also appreciate the opportunity to see first-hand what Norma does when she’s not working on the EiC programme and I’m blown away by how much is going on everyday behind the scenes. It’s made me realise how important the improvement work we do at Healthcare Improvement Scotland is and that my usual role is a worthwhile one to be in. That might be an odd observation to be making, but we’re all guilty of taking things for granted and losing sight of our purpose, and I’m no exception. I’m exceedingly grateful for my roles in both Healthcare Improvement Scotland and NHS Lothian and what it allows me to experience in and out of the workplace. I hope I don’t lose sight of this again.

Katy Haslam is a Project Officer with Excellence in Care, part of Healthcare Improvement Scotland.

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19

Juggling staff, spaces and spreadsheets – Norma’s story

Posted on May 18, 2020

Making sure the right people with the right skills are in the right place at the right time is all part of the job for Excellence in Care’s Norma Dodds. Setting up a nursing staff hub as part of NHS Lothian’s response to COVID-19 has put her to the test…and has her dreaming some unusual dreams…

I used to dream of flowers. The petals, the leaves, the shapes, the structures. I dreamed of how I would put them together, arranging the colours and creating great clusters and clouds of them for displays or wedding bouquets.

Now, I dream of spreadsheets.

Spreadsheets take up my days. I have them for everything and I needthem for everything. I’m painfully aware that I never had a spread sheet for lilies. Yes, COVID-19 has changed me.

I’m NHS Lothian’s Programme Manager for Excellence in Care (EiC). For two days a week, I’m on secondment with Healthcare Improvement Scotland (HIS). Or I was, until the COVID-19 pandemic started. Now, back at NHS Lothian, it’s my job to help pull together the nursing and midwifery workforce plan that will help us deal with the pandemic.

“suddenly I had a few thousand staff to deploy where they were most needed, but that didn’t necessarily match where they wanted to go. This was a huge challenge as I had never been involved in this type work before. HR were my allies, keeping me right on what was and what was not acceptable to the organisation.”

Prioritisation of services to support patients meant rapid changes had to be implemented across NHSScotland, and NHS Lothian was no different. As some existing services were stepped down, staff were redeployed to other services. This all had to happen at speed, and I was the key contact for helping set up the COVID-19 Nurse Staffing Hub.

The idea was to allow managers to ask for assistance with staffing resources or to offer staff to be deployed to other services. Trying to balance requests for staff with actual people to be deployed was a bit of a juggling act, but one of my past roles was Staff Bank Manager for Nursing within NHS Lothian, so this gave me confidence to undertake the role of supporting with the employment and deployment of the workforce into areas of need.

The key to the success of safe recruitment and redeployment of staff is ensuring a robust governance process is in place and streamlining processes to support this. From previous roles, I was aware of the governance process around recruitment, but due to the rapid changes and the number of different routes into the system for staff and volunteers, I knew this role was going to test my knowledge.

A plan had been put in place for a rapid recruitment drive as soon as the pandemic started. The aim was to get people through the recruitment process in less than the normal six week timeframe. We had about 1600 applications – not all for nursing.

Then we heard NES were going to have a portal for staff returning to the NHS, so suddenly there were another few hundred potential recruits applying by that route. Add in the student nurses in year 2 and 3 that were offered an opportunity to work in NHS Boards as paid students as part of the workforce, and that was another six or seven hundred for us to deal with.

Staff from external organisations, universities or partner boards were also keen to volunteer, but they would all need to have either SLAs or secondment agreements to be safe to operate in NHS Lothian.

So suddenly I had a few thousand staff to deploy where they were most needed, but that didn’t necessarily match where they wanted to go. This was a huge challenge as I had never been involved in this type work before. HR were my allies, keeping me right on what was and what was not acceptable to the organisation.

I undertook some of the interviews over the phone. I’ve always preferred meeting and interviewing people face to face, so I found it a bit difficult. Once staff had been interviewed, their pre-employment checks completed and their induction underway I had to place them in a pool of staff per hospital or locality site, trying to ensure everyone got what they needed

My role is really still evolving. Every day something different happens and although I’m enjoying the challenge I do miss the normality of what I had before. I also miss the teaching side of what I was doing with EiC, but now I could teach anybody how to build a spreadsheet! Having Katy Haslam seconded from EiC to work with me three days a week has been invaluable – she loves a spreadsheet and has been my mentor on the process front, writing processes as we go and turning them into something that is visibly good and easy to use. I’m sure my role will continue to change as we move forward. The pandemic is something that happened and needed a quick response – we had no control over that, something that’s difficult for a control freak like me! But I’ve risen to the challenge and just got on with what has needed to be done. You could say I’ve gone from dreaming about flowers to turning over a new leaf.

Norma Dodds is Lead Nurse with Excellence in Care, part of Healthcare Improvement Scotland.

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19

Returning to a familiar part of the frontline – Jen’s story

Posted on May 13, 2020

In our latest blog, Improvement Advisor Jen Pennycook describes what it’s been like to return to her previous team at the Beatson West of Scotland Cancer Centre, and shares her insights on working on the frontline, looking after family and staying resilient.

Before joining Healthcare Improvement Scotland full time as an Improvement Advisor in the ihub’s Acute Care Portfolio in 2019, I was a Practice Development Nurse at the Beatson for five years. I’d been seconded to Healthcare Improvement Scotland part time as Nursing Clinical Lead since October 2017, so by the time I joined full time, I was already familiar with my colleagues and our work.

During that time, I also mentored one of my Beatson colleagues, a staff nurse, to act up on those days I was on secondment. I was delighted that when I moved to Healthcare Improvement Scotland she got the job full time.

“My role has been to train staff to use PPE, whether they’re porters, nurses, domestics or consultants. Our small team has already trained around 300 to 400 staff across the Beatson in the four weeks since I came back.“

Nearly one year on, the COVID-19 crisis hit us all. Improvement programmes were paused and we were deployed to support the system. I was keen to return to the Beatson as I knew the team was busy educating staff around using, fitting and ensuring an adequate supply of personal protective equipment (PPE), not to mention alleviating fears by teaching them how to stay safe.

My role has been to train staff to use PPE, whether they’re porters, nurses, domestics or consultants. Our small team has already trained around 300 to 400 staff across the Beatson in the four weeks since I came back.

Using PPE like this is completely new to some staff. Our updates come from NHS Greater Glasgow and Clyde (GGC) in a core brief based around Health Protection Scotland guidance. At the Beatson, the Practice Development Education and Research Unit is responsible for monitoring the updated guidance and educating others. It’s a big responsibility, but I love it!

One of the most rewarding aspects has been seeing how well my previous colleagues are working together, not least the colleague who took on the role I left. Being back in the team also makes me realise how much I’ve grown. Although I enjoy working at the Beatson, it’s shown me how much I love being part of the Acute Care Portfolio. I enjoy working with teams in different boards and seeing the impact of implementing improvement programmes at national level.

Patient care is paramount at the Beatson, just as it is across NHSScotland. All of the staff are more flexible than ever about what tasks they take on and what hours they work – I’ve worked weekends and out of hours to deliver PPE education sessions. Across the board at every level, people are stepping up without hesitation. As a nurse, I’m ready to take on anything, including working on wards if needed. The team working has been incredible and I hope this supportive behaviour continues after this crisis is over.

The biggest challenge for me, as I’m sure it is for many of us, is maintaining a healthy work/life balance. At work, initiatives like opening the Beatson Cancer Charity Wellbeing Centre to staff as a place to relax have been a welcome move. Treats being delivered to staff have also been much appreciated! In both my Beatson and Healthcare Improvement Scotland teams, we share information and humour using WhatsApp groups – talking is essential. It’s been really inspiring to see how much we are supporting each other.

“Across the board at every level, people are stepping up without hesitation. As a nurse, I’m ready to take on anything, including working on wards if needed. The team working has been incredible and I hope this supportive behaviour continues after this crisis is over.“

While I love my work, family is also incredibly important to me. My husband is also a key worker and we’re making sure our elderly parents and our next-door neighbour, are healthy and keeping well stocked.

We’re also fitting in home schooling our daughter, Lucy, in between shifts. She’s in first year and is working to a self-made timetable. I ‘m incredibly proud of her being mature and responsible enough to manage her own schoolwork and look after herself when my husband and I are out at work. She likes to keep fit in the mornings with Strictly’s Oti Mabuse. As proud as I am of her, she made my heart swell recently when she said, “I’m so proud of you Mummy, being a nurse and helping people.”

Jen Pennycook is an Improvement Advisor within Healthcare Improvement Scotland.

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19