Forth Valley Staff Stories

iMatter Pulse Survey 2020

Forth Valley Staff Stories

 

Introduction

As part of the Scottish Government iMatter Pulse Survey in 2020, the national iMatter team have requested stories from across Scotland, of staff reflecting on their experience in the initial months of the COVID-19 pandemic. The following videos and written reflections depict the way in which staff chose to capture their thoughts. Suzanne McGregor: Community Nursing Team Leader (Falkirk East)

 

Contributions were received from the following members of staff across the organisation:

Name	Topic	Directorate	Story/Video
Aileen Schofield	Supporting staff and patients to cycle throughout COVID	Falkirk HSCP	Story  & Photo
Dawn Gleeson	Acute In-patient Physiotherapy Team	Acute	Story
Elaine Bell	Team HR	Corporate	Story & photos
Eileen Sharp	AHP Stories	System wide	Stories & photos
Elizabeth Murdoch	OH during COVID-19	Corporate	Story
Emma Cavanagh	Single Point of Request	Falkirk HSCP	Story & photo
Emma Tyrell	Views of a Mental Health Nurse	Clackmannanshire & Stirling HSCP	Story
Julia Ferrari	My COVID Journey (MH)	Falkirk HSCP	Story & photo
Imene Merzouki	A Midwifery perspective	Women and Children	Video
Margarita Kaneen	Admin Officer Health Promotion	Falkirk HSCP	Story
Margaret Kerr	Staff Support & Wellbeing Group	System wide	Story
Maureen Walshe	COVID  Assessment Centre	Falkirk HSCP	Story
Molly Greenaway	Experience of COVID as an FY1	Acute	Video
Paul Baughan	CHART Team	Clackmannanshire & Stirling HSCP	Story & Photos
Sarah Dove	Redeployment at Bellfield Centre	Clackmannanshire & Stirling HSCP	Poem
Suzanne McGregor:	Supporting the HR HUB	Falkirk HSCP	Story

Videos:

FY 1 Experience: Hannah talking about her FY1 post 2 months into the pandemic https://nhsforthvalley.com/multimedia/

Molly talking about her experience of the pandemic : https://www.youtube.com/watch?v=ppUmCuCUUKA&feature=youtu.be

Midwife Experience Imene is one of our Midwife Practitioners, this film was done initially for information requested by Radio Scotland.  https://scottish-my.sharepoint.com/:v:/g/personal/david_anderson_forthvalley_nhs_scot/EVYd4QXPE2BOkZdOfoQoQWYBzRPmhbfPdT8vnMlEj2Xo_Q

 

Written reflections

1. Leadership

 

CMHTs and Mental Health Nursing Team in Primary Care- Julia Ferrari, Mental Health Teams Manager in FHSCP- Oct 2020

I am currently Integrated Mental Health Teams Manager in Falkirk. I am responsible for the integrated mental health community service for adult (18-65) and older adult (over 65). I also manage the Primary Care Mental Health Nurse Team (these are our mental health nurses that are based in GP practices across Forth Valley).

I feel incredibly privileged to have my job, I enjoy it immensely and have worked in mental health since the age of 18 so nearly 25 years.  Like most nurses I feel like I am best placed in a crisis and am comfortable when things are very challenging and difficult and require immediate decision making. The last 6 months has been some of the most challenging times we have all experienced. I feel slightly sheepish writing down my own story as I genuinely feel like ‘everyone’ has their own story and I don’t profess that mine is any more difficult but it has definitely been a personal journey which has made me think very differently about how we work as the NHS but also how I function as a leader, manger and nurse.

On March 17^th my husband Stuart tested positive for Coronavirus. When he got his results we think was the 13^th positive test in the Forth Valley area so it still felt quite new at that time. Whilst I was of course worrying about him and his health, (he had relatively mild symptoms at the time) in the back of my mind I was really concerned about not being at work due to myself and my young children having to isolate now that Stuart was positive and trying to get the systems up and running from home so that I could still run and support my services. 

After around 10 days I developed symptoms very similar to Stuart (dry throat, cough, high temp). I contacted Public Health and they advised that they would assume that I was positive and wouldn’t need a test. Mild symptoms meant I could still work at home throughout but the time at home was getting longer which was generating some anxiety that I couldn’t support my Team Leaders with so much change coming down from above.

 Within this period of time I also received (and expected) letter from the Scottish Government to advise that I should shield from now on. I have Rheumatoid Arthritis and I am prescribed biological immunosuppressant medication so knew that I was likely to sit in the high risk category. I was actually devastated by this from a work perspective, mostly because I wanted to be there in the middle of the crisis, supporting the people we serve and my staff who I could see were struggling. I noticed very quickly that I felt overwhelmingly guilty about being at home – so much so that I found it really difficult to switch off from work and felt I had to do a little more than normal, so I was certainly doing more and more hours as the weeks went on.  So like many people I was trying to do my job which was feeling really challenging operationally, home school my kids and just try to keep well in the middle of it all.  

I feel as a leader my style would be transformational, I try very hard not to be transactional and very much work on the premise that we move forward quicker and stronger if we do it together.  There was a very directive command and control type way of working at this time across all organisations – which it had to be in order to keep our service users and staff safe, there was not time to sit down and debate how we might approach everything and to be too centred to particular services. It was tough but it was completely understandable and we all knew that this was the correct and in fact only way that this could be done quickly and safely. 

As I was at home many of these messages I was delivering via email or advising my Team Leaders to go and inform their teams, this was not natural for me, if I have news that’s not going to go down well I would always deliver that in person myself and I felt sad that I had to leave it to team leaders. An example of this is sending staff to be redeployed to inpatient areas in order to support the acute hospitals. Staff knew that they had to do it but it wasn’t easy and having to deliver that news from home rather to them as groups felt very foreign to me.  I also felt that my team leaders were working incredibly hard juggling demand from service users and carers, staff feeling uncertain and anxious and likely feeling their own well being suffering and again I wasn’t there to do what I would normally do to support them and walk along side them to execute whatever we need to ensure our jobs were done correctly.

I came out of shielding from the start of August 2020 and I was so please to get back to seeing some of my staff who have now mostly returned to their original roles, this is good news as the wave of mental health referrals seems to be increasing so I am glad we have all our staff back. I have listened to their reflections of the last 6 months and it’s been so interesting to hear them – those that have been redeployed have been pushed out of their comfort zone and in most cases they see that actually they have more skills than they thought, it’s made them think about other opportunities in our organisation. 

Crisis brings out the best and worst in us and I think we have all experienced every aspect of that. Mostly what I feel is proud though, proud to be a nurse and been part of this, immensely proud of my teams who have gone the extra mile to support those in need (even doing things like a collection to take to the local family centre for the staff to give to children and families that might make use of toys, clothes and non perishable food that our staff all donated). I have seen dedication, compassion between my staff to each other and to the patients and their families.  They have put up with me barking orders around the ever changing climate and me being (I think uncharacteristically) authoritative knowing that we have a job to do and we need to get on and do it so that we execute what’s expected of us safely.

 My manager Marlyn Gardner is incredibly supportive and demonstrated real and genuine care for me during this whole time, she constantly checked in and made sure I was continuing to manage to juggle everything – this made a huge difference especially as a felt a bit out of the loop at home.  As I manage services across a variety of sectors I have seen pressure points across the whole system. My primary care team have been under extreme pressure with the wave of social distress and anxiety that Covid has generated.  They  along with all the mental health services have done brilliantly well and being flexible, supportive and responding in  really person centred way to the needs of the population.

 I have to also say I am so proud of my kids Harris is 11 and Anna is 8, their resilience through this whilst I was locked in a room in front of a screen working hard to meet the need of my services – my son made me lunch nearly every day and they just stepped up knowing that I had to just get on and work. They also managed their school work really well.

Health wise things have continued to be challenging, I had what felt like a resurgence of Covid symptoms in late April, and this resulted in lung pain, shortness of breath. I have since had chest X ray, CT and ultrasound to rule out anything too concerning as it looked like there was a shadow on my lung, it seems to be improving now. My husband on the other hand 6ft 4”, very fit, healthy and active, exercises normally around 8-10 times per week has now 6 months later been hit with extreme fatigue and exhaustion. Having never had a medical certificate in his life he finally went to the GP and is trying to work through these symptoms of what look to be ‘long’ Covid. 

So this is a little but about my Covid journey as a nurse and a leader within the NHS/HSCPs, as a mum, wife and person who has shielded over this last 6 months.

 

 

Forth Valley - Care Home Assessment and Response Team (CHART)

 

Background:

In March 2020, at the outset of the COVID19 pandemic, some care homes within the Forth Valley area of Scotland had significant outbreaks of coronavirus with many residents affected, some of whom were dying.   There was an immediate response from social care, GP practices, Ageing and Health, ‘Out of Hours’ services, public health, care inspectorate, hospice and voluntary agencies to support these care home residents and the staff working within them. Initially the co-ordination of this response was poor, and as a result care homes were phoned numerous times a day by different organisations asking similar questions.

In April a decision was taken to co-ordinate the support for care homes in Forth Valley through a dedicated multi-professional and multi-agency team called CHART (Care Home Assessment and Response Team).

This CHART team was formed of different professionals that included GPs, social care workers, palliative care specialist nurses and Advanced Nurse / Paramedic Practitioners. The associate medical director for primary care initially engaged a small and regular cohort of GPs for continuity and consistent clinical leadership. The FV Advanced practice lead resourced and co-ordinated ANPs from throughout the organisation including acute care, community hospitals, prison health services and primary care.   We also integrated ANPs who were unable to undertake patient facing work to join the team in Stirling and engaged with those ANPs shielding at home. These ANPs undertook telephone triage and also provided care homes with follow up calls. As well as this they were able to provide clinical advice or prescriptions over the phone or undertake ‘near me consultations’ where available.

The daily ‘TEAMS’ video-call with those shielding was linked in with the wider care home liaison ANPs and helped this workforce feel integrated as very valuable members of the team.  

Together CHART supported the 2000 residents living in the 66 care homes across NHS Forth Valley.   There are 2 health and social care partnerships within NHS Forth Valley.  The health and social care professionals working within the CHART team were physically co-located in Stirling Community Hospital, and held a daily morning call with the Falkirk Social Care team.  

The team actively visited some of the sickest people who were affected by COVID19.  This involved putting themselves at increased risk of infection from visiting care homes with known outbreaks of coronavirus, at a time when everyone was getting used to using PPE. They assessed those with symptoms of COVID19, using emerging central guidance and tools.   They kept anxious families and loved ones informed and aware of what was happening – which was particularly important when families were not able to visit the care home.  They were involved in making difficult decisions about whether residents required admission to hospital, and provided good palliative and end of life care for those dying from the effects of the virus.

Building the team:

Coming together from so many different disciplines, as a new team was a challenge.   However the depth and breadth of the health and care experience within this new team was immediately evident.   There was a clear common purpose which immediately focused minds.

A decision to co-locate the team together within Stirling Community Hospital was tremendously important.   It allowed the healthcare staff and social care staff to work together and discuss how they would co-ordinate support for the care homes.   This also allowed a much greater understanding of the individual roles of everyone involved and helped recognise their unique contribution.   As well as the regular daily meetings, the ability to eat lunch together and share a (socially distanced) chat over a coffee and a biscuit, enabled the professionals from health and social care to get to know each other much better, strengthening the team. 

Senior support from within the health and social care partnerships was ever-present, and responsive to the needs of the team. The CHART team was able to discuss requirements, and make operational decisions regarding the running of the service, without the need to go through protracted governance procedures.This allowed for the development of a responsive service within which was able to meet the needs of the care homes and their residents.

Objectives of CHART:

The agreed objectives of the multi-agency response, leading to the formation of CHART, were to:

1. Support care homes with infection control and other measures to protect their residents
2. Encourage completion of Anticipatory Care Plans
3. Ensure rapid access to appropriate medication for symptom control
4. Allow GP practices to separate COVID clinical work from the non-covid work
5. Provide responsive assessment and management of symptomatic residents
6. Improve quality of care within care homes
7. Enhance quality communication between agencies
8. Support Care Homes to develop manage and sustain resilience and recovery planning.

 

 

Activity:

 

All care homes in Forth Valley were provided with a single phone number to call between 8am and 6pm, 7 days a week.   This number could be called regarding any clinical concerns or for advice in relation to COVID19, and the call by-passed their normal GP practice.This then prompted either a video or telephone call with one of the advanced nurse practitioners working with CHART. One of the team could then visit the symptomatic care home resident within the home as required. Colourful posters and flow-charts were produced and circulated to all care homes advertising the new service.

Every morning, a social worker proactively called each care home on a multi-agency basis to provide advice and support, and to check how things were going.  Any clinical concerns were discussed with the clinical component of CHART. The social care staff were able to identify any staffing, infection control, or welfare issues and take the appropriate action to support the care homes.

At the end of each day there was a multi-agency Forth Valley Care Home Strategy Group meeting, led by the Nursing and Public Health directorates – which involved the care inspectorate, CHART, the care home assurance team, senior management and other key stakeholders.   The care home strategic group was able to mount an immediate response within 24 hours to address any concerns raised.

The integration of social care and health care professionals within one team allowed for the sharing of relevant information to support care home residents and staff in a proactive way.  Low level concerns that may not have been reported formally were shared within the team to enable an appropriate response.These included observations about infection control procedures within a home, and where it was felt that care home staff needed additional support.

In the early months of the pandemic there was a focus on updating Anticipatory Care Plans and the sharing of information on the Key Information Summary. This was largely undertaken by the care home staff and care home liaison nurses.The social care component of CHART prompted care homes to focus on this during their daily calls, and the clinical members of the team were there for support and guidance. Education and training sessions on Anticipatory Care Planning, and the use of the ‘ReSPECT’ approach was provided.

Activity and Outcomes following establishment of CHART:

There were 178 referrals to the clinical component of CHART regarding 91 different residents over during the first 10 week period of operation (April to June 2020), due to care home residents experiencing symptoms or signs of COVID19.   34% of these residents were ultimately tested positive for COVID19, and 66% tested negative.  This suggested that the referral flow chart was successful in identifying those that were most likely to have COVID19.

 

An active and complete Key Information Summary was found to be available for 79% of residents at the point of referral.  Specific outcomes following intervention from the clinical component of CHART included:

 

49% of all calls were resolved with advice to the care home staff on management

22% of calls resulted in an antibiotic being prescribed

15% of all calls resulted in a palliative and approach to care with end of life care support

12% of calls resulted in other medication (not antibiotic nor palliative care medication) being prescribed

4% of calls were passed onto the GP practice for non-covid conditions that required ongoing treatment

2% of calls resulted in treatment with portable oxygen within the care home setting

2% of calls resulted in an admission to hospital

1% of calls resulted in a referral to the Respiratory Team

Feedback from key stakeholders

Because this was a newly formed team, responding to a pandemic which had not been experienced before, feedback was actively sought from internal and external stakeholders.   This allowed the team to evolve and develop in an iterative constructive manner.  As well as regular informal feedback, questionnaires were sent to the following groups of people (Care Home Staff, Care Home Liaison Nurses, Social Care professionals, GP practices) to explore their experience of working with the CHART team.

 

 

 

A summary of the responses is given below:

1. Feedback from Care Homes

17 Care Homes returned a questionnaire summarising their experience of working with the CHART team.   Figures 1 and 2 below show that care homes felt that communication and information was provided by the CHART team in a professional and supportive manner (47% strongly agree and 40% agree).   Particular appreciation was shown for the proactive daily calls from the social care component of CHART, with 87% of care homes agreeing or strongly agreeing that they felt supported and were listened to.

Figure 1: Care home feedback on communication with CHART

 

Figure 2: Care Home feedback on Social Care CHART

 

 

 

2. Engaging Managers

Falkirk HSCP Staff Stories

Burnbrae Care Home

The residents and staff of Burnbrae Home have been working together over the summer months creating a garden in memory of a late resident and dear friend who sadly died after contracting COVID – 19.

His beloved family donated money to the home, and after consultation with his peers it was agreed a water feature would be a fitting minder of his years spent at Burnbrae as he just loved the outdoors.

Although it has been extremely difficult over the past 7 months we have all remained positive, stayed strong and supported each other.

Cunningham House Care Home

Cunningham House enjoyed a visit from the Forth Valley Accordion Band on 20^th June 2020. This should have been Grangemouth Gala Day and the band came along and played outdoors for our residents, allowing them to celebrate together although distanced! All but one resident chose to take part, enjoying afternoon tea and live music from the band in our garden area. Some local residents heard the music and joined in from outside our garden boundary. It was a lovely afternoon which residents really enjoyed!

Grahamston House Care Home

At Grahamston House we welcomed five colleagues from Day Service for Adults into our team; this enhanced the care and support of the residents, their relatives and to increase staffing levels during this challenging period.  This has been an excellent example of transferable skills and experience being utilised, and an opportunity for staff teams to share ideas, knowledge and skills, not to mention to inject some new “personalities” into our team at a difficult time.

For example, one of the male Day Centre Officers has worked very closely with one of the residents who has a very rare type of dementia.  The gentleman requires a lot of one to one support to meet his individual needs and this DCO transferred his existing skills from working with adults living with physical and learning difficulties into his practice with this resident.  As a result, this gentleman has more quality time with this male carer, such as enjoying his walking indoors and outdoors safely, which has clearly had a positive effect on his mental and physical wellbeing.  This professional relationship has also given the residents wife great comfort knowing he is being well supported at a time when she could not visit.

I believe my staff have shown amazing resilience during the pandemic as a professional workforce. They have supported the residents; each other, maintained communication between relatives and their loved one in a variety of ways e.g. face time, Skype, telephone, texting, window visits, outdoor visit and now indoor visits. All to the benefit of the residents and the relatives, whilst adapting to major changes in work practice, procedures and workload. 

What makes me so proud of my team, is the fact that all this hard work and genuine commitment to the residents, relatives, service and team has been carried out to a very high standard whilst one of our colleagues became very ill and sadly died, this was not covid related.  The staff team supported our colleague, her family and each other during this difficult time and on top of everything else they were coping with displays their resilience and genuine passion to their profession.

Torwoodhall Care Home

As lockdown eased a resident of Torwoodhall asked his key worker if he could resume going to the local newsagent and bookmakers. Before lockdown this was a regular daily trip for him and helped stabilise his mental health. Staff members raised the request with the management team and following a further meeting, guidance was sought from Public Health Scotland and the Mental Health Welfare commission. All professionals were in agreement this was a difficult situation to resolve balancing the resident’s rights with Public Health’s concern over risk.

Due to concerns Torwoodhall Management sought further guidance from senior management in the Partnership and this resulted in a risk assessment request. This was completed and included a member of Forth Valley nursing staff team coming to the home teaching the resident how to self-test for Covid-19, which he has successfully been doing with support from staff who verify he has self-tested and they send his kit to the test centre. This collaboration has enabled the resident to resume his daily routine, he goes out wearing his face mask and he re-enters the Care Home following the same hygiene procedures as staff members.

This shows the pulling together of Staff, Management, Senior Management and health colleagues to enable a resident regain part of their life in these challenging times. Staff members have commented that the resident’s demeanour is more relaxed and it has also created a feel good factor amongst staff members

Summerford Care Home

When our centre went into lockdown with the rest of the country it very quickly became a very isolated and emotionally difficult time for many of our service users, our once busy service went from being a hive of activity with service users and families coming together daily to a very quiet service with no buzz about it.

In light of lockdown and people shielding my street had created a Facebook support page and lettered all the neighbours offering support of any kind needed to anyone who needed it. Posts went up daily seeking and offering practical support but also offering emotional support and positive thoughts. Some families were finding it difficult to entertain their children so I had suggested on the group if any children wanted a task to do they could draw a picture of a rainbow or something else nice for our older people. 

My letterbox was inundated the next day with lots of hand written letters and lovely pictures for our service users. There was enough for nearly every service user to have one each, when I took them in to work a few days later and assisted by our Activities Therapist distributed them to our service users the building was filled with joy, laughter, conversation and reminiscing.

The service users wanted to send replies and so they did, the children were delighted with these and so continued a flurry of letters and pictures going back and forth between the service users and children. This went on for many weeks, the service users would send the children puzzles or quizzes they had been working on to see if the children could do them and although no-one met in person they formed real relationships, my neighbours children still ask me about some of the ladies they were writing to. All of these service users have since returned home and been able to have that bond with their own families again but I can certainly say that receiving a letter or a picture was definitely the highlight of their day, bringing so much joy to them in what was quite an isolating time but also sparking conversations and memories about their own childhood or their own children growing up. A little light and love for all concerned in what were difficult times.

Oswald Avenue Day Service

Two weeks before lockdown the decision was taken to transfer Oswald Avenue Day service and operate out of Dundas resource centre, for the protection of service users and to release some day service staff members to support other critical care services who were having staffing difficulties. The team was re-worked, some volunteered to work in other services, whilst others worked to inform parents and carers of the changes being made and others supported service users to explain why we were transferring.

The management team contacted other professional colleagues keeping them informed and a week later the decision was taken that Day Services would have to close.  Staff members and the management team followed a similar process as the transfer.

Prior to closure a Risk Management Plan was created by key workers, colleagues and managers which followed a red, amber, green methodology assessing risk to each of the 102 service users not receiving their day service at weeks 1, 4, and 12 of the pandemic.

The risk assessment meetings enabled staff members to review each service user to assess risk based on the criteria detailed and provide an information plan that could be used in supporting the service users and their families through the pandemic and dedicated members of staff have maintained weekly communication. From this communication information provided to staff members has enabled the team to monitor and raise any concerns with health and social work colleagues also to sign post the service users to supports.

A key worker attended an emergency case conference online which they had not done before which contributed to a new support plan for the service user. Day Service staff members have supported a service user in their own home due to a crisis which provided additional support at a time of stress for the family.

As the service closed staff members in Day Services were deployed and through discussions and meeting  with their management over the course of the last few months many staff have spoken of new skills and experiences they have learned from and getting to know new colleagues and the work they do in their roles has changed their perspective. Staff members and the management team worked closely together with other colleagues to achieve this work prior to the full lockdown.

Thornton Gardens

Thornton Gardens closed down on 27^th March due to the Pandemic. Through discussion with my line manager and projecting potential emergency situations I was asked to discuss the possibility of using the building at Thornton Gardens for emergency situations such as hospital discharges and Adult protection issues for all older adults.

The current service at Thornton is short breaks for service users with Learning Disabilities and respite for their families. It caters for up to 4 admissions with an additional emergency bed. The building is a large building and has capacity up to 14 beds. I liaised with the Care Inspector for the service.  They agreed these were exceptional circumstances and I was asked to submit a Care Inspectorate variation form requesting an additional registration to use the building for emergency situations.

Through a number of discussions with various Care Inspectors the registration was approved. When the service re-opened in June it was under its new registration and although no longer involved in the service, I know that the increased capacity has enabled more service users and their families to be supported through these challenging times.

Recently my management colleague has secured a further extension to this part of the registration. Personally I felt good about having done this piece of work, felt supported by my line manager in doing this and the Partnership. It was projecting ahead and acting on this to provide additional support to the most vulnerable service users in our community.

 

Joint Load Equipment Service (JLES)

JLES is the community equipment store for Forth Valley.

The recognition that this pandemic was something very different, serious, unknown and without reference showed the best the staff, throughout our small service, could do when faced with real adversity and critical decision making necessity.

Background

Prior to COVID the service had staff split into small teams each with their own distinct operational activity; equipment, technical and business support. Although under the one roof these teams could often work in virtual isolation from each other and not always in harmony or co-ordination.

Our service covers the whole of Forth Valley, so dealing with two HSCPs and all their constituent bodies can also lead to challenges in dealing with different and competing priorities at the best of times.

Immediately prior to initial lockdown a senior member of the team left to pursue an opportunity in the private sector and within weeks another left for a position in another Partnership area.

Pandemic

The service is recognised as a key and critical part of the HSCP, so very quickly the team had to develop; risk assessments to ensure safe work for emergency working, a new management structure and responsibilities across the team to deal with the vacant posts, alter work methods to accommodate these changes and develop new working relationships with clinical assessors and service requisitioners.

This could only be done with complete ‘buy in’ from the staff across the board in the service, the trade unions and senior management in the HSCPs. There needed to be a change in culture and a recognition that the service must operate as one team rather than three, almost, independent units with separate lines of management and accountability.

This ‘buy in’ did take place and these changes are taking place. Some took effect almost immediately some, by necessity, are taking a little longer to develop and put in place but the direction travel is clear and agreed.

A positive ‘spin off’ from the crisis has been to demonstrate that the service can operate differently: With less managers, that front line staff given the opportunity to show initiative will do this, and confirmation that given more responsibility they will rise to the challenge.

Outcome

JLES has continued to provide to an agreed, if reduced, level of service throughout the pandemic as well as continuing emergency out of hours cover for breakdowns and equipment provision for end of life clients, each and every day and night throughout the period.

This has included working in suspected COVID households.

Because of the nature of the service provided there is extremely limited scope for working from home therefore work practises within the office and warehouse have had to be altered as, on occasion, the full complement of staff have been on-site but organised themselves differently to enable safe distancing and ensure compliance with cleaning regime. There have been zero complaints from staff or their trade unions around these necessities, indeed many of the best suggestions have come from the frontline staff. The ‘can-do’ attitude and concentration on the main ‘goal’ of the service from staff has been evident throughout. Indeed it is management that must occasionally challenge the enthusiasm of the staff for ‘getting the job done’ and balance this against safe working.

The teams are all now line managed so as to be answerable to one manager on-site. Individual tasks have been realigned and job roles reconfigured to better reflect current requirements rather than historic ones.

Staff from the previously different teams now regularly assist each other to complete tasks previously the domain of another. The smaller management team has enabled quicker decision making as well as allowing the voice of the frontline staff to be heard directly.

The lessons learned are being used to review the structure of the organisation post COVID.

It is hoped to develop the excellent cross-team working and to review job roles and responsibilities within the service. To train and develop individuals allowing for greater initiative and responsibility from frontline staff into the future.

District Nursing

When I first heard of Coronavirus through the media, I didn’t pay too much attention to it.   I viewed it as something that was far away and would not affect me directly.  As cases increased and spread throughout the world my view changed very quickly.  At the start of the Pandemic I felt that there was a lot of uncertainty and anxiety.   Personally this was in relation to keeping myself, and my family safe, whilst also being able to provide care to our most vulnerable patients in their own homes at a very difficult time.  I was in a fortunate position that my husband and I both were able to continue working throughout and did not have to worry financially but I know that this is not the case for many others.  Also working full time with 2 children in high school, I was concerned that I wasn’t able to provide enough support to them to continue their education from home.

Initially there was difficulty in accessing appropriate PPE and conflicting advice on its appropriate use.  Once this was available and we were given clear instructions of what PPE should be used in different situations I felt that levels of anxiety reduced.  Patients were encouraged to self-manage their condition where appropriate and were provided with education and support to enable this.  We also encouraged family members to provide care to their loved ones where appropriate and a lot of support which would have normally been provided face to face was given over the telephone.  This was possible for some of our patients but there was still a vast amount of our caseload who continued to need face to face visits especially when providing palliative and end of life care.   All face to face meetings were cancelled and transferred to a virtual platform.  Social distancing was implemented on office areas which posed a challenge due to office space and staff numbers.  At first this felt very strange, however as things have progressed this has become our new normal and the initial feelings of anxiety have reduced and our working practices have continued to evolve to meet the changing needs.

I feel that a positive to come out of this is that it has enhanced team working within individual and the wider teams.  The daily virtual meeting allows areas which require support to be identified and resources managed effectively.  As things move forward I think that this new way of working has become our new normal and as nurses we will continue to strive to safe and effective care and support to all our patients in adverse circumstances.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. Employee Voices

REFLECTIONS ON COVID-19

Tackling any new job out with your normal comfort zone can be daunting without the added stress of Covid-19. But staff across the organisation, including many AHPs, responded magnificently to the challenges of redeployment. To help recognise their efforts, and listen to their personal stories, a number were invited speak at a virtual event led by NHS Forth Valley’s AHP Practice Education Lead, Eileen Sharp.

Here are some of their reflections:

Nicola Orr - Speech and Language Therapist 

“Although we found that we did have transferable skills which enabled us to fulfil the role we were being asked to do, we found the loss of our own “professional” identity difficult. Having worked as a Speech and Language Therapist (SLT) in Children’s Services roles since qualifying at age 21, much of our identity is defined by our clinical expertise, rather than our leadership skills, and at times in our new roles we felt we had lost part of ourselves.

“However, the ReACH team embraced us as paediatric SLT staff with no clinical role in this crisis. Our lack of clinical expertise in rehabilitation or adult care was never a barrier at any point. The substantive Team Leads and coordinators in ReACH were incredibly supportive from the outset, guiding us through processes and procedures and answering every “silly” question. We received very positive feedback from ReACH team leaders and coordinators and heartfelt messages when we left to return to our substantive roles.”

Barbara- Anne Cleaver – Speech and Language Therapist

 

“We approached deployment with humility, acknowledging from the outset that we didn’t have all the answers.  Instead, we tried always to “listen to understand”, and act in a way that staff felt they had truly been heard. Over the course of the 12 weeks, the underlying causes changed and evolved – initially our anxiety was around managing a team we had never met, and the fear of exposure to the virus – particularly exposing our families who had created a ‘safe’ bubble at home.  It became a balance – to be human and travel the journey alongside our colleagues, without our anxieties affecting the team.

 As time moved on, and we became more comfortable in our roles in the teams, our anxiety shifted to what we were missing in our own department and how it would be to find our place back in the team. 

 

“In saying that, the experience has had a positive impact.  I have gained in confidence in my seconded role, and I have built relationships with AHPs that I would not have met otherwise.”

 

Sarah Dove, an Occupational Therapist, has captured her experience of working in the Bellfield Centre, earlier this year in verse.

Deployment 2020

Armed with compassion we went as a team

To assist in the war against Covid-19.

Adrenaline, professionalism (and cake) fuelled

We realised quickly the virus was cruel.

 

Patients had no visitors.

Patients saw no smiles.

Television vomited anxiety,

Patients were worried, so were we.

 

Donning, doffing PPE…..donning, doffing PPE!

A daughter on the phone was reassured to know her Mum had her slippers on to

keep her warm.

She cried and asked me to -

“please, please keep her from harm”.

 

But names on the ward were turning red,

Colleagues were at home, sick in bed.

Numbers were rising every day, we struggled with ways to cope.

Isolation, separation…..challenges to hope.

 

‘Kind hearted, beautiful beings’…essentials on job recipe.

In it together, we knew the score….my colleagues and I family.

One stayed late to play piano.

One gave us seedlings to grow.

Our internal angst was expressed by one, who let all emotions show.

We listened, supported and we laughed…..

We definitely needed to laugh.

 

I made some badges, pinned to our aprons, our faces showing a smile.

A real smiley face, in real life….. maybe quite a while.

 

My family stayed at home whilst I drove car free roads to work.

Home schooling was done, Zoom zoomed, sunny weather was a perk!

I willed the police to stop me, for breaking lockdown rules.

Who ever thought that working for the NHS would ever be kind of cool?

 

In March when this all started, the geese were migrating away.

Now they are returning, for winter they will stay.

Next time we say Goodbye to geese, let’s hope there are no bugs.

Instead, that we can celebrate and give our loved ones hugs.

 

A view from a Mental Health nurse- Emma Tyrrell, Mental Health Nurse, NHS Forth Valley

 

My name is Emma.  I am a Band 5 Staff Nurse in a community hospital in NHS Forth Valley in a ward which provides mental health care for older adults with dementia.  I have spent most of my 19 year nursing career caring for patients with dementia, a condition which can present many challenges not only for the patient but also to those who provide their care.

 

When Covid-19 first hit the news I have to admit that I really didn’t pay it much more than passing attention - it was terrible of course but it was all happening so far away - though, as the weeks progressed and the year turned, it became increasingly evident that this was going to affect us.  In our spare moments at work my colleagues and I would find ourselves gravitating towards the ward sitting room where the television would be on and we might catch an update on infection rates and deaths.  We shook our heads in silent sympathy when we watched reports about the devastating situation in Italy... and then Spain... and we debated amongst ourselves how we thought we might keep ourselves, our families and our patients safe.  It didn’t matter what we talked about, the conversation would inevitably return to coronavirus. We felt anxious and frightened.  We felt stressed.  We would resume work after days off with an unsettling feeling of not knowing what situation we would be returning to.

  

NHS Forth Valley were sending out Covid-19 bulletins and updates on a frequent, almost daily, basis at first and the changes seemed to be coming so quickly that, sometimes, I wouldn’t even read them as I fully expected the situation to very quickly change again.  Guidelines for reporting covid related deaths, guidelines for non covid-related deaths, videos about how to carry out testing, videos on how to don and doff PPE, what PPE to use and when – it felt never-ending and, at times, I wished I could close my eyes and it would go away.  At other times I felt a fierce sense of duty and pride for myself and my colleagues. We would do this, we would keep our patients safe and we would show everyone what stern stuff the NHS is made of.  A rollercoaster of emotions and, thankfully, the latter has endured!

 

Our usual remit for the ward is to admit patients with a moderate to severe level of dementia who have already undergone a period of assessment and who require a further period of inpatient care before they might be ready to go to a nursing home or other long-term care arrangement.  Our remit now was to admit patients with a milder level of dementia, perhaps with more physical or medical concerns than we were used to, in order to free up beds in Forth Valley Royal Hospital to allow them greater capacity to care for the expected influx of patients with Covid-19.  We would not be admitting patients with Covid-19 but we would be instrumental in relieving the pressure on those who were.  A flurry of activity seemed to follow over the succeeding days and weeks, speeding up discharges for those who were ready and admitting those who weren’t.  All but essential visiting stopped as the country went into lockdown.

 

 It soon became policy that we wear masks throughout our shift.  Of course this was the only right course of action but this was also a difficult transition for us.  The therapeutic relationship between mental health nurse and patient relies heavily on non-verbal communication and the ability to appear non-threatening towards patients with severe cognitive impairment who may be confused, disorientated and frightened, and a smile goes a long way towards helping build this relationship.  How would our patients react to not seeing our smiles and other facial expressions?  How would they react to being approached by a masked figure in the semi-darkness of their bedroom at night as the nurses carried out their checks?  Would the incidence of aggression rise?  Would we see an increase in the levels of stress and distress in our patients?  Our relationship with our patients felt especially important now as they would not be able to receive regular visits from family and friends for some time.  We began to smile more, making sure this was reflected in the visible parts of our faces. We softened the tone of our voices and opened our postures. We used touch more, a reassuring hand on a patient’s arm or shoulder, and we endeavoured to bring more into our conversations with them.  Occasionally a patient might pass comment on our masks but it seemed that our efforts paid off and there did not appear to be an increase in any of the behaviours about which we had been concerned.

 

Another concern was how we would contain the virus if there was an outbreak on the ward.  A notable feature of all the dementia wards in which I have worked is the number of patients who wander around the ward.  They might be looking for something, perhaps seeking an exit, or their condition may cause the kind of restlessness which only the ability to be continually active can alleviate.  Providing the patient isn’t distressed this wouldn’t normally be a concern but allowing them to wander unhindered would be inappropriate in the event of any confirmed Covid-19 cases in the ward.  Our patients generally have little concept of infection prevention and control procedures and physical distancing is unfeasible in dementia wards for a variety of reasons but how could we enforce isolation on a patient who was infected but who felt too well to be nursed in bed and who would not understand why their movements must be restricted? Could we reasonably isolate infected patients within their rooms and expect our therapeutic relationship to be unaffected and their sense of mental well-being to be maintained?

 

We asked these questions as mental health nurses-putting the mental health and well-being of our disorientated and vulnerable patients to the forefront, this perspective is in our nature.  We are in the fortunate and most-likely uncommon position of not having identified (to date) a single case of Covid-19 in the ward but we remain on our guard.  We have begun to gravitate back to the sitting room and the television again to hear updates how the virus is being managed amidst concerns about a potential second way. But we are okay, we are increasingly aware of our strengths and weaknesses and of those in our work environment and we are quietly preparing ourselves for what the coming months may present.

 

This is my own personal account. I am not presuming to speak for my colleagues but I have used the word “we” in many cases here because our team effort has endured and we have supported each other throughout.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What Else Can I Say but Thank You to my Most Wonderful Colleagues?

Margarita Kaneen- Assistant Administration Support Officer

If I might be allowed to contribute a little I would like to say that I could never thank my colleagues in our fabulous Health Promotion service enough for looking after me in the way they did from the outset of this truly devastating pandemic, and especially at one of the most frightening times we can probably remember or have to face in our lifetime.  In life I have rarely been treated in this way apart from by my family and closest of friends and that is what they have come to mean to me.  There was no question ever over what they did for me as they not only came forward at a time of great anxiety, upheaval and the burden of much extra work but they put themselves in the firing line of danger over many  months; making sure I was well out of it by seeing that I worked from home, had all I needed to be able to do so, calling with information to update me on Virtual Staff & Tearooms  and ensuring the safest of return to the workplace, going miles out of their way doing my shopping each and every week carrying all the bags bringing them to my door, throwing in sweets, treats and flowers when they thought I might like something special they saw and forever keeping in touch to make sure I was okay and to find out what I needed and what they could do for me with such grace and good humour.  I was very unwell a few short years ago and that was a very difficult period for me as during it, I was unable to do most of the things I have been so fortunate to do for myself and hopefully others my whole life.  Accepting help from others it has to be said can be one of the most difficult things to do when you are a very independent person so when I did accept their help it was because I could see they really cared and not at any time made a big thing about it or ever made me feel a nuisance, that they were doing anything unusual or going out of their way in the slightest.  I can honestly say that I am truly humbled by my most wonderful colleagues and so very grateful to them for their kindness, thoughtfulness and caring; they are very special human beings indeed.

Yours with love and much fondness, Margarita

 

Maureen Walshe- Health Promotion Officer

Hi, I’m Maureen Walsh, I started my NHS career as a podiatrist which I loved but following a work related injury moved to the Health Promotion Service where I have been for the last 12 years with a remit for workplace health, a large part of which is focussed around the Scottish Government Healthy Working Lives Award Programme.

On the 28^th March 2020 I was deployed to the Stirling Covid Assessment Centre. My role within the centre is varied including day to day admin but also managing rotas, ordering supplies and ensuring reports are submitted accurately and on time. Working in the assessment centre has enabled me to use my knowledge and skills to support the smoother running of the service. 

At the start we didn’t know what to expect but the GP’s, nurses, runners and ourselves were all in the same position so we quickly formed strong bonds.  I have been fortunate enough to work alongside a friendly, enthusiastic and committed bunch of staff who I have thoroughly enjoyed getting to know.   I am proud to work in the NHS and for me this deployment has been a really positive work experience.

 

 

 

 

 

 

 

 

Team HR

 

Elaine Bell, Head of Operational HR

 

In March 2020, all departments within the Human Resources Directorate were mobilised to support NHS Forth Valley’s response to the emerging coronavirus pandemic by establishing a Forth Valley COVID-19 Deployment HUB.  For many members of the team this meant standing down or pausing the “day job” moving base and undertaking new work much of which was emergent and saw us working alongside colleagues that perhaps we had never worked with before. The virus and its far-reaching impact touched all members of the team their families and friends and as the scale of the crisis became clear staff were understandably anxious and worried for themselves and their loved ones. The support shown for each other during this time was heart-warming and uplifting to experience.  Team HR pulled out all stops and without hesitation from day one offered to work whenever and wherever it was required – they stepped up.     

 

In March, the COVID-19 Deployment Hub was established as an area wide resource, located in Forth Valley Royal Hospital operating over 7 days and managed by the Human Resources Directorate.  Its purpose was to co-ordinate the deployment of our workforce across the whole organisation ensuring essential services were maintained.  It adopted a ‘hub and spoke’ model that aligned with NHS Senior Decision Makers and Line Managers.  Working closely and making linkages with all NHS Directorates, Partnerships, external partners including Local Authority colleagues, Police, Army and local businesses.

 

Up to date workforce information was key to establishing the skills and experiences of our workforce to ensure any decisions made by senior decision makers to mobilise the workforce whether that be large or small was based on the most up to date information available. The workforce information and administration staff produced daily reports for Silver Command which included updates on Recruitment/Staff Bank activity, sickness absence, numbers of staff self-isolating etc. The team also developed and implemented the use of a home working risk assessment, collating live information numbers of who were shielding.  This allowed the organisation to be proactive in supporting those isolated at home and providing where appropriate opportunities for them to continue to contribute and feel valued.

 

Arguably, one of the most significant demands in relation to workforce was the accelerated recruitment campaigns. Team HR responded magnificently to the challenge and worked tirelessly across all functions when it was required.  This was only possible with the joint working of the whole HR team and the pulling together of the HR senior management team in a coordinated way.

The Staff bank team along with others including OHS, Medical Workforce, Recruitment, Nursing and OD supported the recruitment campaign which saw us work together in the evenings and weekends.  This was all done with a huge sense of responsibility recognising the need to support our colleagues on the front line whether in wards, departments, COVID HUBs, community assessment centres, care homes, NHS Louisa Jordan Nightingale Hospital and more recently test and trace services.

The team within the Learning Centre worked collectively to support each other and colleagues across the organisation welcoming staff, coordinating room bookings to support COVID meetings and redirecting bookings at very short notice. The team worked hard to ensure all rooms were risk assessed and capacity reviewed to ensure staff safety and social distancing.

Last but not least is a shout out to our Occupational Health Service, which has provided an outstanding service for our workforce working again over 7 days responding quickly and professionally to those staff and their families who required to be tested for COVID 19.  The support and guidance they have provided to our workforce is invaluable and we are indebted to them for their ever present and continuing patience and professionalism.

Although, the past few months have at times been difficult, we have learned a lot about each other and have bonded as a team in a way that we may never have done if this coronavirus had not come along.     We have been creative, kind and co-operative and made connections we may never have made otherwise.  We have made difficult decisions calmly and professionally embracing all that has come our way.  

Suzanne McGregor: Community Nursing Team Leader (Falkirk East)

 

During the COVID pandemic back in March, I was asked to support the development of the HR deployment hub and represent nursing. I was a little apprehensive as I was being taken out my comfort zone and being asked to join a new team at a time where staff within the hospital were anxious about what lay ahead with COVID.

From day 1, I was welcomed into the HR team. Everyone worked well together with a shared vision of how the hub would operate. There was a clear sense of team working, and everyone’s opinion mattered. Every member of the team had unique skills and knowledge, and we all complemented each other to achieve the goal of developing a fully operating deployment hub. I really appreciated the opportunity to work with each member of the HR team and have taken new knowledge and skills back to my nursing role.

 

 

Single Point of Request (SPR)-Emma Cavanagh, AHP Team Lead/Physiotherapist

Single Point of Request (SPR) receives referrals for the community AHP Rehab teams. We telephone triage our referrals as close to point of referral as possible, to identify the wishes and needs of our patient population. After this, we offer support and advice, signposting to appropriate services or to intervention at the community rehab team.

We were a largely paper based system, with referrals and paperwork completed for each patient. When Covid became more prevalent, we changed our systems to be fully electronic, with e-triage forms and the use of Morse/email to electronically save our referrals. This streamlined our processes and dispensed with the need for paper, printing and scanning therefore reducing the risk of cross contamination.

We switched from a traditional Monday-Friday model to a 5/7 model for a short period, staffing SPR over the weekend to spread the workload and ensure adequate social distancing in the office. This meant that urgent referrals sent in at the weekend were dealt with efficiently and passed through to our community teams in a timely manner.

The biggest change came from staff working from home. SPR has been an office-based team with staff shared between SPR and the community teams for the most part. This had to be adapted quickly when staff who were unable to be patient facing or shielding had to change their roles. It allowed SPR to have an increase in consistent staffing levels although the challenges that came with managing staff working from home were difficult at times.

There was a rapid learning curve for both the team and the new staff at home who had not been permanently based in SPR before. We had regular communication via Teams, set up a WhatsApp group to keep in contact with each other and the staff working from home liaised with each other for support. There were regular contacts via phone and email to check in on how people were managing, personally and professionally, to ensure as far as possible everyone was coping with the changes. We all pulled together as a team to support each other, making time to chat and have some fun in our day in between our work.

Below are some reflections from staff:

“There have been a lot of changes in my Rotation due to the Coronavirus epidemic and finding out I was pregnant during this time. I was quickly moved to SPR full time as I was classed as higher risk for Covid 19. As a bonus, I was able to work from home for a short time. This really developed my organisational skills, self discipline and independent thinking. It was still nice to be able to speak to colleagues in the office to do some ad hoc clinical reasoning with more complex patients or with situations that has not arisen whilst I was working in the office.

I have really enjoyed my time in SPR and am grateful to have been able to work in a safe and supportive department at a difficult time”

 

“Given that I normally work as part of a large team, my new work environment was hugely different. Overall the emotional challenges were greater than the professional challenges. After MS team meetings there was no alternative but to return to my home office with no opportunity for informal conversations, reflections or to share thoughts on decisions made. WFH during a period of immense change in which there are regular discussions and decisions to be made, highlights the key importance of this style of communication. I think it is invaluable in helping to consolidate new learning”.

I was reassured by initial conversations from Emma (Team lead SPR) that the SPR Morse process was digitally documented and accessible on the shared drives. The whole process from receipt of referral through to intervention/signposting to teams was now paperless. This was new for all SPR staff. It was good to know that this was not any different for WFH staff and that these SPR skills would then be transferrable when returning to the office. There were no expectations that I should be performing at the same speed as other experienced SPR staff and that I would be given time to learn the processes with a team of experienced staff to assist with any questions I had. There was recognition given to my skills as an experienced band 7 OT and this how this could be utilised within SPR which I appreciated.

SPR team communications were welcomed and different streams of communications were set up for all SPR staff (Whats app group chat, regular SPR team meetings, shared telephone numbers). Staff were encouraged to contact SPR or each other to ask questions.

Negotiations were held with regards to the number of referrals WFH staff may be able to process in a day. There were no preconceived expectations that WFH staff should be as quick to process referrals as work based SPR staff and there was appreciation for the IT challenges that can occur. Admin staff forwarded a set number of referrals daily so not to feel overwhelmed with the number required to work through on a weekly basis.

Part of the triage process is to investigate previous interventions and clinical investigations. I felt this was a useful opportunity to investigate more fully specific physical conditions that patients reported with. I found a large majority of referrals required Domi Physio input. Given that I had no Physio to consult during the triage process; this helped me prepare for what I might be presented with during good conversations with the patient or NOK and to be able to offer some therapy solutions. Within ReACH Falkirk there is not always the opportunity to do this due to the high turnover of referrals and face past of work. I think this also highlights the importance of having a clinical skill mix in SPR.

SPR were also aware of my continuing ReACH Falkirk team commitments and the need to stay in touch with staff for when I was due to return to my team. Time was given from SPR to allow these communications/meetings.

I was aware of the staff that were working from home which reassured me that I could contact them to share experiences and I did use this opportunity on a few occasions. It was reassuring to know that other staff WFH could relate to my work experiences.

I am pleased to have had the opportunity to have worked within SPR when working from home. Regardless of what role I could have had while working from home, I appreciate that there would be challenges. There are massive challenges for staff in the NHS as a result of this global pandemic regardless of working environment. I can take forward the learning I have gained within SPR and use this in my role as REACH Falkirk band 7 OT. I am also reassured that should I have to WFH again I can be part of the SPR team with good insight into what my role would entail. I have both the challenges and the opportunities to reflect upon, learn from and share with colleagues.”

“A positive part was it is more productive being at home which I feel I have brought to my new normal now at work. I’m still in isolation, working in the room and have social distancing and protection measures in place as my risk has now increased to the highest risk unfortunately. If I were to return to working at home I could hit the ground running, providing the IT systems were in place and resume the service I provided as before. I would be working at the same level and that is thanks to the support of my Team Lead”.

 

 

5. Integrity to the value and purpose

Acute in-patient physiotherapy team -Dawn Gleeson, Acute physiotherapy Co-ordinator, FVRH

 

At the time that covid was expected we were, like all other staff, anxious regarding PPE and what was ahead of us.  We gained additional physiotherapy staff from other teams whose work was suspended temporarily. The additional staff didn't really know the ward staff but they gelled together into one big team instantly and treated each other with utmost respect and care. They moved onto different work rotas as was required of us without any level of apprehension or reserve for their personal impact and they provided a high standard of physiotherapy service across all wards.  Each morning we met to plan the day and they all looked back at me with large eyes but also contributing to the planning with their ideas and suggestions.  They formed the most amazing large team almost overnight.  I was never in any doubt of their anxiety but at no time did this present itself as anything negative.  They supported each other, listened to each other’s concerns and worked together to share the work.  They provided a high level of service across all wards which they always do but the thing that is wonderful was their approach to the whole situation as a team.  I am sure this was the case in all teams but I can only comment on my team and I am so very proud of them.  They are now exhausted of course, and we head into winter with an increasingly busy hospital and the anxieties are increasing a lot again.  It’s not an individual story, but a team story 😊

 

 

Donna Read – Senior Charge Nurse, Ward B12, Forth Valley Royal Hospital

 

I've been nursing for 32 years. I trained in Edinburgh at the Western General Hospital.  I have 27 years experience working in respiratory medicine, 15 of which as a respiratory nurse specialist and laterally as Senior Charge Nurse of the respiratory ward at Forth Valley Royal Hospital.   I moved to NHS Forth Valley 5 years ago.

 

The main challenges of the last few weeks have been

1.  Preparing staff; training with PPE, ensuring they are kept updated with changing processes and policies, addressing their concerns and fears, keeping them calm and ensuring they are safe.
2. Adapting our work routine on a daily basis
3. Nursing patients with complex health needs who can very quickly deteriorate
4. Adapting to the changes in visiting and keeping family updated when they can’t visit as well as supporting patients who no longer are able to have regular visitors (essential visits are still possible). Also having to have difficult conversations with next of kin on the telephone rather than face-to-face is very hard and helping them to deal with the shock and grief of losing a loved one. To help address some of these challenges we have developed alternative ways for patients to stay in touch with loved ones - we have produced postcards which staff use to pass messages between patients and family members - patients can keep and reread these messages. We are also using some of the ipads which have been donated to enable patients to have video calls with friends and family members.

 

One thing that has emerged through this is a sense of enhanced team working.  Everyone has a common goal which is to look after our patients to the best of our ability.  As a result, roles have at time been blurred and everyone is helping each other - for example doctors have been involved in providing personal care along with nursing staff, housekeeping staff are looking after everyone and ensuring they are remembering to take a break and get a drink. Nurses have also been cleaning rooms with housekeeping staff.  There is a genuine sense of caring and supporting each other. I work with an exceptional team and I am proud to be part of the NHS at this time.

  

Community spirit – we have had overwhelming support from the community and many donations both for patients and nursing staff.  Local scouts have delivered letters for patients with pictures and get well wishes and the wonderful clapping for key workers on Thursday evenings. We also find it rewarding to celebrate the successful discharges from the ward as it’s great to see patients recovering and being able to return home.

 

 A huge thank you to the public for their ongoing support and a plea to continue with social distancing to help the NHS and prevent the spread of this virus. 

 

 

 Rosario Walshe, Senior Charge Nurse, Ward A31, Forth Valley Royal Hospital

 

I’m Rosario Walshe and I have been nursing for 30 years. I was born in Tullamore in County Offaly, Ireland and now live in Denny. I worked as an auxiliary nurse in the former RSNH before attending the former Falkirk Nursing College where I trained and worked in both Falkirk and Stirling before moving to Forth Valley Royal Hospital to become SCN for Ward A31 – a general medical ward which has also developed an infectious diseases service.

The main challenges I found was facing something I’ve never faced before and the uncertainty of not knowing the scale of what we would have to deal with. However, I’ve also learned loads and we have a really strong multidisciplinary team which learns and works well together.  The team spirit has been fantastic and we have been supporting each other to help us get through this. The lows have been when we have lost a patient although thankfully most people do recover.

 

Restricted visiting has also been a challenge as it is difficult not to speak to relatives face-to-face and for patients to spend time in hospital without seeing their friends and family.  The highs have been the support from the public – I didn’t realise until now just how much the public were behind us and how much the value the services and support the NHS provides.

 

The staff have been really fantastic throughout this pandemic – they have been really flexible and gone above and beyond - whether it is working extra shifts, changing their own shifts and plans and making themselves available to do whatever is needed.  They have also supported the patients – thinking of things to bring in for them and little things which will cheer them up. They have been using postcards to pass messages between patients and their families, using ipads and whiteboards to help communicate.

 

We are also looking at ways in the ward that we can celebrate the patients who have recovered and gone home as well as remember those who have sadly passed away.  It’s been a privilege to have had the opportunity to work with the media over the last few weeks to raise awareness of some of the work we have been doing in the hospital.

I don’t normally like being in the spotlight but I’m delighted at the feedback and my daughter Shannon, who works in the Children’s Ward at Forth Valley Royal Hospital, thinks it’s fantastic. I am very proud to be a nurse and very proud of all my colleagues who are continuing to support each other during this pandemic.

 

6. Health & Wellbeing

Team story of support provided by the Staff Wellbeing Group- Margaret Kerr, Head of Organisational Development

The NHSFV Wellbeing Programme was introduced to support staff during the COVID 19 Pandemic earlier this year. The programme aimed to build upon the existing staff health and wellbeing activity within the organisation.

The Staff Support and Wellbeing group is chaired by NHSFV wellbeing champion, HRD Linda Donaldson, team members exceeds 23 members and includes organisation wide representation from Staff side, Nursing, Medicine, Woman and Children’s Services, AHPs, Spiritual Care, Psychology, Organisational Development, Communications, Mental Health, Health Promotion, Public Health, Medical Education, Cancer Services, Palliative Care and Falkirk and Stirling Health and Social Care Partnerships. .

Since the group came together, they have worked as a united team to build on the foundations which were previously developed to ensure staff were provided with the help they needed and worked as a collective to get the support underway quickly. As a group, they showed creativity, passion and commitment to ensure help was accessible for all staff where and when they needed it.

A range of wellbeing resources including information, self-management tools and signposting to further sources was collated by Occupational Health Psychology and disseminated to staff via the intranet and internet. NHSFV Communications department and webmaster supported awareness raising of support services available across the organisation.

Listed below are some examples of support provided:

• Spiritual Care and support led by Tim Bennison which included the hotline and drop in sessions
• The Psychology Service and Mental Health provided support at the Sanctuary in FVRH Library area and other areas in FVRH and community hospitals, where drop in sessions were provided on topics for example relaxation and mindfulness

Additional support provided by Psychology included

• Psychological First Aid for individual staff members delivered by telephone or Near Me, in addition to face to face sessions. Team leads training sessions using Psychological First Aid was delivered across social care, care homes and Strathcarron hospice, with the aim of the team leads cascading the principles to the wider work force.
• A consultancy and advice line was available for team leaders and managers to contact a senior psychologist for guidance in supporting staff wellbeing when particularly challenging situations arose.
• Training sessions and support on challenging communication around death and dying related to Covid-19 were provided by palliative care and psychology.
• Support sessions focused on maintaining resilience were delivered to hospital based teams. Some sessions were delivered jointly with a consultant microbiologist in order that staff members’ anxieties about Covid-19 could be holistically addressed.
• Support sessions tailored for new junior doctors

Support provided by other group members

• Coaching provided by the Organisational Development and the Keep Well team
• Medical Peer Support and Junior Dr support by Medical Education and Consultants within NHSFV
• Virtual Staff Room for shielding staff supported by Health Improvement and Palliative Medicine.
• Via our HRD and Wellbeing Champion, the group linked with national initiatives to ensure Forth Valley was offering support consistent with other Health Boards, and could share local initiatives
• Care-home specific information packs were devised and disseminated to care homes

The team continue to provide support to staff across NHSFV. Evaluations of support accessed by staff have been very positive.

Listed below are some examples of feedback

“The Staff support was very helpful, allowed us to open up and gain insights into one another.”

“Helped me develop coping mechanisms”

“Very helpful and helped me get perspective on how to deal with issues”

“Very helpful session, encourages staff engagement and helps identify issues and resolutions”

“Generally supportive environment in hospital, I haven't had to contact any more formal staff support”

“A very good opportunity to express stress worries and other issues without fear of judgement”

“I felt more able to return to work and have a conversation with my manager about how I can get back to work safely “

“Psychological robustness is a key skill to have in order to fulfil my potential as a doctor. I feel I can take forward the techniques learned to enhance my wellbeing and effectively manage stress”

In addition to positives for those accessing the service, there were benefits to those staff members who provided the support:

“I enjoyed the development of collaborative relationships with other teams throughout the organization with reciprocal benefits of increased knowledge of each other’s roles and skills”

“Feeling valued and appreciated by the teams we delivered sessions to, and a sense that teams had taken something useful away from the experience. This brought me a sense of job satisfaction and improved wellbeing at work at a time when there was significant stress”

 

 

Pandemic Story

Elizabeth Murdoch, Lead Occupational Health (OH) Nurse, Occupational Health Service, FVRH

I have been nursing since 1987, qualifying as RGN in 1992 then specialising in Occupational Health with SCPHN qualification in 1998. I am passionate about the NHS and decided to stay in the NHS, working in NHS OH Departments in Glasgow and in NHS Forth Valley since 2004.

OH is a highly specialised area of Specialist Community Public Health Nursing, our roles are often misunderstood given that OH is not in the curriculum of pre registration nurse training this is understandable. Employees who have been fit, well and not faced any workplace issues impacting on their health will have had minimal contact with the service.

The role of the OH nurse has evolved greatly in my career. There is a national shortage of OH nurses and the courses to qualify are two years of structured training. It takes years of experience to be a confident practitioner. As a practice teacher it involves two years to support an OH nurse through training and achieving all the competencies of SCPHN.  I have completed this process with several OH students and supported a practice teacher in training so it’s a slow process bring new practitioners to the profession.

OH is a small  multi disciplinary Team in a large organisation providing services to NHS Forth Valley’s workforce such as pre employment health screening,  case management for sickness absence, case conferences, health promotion, assessing fitness to work, providing OH advice, health surveillance, administering vaccines and venepuncture to test immunity and infectivity of diseases. The OH nurses work autonomously using clinical and analytical skills to undertake their roles and make decisions. The OH consultant works closely with the team providing expert opinion in more complex cases.  We also have a counsellor and Psychologist in the team providing services to for staff with mental health problems. OH practitioners use a bio psychosocial model of care and the department is a confidential space for employees to talk openly about symptoms, feelings and problems with life.

The admin team are the hub where all enquiries come in to the department and they support the OH team with receptionist duties, secretarial duties, data management, reports and IT skills.

Last year my line manager retired and I was successful in becoming Lead Occupational Health Adviser, which was a once in a life time opportunity. Little did I know the biggest challenge of our life time was going to happen and I would be leading the OH Team along with the very experienced Service Manager in delivering OH services to NHS Forth Valley’s workforce during a pandemic.

Although we have always spoken about a pandemic and being prepared, it has been a completely new experience and the greatest challenge of our careers.

In normal times the OH department is always busy with waves of increased activity when we provide additional services such as Flu immunisation programme. The pandemic was like a Tsunami and I want to describe the challenges the OH Team have come through to now.

Phone calls

In the beginning there was ever increasing telephone calls from managers and the workforce with COVID -19 enquiries, it was overwhelming. We put systems in place to manage and log calls. In order to respond, we had to cease usual daily work and this was difficult for the team to stop what we had always done and we felt like we were letting down our clients.

 

COVID -19 Risk Assessments

The volume of enquiries were the same but started to change. Another more complex wave of calls started to come in. Increasing evidence and media coverage was coming from other countries, individuals with underlying health conditions were at risk of death. Managers along with OH practitioners were to carry out Risk Assessments and decide who was to shield and work from home if possible. I remember everyone with their heads in their hands, expecting we would be experiencing loss of life among health care workers. The risk assessments from Scottish Government were slow to come through, this frustrated us and we were ‘holding’ these enquiries until we had the guidance. The team worked through many Risk assessments and this was new complex work. I had to look at the skill mix and delegate these to the trained OH nurses and consultant.

Testing

OH worked collaboratively with ICT, Public Health, medical records, newly developed testing centres, laboratories and information management to organise a testing service for symptomatic staff. This then expanded to testing asymptomatic health care workers in contact with high risk patients routinely and we assisted services in taking this forward by developing forms for referral and instructions on using ordercomms and labels.

Mask and PPE

Shortages of masks, gloves and alcohol gel became apparent. The ICT led on face fit training for FFP3 masks. We began to experience referrals for staff with allergies and irritation to masks. Skin on faces and hands of health care workers broke down due to PPE use. Referrals with skin issues reached a peak and alternative products, other work and products to relieve symptoms had to be identified to keep those individuals affected safe at work.

Weekends

Normal hours were not possible and the team worked weekends to arrange testing and continue with some normal services.

Near Me/Telephone consultations

Face to face consultations had to cease to reduce footfall and the overall risk of COVID, all consultations changed to being over the telephone or by video call on near me. Clients who were lonely and isolated struggled with this. We worked collaboratively with our partners such as staff physiotherapy who stepped in to draw up return to work plans to assist smooth returns to work. The OH team contacted their clients to support them whilst doing all the other new activities.

Mental Health

Throughout the pandemic the OH team have supported staff with anxiety and stress. COVID has brought challenging times for all and staff contact OH for support to discuss coping strategies. Staff support and well being has been well structured and many additional services are available and more accessible than OH services. Staff tend to come to OH in these difficult times and have not been fully aware these services exist. The OH team have had to adapt and we cannot deliver the support we have in the past, we have sign posted staff to these services and there is good feedback from those who utilised these services.

 

New team members & Help from other services

New team members came to join the OH team during COVID and we have celebrated them joining us.

Help from other services

Emma from health promotion came to help, on loan from her own department and she has continued to support the team by working on reception every Monday and Tuesday.

Medical Records have been wonderful and worked closely with OH, appointing all our Flu appointments this year, reducing the work load of the admin team.

Retired nurses continue to come in and contribute to the workload, revisiting old skills and bringing their expertise back to the fore.

New Doctors August 2020

We recruited new Doctors in August, which is normal but we managed to achieve this along with the COVID work continuing.

Recruitment

There will be a surge in recruitment for winter and we will need to balance this with the flu clinics to ensure the workforce is prepared for the winter months.

Reflection and Appreciation

In July we organised these sessions with Organisational Development to reflect on our experience and take space to talk over what it has been like to work through the pandemic. I think this was important to stop and listen to each other and look at what we have achieved. We have recognised we need to also care for ourselves and each other, looking at self care and being kind.

Flu Immunisation

The OH Team, delivered Peer Flu immunisation training to Peer Immunisers who will assist in vaccinating staff against Flu. A fully comprehensive training package was developed and will be moved on to Learnpro for next year. Along with pharmacy and resuscitation, the training package was presented to 130 peer immunisers. This is already proving to be very successful.

This year flu programme needs to be delivered differently and OH will operate with booked appointments. The admin team are now able to use trakcare and again, medical records have helped OH achieve this.

Looking back it needs to be noted, the Team have been subject to difficult conversations and decisions in the pandemic. It can be very challenging when people don’t understand and are angry. The OH team have been resilient and worked together to overcome the emotional challenges of our work that result from the difficult conversations. We often feel forgotten and invisible as we saw other services being thanked by the community with gifts. It was a special moment to go outside to the sunshine and see the Spitfire fly over and be thanked in such a special way.

The OH team work behind the scenes, caring for the health and wellbeing of the work force. The team work very hard and have been inspirational, adapting to all the changes and challenges. The OH team received positive feedback and praise from many services users and this was shared and celebrated.

Looking to the future we now have 4 members of the team trained as wellness coaches which will be beneficial to our clients once time permits to start using these new found skills.

I cannot thank all of them enough and can’t do what I do without them.

 

 

Supporting staff and patients to cycle throughout COVID-

Aileen Schofield, Health Promotion Officer

Lockdown started in late March 2020 and this meant that those staff who came to work in a car share, couldn’t continue to do so and also bus and train routes were substantially reduced to re-enforce the message of lockdown and the need to be socially distant.  Up until then, I had been working closely with our local Active Travel Hubs (collectively part of Forth Environment Link) to encourage, enable and support staff, patients and visitors to cycle and walk more.

 Just as lockdown started, we had a telephone conversation where we talked of our work stopping at that time and this discussion naturally progressed to where their CEO wanted to show support for NHSFV staff at this frightening and uncertain time resulting in Forth Environment Link making their very kind and generous offer to our staff to borrow one of their eBikes to help them get to work during lockdown.

This offer was promoted to staff via the intranet front page and also I developed a “Physical Activity for All During COVID e-bulletin” which brought together various free opportunities for NHSFV staff to still be physically active throughout lockdown.  From the beginning of the lockdown, The Government and Scottish Government actively recognised the importance of physical activity to our mental health and wellbeing and also to our physical health and as such they encouraged us all to go out once a day for physical activity.  

The response from NHSFV staff to this offer was tremendous and way more than we could have hoped for.  All 60 e-bikes were quickly snapped up and a waiting list started.  At its peak, 92 staff were on that waiting list.  As word reached staff that the waiting list was so long, they stopped contacting FEL about the eBike loans.  I really feel that had we been able to access bikes for everyone who wanted one, we would have seen staff in the hundreds using them.  From here, I started the process of applying for funding with support from FEL (and this involved late nights working on the bids – 11.30pm and beyond which I didn’t mind as I wanted to try and gain the funding for more bikes for our staff) and Mark Craske and me have been successful in the 2 bids we have submitted worth a total of £55,000.

 One is for 20 e-bikes for NHSFV staff and one is for 26 bike vouchers for lower paid staff and 33 D locks for the first 33 staff members who applied for a bike as part of NHSFVs Cycle scheme since April 1^st 2020.  To get word back that those bids had been successful was simply joyous as they would whole heartedly benefit our staff.   The 20 e-bikes are on order using local bikes shops, which is keeping the money in the local economy, the D locks are with the 33 staff and we are in the process of identifying the staff who will be offered the 26 bike vouchers, again all going well staff will use local bike providers thereby keeping this money in the local economy.   (not directly from me as such but we generate ideas between us all - but a natural progression has been the development of a wrap around service for each of the eBikes and our staff members.

Each eBike has its own film showing how to work the e-bike for staff to watch, the bikes are serviced on a regular basis, they are picked up and dropped off using social distance protocols and hygiene measures, if the staff member has a puncture or issue, FEL’s bike mechanic will go to them, try and repair the bike and if this is not possible, the member of staff will be dropped off at work, the bike taken for repair and be ready for the staff member as they finish their shift.  Advice and support is always available to our staff at the end of the phone from FEL). 

In May, staff who had one of the borrowed eBikes filled in a short FEL survey and to read the feedback from them in terms of what the bikes had meant to them was quite emotional at times.  What shone through was the benefit to their mental health as well as physical health from using the bikes.   To date, 81 NHSFV staff have borrowed one of the e-bikes and the waiting list is in the low 50s now.  We anticipate that the above mentioned funding will reduce this waiting list further once the bikes arrive / vouchers are issued and used. 

We now have another brilliant opportunity of free TACTRAN cycling training available to our staff, family, friends and patients, their family and friends and this is currently being promoted to staff.  We have supported similar training in the past from the Cycling Officer at Falkirk Council and the staff who attended that session really valued it.  I plan to take further develop our good partnership working with TACTRAN for the benefit of our staff, patients and family members.  

When I moved over to this role, simply through an initial, early conversation with the Bowel Cancer Clinical Nurse Specialist at FVRH and then a different conversation with FEL’s CEO, this sparked ideas which have culminated (after a huge amount of work and joint energy from everyone involved) in a multidisciplinary and multiagency bowel cancer patient and eBikes pilot going ahead. 

I mentioned above that we generate ideas from each other and based on feedback from staff, I ask if it was possible to increase the amount of the Cycle scheme loan for staff from £1,000 to £2000.  This has happened.  The next discussion that will take place strategically is for the consideration of the loan timescale to be extended for certain grades of staff to 15 months and review? 

I just look for opportunities and run with them. I have great partnerships that are a joy to work with and between us all we are making things happen that will benefit our staff and patients.  I know the NHS structures and have great partnership relationships externally and internally, I can approach the right people to start a conversation and share ideas, listen, and make it work. This bit sounds awfully big headed but I’ve been told that without me, none of this great work that we are all working together on, would be happening.  That is really humbling.    

One final but very important point for me is that the above success is all down to my new, fantastically supportive, enabling, respectful, and ambitious Lead Health Promotion Officer Anita Paterson.  Without Anita, none of the above would have happened.