Posts tagged “COVID-19”

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

Posted on August 6, 2020

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

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

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

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

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

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

The issue of COVID-19 and antibiotics

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

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

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

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

Emerging from lockdown

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

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

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

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

@jacquisneddons @SAPGAbx

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19

From making meals to buying them: Volunteering during COVID-19

Posted on July 8, 2020

Supporting people lies at the heart of our Community Engagement Directorate, and for many of our staff, that’s true both inside and outside their working hours. Here, Admin Officer Susan McLaren tells us how her role volunteering with older people has changed during the current pandemic – and why she now recognises the importance of the humble chocolate teacake.

Helping hand

Before I started working as a volunteer, I had no idea of the importance of chocolate teacakes in Scottish society. To me, they were just another biscuit – the one I get offered with a cup of tea each time I give blood. Now I know differently.

Eighteen months ago, when teacakes were the furthest thing from my mind, I started volunteering as a meal maker for a charity called Food Train. In my day job for Healthcare Improvement Scotland’s Community Engagement Directorate, I support my team to engage with people across Scotland and get them involved in health and social care. Community matters to me, and that doesn’t change when I stop working, which is part of the reason I volunteered. As a meal maker, I was paired with an older person in the community called Helen and cooked a nutritious (and hopefully tasty) meal for her once a week.

“In my day job for Healthcare Improvement Scotland’s Community Engagement Directorate, I support my team to engage with people across Scotland and get them involved in health and social care. Community matters to me, and that doesn’t change when I stop working, which is part of the reason I volunteered.”

Then the virus hit and lockdown happened. I quickly realised that Food Train would have a lot of extra demand for their shopping service but may be experiencing a reduction in numbers of their regular volunteers. They’ve been going since 1995 and recently celebrated their 25^th anniversary, but have never experienced anything like this. A quick phone call and I was approved to help with the supermarket shopping service. Now I and a team of four or five volunteers are up and out with the lark three days a week to do shopping for about 140 vulnerable people in my community – all before I start the day job.

Simplicity is the key to shopping for others

When I first started the shopping role I was a bit unsure what to expect, but the co-ordinator for my supermarket shopping was really welcoming and explained in detail how it all works. As with the best things in life, simplicity is key. I am given the shopping list, do the shopping, pop it into crates (that have been sanitised, of course) and it’s then delivered by volunteer drivers throughout West Lothian.

Of course, it’s not always straightforward, especially when things aren’t avaiIable. I now understand the dilemma facing supermarket staff doing the pick for online shoppers – to substitute or not to substitute, that is the question! Luckily all the volunteers are willing to help with suggestions on this – it’s real team work. The one that did stump us for a while, though, was those chocolate teacakes. We had so many shopping lists given to us that contained them that when the factory at Uddingston closed and the shelves were bare we really struggled – I’m sure there were a few disappointed faces when the deliveries arrived. Apparently nothing beats a chocolate teacake with a cuppa! Fortunately production started back within a few weeks and we were once again able to meet the demand – phew!

Making a difference

Volunteering means an early start for me, shopping from 7-8 am (and that is after walking the dog) but the shop is usually quiet at that time and I also get to scope out all the bargains. I feel glad I’m able to help out someone who might be anxious about how they will manage if they can’t get out to shop for themselves. And as volunteers, the people we help have left us in no doubt just how much what we’re doing is appreciated. I recently received a note from one older person we’ve helped which read: “I was so worried about my food and shopping before you called me. Nobody could help me and I’m on my own. Not only do your volunteers shop for me but their wee visits really cheer me up. Wish they could visit every day”.

We’ve also had lovely surprised like a request on one shopping list for a box of chocolates for the Food Train helpers. This was lovely and totally unexpected but really brought it home how much this means. As one grateful daughter said “Knowing you can support my elderly mum is such a relief to me, you are all wonderful”. It’s very satisfying to know that my little bit of volunteering is making such a difference to other people’s lives.

“As volunteers, the people we help have left us in no doubt just how much what we’re doing is appreciated. I recently received a note from one older person we’ve helped which read: ‘I was so worried about my food and shopping before you called me. Nobody could help me and I’m on my own. Not only do your volunteers shop for me but their wee visits really cheer me up. Wish they could visit every day‘.”

Once COVID-19 is over and we’re all living in whatever the new normal will be, I like to think I’ll still be there with my shopping trolley, hunting out those teacakes. Whatever happens, I expect to still be making my weekly visits to Helen bringing her a tasty meal and having a bit of chat as well – it’s as important to her as it is to me. We’ve seen fantastic examples of community spirit during the pandemic lockdown and I look forward to seeing so much of it, not just in my day job, but by all of us, every day, all year round. It will be so important to help us all recover.

More information

You can find out more about the work of Food Train or Mealmakers on their websites: https://www.thefoodtrain.co.uk/ and http://www.mealmakers.org.uk/

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

Categories: COVID-19 blogs

Tagged: COVID-19

Long journey for travellers to have their voices heard

Posted on June 29, 2020

Community engagement is about everyone in Scotland having a right to take part in decisions about their health and wellbeing. But for some groups this is harder than for others. As part of Gypsy Traveller History Month, Community Engagement Officer Gillian Ventura tells us how important it is for this resilient community to have their voices heard.

Lockdown has been hard for everyone. Staying home, staying safe, doing your bit. It’s a struggle being cooped up when you’re in house with a garden. Imagine doing it when you can’t get things delivered to the place where you live. Imagine doing it when you’re part of a community where family is everything, but you can’t be within two metres of loved ones whose home you could touch if you just stretched out your hand. Imagine doing it when the land your home sits on is no guarantee of permanent residency.

As family and kinship are central to Gypsy / Traveller culture, the reality of lockdown has been particularly challenging. It can be difficult to maintain a two metre distance in a pitch which requires space for at least two caravans to accommodate one family.

“Due to discrimination, many Gypsy / Travellers won’t challenge the system anymore as they feel nothing is really going to change for their community. This means there’s little point in me knocking on doors on a site and asking them about their healthcare and what matters to them. The first step is building a relationship. And that takes time.”

Yet lockdown has simply highlighted the many struggles and inequalities that this community face. Helping to get those struggles voiced at the highest levels is part of my job as one of Healthcare Improvement Scotland’s Community Engagement Officers.

Taking time to engage

There are around 20,000 Gypsy / Travellers living in Scotland. Among them are groups as diverse as Romany Gypsies, Scottish Gypsies / Travellers, Irish Travellers and European Roma. Some will have arrived in the UK as asylum seekers and refugees, fleeing persecution. They all consider travelling and a nomadic identity as an important part of their traditional and contemporary culture. Recognised in law as a distinct ethnic group, they also have the worst health outcomes of any ethnic group, primarily due to poverty and discrimination.

Due to discrimination, many Gypsy / Travellers won’t challenge the system anymore as they feel nothing is really going to change for their community. This means there’s little point in me knocking on doors on a site and asking them about their healthcare and what matters to them. The first step is building a relationship. And that takes time.

I’ve been working with the Travelling community at the Swinhill site in Larkhall for two years now, supporting the work of NHS Lanarkshire’s Keep Well Team, nurses Heather Craig and Sandra Kelly. Gypsy / Travellers face a range of health problems at an earlier age than the general population and it’s important to reach them so they can get the right healthcare and support. They typically live 10 – 12 years less than “settled” people. They have higher rates of anxiety and depression and their suicide rate is six times higher than the general population – this increases to seven times for young Traveller men. Infant mortality is three times higher. Around 42% of Gypsy / Travellers are affected by a long-term condition, compared to 18% of the general population. People from Gypsy / Traveller backgrounds also engage later with health services and can often experience barriers accessing primary care as a result of living in unauthorised areas or moving frequently, having low levels of literacy and experiencing discriminatory attitudes.

“The input of the community and their leaders is vital to this work. There are some strong community leaders among the Gypsy / Travellers, and they play central roles in the Travelling Community Network at local, regional and national level.”

The key to engaging the community has been the site manager, Roy Overend. Roy has been at the site since 2003, and thanks to the great relationships he’s built up with the residents and the Gypsy / Traveller community in Lanarkshire, he’s helped us engage with them and understand the complexities of their community. The on the ground work done by Heather and Sandra has also been vital: by carrying out health checks, monitoring blood pressure, diabetes, addressing issues with mental health and wellbeing etc, they have built a rapport with the community. At first it was just the women from the site that went along, now the guys are coming as well. They all see the benefits and the advice they get opens the door for me to be able to do work around things like Realistic Medicine and What Matters to You.

What matters to them

Through the What Matters To You work, we found that the main issue for the community was accessing primary care services, in particular getting registered with a GP service when they are travelling, which is part of their culture. This work was shared with the Travelling Community Network and also with Scottish Government, to help raise the profile of the issues that matter to the community. Through this, we’re linked in to the Improving the Lives of Scotland’s Gypsy/Travellers (2019-21) action plan, launched by Scottish Government at the end of last year. The five key priorities are: provide more and better accommodation, improve access to public services, better incomes in and out of work, tackle racism and discrimination and improve Gypsy / Traveller representation.

The input of the community and their leaders is vital to this work. There are some strong community leaders among the Gypsy / Travellers, and they play central roles in the Travelling Community Network at local, regional and national level. One lady from the community within Lanarkshire assisted the Scottish Government Person Centred Care Team to develop GP Registration Cards. The Keep Well team worked with the community to promote the cards within Lanarkshire and the wider partners working with Gypsy Travellers.

The Blue GP Registration Cards are a pocket sized card promoting the right to register at GP practices. I’ve been encouraging their use by the community, asking them to keep a card in their pocket or bag so wherever they are, they know they can access GP services. Helping improve healthcare here is all about teamwork, and it doesn’t matter that people don’t know which organisation we’re from or who we work for. It’s about working together to ensure the community gets the health and social care support they need. We’re simply the people who can help them do that.

What matters to me

But this is not a quick job. Gypsy / Travellers enjoy and are proud of how they live – it’s the discrimination and lack of respect and resource that they get annoyed about the most. This lack of understanding from “settled” people can make it harder to engage with them – why should this time be any different? Yet building relationships, persevering, and, most importantly, understanding their culture will, over time, pay off, ensuring better health and social care not just for them but for everyone using local healthcare systems. At a time when Gypsy / Traveller culture is being compromised due to lack of site provision, it’s important to me that their voices are heard.

Gillian Ventura is a Community Engagement Officer with Healthcare Improvement Scotland

More information

Find out more about the Improving the Lives of Scotland’s Gypsy/Travellers (2019-21) action plan

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

Categories: COVID-19 blogs

Tagged: COVID-19

How the COVID-19 infodemic is changing the way we look at evidence

Posted on June 24, 2020

When COVID-19 struck, Scottish Intercollegiate Guidelines Network (SIGN) had an obligation to support healthcare professionals in Scotland with contextualised guidance on the diagnosis and treatment of a new and emerging disease. Angela Timoney, Chair of SIGN, explains the challenge of developing evidence-based guidance with very little high-quality evidence.

The scale and pace of the COVID-19 pandemic has presented numerous challenges to healthcare professionals. It has also presented a new type of problem for people who seek to aid health and care professionals by making sense of evidence. The so-called infodemic is almost a virus in its own right – the endless circulation of information and misinformation from many different sources and experts causing hope and confusion on an almost daily basis, and spreading with great speed through social media and 24-hour news. In fact, the World Health Organization has said that the infodemic around COVID-19 is almost as dangerous as the pandemic itself.

“The so-called infodemic is almost a virus in its own right – the endless circulation of information and misinformation from many different sources and experts causing hope and confusion on an almost daily basis, and spreading with great speed through social media and 24-hour news. In fact, the World Health Organization has said that the infodemic around COVID-19 is almost as dangerous as the pandemic itself.”

Some steady voices, including the Centre for Evidence-based Medicine and Cochrane, have helped filter this information overload, and Healthcare Improvement Scotland’s Evidence Directorateis providing expertise in evaluating evidence and highlighting the most reliable sources. Internationally, SIGN has been involved in a COVID-19 taskforce as part of Guidelines International Network to reduce duplication of effort. There’s lots of information – but is there evidence?

The need to adapt

Indeed, there is plenty of evidence – it comes thick and fast. But it’s not the robust evidence we need for clinical guidance. We like large, randomised controlled trials; currently, most evidence related to COVID-19 is retrospective and observational at best. It’s fast-moving, incomplete and often from populations that don’t always match with ours. This rapid pace of change means that, even with the best of intentions, outdated clinical guidance can actually do more harm than good.

Over the past 27 years, SIGN has developed an international reputation in producing highly regarded clinical guidelines. We have worked to a robust methodology during this time, but quickly realised that the lack of high-quality evidence related to COVID-19 wouldn’t fit this mould. Uncomfortable as it was, we had to adapt to ensure that our contribution would be meaningful and timely.

Initially, we worked with the National Institute for Health and Care Excellence (NICE) to learn from their development of rapid ‘living’ guidelines within one week. We also collaborated with the University of Glasgow to develop a rapid review to support colleagues in general practice.

“Over the past 27 years, SIGN has developed an international reputation in producing highly regarded clinical guidelines. We have worked to a robust methodology during this time, but quickly realised that the lack of high-quality evidence related to COVID-19 wouldn’t fit this mould. Uncomfortable as it was, we had to adapt to ensure that our contribution would be meaningful and timely.”

We are also supporting the Scottish Government’s COVID-19 Clinical Guidance Cell, a large multidisciplinary group acting on behalf of the Chief Medical Officer, Dr Gregor Smith, to develop rapid, high-quality guidance. Dr Smith recently acknowledged our role: “your willingness to collaborate has resulted in a process that is responsive to clinicians’ need for guidance. It will also ensure that Scotland’s clinical guidance will continue to be highly regarded, and provide our healthcare professionals with much needed support.”

Learning for the future

There’s a common word in all of this: ‘rapid’. In a short space of time, we’ve learned a great deal that we can apply to future guideline development, while retaining our reputation. It is easy to state that we must not ignore the good in search of the perfect, but in the middle of the storm the real challenge was determining not if it was good but ‘good enough’. History will determine if we got that balance right, but it feels that we have and this is reflected in feedback from others.

We’ve seen how guidance can be developed more quickly and without physical meetings, and we’ve also seen how our methodology remains valid; it is still necessary to have debate among multidisciplinary healthcare professionals and involvement from patient and public involvement groups and representatives.

Whether it is producing rapid guidelines, pinpointing where more research is needed or highlighting the most reliable resources, SIGN’s role in Scotland’s response to COVID-19 is vital –by sticking to our founding principles and robust methodology, we aim to continue to be a guiding light for healthcare professionals in Scotland throughout the crisis. We look forward to finding ways that we can take this knowledge and experience to benefit other areas of our work in the future.

Angela Timoney is Chair of Scottish Intercollegiate Guidelines Network (SIGN)

More information

Weekly updates on SIGN’s work throughout the pandemic can be found on the Healthcare Improvement Scotland website.

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

Categories: COVID-19 blogs

Tagged: COVID-19

(Not going) Out for Pride – Rosie’s story

Posted on June 17, 2020

Pride Month is about being out and proud. But while COVID-19 means we’ve all been spending more time inside, the LGBT+ community aren’t going to let a pandemic stop them celebrating, as our Equality and Diversity Advisor Rosie Tyler-Greig tells us.

June is Pride Month, when LGBT+ communities around the world celebrate the diversity and influence of LGBT+ people. Local organisers fill the month with events, headlined by Pride marches – loud, proud and colourful parades of LGBT+ people, our allies and our flags. We take over the streets for a few hours then spill into events and venues which centre and celebrate our love, our rights and the amazing versatility of glitter.

Pride started in New York in 1970 and spread round the world, arriving in Scotland in 1995. Each Pride marks the years following the Stonewall riots – three nights of unrest in June 1969, when LGBT+ people resisted arrest and victimisation during police raids on the Manhattan gay bar, the Stonewall Inn.

“Pride events not only celebrate the diversity of LGBT+ lives, but have raised awareness about issues facing the LGBT+ community”

From that inaugural moment of visibility and demand for equality, Pride events have not only celebrated the diversity of LGBT+ lives but have also raised political awareness about issues facing the LGBT+ community. They have kept a steady beat as the country has woken to LGBT rights – sexual decriminalisation in 2001, equal marriage in time for Christmas 2014, commitments to gender recognition for trans people last year.

Pride however looks a lot different this year. There is no flamboyance on our streets. Placard art projects are paused until Pride ’21. Celebrations have moved online, virtually re-imagined. For those who can get online, there has been an impressive offering of creative, educational and therapeutic spaces for LGBT+ people. With loneliness a particularly acute issue for LGBT+ communities, groups and organisations have had to adapt quickly to maintain that vital connection.

“When I go to the big Pride events, I’m genuinely proud. I know why I’m there. I really mean it when I raise my placard or wave a flag. And that doesn’t change when I join in from my sofa at home instead.”

***Rosie celebrating Pride Month at home***

I’ve enjoyed seeing more virtual events appear and being able to attend things I may not otherwise have got to. I’ve been reminded that it’s the connection we build and the conversations we have all year round that actually make each Pride an event. As a bi woman, the friendships I’ve made and the smaller year-round events I’ve attended have raised my awareness and given me a sense of having an identity to celebrate. I’ve also learned about my fellow community members and how to be an ally. When I go to the big Pride events, I’m genuinely proud. I know why I’m there. I really mean it when I raise my placard or wave a flag. And that doesn’t change when I join in from my sofa at home instead.

There will be future Pride parades. But in these locked-down times, my intention has become to nurture my pride by continuing to connect and learn with the LGBT+ community and improve my knowledge and support of LGBT+ lives, especially at the intersection of other identities. As Phyll Opoku-Gyimah from UK Black Pride says, ‘we have not achieved equality until every LGBT person, of every colour and background, is able to enjoy equality within our community and outside of it’.

The next time Pride is a physical event, flags and sparkle will make sincere statements about my identity and ally-ship. And in the meantime, I’ll tune in to the multitude of other ways to fly the Pride flag.

You can found out more about Pride events during June on Pink News’ Pride for All webpage Year-round events for the LGBT+ community in Scotland can be found on LGBT Health’s What’s on webpage

Rosie Tyler-Greig is an Equality and Diversity Advisor 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

Transitioning from quality improvement to a COVID-19 ward – Scott’s story

Posted on June 15, 2020

Scott Hamilton, Associate Improvement Advisor, was deployed back to the frontline as a nurse on a COVID-19 ward. He describes what it’s been like to manage the fear, connect with family and appreciate the many things that nurses do to make a difference.

On 17 February this year, I joined Healthcare Improvement Scotland’s Acute Care Improvement Portfolio as an Associate Improvement Advisor. Having completed the Scottish Improvement Leader Programme, I was excited to get stuck into my new improvement role at a national level.

Then, just a few weeks in, COVID-19 happened.

I’ve got over 20 years’ clinical nursing experience, from working in acute admissions at the front door to focusing on practice development, quality improvement and clinical teaching within older peoples’ care. I thought I’d seen plenty of what life throws at the NHS. I remember the SARS and flu outbreaks in recent years, but both now seem like a storm in a teacup compared to this. It is astonishing to see the speed with which this virus affects people, particularly the elderly.

Mentally, emotionally and physically demanding

Once the scale of the problem became clear, I was keen to go back to my previous team at the Royal Alexandra Hospital (RAH) in Paisley to help. Very quickly the ward I was on, ward five, became a designated COVID-19 unit.

The past 12 weeks have been the hardest challenge of my career.

When our first COVID-19 patient came in, my colleagues and I were anxious about what to expect. We were – and are – learning new ways of working in a new environment, all at speed and on the hoof. And it is demanding work. We’re dealing with situations we wouldn’t have thought possible. For example, in usual circumstances, we would be looking for oxygen saturation levels of 96-100%, but now we are accepting lower levels like 88-94% or occasionally even lower. Patients seem to do OK on that and it blows your mind as a clinician. But it is taxing mentally, emotionally and physically. We have to concentrate constantly on keeping ourselves safe by following the guidance on how to don and doff personal protective equipment (PPE) and keep it in place. The frequent hand washing is causing me some skin problems, and 12-hour shifts are something I’ve not experienced since 2008.

“I’ve got over 20 years’ clinical nursing experience, from working in acute admissions at the front door to focusing on practice development, quality improvement and clinical teaching within older peoples’ care. I thought I’d seen plenty of what life throws at the NHS. I remember the SARS and flu outbreaks in recent years, but both now seem like a storm in a teacup compared to this.”

New rules

Thanks to previous work by the Scottish Patient Safety Programme (SPSP), we are used to using the National Early Warning Score (NEWS) to help identify deterioration in patients. The system remains invaluable in clinical settings. However, In COVID-19 patients it is more about how the patient looks at a particular time based on their NEWS score. There is no broad standard for everyone – it is much more focused on goal setting and getting the right parameters for each individual’s care. We need to maintain existing standards and guidance and develop a complementary new rulebook for COVID-19 patients, because it’s so different.

Teamwork is outstanding

There is one thing that has remained very much the same, though – the teamwork. I work in a multidisciplinary team including nurses, student nurses, consultants, junior doctors, physios and occupational therapists. Thanks to a combination of strong leadership, teamwork, compassion and camaraderie, we’ve become tight and slick! Everyone has an essential role in dealing with COVID-19 patients, whether we are helping them overcome viral fatigue, connecting them with loved ones using technology (usually tablets) or treating various complications that they may be dealing with. The team is phenomenal – they are my NHS heroes.

This experience has shown us that when the motivation is there, amazing things can happen in a short space of time. There has been no adoption curve – everybody is moving in the same direction at the same time. It’s amazing what we can do. Frontline staff have been supported to be innovative and creative and the whole team has been able to contribute. I think we’ll need to re-scope the landscape – for example, treatment for older people looks different now. There has been so much invaluable learning and the NHS has done a tremendous job, now we need to keep sharing and spreading that learning.

“Everyone in my team has an essential role in dealing with COVID-19 patients, whether we are helping them overcome viral fatigue, connecting them with loved ones using technology or treating various complications that they may be dealing with. The team is phenomenal – they are my NHS heroes.”

Connecting with others

My wife Elaine, who is also a nurse, usually works in Practice Development however, due to the pandemic she has returned to work in the Queen Elizabeth University Hospital Intensive Care Unit. We’re working different shifts so we make the most of the one day a week when we can spend time together as a family, along with our three children.

Usually, you could describe our life as “pedal to the metal”, week in and week out. Lockdown has led us to reflect on what’s important in life and we have been spending our family time playing board games and walking outdoors together. We appreciate that time together a lot more now.

My two boys both had birthdays during lockdown. Our youngest, Matthew, turned 10 and had a virtual party on Zoom. Using the internet has been essential to connect all of us, not just with each other but with the wider world so we can do things we took for granted before. For example, both my mother in law and sister in law have both used NHS NearMe for medical consultations. For me, it’s meant I can learn from my Healthcare Improvement Scotland colleagues through a webinars that share learning from those using the service. It’s been interesting to see these things from both sides.

This experience has made my introduction to Healthcare Improvement Scotland interesting, to say the least I can’t wait to get back to that role, but I would not change the experience. I’m so proud to be a nurse. The leadership, teamwork, connecting patients and their families – it’s all the little things that nurses do that make a difference to patients, families and the whole NHS team.

Scott Hamilton is an Associate Improvement Advisor with the ihub’s Acute Care team.

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19

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