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.

Categories: ihub

A day in the life of a Hospital At Home nurse – Richard Wells-Holland

Posted on February 10, 2021

Hospital At Home is a service gradually growing across Scotland and Healthcare Improvement Scotland is helping NHS boards establish and develop their services. But what is it like to deliver such a service? How does it work? NHS Lanarkshire Hospital At Home nurse Richard Wells-Holland explains a typical day.

Experience and research tells us that not everyone needs to go into hospital and not everyone wants to go to hospital either. Some people will be worse off as a result of their illness, either through the risk of delirium, falls or infection. In addition they will miss their family, partner or friends, as well as their own home surroundings and comfort. But, at the same time, they need the kind of interventions and care that a hospital can provide.

Hospital At Home aims to support people by providing the same level of care in the home as they would get in hospital. The service also supports A&E and ward discharges from hospital for those adults who still require acute monitoring, but are safe to be discharged home.

As a Hospital At Home nurse, I’m part of the emergency community service which is managed by Health and Social Care North Lanarkshire, based in the University Hospital Monklands. What is it like to do the job that I do? To support Healthcare Improvement Scotland’s work to develop more Hospital At Home services across Scotland, let me explain what a typical day for me is like…

8.00am: There are various shift patterns within the Hospital At Home service such as 8am to 6pm, 8.30am to 6.30pm and 10.00am to 8.00pm. Today’s shift starts for me at 8.00am, meaning that as the first nurse on duty I am responsible for organising the daily workload for my colleagues coming in later. Today we have 23 patients currently under our caseload and we have three new referrals, two from the care of the elderly wards and one from A&E. So 26 in total at the start of the day and that’s before any referrals from GPs. The team consists of Care of the Elderly consultants, nurses, allied health professionals and assistant practitioners (APRs).

9.15am: I get a call referred by a GP who is wanting an elderly lady reviewed. She lives in a residential living complex and is feeling unwell. She also has reduced consciousness and is suspected of having a urinary tract infection (UTI). Emergency patients like this are reviewed within a one-hour response time with an APR attending first to obtain emergency bloods, followed shortly afterwards by a nurse practitioner who will assess the patient and carry out a diagnosis. This will be followed up by the consultant who will review the clinical notes and plan treatment. When I arrived, the patient was fluctuating in and out of consciousness and had all the symptoms of sepsis. Sepsis can often be treated at home. However, after contacting the consultant on call, it was advised for an ambulance to be called in this instance. Paramedics arrived and she was taken to hospital for further examination. Despite us being a hospital at home service, not every patient can be managed at home, and sometimes hospital admission is required.

11.20am: Another emergency call arrived on my way back to the hospital – this was to go and see an elderly man 18 miles away. One of our APRs was already in attendance and had carried out the initial clinical observations and obtained a blood sample. The gentleman had been found wandering the streets and was becoming more and more confused. His family were all very concerned. He was very polite in his manner, but kept referring to me as his school teacher and he saying he had to get to school. Delirium and the manifestations were discussed with the family. It was explained that admission to hospital may make the delirium worse and trying to keep their dad in a familiar environment with our support would be the best option. The family agreed to keep him at home and to take it one day at a time.

12.30pm: After having some lunch in my car I headed back to the office as there were no other emergency calls. While there, I called the social work department as one of the patients under our caseload needed homecare to assist with her activities of daily living. She had recently suffered the bereavement of her husband who was her main care provider and as a result she was unable to fully look after herself at home. She had no family support and had recently developed a chest infection. I carried out the necessary assessment paperwork and sent it over. Working closely with social care departments can be a key part of what we do for our patients.

2.45pm: I took a call about a 91-year old lady who had had a fall. Prior to leaving, I accessed the patient’s medical records for any additional information. She lived alone and there was a key safe box in place and the entry code was in her medical records. I gained entry and found her in bed lying at a strange angle. She explained that she had fallen in her bathroom early in the morning and was unable to get up. She had banged her left hip off of the toilet pan which was likely a fracture, so we had to get her to X-ray as quickly as possible. Hospital At Home has access to priority X-rays, just as you would expect for an in-patient, so I knew that we would be able to get her condition confirmed as quickly as possible.

4:00pm: I was given another call to attend to an elderly man suffering from increased shortness of breath and green sputum. He was expecting me, as my APR colleague had already been and had taken venous bloods, and carried out an ECG and clinical observations. Communication both verbal and non-verbal play a fundamental role in the nurse-patient relationship and helps in gaining not only trust being built but also leads to vital patient information being obtained. The gentleman explained that he felt extremely short of breath even at times of rest. He also complained that he couldn’t stop coughing.

I explained that he would be started on a course of antibiotics and that we would arrange for him to go to the hospital in a few days’ time for a chest X-ray which he could attend before going home again afterwards.

5:00pm: I headed back to the office which was busy as everyone was trying to get their documentation done and get the results back from the laboratories for their patients’ records such as blood results etc. As an emergency service we get our blood results back the same day, avoiding any delay in treatment for the patients being kept at home.

5:45pm: After discussing my patients in full with the consultant on duty and putting plans in place for the next day, it was nearing the end of my shift. As my route home was passing my last patient, I volunteered to deliver the antibiotics that had been prescribed for him on my way home. That way he could get his first dose that night and it would also give me a chance to see how he was doing and to be reassured that he was coping.

Though no two days are ever the same, this was a pretty typical day: it’s varied, full of communication with a wide range of people and it’s satisfying to help patients stay in their familiar surroundings but get the essential treatment they need.

I’m excited about the work Healthcare Improvement Scotland is doing to increase Hospital At Home services across Scotland – it can only mean better care for patients, as well as being rewarding and satisfying for nurses like myself.

Richard Wells-Holland is a Hospital At Home nurse based within University Hospital Monklands, NHS Lanarkshire.

More information

Visit the ihub website for more information our Hospital at Home work.

Categories: ihub

The many reasons to love Hospital At Home – Dr Claire Steel

Posted on February 3, 2021

Dr Claire Steel ended up in Hospital At Home by accident. A snowboarding accident to be precise. But she quickly became a convert to the benefits it brings to patients. As our organisation’s ihub works with NHS boards across Scotland to establish more Hospital At Home services, Claire explains why every NHS board should introduce Hospital At Home as part of the service they provide to people requiring acute care.

In a way, it was becoming a patient myself that made me a convert to Hospital At Home. When I was due to take on my first consultant role, I broke my wrist snowboarding and couldn’t go onto a ward until I was healed. Instead I spent time in the community with a Hospital At Home service. Hospital At Home delivers acute care to people in their own homes through the co-ordinated efforts of a specialist team working together to keep the patient out of hospital, at the same time improving their health. I found it so inspiring that when a consultant position came up with NHS Lanarkshire, I was keen to apply as I knew they had a Hospital At Home service.

As Healthcare Improvement Scotland works with other NHS boards to help establish similar Hospital At Home services across Scotland, I’m reminded of the many reasons to love working in a Hospital At Home service and being out in the community, delivering care to patients in their homes. It might seem like a lonely business driving from one patient to another, but that’s far from being the case. It’s a day filled with discussions and conversations with other professionals, patients and family members. You still spend a lot of time on the phone discussing patients and making arrangements. Every morning we have a ward round with nursing staff before going out to undertake our visits. On home visits, usually another clinical member of staff will be there with me. The teamwork is great. It feels a lot less hierarchical – everyone is on the same level carrying out their individual duties.

In hospital, if I’m trying to get the history of a patient, it’s a matter of asking many questions and then using my imagination to try and piece together what their life at home looks like. With Hospital At Home, it’s all there. If I’m trying to get a history of a patient, Hospital At Home gives me a vivid picture before my very eyes. I get an immediate sense of what the patient’s situation is like, the care arrangements and what is required for them. Each patient’s home tells a different story and this story can be vital in helping me and the team to give the patient the care and support they need.

When is a hospital a Hospital At Home?

A typical Hospital At Home has three components: the severity of the condition that’s treated has to be similar to the type of condition they would be admitted to hospital with, the service must have access to diagnosis (for example, being able to get test results, X-rays or scans as promptly as would be the case in hospital), and care must be led by a consultant.

The Lanarkshire team works out of a space within University Hospital Monklands (one of three hubs in Lanarkshire). I work from there, but the services at Hairmyres and Wishaw have all our medications and equipment. Each member of the team acts as if each patient is right there in front of them in a hospital bed. The nurse will have phoned on ahead to see how the patient is and we discuss their condition; there may be bloods or reviews; we decide on treatment or an investigation plan. It just so happens that the patient requiring acute care is still in their home.

Our service in Lanarkshire was set up for over 65s – other parts of the world that provide Hospital At Home can provide care from mid-teens onwards. The main conditions that we treat are delirium, infections of all kinds, wounds, dehydration, kidney injuries, falls, heart failure, CPD (COPD), and palliative care.

In terms of equipment, we can provide support that a GP would not be in a position to provide. For example, we can provide drips for dehydrated patients, heart traces, intravenous antibiotics, nebulisers and oxygen. We also help provide advice to GPs, which can be helpful when a patient needs a quick diagnosis as we can get test results back more quickly.

The benefits to patients

There is, of course, still an important place for hospitals, especially in the care of older people. We admit patients when they can’t be looked after at home and when patients themselves are not comfortable being treated at home, or able to get the care and support that they need. But the real benefits to patients of care at home are many. We’ve seen during COVID-19 the loneliness of hospitals, especially for older patients, when contact with relatives was not possible.

We know that many older patients worry that if they go into hospital that they won’t come out or will end up in a care home. We know that there’s an increased risk of confusion, especially when patients are moving between different wards, and the risk of falls goes up also. Older patients can become medicalised in hospital and bedbound, where at home they’re more likely to continue their day-to-day routines, getting up and about, which can help them to stay healthy.

The benefits of Hospital At Home are being seen by more and more NHS boards across Scotland. But it’s great to see Healthcare Improvement Scotland providing support to boards so they can understand the benefits of Hospital At Home and work to establish services of their own. Some are gradually growing the service while others are scoping out how they might put it into practice. After 10 years of Hospital At Home in Lanarkshire, we know that this can only be good for patients and families alike.

Dr Claire Steel is a consultant geriatrician working in the Hospital At Home service at University Hospital Monklands in NHS Lanarkshire.

More information

Visit the ihub website for more information our Hospital at Home work.

Categories: ihub

Training the AHP workforce of the future – Lynn Flannigan

Posted on January 25, 2021

Placements don’t just provide benefits for students, as Improvement Advisor Lynn Flannigan found out when she and Focus on Dementia colleague Stephen Lithgow supported Healthcare Improvement Scotland’s first ever Allied Health Professional student placements recently.

As a registered Allied Health Professional (AHP), I have a responsibility to support practice-based learning. That didn’t stop me feeling just a little apprehensive when my colleague Stephen Lithgow and I – both of us from our organisation’s Focus on Dementia team – were the first AHPs in the organisation to supervise a project placement for two MSc physiotherapy students.

It had been a long held ambition of June Wylie, our Allied Health Professional (AHP) Lead, that Healthcare Improvement Scotland would support AHP student placements. For the past few years June and a small working group of AHPs in the organisation have been working with Pete Glover from National Educational for Scotland (NES) and Dougie Lachlan Glasgow Caledonian University to bring this into fruition. In October last year, our first two students joined us for a four-week virtual placement.

Learning together

Once they joined us, it was not surprising to find out that our two students, Laura and Shelagh, were just as apprehensive as we were. For them, as physiotherapy students, it was nervousness at being on a placement that wasn’t clinical. For us, it was more about how we could make a placement effective when it was being conducted virtually, as well as how much time it might take on top of the day job. On top of that, for Stephen as an Occupational Therapist, it was whether supervising students from a different profession would work.

To mitigate this, we decided to adopt a 2:2 model of placement so that the two practice educators (Stephen and I) could support each other, and Laura and Shelagh could also support each other. We provided them with a project brief around involving carers in dementia care. The brief specified what outputs were expected and what learning outcomes we hoped to cover. A range of tutorials and interviews with stakeholders were set up in advance for the students which covered topics such as quality improvement methodology, dementia, physiotherapy contribution to dementia and involving carers.

Given the virtual, project-based nature of the placement, we had to give consideration to how Laura and Shelagh could achieve their learning outcomes in order to fulfill University standards. This included subject matter specific teach-back sessions, a case study example, a hypothetical physiotherapy quality improvement project and an evidence summary of their learning.

Making it work

While our initial concern was that trying to support placements virtually would be harder on all of us, in many ways the online technology such as MS Teams provided great benefits. We could link in with Laura and Shelagh daily for short sessions, and they could access a range of staff from across Healthcare Improvement Scotland, wider stakeholder and carers, which gave them a real breadth of experience.

Where we did have a challenge was around the assessment forms, which were still designed for clinical placements. We got round it by creating a case study based on the experience of a person living with dementia during the pandemic, and we built questions around that to help assess Laura and Shelagh’s clinical reasoning. Laura and Shelagh provided us with really positive feedback about how the placement helped them gain an understanding of dementia, physiotherapy interventions, specific issues relating to informal carers for people with dementia, and the QI methodology. We were able to observe their learning develop around quality improvement and how to use tools such as aim statements, driver diagrams and logic models. I think they will take that quality improvement experience with them and incorporate it into their future clinical practice – very few students get that kind of experience.

Everyone’s a winner

From Stephen and I’s perspective, we didn’t feel the placements were too onerous in terms of time, especially as we had so many willing volunteers from across the organisation to help out! For us as practice educators, it also helped support our on-going professional registration, refresh our supervision skills and our subject matter knowledge and skills.

For Healthcare Improvement Scotland more widely, the four weeks we spent working with Laura and Shelagh has tested the concept of student placements within the organisation, and now we plan to expand placement to other AHP groups and nursing colleagues are developing models to support nursing placements. The vision is that all AHPs within the organisation will support student placements and education in some way in future, and we hope to explore other models such as split placements with NHS Boards clinical sites and other national bodies. Providing student placements for AHPs brings so many benefits, including building quality improvement capacity and capability within our future health and social care workforce, raising awareness of non-traditional career pathways for AHPs and enabling AHPs in our organisation to maintain their registration and supervision skills.

It was great to dust off the cobwebs and be supporting students again. It was a very rewarding experience which Stephen and I would fully recommend.

Lynn Flannigan is Improvement Advisor with the Focus on Dementia Team of Healthcare Improvement Scotland.

More information

Visit the ihub website for more information our Focus on Dementia work.

Categories: COVID-19 blogs

Living with Long COVID – Mabli Godden

Posted on December 18, 2020

Ten months ago, Mabli Godden couldn’t imagine how much her life was about to be changed by COVID-19. But now, as one of the many people experiencing the effects of the virus, she is trying to recover, as well as helping Healthcare Improvement Scotland develop the first UK guideline on Long COVID. In our blog, she tells her story.

In March of this year I was the most active I have ever been: commuting from Glasgow to Edinburgh daily for work, running two youth arts programmes, cultivating my own arts practice, lifting weights regularly, taking care of an active dog and all the typical things someone in their late twenties and early thirties might do with their lives.

But this was all brought to a very abrupt halt when I got ill – at the most inopportune time, with a million deadlines looming. I was bed-bound for nearly a month. Although I couldn’t access a COVID-19 test (they were only for those in hospital at this point) my GP diagnosed me, with a strong clinical suspicion, as being one of the many people to have been affected by the pandemic virus.

I attempted a phased return to work, though it became clear very quickly that large swathes of my job were no longer possible for me. As I work in the Arts, I lost most of my work due to the struggles of the industry, but I would have been unable to continue because of my health. It’s now December, and COVID-19 is still with me. I have had to adapt to a ‘new normal’, one that shifts each day: going from being a busy and active person to struggling to do the simplest of tasks has been incredibly difficult. Working with Healthcare Improvement Scotland to develop a clinical guideline on an emerging condition has helped me gain back some agency, and the guideline we have put in place will hopefully support others to gain that agency and healing as well.

Symptoms and support

My Long COVID symptoms have been bizarre and varied; the only thing that has been consistent is the crippling fatigue. Most days I sleep for between 12 and 20 hours and have done since March. I had a period of respite, where the fatigue was my only symptom from late April until late May and then I began to develop severe muscle and joint pain, brain fog, shortness of breath, chest pain, dizziness, exacerbated migraines, Raynaud’s and skin issues— among other things. The symptoms come in waves and often seem illogical and unconnected: they leave me deeply frustrated, upset and isolated. I am not an angry person and yet some days all I want to do is shout, but there is rarely enough air in my lungs to do so.

My anger abates somewhat and sometimes, now that better days become more frequent. I am slowly but surely starting to heal: my victories are small, a 20-minute walk where I only use my inhaler once, but they’re victories nonetheless.

I am lucky in that throughout this experience I have had a strong support network of family and friends – they have supported me practically, emotionally, physically, and, when needed, financially. I am very aware, though, that many people with Long COVID do not have these things, and struggle without enough support. I am lucky – and yet this is still one of the hardest things I have ever done.

Using my experience to help others

As part of the Expert Advisory Panel developing the UK-wide guideline for the treatment of Long COVID I attended multiple digital meetings to discuss the wide-ranging needs of Long COVID patients, and how these needs might be effectively addressed and treated by the NHS. Waiting to be ‘let into’ the first virtual meeting with SIGN (which is the part of Healthcare Improvement Scotland that develops clinical guidelines), NICE and the RCGP, was somewhat akin to the first day at a new school, but I was delighted to find that the meetings were open and welcoming with all voices listened to and treated as equal.

Myself included, there were five lay members on the panel (patients or carers of patients), we were there to represent the patient voice and discussed our own experiences and opinions alongside our perceptions of the wider patient voice and opinion. The guideline has also been sent out to various patient groups for comments, so a wide range of patient voices have been heard.

We acknowledge, as well, that Long COVID is ever-changing and not yet fully understood: this version of the guideline will not be perfect, things will change as more research happens, patient voices of their varied experiences are heard and discoveries are made. That is why it is a ‘living guideline’, this is not the final version and amendments will be made as and when they are found or required.

I am 10 months into this experience and am more exhausted than I thought it was possible to be, but I am starting to see the light at the end of the tunnel: these guidelines acknowledge us as a multi-need patient community who require personally-catered support. That person-centred and catered support may well be the turning point for our care as individuals and hopefully these guidelines establish a path to better health for Long COVID patients as a collective.

Mabli Godden is a Glasgow-based Theatre Practitioner and Community Artist and was a member of the Independent Advisory Expert Panel for the development of the UK guideline on the long-term effects of COVID-19.

To access the full guideline and the patient version, click here: www.sign.ac.uk.

Categories: Uncategorized

Listening to understand: learning from an unpaid carer – Alan Bigham

Posted on December 10, 2020

As part of the Scotland-wide Carers Wellbeing Campaign, Alan Bigham, Senior Programme Manager with Healthcare Improvement Scotland’s Transformational Redesign Team, reflects on his own role caring for his father.

Something that’s still fresh in my mind from when my mother was still alive, is my dad showing me something from one of the Sunday papers, an article about ‘carers’.

“This is me now for mum,” he told me.

Now, it’s me for him.

Our awareness of what caring is, and what we mean by carers and unpaid carers can vary and changes over time. It can lead to assumptions being made if we are not clear in our language. Even those of us who are in a caring role, to any extent, may not always grasp what the role is.

I live an hour away from my dad and although I visit regularly, a year ago I would not have considered myself a carer because I’m not there all the time. This year has changed that quite significantly.

On the same week my brother’s family returned to Australia, my Dad became very unwell, deteriorating physically and mentally over a number of weeks. The system didn’t ‘kick in’ and I had to become a full time carer. This happened during a period of planned leave for me, but for those four days I got an insight into what a day might look like for an unpaid full-time carer. I managed to arrange care for when I returned to work, but I returned from leave more exhausted than I was when I had finished.

Sadly, Dad’s condition deteriorated and he was hospitalised. It was only then that his needs were assessed and at the discharge process that the right level of care was put in place. Did this now mean I was no longer a carer? No, I am. It has just changed what the extent of my role was – something it took me time to realise.

**Alan’s Dad with Alan’s niece Cora and nephew Callum**

Making the time for care – and self-care

For those of us working in Healthcare Improvement Scotland and the wider NHS, person centred care is a strategic priority. But what do you do when the person doesn’t want the care? Whether it was social or health-related, if you value the individual and believe in their right to self-determine, where does this leave you when they refuse everything until a crisis situation occurs?

The feelings of failure and guilt are difficult to shift. I’ve learned this is not uncommon. The same feelings also transfer to work, where the impact of a caring role, even remotely as I am now, affects your ability to focus and concentrate, to balance being responsive to the person you care for against what you are employed to do.

Fortunately I’ve found my managers to be extremely understanding and flexible, as are colleagues across Healthcare Improvement Scotland. But – and this takes me back to the point about assumptions, both my own and those of other people – it was only when I described what was happening on a daily and weekly basis that I really articulated what I needed both for the person I care for and my own wellbeing. ‘Protected lunchtimes’ if you will.

Only this week, someone referred to me as a carer. What they reflected back to me was that the time I was setting aside for a lunch break, to prepare and eat lunch, get some exercise and make that vital call to my father wasn’t just a lunch break. It was a break for caring too. No wonder the 30-60 minutes set aside for this wasn’t working. The calls alone are typically 30-60 minutes. My work calendar is now populated with ‘lunch and carer time’ each day.

Golden opportunity to hear – and improve

If you have a caring role you should consider what your needs are. As a good friend has often said to me, “You can’t pour from an empty cup”. We can each know what we do, but much of it is unseen by others, including the mental and emotional toll. The cup needs to be refilled and you and those around you will know best how to do that.

We have an opportunity in Healthcare Improvement Scotland to listen, really listen, to each other and to the people we work with so that changes can be made and people are supported before crisis point. That means some really tough questions about policy and practice, as well as considering what ‘managerial discretion’ really means in policies – what it could limit just as much as what it can and does achieve.

We are in a privileged position to be seeing and understanding the experience of unpaid carers. We have a golden opportunity to consider how we hear those voices now and what that means for what we do, what we produce and how it is implemented and evaluated in the health and social care system.

By listening to others, truly listening, we can identify and challenge our own assumptions that we might not even be aware of. Sometimes it’s just being listened to that can make all the difference.

Alan Bigham is a Senior Programme Manager with Healthcare Improvement Scotland’s Transformational Redesign Team.

Further information:

If you or someone you know would benefit from support as a carer you can contact Care Information Scotland online or phone 0800 011 3200 to find out about support available.

Phone lines are open Monday to Friday 9.00am to 5.00pm.

Categories: COVID-19 blogs

Take action to benefit from the Act – Karen Mackenzie

Posted on November 17, 2020

Think that that email about workforce planning and legislation doesn’t apply to you as an Allied Health Professional? As part of Healthcare Improvement Scotland’s Healthcare Staffing Programme, Karen Mackenzie advises holding fire with the delete button.

How many times a day do you hit the delete button if you think an email isn’t for you? In my busy clinical role as a NHS Scotland Speech and Language Therapist, I’d often skim over emails that dropped in to my inbox with the words “legislation”, “workload” and “workforce planning” in the subject field. Surely that information was for managers or executives? My experience was that clinicians on the ground didn’t have any involvement in workload and workforce planning.

In 2019 I attended a Royal College of Speech and Language Therapists (RSCLT) Scotland Hub event that completely changed my perspective…and stopped me hitting that delete key. As a clinician with 14 years of experience in a range of settings where Allied Health Professional (AHP) services often struggled to meet service demand with a limited resource, the Health and Care Staffing Act (Scotland) 2019 got my attention. And like many of my colleagues, I had a lot of questions. What do I need to know? How is this going to affect my team’s day to day work? Can we get any support with this?

Not just for nurses

For a start, I found out that this legislation is not just for nurses. It applies to all Health and Social Care staff groups. What’s more, the Common Staffing Method and General Duties enshrined within the Act could change the face of AHP workload and workforce planning, helping us ensure that we have the right people in the right place at the right time to deliver safe, high quality person centred care.

While the Act does not impose minimum staffing levels, all NHS Scotland Health Boards will have a legal duty to ensure that they implement the General Duties of the Act. For AHPs, this means several things. First of all, our professional judgement matters when it comes to making decisions about staffing numbers and skill mix. As clinical leads for our services, we can help shape vital decisions around staffing. And even if you’re not the lead, your thoughts matter when it comes to workload and safe staffing. Every team should have a process that allows them to decide on a daily basis whether their service is “safe to start” based on available staff. That way, the impact of staffing numbers and skill mix on quality of care will be made clearer. Furthermore, when clinical staff identify risks associated with reduced staffing levels, there will be clear, easily accessible processes for mitigating and escalating these risks.

From deleting to developing resources

I’m now an Assistant Programme Advisor with Healthcare Improvement Scotland’s Healthcare Staffing Programme. I’ve come a long way from hitting the delete button. I work in partnership with people from a range of health and social care professions to help them understand what they need to do to get ready for the enactment of the legislation. The team I’m part of also develops tools and education resources to help our stakeholders measure and plan their workloads and capture the quality of patient care and staff wellbeing.

We’re talking to everyone from AHPs to care home staff, and in the current pandemic we have supported teams with simple solutions to real time staffing assessment. For example, our team members worked with our stakeholders and the Scottish Government to develop simple Safety Huddle and Professional Judgement templates that can be used in a variety of settings, including care homes, to assess real time staffing and risk on a daily basis. Over 1000 Care Homes across Scotland registered to use the safety huddle template. We collaborated with our colleagues at NES Digital to further develop the Care Homes Safety Huddle into a digital resource on Turas. We also work with Workforce Leads from NHS Scotland boards to ensure that they have the right knowledge, skills and training to support Health and Social Care staff to embed the duties of the Act. The clinical voice of a wider range of professionals is a welcome addition to the support we offer and the resources that we develop.

So the next time you see an email with the words “legislation”, “workload” and “workforce planning” in the subject field, don’t just hit delete. It could hold the key to making your team safer, stronger and ready for anything.

Karen Mackenzie is an Assistant Programme Advisor with Healthcare Improvement Scotland’s Healthcare Staffing Programme.

Find out more

Check out our webpages on the Healthcare Improvement Scotland website

Speak with the Workforce Lead for your NHS Board area for information and suggestions on how you can get involved.

Categories: COVID-19 blogs

Patients benefit from moving vital work to a virtual space – Daniel Cairns

Posted on November 4, 2020

When the pandemic arrived, routine decisions on the status for Scotland of newly licensed medicines were paused. Daniel Cairns of Myeloma UK, Scottish Cancer Coalition’s representative on the SMC Public Involvement Network (PIN) Advisory Group, explains how moving one of Healthcare Improvement Scotland’s biggest and most complex meetings into a virtual space, allowing vital decisions to be made, has been welcomed by patients.

Access to new medicines is a vital part of a cancer patient’s journey. As a patient advocate, I represent patient views, insight and experience on new medicines, and help to feed that insight into the work of the Scottish Medicines Consortium (SMC) as they look to make recommendations for newly licensed medicines, including those for cancer patients.

Cancer medicines are a large part of the work for the SMC. When the pandemic arrived, it was understandable that parts of the SMC process had to pause as Healthcare Improvement Scotland helped to tackle the challenges posed by the pandemic.

Whilst we were all disappointed for patients, we were not surprised that the work of SMC was paused, since a large part of both the committee membership and SMC staff is made up of healthcare professionals who were needed elsewhere to help with the pandemic.

With continued uncertainty as to when face-to-face meetings will be able to begin again, I was heartened to hear that SMC had found a way to restart its confidential meetings by moving them online.

The benefits of moving SMC online

It feels like every organisation in the country has been given a crash course in online working. With that in mind, a virtual meeting format was almost expected to be rolled out for SMC, and the Scottish Cancer Coalition is very happy that this has happened. The work of SMC is vital in enabling patients in Scotland to access potentially lifesaving new treatments and extending access to existing treatments.

We are pleased that the work of the SMC has now fully resumed and are keen to work in constructive ways to help develop new ways of working which minimise any delays in access to new medicines due to the pandemic. I have been involved in informing some of this work through my participation in the SMC PIN Advisory Group.

Running smoothly

Between its pause and restart we were kept informed on the situation by both the SMC Public Involvement Team and the Scottish Government.

I recently took part in one of the first virtual Patient and Clinician Engagement (PACE) meetings, followed by the second ever virtual SMC Committee meeting in September. There was plenty of preparation given before each meeting. When we were notified of the PACE and SMC committee meetings, there was a helpful briefing detailing what to expect from the virtual meeting, together with some virtual meeting etiquette.

Alongside this, the Public Involvement Team were always on hand and happy to meet virtually to discuss any questions that I had. This was useful for me preparing for my first meeting.

Both the meetings I attended ran smoothly. There were no significant technical issues. The chair of the committee meeting was in good control over the virtual platform, allowing ample opportunity for patient organisations to contribute to the discussions around the appraisal.

The meetings were relaxed and easy to follow, with clear instructions from the SMC team. All of the attendees were courteous and we were given plenty of breaks to refresh our coffees and continue with each section of the meeting.

Could virtual meetings be the future?

I think virtual meetings certainly have a place in the future of the SMC. This kind of meeting is good for Patient Organisations who are based more remotely. It is also especially significant for PACE/SMC meetings when a patient organisation nominates a patient or carer to attend and speak about their own experience. Cancer patients have to take each day as it comes depending on how their illness or treatment is affecting them. It would be a huge advantage for patients to be able to contribute from the comfort of their own home instead of journeying in to attend a meeting in person.

That being said, the pandemic has had an impact on the third sector with many patient organisations restructuring due to huge losses in fundraising. Unfortunately, this may impact on the ability of some patient organisations to participate in health technology assessments.

As new treatments are such a vital part of myeloma patients’ outcomes, we remain committed to working with the SMC and the Scottish Cancer Coalition to ensure that these new treatments are delivered to patients.

Clearly, a great deal of hard work and dedication from the SMC team has gone into finding an innovative solution to the problems raised by the pandemic. The virtual meetings have so far been a success and it is brilliant for patients that the work of the SMC is continuing.

Daniel Cairns is Patient Advocacy & Policy Officer with Myeloma UK, a member of the Scottish Cancer Coalition and a member of SMC’s PIN Advisory Group which sits within Healthcare Improvement Scotland.

More information

Find out more about the SMC

Categories: COVID-19 blogs

Taking a vital meeting from actual to virtual – Lindsay Lockhart

Posted on November 2, 2020

How do you take a complex committee meeting and make it work online? Scottish Medicines Consortium’s Public Involvement Advisor Lindsay Lockhart explains how they successfully took one of Healthcare Improvement Scotland’s biggest and most vital meetings virtual.

So you think you’re pretty good at managing virtual gatherings – team meetings, drinks with friends, quiz nights with the family. But then you’re asked to get involved in setting up a really complex, really important committee meeting. Cue a sharp intake of breath.

Meeting the need

The Scottish Medicines Consortium (SMC) monthly committee meetings are the centrepiece of our work – and one of the largest, most complex and vital meetings in Healthcare Improvement Scotland. They’re the moment when everything comes together, in one large room, with lots of different stakeholders present, and complex decisions are made by committee members on whether medicines should be accepted for use in NHSScotland.

Well, that’s the way it used to be. Then COVID-19 happened. In March 2020, with agreement from Scottish Government, some of the work Healthcare Improvement Scotland does was put on pause. For SMC, that meant all our meetings, including the New Drugs Committee (NDC), Patient and Clinician Engagement (PACE) meetings and SMC Committee meetings, were suspended. Many of the SMC team were redeployed to working on frontline NHS services. By May, while many of SMC’s pharmacists and clinical staff were still needed elsewhere in NHSScotland, we started to plan our business recovery, something that was vitally important to ensure any further delay on decision-making and patient access to new medicines was minimised.

It quickly became obvious that we couldn’t meet in person for the foreseeable future. Urgent work had to be done to reinstate SMC’s meetings securely and professionally, avoiding reputational risk. We had to get this right for all stakeholders – committee members, patient groups, public partners, industry representatives, and members of the public.

A new role to help roll out a solution

Stepping out of my day job (and comfort zone) as SMC’s Public Involvement Advisor, where my role is to ensure the voices of patients and carers are heard as part of the assessment of new medicines, I became part of a small team with Ailsa Brown, our Lead Health Economist, and Rosie Murray, our Admin Manager. We undertook a rapid review of the options and quickly established that NDC and PACE meetings could be held virtually with Microsoft Teams.

To make this work, the staff who organise and assist at these meetings and liaise with external stakeholders had to become ‘technical hosts’ almost overnight. The speed with which we all learned how to manage meetings in this way was impressive. After a ‘mock’ NDC was held to iron out any technical issues, a virtual meetings protocol and etiquette document was produced. Thanks to the commitment of everyone involved, we were able to successfully reinstate NDC and PACE meetings in June and July respectively.

NICE to (virtually) meet you…

Then came the real challenge. The SMC Committee with its various complexities – confidentiality of information, public gallery, closed sessions with no public or external attendees, private voting by ballot – demanded more research … and quickly. Working with NHS National Services Scotland (NSS), it was established that the current roll out of MS Teams across Healthcare Improvement Scotland did not, at the time, provide sufficient functionality. While this is likely to change in future, for the short term, another solution was needed.

Through other COVID-19 related work, we knew colleagues in NICE were using the Zoom platform for their health technology assessment committee meetings. They had chosen to take this route long before COVID, following a full option appraisal and two years’ work to introduce virtual meetings for sustainability, cost and environmental reasons. With agreement from the Healthcare Improvement Scotland Executive Team, it was agreed that Zoom was the best option, in the short term, to allow its committee meetings to be reinstated quickly and efficiently. This included support contracted from NICE and their virtual meetings team, which provided us with the benefit of their experience and excellent knowledge.

Early discussions identified key requirements for SMC including licences, dedicated technical/digital support, testing and training for committee members and staff, production of guidelines, slides, corporate visual backdrops and branded meeting communications.

The complexities of committee

We also had to consider amending some processes to match the technology, for example, how committee members could vote in private. With six medicines on average discussed at each meeting, committee members used to cast their vote at the end of discussion for each medicine. With Zoom, this couldn’t be done without moving committee members in and out of a break out room for each individual private vote. The answer was to ask voting members to note their vote for each medicine and then cast their votes for all medicines privately once the public part of the meeting was over.

Slides to complement presentations were introduced. Non-committee members could follow the discussion using the slides instead of receiving a set of redacted Detailed Advice Documents (DADs) for each medicine. More staff were required to manage waiting rooms and break out rooms, and to keep an eye on technological hiccups so they could be quickly resolved. And then…we were ready.

Opening night nerves – and the importance of audience feedback

Our first SMC Committee meeting using this new method took place on Tuesday 4 August. SMC’s reputation – and indeed, that of Healthcare Improvement Scotland – was at the forefront of everyone’s minds so there was an element of ‘opening night nerves’ for all of us. Everyone had their own roles and responsibilities to ensure the meeting went well, and it did.

A debrief highlighted things which the team felt they would do differently for future meetings. Feedback from attendees also helped identify anything else which may have to be reviewed, so it was important to follow up all virtual meetings – NDC, PACE and SMC Committee – with an online survey for all attendees.

Feedback from the first meetings has been very positive, with all participants rating the overall experience of attending virtual meetings as being ‘very good’ or ‘good’. The majority of attendees found the technology ‘very easy’ or ‘easy’ to use and there has been a positive response to slide presentations. Clarity of communication from presenters/speakers has been commented on, with some attendees preferring virtual meetings.

Becoming experts

It’s early days, but they say practice makes perfect. Fortunately our virtual meetings team are fast becoming experts in the technology which will need to be a feature of all our work for some time to come. And with Rosie, Ailsa and I back in our “day” jobs, plans for future meetings are now in the very capable hands of SMC’s Operations Manager, Donna Leith, who has recently returned from maternity leave.

Still, it’s been said that everyone should acquire some new skills during lockdown. I’d like to think I know more now about virtual meeting technology than I did a few months ago … that and how to cut my husband’s hair!

Lindsay Lockhart is a Public Involvement Advisor in Healthcare Improvement Scotland’s Scottish Medicines Consortium (SMC).

More information

Find out more about the SMC

Find out more about SMC’s role in our Evidence Directorate

Categories: COVID-19 blogs

Virtual events: feel the fear and do it anyway – Stuart Donald

Posted on October 26, 2020

The last eight months have seen Healthcare Improvement Scotland’s wealth of events and meetings move from actual to virtual. As someone used to delivering workshops face to face – despite an early fear of speaking in front of large groups – Interim Portfolio Lead for Strategic Planning Stuart Donald offers us some food for thought.

Earlier this year, on my way to deliver a fairly typical workshop in a fairly typical conference room, I started thinking about my early experiences of speaking in front of large groups of people. As I’m sure is the case for most of us, this involved getting up in front of my high school English class and talking for five minutes about whatever generic topic our teacher could think of. Being an awkward, ridiculously self-conscious teenager, it wasn’t the most enjoyable experience I’ve ever had – particularly when it got to the point of panic attacks and vomiting.

If you’d told that kid that twenty odd years later he’d end up speaking to large groups of people for a living and that he’d actually enjoy it and be pretty good at it, he would probably have laughed in your face. Then vomited again.

Cutting a very long story short, over time and with a load of trial and error, the sheer terror of speaking to large groups of people gave way first to an ability to tolerate it, then to enjoying it and ultimately to approaching a level of competence. The nerves and self-doubt never go away, you just find ways to use them positively.

The point is that often the only way to take the fear out of something is to just get on and do it, that way you learn what works – and what doesn’t.

The days of getting a group of people into the same room to discuss, debate, share ideas, collaborate and generally put the world to rights might be a long time returning. For those of us whose work largely revolved around doing exactly that, we’ve had to figure out how we do it in an inclusive, yet physically distant way.

As Healthcare Improvement Scotland is an organisation that’s all about finding out what works well and what can be improved, a small team of us have pulled together learning from across the organisation to help us all get better at collaborating virtually. Here’s some of what we’ve learned.

Accept that it’s not the same as face to face

We’ve all experienced the joy of sitting staring at a blank flipchart while nobody answers the facilitator’s questions. Or the awkward ‘introduce yourself to the rest of the room’ and ‘share an interesting fact about yourself’ ice-breaker. Do we really need to recreate that virtually? I really, REALLY hope not.

Everyone knows the way we work now and in the future is going to change, so we need to adapt and maybe move out of our comfort zones a bit. For example, why do you need to run a virtual workshop ‘live’? Could you get the same, or better, outcomes by setting some sort of challenge to people and giving them a set time to complete it? Naturally there’s going to be risks and benefits to doing that, but that’s true of running something live too – if it’s going to achieve the outcomes you’re working towards, just do it.

Don’t be limited to one way of working. Try things out, keep doing what works, stop doing what doesn’t. By focussing on outcomes and the needs of our participants, we can design effective interventions that work for us.

How will you make sure everyone can participate?

Any time we run any kind of meeting or event we should always be thinking about accessibility. Virtual collaborations are no different. For example, you don’t need to be thinking about physical access to a venue, but you do still need to think about things like how people with sensory impairments can participate.

It’s important to remember that accessibility also means your participants having access to technology and the confidence to use it. As we get more and more used to communicating virtually, we need to make sure we’re not putting up unnecessary technological barriers for our participants as well. For example, do you know if some people might have to join your session using a smartphone rather than a PC or laptop? How does that change the experience for them? What do you need to do to make sure they can still participate?

It’s a team effort

You could certainly try and run a virtual meeting or event yourself, but I wouldn’t recommend it! What if your technology fails, the cat jumps on your keyboard and disconnects you from the session, or a child really must tell you RIGHT NOW all about the episode of Paw Patrol they’ve just watched? Take it from me, these things happen…

There are lots of eventualities and you can’t always prepare for them all, but as a minimum a good virtual session needs a delivery team. This includes someone to lead and facilitate the session, a backup facilitator, someone to monitor the chat box and respond to comments or flag them to the facilitator and someone who can support participants who need any extra help or IT troubleshooting (and potentially, someone who can provide 1-2-1 support throughout to anyone who couldn’t otherwise participate). The bigger the meeting or event, the bigger the delivery team you’ll need. In Healthcare Improvement Scotland we’re very fortunate to have so many talented and helpful colleagues to help deliver virtual meetings and events, so make the most of them.

Share your learning

As with everything we do, we should be seeking feedback and learning to help us improve for next time. Ask your participants, have a debrief amongst your delivery group, be honest with yourself about what worked well, what could have been better, and what you would do differently next time. Then share those insights with everyone else.

I’m not going to lie, I really miss presenting to a room full of people. The thought that it could be six months or more before I get to experience that buzz again is a bit sad. Delivering things virtually is definitely a different thing altogether, but it’s been great to learn about how as an organisation we’ve already started to embrace it, and to help pull what we’ve learned so far into something we can all keep building on.

Stuart Donald is Interim Portfolio Lead for Strategic Planning, within the Transformational Redesign Unit in the ihub

More information

For more information on the work of the Transformational Redesign Unit visit the ihub website.

Categories: COVID-19 blogs