The Lothians & Edinburgh Abstinence Programme (LEAP) has become the first rehabilitation service in Scotland to hire people with lived experience to bridge the gap between community treatment and rehab.
LEAP, run by NHS Lothian and partners, is the only therapeutic community rehabilitation for alcohol and other drug dependencies offered by the NHS in Scotland.
Before the launch of this programme, the service was supported by volunteers with addiction and recovery experience but now officially employees six Peer Bridgers.
Peer Bridgers are people with lived experience of addiction and recovery whose role is to support others through rehabilitation and help improve outcomes.
Recruitment began earlier this year, with the most recent bridger joining in June 2023.
Phil Hayes (above, right) is one of the new Peer Bridgers now employed by LEAP.
Phil suffered from substance misuse issues earlier in his life but, thanks to a community programme, moved into recovery over 20 years ago.
Since then, he spent several years learning about the behaviours that led to his own issues around addiction.
Phil said: “I think society in general views recovery as either unattainable or a continual hard slog of fighting your inner demons day in, day out. I want to be able to show people that isn’t the case.
“With the right support and guidance, as well as some honest hard work, anyone can move completely into recovery and be both happy and of value within their wider community.
“The peer bridging project allows me, and the rest of the team, to engage with people from the moment they decide to change their lives.
“We can provide continuity of support and guidance for them to build a life for themselves outside of addiction.”
Recently published research has shown that residential rehabilitation programmes, like LEAP, are effective in reducing the use of substances and have a positive impact on the overall health and quality of life of those with substance use issues.
Research also shows that positive changes in behaviour after residential rehabilitation can be maintained over time.
David McCartney, Clinical Lead for LEAP, said: “Tackling Scotland’s drug and alcohol-related deaths and improving outcomes from substance misuse treatments, including residential rehabilitation, is a national priority.
“LEAP is a unique programme in Scotland. In other areas, the road to rehab can be much more complicated so we’re very lucky in Lothian to have this service.
“There are few people in Scotland whose lives are untouched by the harms of addiction, whether experienced by individuals, their families, friends or colleagues – addiction affects us all.
“We support our service- users through medical and psychosocial interventions within a therapeutic community setting, giving individuals an opportunity to heal from trauma and addiction and continuing to support them after treatment.”
LEAP is part of the services provided by the Addiction Treatment and Recovery Care Directorate in NHS Lothian and is delivered in partnership with the City of Edinburgh Council, the Cyrenians, Encompass and Alcohol and Drug Partnerships.
The service is funded thanks to both Scottish Government as well as the Alcohol and Drug Partnerships.
A West Lothian doctor is leading the way in helping to build services across Scotland that allow people to be treated at home rather than hospital.
And with a strong sense of family firmly at the heart of Dr Latana Munang’s ethos, her role at Healthcare Improvement Scotland as National Clinical Lead for Hospital at Home, has given her a job with purpose.
Healthcare Improvement Scotland is supporting the development of Hospital at Home services which reduce hospital admissions for elderly patients by providing acute care in the comfort and familiarity of their own home. Latana brings her wealth of clinical experience to the role, supporting Hospital at Home services across the country to be established and to grow. Hospital at Home services now cover nearly every NHS board and health and social care partnership in Scotland.
Latana was born in Malaysia and came to the UK on a sixth form scholarship before gaining a place at Edinburgh University to study medicine. She spent a year in Singapore as part of her registrar training before returning to Scotland where she has remained ever since.
The mum-of-two began working at St John’s Hospital in Livingston in 2011 and has remained there since. She is currently a consultant working in general medicine and medicine of the elderly.
Latana said: “Growing up in Malaysia the family structure in Asian communities was very strong. When my granny became ill she moved in with us to be cared for and that was the norm.
“Differences in society and different pressures mean that’s not possible everywhere but I do think most people are happiest being at home with family when they are ill, if it’s an option, and I really enjoy being involved in how we can make that happen.”
Ten years ago Latana was a key figure in setting up Hospital at Home in West Lothian and she remains as committed today as then to “push the boundaries in providing the best possible care for the frail and elderly”.
Latest figures show the Hospital at Home programme has seen an increase of 68% in the number of patients. The amount of areas where Hospital at Home is an option for patients has also more than doubled.
Latana said: “Sometimes people are admitted to hospital as they feel there’s no other safe alternative, but actually for older and frail patients if it’s possible to stay in the security and familiarity of home that can be best for them.
“With Hospital at Home we have a visit at the beginning to see what needs to be organised for each patient. In many cases we are able to cut out unnecessary procedures that would have been done routinely in hospital when we consider how much more complicated it would be to do from home, as we sometimes realise they’re not needed.
“Hospital at Home is a true generalist service where on occasion we’ve had nurses change a lightbulb to prevent someone falling or check for out of date food in patient’s homes.
“Seeing people in their own homes gives us a different perspective and empowers them to feel their wishes and choices are being fully respected.”
For Latana and her husband Phil Buchan, whom she met at university, and their two children Leo (11) and Zola (9) home is Linlithgow. Latana said: “It’s a great place to live, it’s really family friendly with a strong sense of community.
“Spending time in other countries has made me appreciate the NHS and I’m lucky to be in a role that I feel so passionate about.”
LOTHIAN MSPs have spoken out following a critical report on safety issues at the Royal Infirmary of Edinburgh at Little France. Inspectors reported safety concerns following visits to the hospital’s A & E Department in February and subsequent follow-ups.
Conservative Lothian list MSP Miles Briggs said: “These are very serious concerns in regards to overcrowding at Royal Infirmary of Edinburgh and the fire safety risk it creates.
“The A&E department at the hospital has been running over capacity for a number of years now, with SNP Ministers showing an ability to make any progress.
“Patient and staff safety must be the number one priority at the RIE and urgent improvements must be made.
“I have written to NHS Lothian to ask for further details and a timetable for when these improvements are being made .”
Labour list MSP Foysol Choudhury added: “It is incredibly disappointing and worrying that inspectors raised numerous serious concerns about safety in the A&E department at Royal Infirmary Edinburgh (RIE).
“Constituents in Edinburgh need to be sure that they can safely attend hospital for care and treatment. Instead, patient safety, care and dignity were called into question.
“This is terrifying for those patients in the region who need to be able to rely on and trust the A&E department should they ever need it.
“I’m very concerned that our hardworking NHS staff may also be put in danger by this crisis in the NHS, with concerns raised over staff wellbeing at RIE. Our hospital staff work incredibly hard to provide the best service possible.
“Patients at RIE and their relatives spoke highly of the compassionate care they received from staff. “This makes it all the more disappointing that staff and patients alike are being affected by 16 years of SNP incompetence.
“Staff and patients are crying out for help. Will the new Health Secretary answer their call and reverse years of damage done by Humza Yousaf when he held the post?”
NHS Lothian says the concerns expressed in the report are already being addressed. Alison Macdonald, nurse director at NHS Lothian, told the BBC the HIS visit came at a time of “unprecedented pressure” on the hospital.
She said: “We accept and acknowledge the findings of the HIS report and we sincerely apologise to patients for longer than usual waiting times in the emergency department and a poorer experience of care.
“We had already begun our own improvement work when the inspectors carried out their first visit.
“When they returned for their follow-up, it was clear to see that improvements had already been made, but more was required. We are now focused on our improvement and safety action plans.”
HEALTHCARE IMPROVEMENT SCOTLAND’S REPORT
HEALTH watchdog Healthcare Improvement Scotland carried out an unannounced inspection to the Royal Infirmary of Edinburgh, NHS Lothian on Monday 20 to Wednesday 22 February 2023 using our safe delivery of care inspection methodology.
During our inspection, we:
inspected the ward and hospital environment
observed staff practice and interactions with patients, such as during patient mealtimes
spoke with patients, visitors and ward staff (where appropriate), and
accessed patients’ health records, monitoring reports, policies and procedures.
As part of our inspection, we also asked NHS Lothian to provide evidence of its policies and procedures relevant to this inspection. The purpose of this is to limit the time the inspection team is onsite, reduce the burden on ward staff and to inform the virtual discussion session.
On Tuesday 14 March 2023, we carried out an unannounced follow-up visit to the Royal Infirmary of Edinburgh to establish if concerns we raised during our initial visit had been addressed.
On Thursday 16 March 2023, we held a virtual discussion session with key members of NHS Lothian staff to discuss the evidence provided and the findings of the inspection.
As a result of serious concerns about patient safety within the emergency department identified during this inspection we wrote to NHS Lothian to formal escalate our concerns in accordance with level 1 of our escalation process in the Healthcare Improvement Scotland and Scottish Government: operating framework.
A copy of the letter has been published with this report.
Summary of our findings
At the time of inspection, the Royal Infirmary of Edinburgh, like much of NHS Scotland, was experiencing a significant range of pressures including increased hospital admissions, increased pressures in the emergency department and admission units and reduced staff availability. During our onsite inspections the hospital was operating at over 100% capacity.
In ward areas, senior managers were visible, wards were generally calm and well organised and we observed good leadership and care being delivered. Patients and relatives spoken with described a good experience of care and helpful staff.
During the safety huddles we attended, we observed a strong focus on patient care needs across the hospital. However, serious patient safety concerns within the emergency department were identified during this inspection.
Inspectors raised a number of serious patient safety concerns regarding the emergency department during both our onsite inspection and return visit regarding the delivery of fundamental care for patients, patient safety, care and dignity, the current operating environment, leadership and coordination of care in the emergency department, as well as concerns about staff wellbeing.
Other areas for improvement identified during the inspection include the management of intravenous fluids, medicine administration processes, locked doors policies and procedures, and feedback to staff following incident reporting.
NHS Lothian senior managers responded quickly to concerns raised during the initial inspection. However, during our return visit on 14 March 2023, we remained concerned that the immediate actions put in place by NHS Lothian did not lead to significant improvements in the delivery of safe and effective care within the emergency department.
This resulted in us writing a formal letter of non-compliance to NHS Lothian in accordance with level 1 of our escalation process, setting out the serious patient safety concerns that required immediate action.
NHS Lothian promptly responded to this escalation, providing a detailed plan of improvement action to address each of the concerns. We will seek assurance on progress with planned improvement actions in accordance with our published inspection methodology.
This inspection resulted in five areas of good practice, three recommendations and 13 requirements.
Following performance improvements in relation to the delivery of Children and Adolescent Mental Health Services (CAMHS) and Psychological Therapies, NHS Lothian Health Board has been de-escalated to Stage 2 of NHS Board performance escalation framework.
Robust measures will remain in place to ensure NHS Lothian continues to receive support to help maintain improvements.
NHS Lothian was originally escalated to Stage 3 for mental health performance in July 2019.
The improvements to CAMHS and Psychological Therapies has resulted in a significant decrease in the number of children, young people and adults waiting to start treatment compared to the period prior to escalation.
Health Secretary Michael Matheson said: “Escalating a health board is never done lightly and, following progress to improve the provision of mental health services, care and support, I am pleased that we are now able to de-escalate NHS Lothian. This is a positive step forward.
“Staff have worked hard to support the improvement work while delivering high quality patient care. It has been a challenging time for them, as well as patients and families, and support for the Board will continue to improve services even further for patients.”
‘significant number’ will be accessible and affordable for social or mid-market rent
The City of Edinburgh Council has successfully secured a major new site for accessible affordable housing in the South of the city.
A successful £14.8m bid for Liberton Hospital and its grounds, including the former Blood Transfusion Centre, has been accepted by NHS Lothian – paving the way for around 400 hundred homes in the area, a ‘significant number’ of which will be accessible and affordable for social or mid-market rent.
The NHS will continue to occupy the premises until March 2025 to allow the hospital’s remaining services to be gradually relocated. During this time, the council plans to appoint a development partner and consult with the local community to draw up plans for an accessible green neighbourhood – making sure to retain many original features of the historic hospital, gatehouse and gardens facing Lasswade Road.
The council’s vision for the site is to focus on supporting a range of housing needs while delivering homes at scale to help meet the city’s growing demand. It is anticipated that the regeneration will deliver at least 380 energy efficient mixed tenure homes for sale and rent, all of which could be fully accessible, with up to 50% affordable. This would exceed the council’s commitment of at least 35% affordable homes on residential developments.
The area already has a significant level of public amenity due to existing woodland and original hospital gardens, creating a fantastic opportunity for a range of high-quality public spaces as part of a wider green network.
The regeneration of the land will retain as many of the existing trees as possible and incorporate them into green routes throughout the site, allowing for active travel connections to Burdiehouse Burn Valley Park, St Katharine’s Park and Liberton Park.
A Prior Information Notice (PIN) seeking interest from potential development partners has been issued and work will be carried out to prepare for construction, including developing detailed designs and agreeing a net zero carbon energy solution for the site, contributing to the council’s ambitious target to reach net-zero emissions by 2030.
Councillor Jane Meagher, Housing, Homelessness and Fair Work Convener, said:For close to 150 years Edinburgh residents have been cared for under the roof of Liberton Hospital. I’m delighted that we’ll be able to pay that care forward as we convert the site into much needed new homes.
“By demolishing the 1960s built extensions, including the disused Blood Transfusion Service, we’ll be able to design an accessible green neighbourhood of low-carbon housing from scratch. This will help lots of people with specialist needs to live comfortably and with independence. Plus, it will allow us support people who are in desperate housing need as we’re looking for a developer who can commit to our vision of at least half of these new homes being affordable.
“We’re committed to putting care-based housing at the centre of this redevelopment and I’d like to thank our partners at the NHS for working with us to secure the land. It has been many years in the making.
NHS Lothian’s Western General Hospital has significantly reduced its carbon emissions thanks to a team of environmentally conscious anaesthetists.
By replacing the use of one medical gas alone with an eco-friendlier alternative, the Department of Anaesthetic’s carbon footprint has decreased by over 125 tonnes annually.
Anaesthetic gases have a significant impact on the environment and account for around 5% of the overall carbon footprint of health services.
Desflurane and Nitrous Oxide are two of the most environmentally harmful gases used in operating theatres, with Desflurane having a global warming potential 2,500 times greater than carbon dioxide.
The team at the Western stopped using Desflurane in April 2022, switching to eco-friendlier alternatives, which reduced the carbon emissions of their anaesthetic gases by 73%.
Dr Matthew Royds, Clinical Director of Anaesthetics & Theatres at the Western, said: “Operating theatres are significant contributors to the carbon emissions generated by healthcare. A lot of this is due to the gases and techniques which have long been used in anaesthesia.
“Our team feel that, as professionals, we have a moral obligation to find more sustainable alternatives, while continuing to deliver the same high level of patient care.
“It is incredibly rewarding to see the real and measurable reduction in our environmental impact, which has been achieved through a passionate team effort and a long-term commitment to more sustainable practices, which will ultimately benefit us all.”
Withdrawing desflurane is the first action of the Scottish Government’s National Green Theatres Programme, part of the NHS Scotland Climate Emergency and Sustainability strategy.
Carbon emissions due to Nitrous Oxide at the Western last year were also less than 25% of previous levels due to a change in the way this is used and delivered.
In the next two years, the aim is to reduce these emissions to zero at the Western, with piped Nitrous Oxide at two other Lothian hospitals awaiting decommissioning.
Jane Hopton, Programme Director and Sustainability Lead for NHS Lothian, said: “The changes being driven by Dr Royds and his colleagues are essential if we are to achieve our Net Zero goals.
“The support and commitment of the staff in anaesthetics and theatres has a had huge impact on making this work a success, as well as creating financial and environmental savings for NHS Lothian without compromising patient care.
“In the Royal Infirmary and St John’s hospitals, the teams have also been hard at work to safely reduce the environmental impact of these gases.
“In late 2021, St John’s became the first hospital in Scotland to use a new technology during labour which breaks down exhaled Nitrous Oxide into harmless Nitrogen and Oxygen.
“We are proud to support the increasing number of professionals across NHS Lothian who are taking action to reduce the impact of health care on the environment.”
Scottish Conservative and Unionist MSP for Lothian Miles Briggs said:“The figures are an embarrassment for Humza Yousaf and are indicative of the extent to which he failed in his role as Heath Secretary.
“It is completely unacceptable that in the space of 3 years the percentage seen withing 4 hours dropped almost 35% from 94.6% to 60% in Lothian.
“Despite being well into the swing of Spring, the figures for Lothian are now worse than at the peak winter times.
“In taking his eye off the ball and doing his best to appease the independence hardliners during the leadership contest, Lothian and Scotland’s figures have deteriorated further.
“While as Health Secretary he was clearly unable to find a solution to the mess he created, one of his first priorities as the new First Minister must be to get on top of the situation and find someone who can clear up the disaster that he presided over.”
A new government-backed national day of action will be marked today (Monday 27 March) to boost the number of people with a learning disability or autism spectrum condition in employment.
Led by the charity DFN Project SEARCH, the first-ever National Supported Internship Day showcases the tremendous contribution young adults with Special Educational Needs and Disability (SEND) can make to the workforce.
In Edinburgh, the City of Edinburgh Council, NHS Lothian and Virgin Hotels will hold a series of events throughout the week, including a celebration for newly graduated interns. Young people will take over the city’s Project SEARCH social media channel on Monday to share what they are getting up to on their supported internships.
Employers in all sectors are also being called upon to redouble efforts to employ young adults with SEND and come together to challenge the everyday misconceptions that all too often unfairly shape their life opportunities.
Councillor Mandy Watt, Depute Leader of the City of Edinburgh Council, said: “Training and employment chances were pulled from under young people’s feet because of Covid. So, one of our biggest priorities in the aftermath of the pandemic has been to improve opportunities and outcomes for our young people, including those with complex needs.
“I’m proud of the inspiring and talented group of graduates we’ve nurtured. Many have held internships with us while others have been supported by NHS Lothian and Virgin Hotels.
“This day of action, I want to call on other Edinburgh-based employers to follow suit. We require a variety of placements every year to ensure we’re able to provide a full range of experiences to our young people and interested organisations should get in touch with Edinburgh Project Search.
“These are ten-week work placements beginning in September and the benefits are life-changing. They give special young people the same opportunities as their peers and space to shine.
“The placements can unlock confidence, build CV skills and be the difference between someone choosing to enter the workforce or feeling unable to. Plus, employers may well find their intern is exactly the type of person they’ve been looking for to expand their talent pool.”
Luke Baillie has been taking part in the programme and has a placement at Edinburgh’s bus station. He said: “Project SEARCH gives us the chance to get real work experience, build our CV and prepare for employment.
“It allows us to build our confidence and learn skills we otherwise wouldn’t be able to access. It changes our lives.
Adam Gray, Regional Director of People, Scotland at Virgin Hotels Edinburgh, said: “At Virgin Hotels, our teammates are fundamental to our success. It is important to us that our teammates reflect the guests that we welcome to our hotels, inclusive of everyone.
“Being a host business with DFN Project Search Edinburgh is something we are incredibly passionate about and proud to be the first privately owned organisation to do so.
“National Supported Internship Day is a great way to shine a light on the incredible talents of the interns of the 2022/2023 Cohort, and showcase the positive impact that supported internships have on business, organisations and also the local community.”
Most recent figures show that just 4.1% of young adults with a learning disability and/or autism in Scotland enter secure paid employment following education, compared to 80% of their peers.
Supported internships – work-based study programmes for 16 to 29-year-olds with SEND – dramatically change the employment outcomes for those who take part. DFN Project SEARCH figures show that 70% of people who complete their supported internships achieve this and successfully remain in employment.
Having meaningful paid employment is known to improve health and wellbeing and is central to individual identity and social status. If given the correct support and opportunities, young adults with SEND can thrive in a wide variety of jobs.
Minister for Children, Families and Wellbeing, Claire Coutinho said: “Supported Internships provide brilliant support to young people with EHC plans, equipping them with the skills they need to have fulfilling and successful careers.
“This is why we are boosting investment for the internships by doubling their numbers, and through the extra £3m the Chancellor announced last week we’ll explore ways to extend this programme to young people with SEND and without an EHC plan.
“Ensuring successful transitions into adulthood is a central part of our SEND and AP Improvement Plan, through which we will make sure all children and young people have the support they needed, no matter where they live or what school they go to.”
David Forbes Nixon, Founder and Executive Chair of DFN Project SEARCH, said: “We created National Supported Internships Day to give every young adult with a learning disability the same opportunities as anyone else to transition from education to employment.
“There is often a fear factor among employers of getting it wrong in hiring young adults with a learning disability, but it doesn’t need to be like that. It makes good business sense to explore the wealth of untapped potential among this group of enthusiastic and capable young people.
“They are keen, ambitious, and have an array of talent to offer employers.”
Scientists in NHS Lothian have helped to develop national infection controls after studying COVID-19 transmission between hospitals and care homes.
The teams found that 99 per cent of patients discharged from hospital into care homes during the first wave of the pandemic did not introduce COVID-19 into care homes.
The study, conducted with the University of Edinburgh, focused on patients in Lothian discharged from hospital into 130 care homes from 1st March 2020 to 31st May 2020.
Of the 787 discharges in this time, the researchers found that the majority – a total of 776 – did not introduce COVID-19 into care homes as a result of their hospital stay.
Forty-one of the discharged patients had a positive COVID-19 test within two weeks of leaving hospital and genome sequencing was used to identify if these cases could be linked.
The study found that 30 patients likely contracted this in the care home or from the community.
The results of 10 patients were inconclusive and one patient was confirmed to have contracted COVID-19 during their stay in hospital.
Very sadly, this patient later passed away and a number of residents in their care home subsequently contracted COVID-19.
Dona Milne, Director of Public Health and Health Policy, NHS Lothian, said: “This study has shown that 99 per cent of hospital discharges didn’t introduce COVID-19 cases into Lothian care homes during the first wave of the pandemic.
“However, we’re able to say with certainty that one care home outbreak in this time originated from us. We are deeply saddened by this, and our heartfelt apologies and condolences are with the families and loved ones of those affected.
“We began testing symptomatic care home residents very early in the pandemic, so it’s been really important for us to use this information to find out what we can learn about how the virus was contracted and spread and how this linked to our hospitals.”
Before the nation went into its first lockdown when testing wasn’t widely available, NHS Lothian built capacity into its labs specifically to PCR test those who were symptomatic in hospitals and care homes.
Because of this early testing of symptomatic patients, in-depth data was available to the research team to enable them to genome sequence the transmission of the virus as part of the study.
Dr Kate Templeton, Head of Molecular Diagnostics for NHS Lothian who led the study, said: “Testing was a priority for us from the beginning and we were the first health board in Scotland to build capacity in our labs specifically for care home residents.
“This early testing has enabled us to genome sequence the virus and track where this was acquired and how this spread, leading to the creation of an outbreak methodology which has informed best practice at both Scotland and UK-level.
“This methodology not only has applications to COVID-19 but other viruses too and has been vital in learning lessons around infection control. It also clearly shows that the protection of the most vulnerable in society needs to involve not just health authorities but the community too.”
