Devices and data – keeping Scotland connected – Wendy McDougall

Posted on October 2, 2020

During lockdown, those people who were digitally excluded became even more isolated. Wendy McDougall, Engagement Officer in Healthcare Improvement Scotland – Community Engagement explains how her team helped keep people connected.

When the world went into lockdown, our lives moved online – even accessing health and care services was online, along with grocery shopping and only being able to see loved ones through a video call. As a result, the Scottish Government quickly implemented a £5million initiative called Connecting Scotland to get 9,000 vulnerable households online. The idea being that those who are most vulnerable across our communities will be provided with a device or training that enables them to connect with health and care services, as well as other people in their community and family that may be further afield.

There were eight teams working across the country on the Connecting Scotland initiative and our role was to find community venues that could be used for training on how to use digital equipment and distribute the devices, should they be required. We were an important part of a big jigsaw!

To do this, each engagement office across the 14 NHS board areas spent a number of weeks contacting their local third sector and community group networks. This was a great opportunity for me as a new recruit to pick up the phone and, not only introduce myself as the new Engagement Officer for Forth Valley but, more importantly, actively listen to the challenges that are sadly being faced by people living in poverty and the resulting barriers they can face on a daily basis.

Over 60 community groups were contacted in the Forth Valley area alone and we still managed to make a number of new connections ranging from the Church of Scotland to bowling clubs. The conversations had such a positive impact on me, highlighting that organisations and volunteers were willing to do anything within their power to help others. It was so insightful being in a position to witness a strong sense of community spirit and strength in practice.

Another team was responsible for identifying those who were eligible for devices and data. To be eligible households had to be digitally excluded, on low incomes and be at risk of isolation due to the coronavirus pandemic. We were able to link our community groups to these other teams to ensure they could access the resources of the Connecting Scotland initiative.

Once eligible people or organisations who worked directly with eligible people were identified, they were given an internet-enabled device and were linked with a Digital Champion who provides six months of training and support over the phone.

Connecting Scotland has made a significant difference to the lives of thousands of people who were missing out on the benefits of being online. It has enabled them to stay connected to friends and family, be informed and entertained, access health and care services and able to continue learning and working.

In the Falkirk area, a community centre was able to get iPads, Chromebooks and MiFis, – a MiFi taps into mobile phone networks and uses this to create a mini wireless broadband cloud or hotspot. Four of the community centre leaders have been trained as Digital Champions via the Connecting Scotland initiative. The centre was also able to source funding for six further laptops and a printer to start a computer companions Sunday coffee club. This allowed people to be paired up and learn from each other. They also have an IT suite through the week for people to access and get help.

One of the community centre leaders commented that, “Many of our families are living in deprivation with no access to the internet and cannot afford digital equipment. One of our aims is to help bridge the attainment gap by providing the digital equipment needed to access education to local families. Another barrier our individuals are coming up against is lack of training and isolation. They are isolated in their homes or community and unable to use the internet to stay connected. With the equipment and mentoring we aim to create ‘inclusive growth’ online through Connecting Scotland. By tackling these barriers we are encouraging education, upskilling and contributing to the community which aligns with the national framework.”

It was heartening to hear how communities have accessed Connecting Scotland, and have further developed what is on offer in their areas. I heard someone say that digital connectivity is a necessity for modern life, not a luxury. I’m glad that I could be part of a team working towards this vision.

Little did I know that this was only the first phase of the Connecting Scotland initiative.

As local lockdowns are being put in place across the country, Connecting Scotland clearly has an important role to play. An additional £15 million has recently been allocated by Scottish Government. This will help thousands more families who cannot afford to get online, making sure they are not further disadvantaged by providing the necessary hardware, data, and skills they need to get connected.

Wendy McDougall is an Engagement Officer with Healthcare Improvement Scotland – Community Engagement.

More information about the Connecting Scotland initiative.

Categories: COVID-19 blogs

Come together: how we kept on huddling in the virtual world – Claire Gordon

Posted on September 24, 2020

Huddles are a key part of most NHS organisations nationwide. But how do you huddle virtually – and successfully – in an organisation of 500 people? Senior Communications Officer Claire Gordon tells us how we’ve done it – despite the photo bombers.

When I was first asked to take over organisation of our staff huddles back in 2016, I was a bit bemused. They didn’t sound like huddles to me. They were quite formal sessions where senior managers presented to staff in a boardroom, questions were posed in advance and responses were scripted. There also seemed to be a huge amount of work involved in organising them. Not that I’m shy of a bit of hard graft, but if there’s a better way, I’ll find it!

I quickly decided it would be best for everyone if the huddles were exactly that; an informal get together, on the office floor, where staff and managers could come together to hear updates from each other, share news and celebrate success.

This worked pretty well for people based in our Edinburgh and Glasgow offices. We often attracted large numbers with good levels of engagement and interaction from staff and, latterly, board members. But it didn’t translate across to the tele huddle, which always felt like a very stilted one way conversation down a phone line. Colleagues based in local health board offices just didn’t get the same opportunity to engage with senior managers as everyone else.

Taking to Teams

Fast forward to 2020, COVID-19 and the rapid move to homeworking and all of sudden it wasn’t possible to huddle. Well, not in the physical sense. We thought about videos and webinars but nothing seemed to fit the bill. Then along came MS Teams and a chance to gain back a little bit of that organisational closeness we’d lost.

The first huddle on Teams was a test of technology and nerves. We’d often talked about how we couldn’t possibly accommodate the whole organisation in one huddle when we we’re all office based because phone lines would crash, video conferencing facilities would stall and the world, as we knew it, would undoubtedly end.

But, with big girl pants on, I invited the entire organisation to join us for a virtual huddle on Teams for the first time back in May. The response to the invite was overwhelming. Almost every employee said yes, they’d be there with bells on (not quite, but I like to pretend everyone is as enthusiastic for huddles as me). A second session was hastily arranged after I realised that Teams could only accommodate a maximum of 250 participants!

Tech issues vs human errors

Ahead of the first session, my Comms chums helped out with a dry run. My Comms colleague Stephen Ferguson doing a grand impression of our Chief Executive and huddle host, Robbie Pearson, and another colleague, Victoria Edmond, testing the chat function, a display of skills which later saw her promoted to official Chat Monitor. It worked with six, so it would work with 250 surely!?

And it did. Surprise and relief washed over me as our first virtual huddle went without a hitch, technically speaking. We had over 200 people on the call with no obvious sound or vision issues to report. And I felt rather emotional when I saw lots of folks commenting on the chat about how nice it was to get together, saying hello to each other for possibly the first time in many weeks and sharing the odd smiley face emoji or two.

It hasn’t all been plain sailing. We’ve had what I like to think of as the Teams equivalent of a ‘photo bomber’ – that rogue person whose camera suddenly switches on while the CEO is mid-flow and then walks away from the screen – cue mad panic and quick @mention in the huddle chat in the hope they’ll come back and notice we’re all staring at their front room.

Apart, together

It might sound a bit over the top, but I feel like our huddles have been redefined during lockdown. They now give us a chance to unite as one organisation, if only for 45 minutes. We don’t get the facial cues, the spontaneity or the visual feedback, but we do have the ability to ask questions and make comments in what feels like a safe space. And it’s reassuring, when we see colleagues reacting to those posts, to know that we’re not alone and that someone else, sitting somewhere else, feels the same way. Okay, that was maybe a little bit over the top.

Since organising the virtual huddles I seem to have gained the reputation of being some kind of expert on Teams – which I’m really not! So, despite the imposter syndrome, here are my top tips for a good virtual huddle:

Set the expectations out in the invite. Be clear on what participants need to do and if you’re asking them to do something a bit techy give some simple steps to follow.
Prepare speaking notes and circulate these to all the speakers in advance. Keep the notes brief, bullet points, to encourage talking rather than reading from the page.
Set the tone of the session from the top. Pop a nice friendly message in the meeting chat while everyone’s waiting to go and open with a warm welcome.
Encourage participants to use the chat function. It makes the session more interactive and engaging. It works best if you have someone monitoring the chat and cherry picking questions and comments to pose to speakers.
If someone’s not following the agreed etiquette then @mention them in the meeting chat and reiterate the rules and do this promptly and consistently.
Start and finish the session on time. We’re all suffering from Teams fatigue so don’t keep anyone longer than you said you would.
Build in time for Q&A, and try to cover as many questions as this allows, with follow up after the meeting if it’s not possible to answer them all.
Be brave. If it all goes horribly wrong then just politely apologise, bring the meeting to a close and promise to try again soon.

Claire Gordon is a Senior Communications Officer with Healthcare Improvement Scotland.

More information

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

Categories: SPSP

Tagged: World Patient Safety Day 2020, WPSD

Right people, right place, right time = right care for Scotland – Mairi McConnochie

Posted on September 22, 2020

Mairi McConnochie of our Healthcare Staffing Programme reflects on last week’s World Patient Safety Day, the challenges ahead and the successes we need to continue to build on.

The theme for this year’s ‘World Patient Safety Day’ was ‘Safe Staff, Safe Care’. In the wake of the COVID pandemic, this theme conjures up images of PPE-clad healthcare workers doing their best to create a safe environment and provide care to patients and service users under considerably trying conditions. But what if we look to the broader landscape of safe workforces? There is much evidence to demonstrate a strong link between safe workforce levels and patient outcomes. A recent European study by the Registered Nurse Forecasting System (RN4CAST) identified that each additional patient per nurse is associated with 32% higher odds of poor quality care. Another RN4CAST study identified that for every 10% increase in the amount of care left undone, there is a 16% increase in the likelihood of a patient dying following common surgery.

There are challenges with shortages in the health workforce in many parts of the world, with the WHO estimating a global shortfall of 18 million healthcare workers by 2030. The situation in some low income countries, such as Uganda where there are 1.6 doctors per 10,000 of the population, contrasts starkly against the more favourable situations in the UK and other high income countries. However, ensuring safe staffing levels is more than about balancing the demand and supply figures – it’s about making sure that the right people with the right skills are in the right place at the right time.

Scotland: leading the way

In this area, Scotland is leading the way by enshrining safe staffing in law. In 2019 the Health and Care (Staffing) Act was passed which requires health boards to adopt particular workforce and workload planning strategies. Using a range of workload planning tools alongside their professional judgement, hospitals, community services and care homes now have to look very closely at which kind of practitioners they should have where and when, to meet the needs of the patients or service users in their local context and to mitigate or escalate risks. At Healthcare Improvement Scotland, the Healthcare Staffing Programme is helping NHS boards carry out better workload and workforce planning so they can meet the obligations of the Act. We do this through training, staffing tools and methodology development and through offering tailored support and guidance to boards. The end goal is to empower boards to be able to re-design services to help ensure they are providing safe care.

Pandemic brings requirements into sharp focus

Never has this need been more pertinent than over the past few months when services have had to dramatically re-shape to handle COVID patients and everything that an infectious disease outbreak brings. Health Care Staffing Programme team members worked within the Chief Nursing Officer’s Directorate (CNOD) at Scottish Government during the peak of the COVID-19 pandemic on the development of staffing templates for use during COVID and immediately post-COVID in various environments such as Care Homes and Community Nursing settings. Team member Nancy Burns devised the Care Home Safety Huddle template, which went live in August, and now has over 1000 care homes across Scotland registered to use it.

Staff absences and an inconsistent approach to workforce planning have increased the pressure on Care Homes during the pandemic. At the same time, Homes were also expected to report a raft of information for various sources. The template aims to provide an overview of individual care homes for care home managers, Boards and Health and Social Care Partnerships to understand, intervene in and mitigate any areas of risk as they emerge. It also offers a clearer national picture of care homes and any emerging issues that require a national response, and allows easier reporting, freeing up vital care home resources.

Turning the spotlight on safe staffing

Now bringing this experience back with them, the programme team is building on these Scottish Government templates to ensure they are robust and have longevity for service delivery after the immediate post-pandemic phase.

The emergence of COVID 19, combined with this new government legislation, have both turned the spotlight on the importance of safe staffing for safe care. Now more than ever we must pay close attention to how best to use our workforce as we ride out this pandemic and we must use this opportunity and momentum to bed in new ways of working and allow innovation to flourish.

Find out more about the Registered Nurse Forecasting Studies:

https://apps.who.int/gho/data/node.main.HWFGRP_0020?lang=en

https://pubmed.ncbi.nlm.nih.gov/28844649/

Find out more about the WHO’s health workforce statistics:

https://pubmed.ncbi.nlm.nih.gov/28844649/

https://apps.who.int/gho/data/node.main.HWFGRP_0020?lang=en

Mairi McConnochie is Programme Manager with the Healthcare Staffing Programme of Healthcare Improvement Scotland.

Categories: SPSP

Tagged: World Patient Safety Day 2020, WPSD

The pursuit of quality: a healthcare journey – Robbie Pearson

Posted on September 16, 2020

To mark World Patient Safety Day, our Chief Executive, Robbie Pearson, reflects on Scotland’s patient safety journey and looks ahead to a more holistic approach to safety in the future.

With the celebrations to mark 72 years of the NHS, I was reflecting that it is now 10 years since the Scottish Government published the Healthcare Quality Strategy. While we don’t mark anniversaries of documents as we do major events like the birth of the NHS, this publication was a critical step in NHS Scotland’s improvement journey. The Strategy is centred on three linked ambitions of safe, effective and person-centred care, and, with that simple and clear ethos, it has withstood the test of time.

Safety – as one of those ambitions – is also only one dimension of quality, but I am very conscious that it is at the heart of the work of Healthcare Improvement Scotland.

One major element of Healthcare Improvement Scotland’s work is the Scottish Patient Safety Programme (SPSP) which was formally launched in 2008. In the very early days of SPSP, a small handful of committed individuals had a determined fight on their hands to plant its roots and to nurture its growth, in the face of other competing improvement initiatives, sceptics and some vocal opponents. In building on small early wins, SPSP has grown to be a success which reflects the dogged determination and enthusiasm of the many who have worked hard to implement improvements in frontline care, in order to reduce harm and mortality.

The results have been impressive:

Hospital Standard Mortality Ratio (HMSR)reduction 14%
Cardiac arrest rate reduction 29%
Pressure ulcer reduction 26%
Neonatal mortality reduction 15%
Paediatric Ventilator Associated Pneumonia (VAP) reduction 86%
Stillbirth reduction 24%

There isn’t one answer to safety though, nor is SPSP the only aspect of Healthcare Improvement Scotland’s contribution to achieving the ambition of a safer NHS.

Whether it be in tackling variation in the use of medicines, the monitoring and tools to support safe staffing, learning from adverse events, the development of guidance for the diagnosis and treatment of major priorities such as cancer and heart disease or in the external assurance of hospital care, we are focused, as an organisation, on supporting the wider implementation of good practice and reducing avoidable harms.

In so much as the Healthcare Quality Strategy emphasised the different dimensions to quality, we need to recognise that there are also different ways to support the creation of a safer system of care.

We already know that evidence-based clinical interventions in wards delivered consistently improve safety, but so does the right leadership, working environment and organisational culture. Indeed, I would argue the provision of safe care, also fundamentally depends on a safe and supported health and social care workforce. This echoes the priority set out in the World Health Organisation’s ambition to ensure we prioritise the safety and well-being of all those staff working in the health and social care system.

It has been a long journey since the early days of SPSP. We have though, over that time, gained a better understanding of the many dimensions that contribute to safer care. Healthcare Improvement Scotland is taking that into account in redesigning our approach to safety for the next ten years – which holds and builds on the gains of SPSP – but brings together in a more cohesive and connected way our approach to improving safety.

‘Safety’ cannot be seen as only relevant for specific moments of care, whether it be the safe use of equipment, avoiding a fall, pre-operative checklists and so on. The reality is that this aspect is highly relevant but also insufficient. We must keep a focus on safety at the point of care for our clinical and care staff as well as our aspirations for safer systems.

In future, we will see a more holistic approach to safety. We will rapidly review the evidence for safety in key priority areas and ensure that there is both the national support and external assurance in making care safer from the frontline to the very top of the organisation.

Today of course is WHO World Patient Safety Day. As mentioned earlier, this year’s theme attempts to raise awareness of the personal safety risks health care workers face around the world. Such risks have been highlighted this year by COVID-19 but sadly these risks are a more common reality for some in the most deprived parts of the world.

Scotland’s healthcare workers are part of a system that by global standards is generally very safe. However this level of safety has been achieved by constant vigilance and hard work. Our collective efforts to keep health care workers safe are themselves a vital component of patient safety. Today provides an opportunity to focus on Scotland’s success as well as better understand and learn from the global issues in continuing to make all aspects of care safer in future.

Beyond today, our improvement journey must continue, supported by the same commitment, determination and enthusiasm with which it began.

Looking back we can see the positive impacts resulting from the Healthcare Quality Strategy that was set out a decade ago. Looking forward, even with the deep challenges we continue to face in managing COVID-19, we must hold on to these ambitions and ensure they remain at the heart of what do in the coming weeks, months and years.

Robbie Pearson is Chief Executive of Healthcare Improvement Scotland

More information

Categories: SPSP

Tagged: World Patient Safety Day 2020, WPSD

Putting Evidence at the heart of everything we do – Safia Qureshi

Posted on September 10, 2020

Our Evidence Directorate are about to launch a new approach to the way they take on work. Director Safia Qureshi explains her vision for the directorate – and why evidence should lie at the heart of improvement.

Have you ever stopped to wonder how many pieces of advice or guidance, reviews, reports, statements or strategies Healthcare Improvement Scotland has published over the years? It’s the sort of question you might ask yourself if you were coming along for a job interview, which is exactly where I was around about fifteen months ago, gearing up for round one of interviews for the role of Director of Evidence.

The answer is: a lot! Search our website and there’s over 1000 items to choose from, published over the last 10 years. And that doesn’t include the work of the Scottish Antimicrobial Prescribing Group (SAPG), the Scottish Intercollegiate Guidelines Network (SIGN) or the Scottish Medicines Consortium (SMC) which sits on separate sites. Adding these publications in takes our total to well over 2600 – with around 1560 pieces of medicines advice from SMC alone – all of it robust and trusted advice.

That’s a lot of work, covering an enormous range of subjects. How did we decide what to do? How should we decide what to do? Can we make better use of our resources? How do we make best use of our resources to provide the advice and guidance that will best help to shape the decisions made by health and social care organisations as they work to resolve the issues facing the NHS in Scotland?

Building on our strengths

I didn’t get asked about publication numbers at my interview – it’s all a bit of a haze now – but we did talk about the role of Healthcare Improvement Scotland in making sure evidence is at the heart of decision making. As Angela Timoney, the Chair of SIGN, likes to remind us in these days of disparaging experts: “evidence matters – our challenge is to ensure we address the most important issues”.

This is the challenge I’ve set myself – and the teams across our Evidence Directorate: to put evidence at the heart of decision making. There’s been some great work from all the teams in the directorate- SAPG, SIGN, SMC, Scottish Health Technologies Group (SHTG), Standards & Indicators and the Data Measurement and Business Intelligence team (DMBI). Now we’re looking to build on their strengths to ensure we have something even better to offer.

A force for improvement

At present, each team has its own approach to topic selection and prioritisation of work. In practice that means each sets its own timetable for taking on new work, each has its own selection criteria and each its own selection committee. All of these individual approaches are perfectly valid – this is the Evidence Directorate after all, we think very carefully about the right way to do things. But by harnessing all these parts into a whole directorate approach that aligns stakeholders’ needs with our wide range of skills and expertise, we can think strategically about our work programme and maximise the impact of our work. This way, I think we can provide a real force for improvement, something that will make a real difference to NHSScotland.

More than the sum of our parts

With that in mind, from 17 September we will be thinking about our work programme in a completely new way. We will start our move towards a coordinated work programme that aligns more clearly with national and organisational priorities. One multidisciplinary committee will use one process and one set of criteria to agree a coordinated work programme for SIGN, SHTG and Standards & Indicators, with more explicit alignment and support from DMBI, SAPG and SMC. This will help us to use the resources of our directorate in a way that is more responsive to the questions and problems posed by stakeholders. We think it will allow us to provide a more coordinated and flexible response that can call on any or all of the skills and outputs across the directorate. At the same time we’re going to raise the profile of the Evidence Directorate in its own right, as more than a collection of the sum of its parts.

Of course, given the consideration, development and production time of our advice and guidance, it will take a while for our new approach to fully kick in. We’re still committed to delivering all of our existing programme of work, but it’s very exciting to be taking the first steps down a new road.

Safia Qureshi is Director of Evidence for Healthcare Improvement Scotland. Follow her on Twitter @qureshisafia1

More information

Find out more about the new approach

Categories: COVID-19 blogs

Tagged: Evidence

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

Posted on September 8, 2020

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

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

Opportunity knocks…

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

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

Welcome result

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

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

Looking to the future

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

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

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

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

@jacquisneddons @HISengage @SAPGAbx

More information

Visit the SAPG website

Categories: COVID-19 blogs

Tagged: COVID-19

A helping hand to be treated at home – Shirley MacKenzie

Posted on September 2, 2020

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

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

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

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

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

Same day service

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

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

A final wish fulfilled

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

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

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

More information

Visit the Hospital at Home section of the ihub website.

Categories: COVID-19 blogs

Tagged: COVID-19

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

Posted on August 28, 2020

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

Safety is at the heart of what we do

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

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

A rare and unique role in healthcare

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

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

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

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

Training is vital

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

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

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

Alastair McGown is a Senior Inspector with Healthcare Improvement Scotland

More information

To find out more visit the Healthcare Improvement Scotland website

Categories: Inspections and Reviews

Tagged: Inspections, Quality Assurance

Rich tea and sympathy – Julie Davidson

Posted on August 18, 2020

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

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

Face to face vs virtual meetings

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

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

The value of visiting virtually

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

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

Julie Davidson is an Engagement Officer in Dumfries and Galloway

More information

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

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

Categories: COVID-19 blogs

Tagged: COVID-19

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

Posted on August 13, 2020

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

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

Responding to the crisis

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

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

A new project for our team

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

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

Going at 90 miles per hour

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

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

Adapting to changing circumstance

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

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

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

More information

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

Categories: COVID-19 blogs

Tagged: COVID-19