Healthcare Improvement Scotland – The NEN

James Morton’s new NHS role aims to ensure care is right for the patient – and right for the planet

Glasgow GP and former Bake Off contestant James Morton is on a campaign to save the planet – one patient at a time. James has a new role with Healthcare Improvement Scotland, the lead organisation for improving the quality of healthcare in Scotland.

As part of his new role, James is keen to help tackle the issue of over-prescribing in the NHS – an issue that costs the health service £300 million in waste in the UK each year – by ensuring that clinical guidelines and advice put prevention and non-pharmacological treatments ahead of those medicines that don’t help improve the health of the patient in the long term. As a result, helping ensure that healthcare is right for the patient and right for the planet, while ensuring the NHS is fit for the future.

The GP is advising people who take medications regularly to consider having a review with their GP at their next visit to ensure their healthcare regime is the right one for them.

He said: “There are so many things we can all do to help our own health and to cut down on over reliance that might lead to waste in the NHS. I would ask people, particularly those who have been on medicines for a long time, to have a look at what they are taking and review it with their GP to ensure they’re not taking them unnecessarily.

“I want to emphasize that this is not about saving money, but about improving health and encouraging people to have more involvement in their own health.

“Traditionally, this time of year is when lots of people resolve to try to lead healthier lives in the new year. It would be good for all of us to think about our health, and our healthcare regimes in general, as part of those fitness and improvement commitments.”

James is also encouraging people to look again, particularly over the festive period, at the regular medication they take and ensure they’re not over-ordering on repeat prescriptions.

In his new role, James has been elected as the new vice-chair of the Scottish Intercollegiate Guidelines Network (SIGN) Council, part of Healthcare Improvement Scotland. SIGN develops guidelines, based on the most recent medical research, to help health and social care professionals make decisions, with their patients, about care, and make sure patients get the best care available, wherever they live.

James, who lives with his wife and two young children, practices sustainability in his own GP practice in the city’s southside, by cycling to see patients. He is a passionate campaigner for people to make positive lifestyle changes and have more ownership over their own health.

He said: “Sustainability is an issue for all of us as the vast majority of our carbon footprint is preventable. For GPs, like myself, we need to look at prescribing as at least half of medicines that we prescribe are not taken as prescribed. This is a huge waste.

“For example, we understand the messaging with regards to antibiotics, and not to over prescribe to cut down on antibiotic resistance, but we can certainly use the climate and sustainability argument to add some further emphasis to the good practices we already should be following.

“I want us to try to engage with patients to motivate them to improve their health and prevent illness in future where possible through social prescribing. That means sometimes rather than giving someone medicines, working in a garden or taking part in an exercise class can have greater benefits.”

Safia Qureshi, Director of Evidence and Digital at Healthcare Improvement Scotland, said: “We are delighted that James is supporting us with our focus on sustainability.

“Our guidelines already have a keen focus on sustainability, for example, emphasising effective non-pharmacological treatments, such as our guideline on management of depression, and our forthcoming guideline on type 2 diabetes.

“We want our guidelines and advice to provide the best evidence that will empower people to be fully involved in decisions about their health and wellbeing.”

Improving cancer care

Funding for projects to benefit patients and clinical staff

A total of £1.5 million funding in 2024-25 is supporting 12 projects to continue providing direct and personalised support to patients with cancer.

The Single Point of Contact (SPoC) pilots provide patients with ongoing contact to support them, putting them at the heart of all decisions and actions involving them throughout their care journey.

The NHS Lothian SPoC uses a centralised digital hub delivering telephone communication and support to patients with a range of cancer types.

Around 40% of calls are diverted away from Clinical Nurse Specialist workload, which has led to improvements in the quality of their telephone contacts. Patient engagement work carried out by NHS Lothian and Healthcare Improvement Scotland has indicated high satisfaction with the service.

Confirming the funding, which is included in the 2024-25 Budget, as he met nurses at Edinburgh Cancer Centre with experience of the service, First Minister John Swinney said: “We are fully focused on improving cancer survival, and delivering excellent and accessible care is at the core of how we do that.

“The Single Point of Contact Service meets requirements identified by Boards to deliver improvements in communication and support for patients with navigating cancer care.

“By taking in the region of 2,000 calls per month and providing person-centred support to those patients throughout their care journey, the Edinburgh Single Point of Contact project provides consistent access for patients to have conversations about their care, freeing up capacity for specialist staff to focus on the most complex cases.”

Katie Gibson, Neuroendocrine Tumour Clinical Nurse Specialist at the Edinburgh Cancer Centre, said: “I’ve seen first-hand how the SPoC service has transformed our ability to care for cancer patients.

“The centralised system streamlines communication and allows us to spend more quality time with those who need it most.

“As a result, patients are aware of who to contact for the support and advice they require from diagnosis , treatment and beyond.”

Over £1.5 million will support 12 pilot projects across Scotland to deliver a single point of contact to people diagnosed with cancer.

Funding has been delivered in response to needs identified by individual Boards and proposals submitted by them, pilots vary by cancer type and location:

NHS Lothian has received £ 343,740 to support the telephone-based SPoC service at Edinburgh Western General, serving boards within the South East Scotland Cancer Network
NHS Borders has received £82,000 for 3 cancer care co-ordinators, providing support across a variety of cancer sites
NHS Dumfries and Galloway has received £71,000 for 2 cancer co-ordinator posts, providing a telephone-based support service across a range of tumour sites
NHS Fife has received £107,354 to staff a Single Point of Contact Hub, dealing with all urgent suspected cancer referrals.
NHS Forth Valley has received £67,556 for 2 healthcare support workers (HCSW) providing a single point of contact for 7 tumour groups
NHS Ayrshire and Arran, NHS Forth Valley, NHS Greater Glasgow and Clyde, and NHS Lanarkshire have received total funding of £202,668to develop a regional approach to digital remote follow up of prostate cancer patients in the West of Scotland
NHS Greater Glasgow and Clyde has received £67,566 for 2 support workers to augment specialist gynaecological nursing support and £141,324 for 4 SPoC roles across GGC sites to smooth and facilitate the patient journey, for people diagnosed with lung cancer
NHS Grampian has received £84,500 for 3 posts to provide a joint service with Macmillan Navigators, providing support following an Urgent Suspicion of Cancer (USC) referral
NHS Highland has received £270,680 for 7 Cancer Support Workers providing tailored support throughout diagnostic pathway and onto treatment
NHS Tayside has received £33,288 to provide support for people diagnosed with advanced Upper Gastrointestinal or Hepatopancreatobiliary tumours and lung, renal and prostate cancers
NHS Western Isles has received £68,000 for 2 HCSWs, as part of the Macmillan Team, to support people with all types of cancer

Health Improvement Scotland is currently carrying out a scalability assessment of all 12 projects in order to identify best practice and how best to scale and expand these pilots.

Hospital at Home funding

Providing older people with a safe alternative to hospital

The number of patients using Hospital at Home in Scotland rose by almost a quarter last year, it has been revealed, as funding allocations for NHS boards were announced.

A total of 13 local healthcare providers have been allocated a share of £3.6 million for Hospital at Home for older people to help ease pressure on frontline acute services.

Hospital at Home offers a safe alternative to admission to an acute hospital, with almost 15,000 older patients using the service in 2023/24 and this funding will support the continuation and development of existing programmes.

NHS Borders has been allocated £600,000, with a further 12 healthcare partners also receiving a share of the allocation.

Confirmation of the awards comes as a new report from Healthcare Improvement Scotland highlights the impact that the Hospital at Home service for older people has had in 2023-24. The findings show:

14,467 patients used Hospital at Home in 2023, up from 11,686 in the previous year
total bed numbers increased by 58%, ahead of the Scottish Government’s 50% target
an estimated £14.9 million was saved in traditional hospital admission costs
a further estimated £36.3 million was saved in post-hospital care due to a reduction in re-admissions

Health Secretary Neil Gray said: “I am very pleased to see the progress that local health providers are making on delivering Hospital at Home services and the positive impact it is having, particularly on elderly patients.

“Hospital at Home allows patients to receive acute treatment in an environment that they feel comfortable and familiar with.

“There are more Hospital at Home beds for older people available and an increasing number of patients are choosing to use the service.

“Hospital at Home gives people greater independence during their recovery. Evidence shows that those benefitting from the service are more likely to avoid hospital or care home stays for up to six months after an acute illness.

“It is also one of a range of measures that we have put in place to tackle delayed discharge numbers and free up beds within our hospitals.”

Belinda Robertson, Associate Director of Improvement, Healthcare Improvement Scotland said: “We know that patients benefit from receiving safe, patient-centred care in the comfort of their own home whilst continuing to benefit from the support they are used to from families, friends and carers.

“Our latest annual report for Hospital at Home across Scotland shows that more and more NHS boards and Health and Social Care Partnerships are providing acute hospital care to people in their own homes.

“Four new services for people living in and around Dumfries, Galashiels, Lerwick and Oban have been established in the last year, and Hospital at Home services across the country have prevented over 14,467 people spending time in hospital.

“We would like to commend the Hospital at Home services for the fantastic work they’ve done to establish and grow their services. In the year ahead, we look forward to continuing to support NHS boards and Partnerships to further develop the services they provide, and to share learning across all Hospital at Home services.”

Volunteering helps Safia find the perfect work and life balance

As a girl who began watching ballet at the age of 10, little did Safia Qureshi realise that one day her interest in dance would lead to a career in helping to improve people’s health and wellbeing.

Safia is currently Director of Evidence and Digital at Healthcare Improvement Scotland, the national improvement agency for health and care in Scotland, whilst also being a volunteer with Scottish Ballet. She is involved with them as part of a ground-breaking initiative that uses dance as an alternative to medication.

Safia, from Penicuik, is one of 3485 NHS volunteers each month, who give up their time to help others. In total, NHS volunteers donated 584,000 hours in 2023-24 – the equivalent of 24,333 days.

She is encouraging others to do their bit and give up some of their spare time, as part of Volunteers Week, which runs from Monday, 3 June until Sunday 9.

Safia said: “I grew up loving ballet. I went to see it with my mum when I was a little, so I’ve always gone to see it when I can.

“I was doing a leadership development course run by the Scottish Government called Project Lift when I first came into contact with Scottish Ballet in a work setting. and they had this idea which they called Colliding Perspectives.

“I was involved in an initiative where small groups of people who were on the course came together with folk from different industries, and one of the companies involved was Scottish Ballet.

“They were looking for help with developing their Dance Health programme so I was straight at the front for that one, saying ‘Let me help!’

“Some colleagues and I were invited for a visit, to meet them and talk about what they were looking for.

“When I was there, I wondered if Healthcare Improvement Scotland might be able to help them, because one of their challenges was persuading healthcare professionals that dance could be used as an alternative to medication.”

Safia initially volunteered with a programme which helped people with Parkinson’s Disease.

She explained: “Having heard about their dance health programme at a high level, I got the opportunity to volunteer with the Dance for Parkinson’s programme that Scottish Ballet was running in Peebles, so I volunteered with them, probably on and off for maybe a year-and-a-half, and that was what really did it for me.

“It was just the most amazing experience, as the classes were run by professional dancers and they treated everyone who was in the room as a dancer. It was all really respectful and the programmes are based on whatever Scottish Ballet are working on, so there’s always a connection back to the company.

“The class became this real community, where people with Parkinson’s and a friend or a partner would come, and we’d all do the class together. It was great for helping people to relax and unwind.

“There were times when I would be blinking back tears at the positivity and community in the room. There’s something really special about the way that dance helped and united us all. I got such a lot from it personally, and it made me more determined that we need to show other people this is something that is amazing.”

With her knowledge as a health and care professional, Safia has been delighted to bring her professional expertise, her contacts within the world of healthcare professionals, plus her love of ballet together, and in turn has made many friends.

She said: “I helped Scottish Ballet set up their research committee and bringing in clinical experts.

“Having been a volunteer for a while, I was thinking some of the exercises that Scottish Ballet do might benefit people with Long COVID.

“We asked some of the patient representatives who’d supported us develop a clinical guideline for people with Long COVID guideline if they would meet with Scottish Ballet and talk them through what might be useful. They then introduced Scottish Ballet to more people in the Long COVID community. There was a real example of thinking differently, and using what you do in a different way to help people.”

Safia added: “When I was 10 years old and going to the ballet with my mum, I wouldn’t have believed this was all possible and that one day, I’d be working with Scottish Ballet. It still catches me every time I go.

“Through volunteering, you meet fascinating people who you would never otherwise have met and you also get to learn about yourself as you broaden your horizons. It’s very rewarding.

“Volunteering makes you feel good in lots of different ways, by doing something that takes you out of your day-to-day routine. I’ve been part of a community I never knew existed, which is lovely and I couldn’t recommend it highly enough.”

Hospital at Home for Older People

£3.6 million investment as capacity increases by 57% to exceed targets

The Scottish Government is continuing to invest in Hospital at Home for Older People with £3.6 million allocated for 2024/25, bringing total funding allocation for the initiative to over £15 million since 2020.

Recent statistics released by Healthcare Improvement Scotland (HIS) show that last year the Hospital at Home service for Older People, which provides a safe, alternative to being admitted to an acute hospital, exceeded targets in several key areas between April 2023 and March 2024, including:

total bed numbers have increased by over 57%, ahead of the Scottish Government’s 50% target
14,467 patients used Hospital at Home, up from 11,686 in the previous 12-month period
the Hospital at Home service is now the eighth biggest “hospital” for older people emergency inpatients, alongside Forth Valley Royal Hospital in Stirling.

Health Secretary Neil Gray said: “These figures from HIS show that Hospital at Home is becoming an increasingly popular care alternative for elderly patients to receive acute treatment in a place they feel comfortable and familiar with.

“There are more Hospital at Home beds available and an increasing number of patients choosing to use the service.

“Hospital at Home gives people greater independence during their recovery process. Evidence shows that those benefitting from the service are more likely to avoid hospital or care home stays for up to six months after an acute illness.

“It is also one of a range of measures that we have put in place to tackle delayed discharge numbers and free up beds within our hospitals.”

Belinda Robertson, Associate Director of Improvement, Healthcare Improvement Scotland said: “This announcement of additional funding will continue to improve access to Hospital at Home services and make them more sustainable to the benefit of patients across Scotland.

“It’s heartening to see that Hospital at Home services prevented over 14,400 people spending time in hospital over the past year.

“Moreover, with our support we’ve witnessed more NHS boards and Health and Social Care Partnerships embracing Hospital at Home by establishing and developing services.

“We look forward to continuing to help services develop and share learning in the year ahead.”

Expert warns of the dangers of using old antibiotics

A health expert has issued a warning to people not to save unused antibiotics at home to take later at their own discretion – as this risks more harm than good.

As concerns over antibiotic resistant infections grow, an expert from Healthcare Improvement Scotland has urged people to avoid using antibiotics they may have saved up at home, as their overuse presents a serious threat to the future of healthcare.

Professor Andrew Seaton, Chair of the Scottish Antimicrobial Prescribing Group (SAPG), part of Healthcare Improvement Scotland, said: “We know that many people have antibiotics at home which they or another family member have been previously prescribed and there can be a temptation, when feeling unwell, to use them.

“However, it’s quite likely, at times when chest and throat infections are common, that infection will be caused by one of the many circulating viruses rather than by an infection that requires an antibiotic.

“Antibiotics will not speed up recovery from a viral illness and they may cause unwanted effects including stomach upset. Critically, future infections may be more difficult to treat because overuse of antibiotics drives the development of antibiotic resistance.”

Using antibiotics that have been lying around the house for a while means they may also have expired. Once the expiration date of a medicine has passed there’s no guarantee that it will be either safe or effective.

A survey of 2000 people in 2022 found that one in three people said they had taken expired medicines and almost a third of these said they had taken medicines that were not meant for them.

The most common reason for an antibiotic prescription is for respiratory tract infections eg infections of the throat, ear or chest.

Professor Seaton, an infectious diseases consultant in NHS Greater Glasgow and Clyde, explained: “Although we are making progress in getting across the importance of not overusing antibiotics, we know that the pandemic has had a significant impact on our healthcare system including the way in which people access healthcare advice.

“We think this has at least contributed to an increase in the use of antibiotics. Work is still needed to protect our population from the very real threat of antibiotic resistant infections and to help preserve our precious antibiotics for future generations as well as for those who need them most now.”

Professor Seaton has also highlighted the importance of safe disposal of unused medicines. He said: “Antibiotics don’t only act on germs inside of us, but also act on the many germs living in soil and water and we know that antibiotic resistance in the environment has important consequences for plant, animal and human health.

“It’s essential therefore that we avoid environmental contamination by not disposing of antibiotics in household waste for landfill or flush them down the toilet. Safe disposal of unused antibiotics will reduce the environmental impact and help protect our planet.”

Global analysis of more than 200 countries in 2019, before the COVID-19 pandemic, estimated that infections due to antibiotic resistance are now a leading cause of death worldwide, higher even than HIV/AIDS or malaria.

More than one million deaths are estimated to occur annually as a direct result of antibiotic resistant infections due to common, previously treatable infections such as pneumonia and bloodstream infections.

In a bid to encourage people to safely dispose of unused antibiotics, pharmacies throughout Scotland are offering an ‘amnesty’ where people can return medicines to them to be safely disposed of.

Professor Seaton said: “For the majority of people who are feeling unwell with a cough, cold or sore throat, symptoms will settle with simple measures including rest, increasing fluid intake and careful use of pain killers like paracetamol.“

There is a useful check list which people can go through on the NHS 24 website to decide if further advice is needed Cough | NHS 24 .

Professor Seaton added: “For people with known serious underlying health conditions or for those where symptoms are not settling within a few days or are worsening it is advisable to take advice from NHS 24, their pharmacist or GP.”

Inspection report for Royal Infirmary of Edinburgh, NHS Lothian

Healthcare Improvement Scotland has published a report relating to an unannounced follow-up inspection visit to the Royal Infirmary of Edinburgh, NHS Lothian. The inspection took place in September 2023.

The purpose of the follow-up inspection was to assess progress and provide assurance on NHS Lothian’s improvement actions in response to serious patient safety concerns that were identified and escalated during a previous inspection of the hospital in February 2023.

To provide assurance of improvement following the concerns previously identified, the main focus of the follow-up inspection was the emergency department. Inspectors also visited a number of wards and the medical assessment unit.

Donna Maclean, Chief Inspector, Healthcare Improvement Scotland, said: ““Serious concerns raised in our previous inspection related specifically to the safe delivery of care and to potential patient safety risks. During this follow-up inspection we observed that considerable progress has been made in responding to these concerns.

“The delivery of fundamental care has improved with the addition of care and mealtime coordinators in the emergency department. Improvements have also been achieved in supporting patient care, dignity and leadership and in the coordination of care within the department.

“Implementation of a new continuous flow model has improved the flow of patients through the hospital during weekdays. However, further work is needed to support the timely flow of patients from the emergency department to an appropriate care area out of hours and at weekends.”

Six of the previous 13 requirements have now been met and progress has been made with four requirements, with further work to be undertaken.

Three requirements have not been met. These include hand hygiene, the use of personal protective equipment and the management of intravenous fluids.

One new additional requirement has been added with regard to the safe management of cleaning products. One new recommendation has been added in relation to the timeframes for the completion of significant adverse event reviews.

An improvement action plan has been developed by NHS Lothian in order to meet the requirements.

The full inspection report is available to view at:

Royal Infirmary of Edinburgh (healthcareimprovementscotland.org)

Scots want to see more done to limit tobacco sales and use

A report published yesterday by Healthcare Improvement Scotland finds that people want more to be done to limit the sales of tobacco products.

The survey, commissioned by the Scottish Government, asked questions which will form part of a refreshed plan to be published this autumn, to support a tobacco-free Scotland.

The Citizens’ Panel survey, which ran between November 2022 and February 2023, found that of the 667 people who responded to the survey, 75% want more action to be taken to further limit who can sell tobacco products, and while 63% agreed the legal age to buy them should be raised from 18 to 21, 25% were opposed.

Some 65% agreed that Scotland should increase the legal age of the sale of nicotine vaping products from 18 to 21 years.

In addition, the survey found that 80% of respondents said that they either strongly agreed or agreed that action should be taken to further limit who can sell nicotine vaping products. Just 9% either disagreed or strongly disagreed.

In addition, 67% felt packaging, in pack information and the appearance of cigarettes should be made more unappealing. Some 64% agreed that taxes on tobacco and vaping products should be raised, but nearly a quarter of respondents (23%) disagreed with this.

There was also wide agreement that the smoking ban should be widened to create more smoke-free areas where children congregate, such as outside schools and play parks, with almost nine in ten respondents (86%) in agreement. Just 8% disagreed.

The report recommends that the Scottish Government considers including all the measures that have the strongest public support in its Tobacco Action Plan 2023.

It adds that the Scottish Government should then consider further around more punitive measures, such as raising the age of purchase and raising taxation on tobacco and vaping products. After assessing the impact of these measures, these could also be implemented following a staged approach.

Clare Morrison, Director of Community Engagement at Healthcare Improvement Scotland said: “As Scotland looks to become tobacco-free in the near future, this shows that the majority of people believe more should be done to limit access for younger people to tobacco and vaping.”

Visit our Community Engagement website to access the full report.

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