By Fraser Ferguson, Unscheduled Care Team, Directorate of Performance and Delivery in the Scottish Government. Proudly an AHP & Physiotherapist by default.Views & opinions expressed in this blog are my own.
As our First Minister said recently “Life shouldn’t feel normal right now, so if your life still feels entirely normal, ask yourself if you are doing the right things”
I’d suggest in this adversity, there are now even greater opportunity to make the case that AHPs are indispensable as they work in a more fluid way with digital being the main driver.
It is the end of week one in lock down for Covid-19 pandemic and acute sites across Scotland are incrementally getting busier and busier. It is clear the situation is about to take a turn for the worse.
It is also becoming quickly evident that AHPs in the whole are an adaptable bunch of health care professionals who already in the early stages of this frightening pandemic are not only working in different areas than they are used to but are agitating and champing at the bit to get involved, sooner rather than later: redefining the normal. I have seen in unscheduled care, walls and barriers that people have spent years and years trying to break down, tumble almost overnight as medics realise that Covid-19 is a frightening game changer and it is now an adapt, and quickly environment. I totally applaud this.
AHPs, as you would expect, have started to quickly change what they are doing and who with. Years of unnecessary barriers between acute and community services are starting to crumble too, and these should never ever be allowed to go back up. All of this has happened since March began; 29 days and counting.
In recent days I have witnessed AHP leaders, who previously blocked and actively discouraged staff from using digital, use these as freely and easily as they used pens (black ink of course). A video call was something you did with your relatives in New Zealand at Christmas, and now they are being used for routine interactions and as default. I would suggest that many of these changes have been driven by the middle and lower grade AHPs and our future is bright if they are allowed to continue to lead.
It is a remarkable change and every AHP involved should be immensely proud of what they have done.
Resistance to change?
On reflection I suspect a lot of resistance, is due to anxiety, fear of the unknown and change. Yes, there will be some AHP leaders who will be laggards to adopt new things, but resistance can stop team members who are innovators trying to bridge the chasm and get to early adopters. In the whole, this reluctance will be due to concerns about working in a totally different way. This will be similar to many of us who are about to start working somewhere else, outside our comfort zones. We just need to understand that will take time.
I have to say I am fairly terrified as I volunteer to leave the relative comfort of my MSK and Unscheduled Care background and head back to the wards. Many of us will not have worked for a long time with patients who are dying. This will be hard. We just need to support each other through this.
The thought of being anywhere near a ventilated patient is horrifying to me. It must be 30 years since I was last there. But we all have basic AHP training that will enable us to carry out basic tasks and if we are getting into scarier territories there will be more experienced AHP colleagues and potentially more junior too who will help us. We just need to ask.
In a similar vein, there are many digital leaders in NHSScotland who can help you. All bets are off just now – all old rules are currently open for debate. So if you have an idea on how to change your current practice by using digital means and don’t know how to or are getting blocked, then we just need to ask for help.
Adapting what we already do.
It is correct that Covid-19 is the biggest thing in town just now. It is correct that our AHP work force is being redeployed to deal with this. The impact AHPs will have treating this will save lives. I do not for one second under estimate the approaching health care emergency that we face. Our wonderful AHPs will be front, right and centre of this care.
However, I do think that some of us have a responsibility to try and make sure that Covid-19 isn’t the only show in town. It is important that we think about how we could maintain some of the amazing AHP led services. Every week I have the privilege of reading the blogs that are sent to AHPScot before others. I am blown away by the ingenuity and the impact of the work outlined in these blogs upon the citizens of Scotland.
I can only speak for unscheduled care and MSK but I wonder how the amazing COPD front door work at one acute site can be adapted to keep citizens out of hospital. That particular service managed to safely avoid admitting over 20% pre-Covid-19. So can these determined and inspired AHPs be empowered to use digital to move their intervention beyond the front door and up the garden path so to speak – delivering modified care at home? It might not have the same impact as the preferred model but any one less person in ED, especially one with a chronic respiratory problem is a success, now more than ever.
I would argue that pausing totally a national MSK Helpline, which covers 80% of Scottish population (apart from Glasgow and the Islands) and other MSK services is not in the necessarily in the best interests of our citizens with acute MSK presentations. Necessary? Absolutely!
But not anywhere near the best patient journey. Replacing services with a ‘Contact your GP or go to A&E’ message is not enough. There will be cauda equina patients (if positive, then a surgical emergency) that will slip though this well-intended net. Giving advice to go to ED just now with acute back pain or any other MSK presentation could have dire consequences for the patient or somebody they know. Are there enough MSK AHPs out there who in small teams can fix this using digital and technology and processes in a Once for Scotland approach?
There will be other services too. What about where you normally work? What has been shelved for the moment whilst we build up to manage Covid-19? How can digital technologies support these and many more services, even in a shorted form to give some support to our citizens? Keeping a pause progress summary of what you have been working on is an idea which might help you re-establish services as soon as the time is right: One page – Aims, success to date, key first steps post cover and key documents. Make sure your teams touch base regularly – 10 minutes, using digital tech once a week is key to remember what is normal. This storm will pass – you need to keep your eye on the prize afterwards.
For further information on embedding digital, look at our last blog by Lesley for info. Contact Debbie who is Chair of the dNMAHP leadership group and she will put you in touch with your local Digital Health lead; they are primed and ready to go. This terrible pandemic is giving you a unique opportunity to make a digital change. Don’t be frightened or actively discouraged by others. There are no daft ideas anymore.
When this is all over, and it will be, what happens next? How do we avoid defaulting to the old norm:
- Using digital as a nice alternative rather than by default?
- Back to our acute and community silos?
- Uni specialty and professional working?
Who amongst you are going to pick up the mantel and keep our AHPs in Scotland as leaders in our new, flexibly and digital savvy workforce? Any takers?
Whatever you do and wherever you end up in the next few months stay safe, stay strong and be as kind to yourself as you are to your patients.
(PS – If you are keen on keeping the MSK and COPD fires burning – get in touch)
FootnoteWe are not actively looking out for blogs during Covid-19. But if you feel you have something to share or say then drop us a direct message via Twitter. Even a quick Tweet about what you’ve done or seen about wonderful AHP practice would be good. Just copy in @ahpscot.