Reflecting on the past year or so and the future for Health and Social Care Professions

When I initially drafted this blog it was just coming up to a month on from our successful launch of HSCP Deliver – A Strategic Guidance Framework for Health and Social Care Professions 2021 – 2026, and I was focussing on moving forward with implementation.

We were delighted to have been joined by 635 people at the launch webinar where attendees had the opportunity to hear perspectives from Dr Colm Henry, Chief Clinical Officer, Anne Lawlor, Co-Founder of 22q Ireland and HSE Patient Forum member, Anita Murray, Clinical Specialist Podiatrist, Paul Nolan, Chief Cardiac Physiologist and Anne O’Connor, Chief Operations Officer.

^{A Framework for Achieving Our Collective Potential}

HSCP Deliver is a pivotal development for HSCP, as the first co-created, overarching, strategic framework for our professions in this country.  The strength of HSCP Deliver lies in its co-creation, informed by more than 16,300 contributions from HSCP, service users and stakeholders.  It is fully aligned with national policy and informed by international best practice.  While COVID-19 necessarily delayed finalisation and publication, I had thought that the timing, launching late spring, was ideal as things were improving leaving space to consider next steps. However, the impact of the cyber-attack has inevitably altered plans. 

The launch of HSCP Deliver came at a time where the health service had been through unprecedented, rapid changes, developments and transformation.  The huge flexibility and adaptability demonstrated by HSCP and all staff and the pace of change during the pandemic was incredible, widely acknowledged and something about which everyone can be justifiably proud.

The changes and transformations that have occurred in the last year or more, coupled with the substantial investment and staff increases coming through with the Winter Plan and then National Service Plan bring very significant opportunities for HSCP.  With HSCP Deliver, we now have the framework within which to situate and grow this work.

There are of course, as always, challenges.  None of us were expecting the cyber-attack or the scale of devastation it brought to our health services.  Once again, everyone has risen to the challenge but I am very aware of the high cost personally for so many in terms of the stress, drain on resources and fatigue people are experiencing.  The need for time to rest and recharge was already evident as we emerged from the pandemic and has increased by a huge order of magnitude as a result of the work required to continue to provide services in the wake of the attack.

However, with the Trojan work of so many, things are turning around and we will get back to having capacity to look forward and space for that characteristic HSCP innovation, problem solving and drive for excellence and quality to flourish.

In the meantime, I thought it might be helpful to reflect on some of the highlights of what HSCP have achieved at national level as we continue to build and progress further.  The situation of the National HSCP Office within the Chief Clinical Officer function has been an important step in enabling further HSCP development and influence at national level.

• We have a first overarching strategic framework for HSCP supported by senior HSE management.
• HSCP are included in key high level national steering groups and fora.
• There is enhanced and developing HSCP input to clinical design through the National Clinical Programmes.
• Six new funded HSCP representative roles were created over the past 12 months.
• Work is underway to progress HSCP senior clinical decision making and advanced practice with high-level sponsorship working with the Department of Health.
• There is a significant uplift in HSCP posts.
• A comprehensive report on practice placement has been completed.
• Recognition of the significant HSCP innovation and adoption of telehealth and ehealth solutions including publication of the HSCP Telehealth Toolkit and Examples of HSCP Telehealth.
• HSCP Leadership in Practice in COVID webinar series.
• A rejuvenated HSCP Research Group and recent Research Speed Networking Event.
• The HSCP hub on www.hseland.ie has been redesigned and the new upgraded version is under construction.  In the meantime, key information is hosted on the Discovery Zone and will be available once access is restored following the cyber-attack.

These are just a few examples of the strides being taken and the developments and opportunities for HSCP.

A suite of supports to support implementation of HSCP Deliver is planned.  These include webinars and virtual workshops together with tools to support implementation.

After the summer, once you have had the chance to take a very well deserved break and have some rest, I urge you to engage and to consider how you might implement aspects of HSCP Deliver in your own setting or service.  Please do keep in touch with us and share your work with us too.  I am committed to recording and sharing all of the work that HSCP are doing to progress HSCP Deliver.  It is so important to share learning and to highlight, showcase and recognise all of the developments, of all sizes and sorts and the strides we are taking collectively as HSCP.

This Blog was written by Jackie Reed, National Lead in the HSE’s National Health and Social Care Professions Office.

Brain Smart: Start Minding your Mind

Currently, there are around 65,000 people living with dementia in Ireland. It is predicted that this number could reach 157, 883 by 2046 (O’ Shea, Cahill & Pierce, 2017). Dementia remains hugely undetected and under-diagnosed in Ireland. Internationally, we know that fewer than half of people with dementia ever receive a formal diagnosis.

Receiving a diagnosis of dementia is a life-changing experience. It is widely accepted that comprehensive post-diagnostic supports are essential to assist with education, symptom management, maintaining independence, sign-posting as well as supporting individuals and families. Occupational therapists are uniquely placed to address cognitive deficits that impact on people’s daily lives due to their understanding of the relationship between the person, environment and daily occupations.

In 2019, we were very fortunate at St. James’s Hospital to be awarded a National Dementia Office grant to implement post-diagnostic support for people with dementia. This grant was the seed from which SMART – Specialised Memory and Attention Rehabilitation Therapy grew.

SMART is an occupation focussed cognitive rehabilitation programme for people with mild dementia and their families or carers. SMART is usually delivered in a group based format however, it was adapted to individual sessions during the Covid-19 pandemic.

SMART incorporates education, individual goal-setting, discussion, activity tasks and individual home programmes. Consistent with other evidence, SMART demonstrates that people with mild dementia can significantly improve;

Realising the benefits of customised cognitive rehabilitation via objective outcome measurement and clinical observations is a truly rewarding experience for any occupational therapist. However, no standardised assessment score or clinical judgement can portray the true benefit as effectively as one’s own lived experience;

“I now feel confident again. I am able to carry out a conversation with confidence – not forgetting words as much. My days are more normal. I would like to say thanks for the wonderful guidance, it has made my days so much brighter.” – SMART participant

“For my part as a husband, the program gave me guidelines on how to help.  At first, I was so lost but believe me now I’ve got lots of knowledge about dementia and this can be of real help. This in turn has made life much better for my wife. We can deal with the down days and any frustrations that may occur.  It was of so much value to us both.” – SMART participant’s husband

A significant development in dementia care is the establishment of a nationwide network of 25 Memory Technology Resource Rooms (MTRRs) spanning all 9 CHOs. A predominantly Occupational Therapy led programme, the MTRRs provide assessment of client needs, showcase a wide range of assistive technologies and provide advice to families and carers. The current Covid-19 context has further emphasised the vital role that MTRRs can play in supporting people with memory difficulties during what is proving to be an incredibly stressful time for us all. Check out the network at

https://dementiapathways.ie/services-and-support/memory-technology-resource-rooms
https://www.understandtogether.ie/training-resources/helpful-resources/memory-assistive-technologies/

More and more, we are hearing about the importance of brain health. Regular commentaries cover topics such as the relationship between diet, sleep, physical activity, stress and brain health or how brain health affects cognition. Strong evidence supports the thinking that lifestyle can affect brain functionality and our reaction to the ageing process. It is never too late or too early to start “minding your mind” or looking after your brain health. Start thinking of it as a pension fund.

Practising healthy brain habits now builds up your brain’s reserves, similar to making bank account deposits for later in life. Consider your brain as a muscle – if you don’t use it, you lose it. Challenge your brain to stay in shape with a “cross-training” assortment of puzzles, reading, art, learning a musical instrument, a new language or any activity that is meaningful to you.

Social interaction and connectivity is hugely significant in optimising brain health. Never has this been more relevant than now as we continue to adapt to the realities of the Covid-19 pandemic. Considering the unprecedented pressures and demands that HSCPs have faced both professionally and personally over the past year, it would stand us in good stead to consider adopting the advice we so readily impart to our clients. Don’t we always say that timely diagnosis and early intervention is key? Perhaps, it’s time for us all to start “minding our minds”.

Simple steps to get you started on your brain health journey could include;

Dementia cannot yet be prevented or cured. However, experts advise that by making small changes to the way we live, we can reduce our chances of developing dementia or at the very least, improve our overall health and well-being. Don’t delay, get brain smart and start minding your mind.

Acknowledgements

The authors would like to acknowledge the support of the National Dementia Office, Dr. David Robinson, Mercer’s Institute for Successful Ageing, Matthew Gibb, the Dementia Services Information, Development and Support Services and Dr. Tadhg Stapleton, Head of Discipline of Occupational Therapy, Trinity College Dublin.

This Blog was written by Aoife O’ Gorman, Occupational Therapist Manager in Charge III and Aislinn Griffin, Senior Occupational Therapist and SMART Programme Co-ordinator in St. James’s Hospital.  

Taking Our TEAM from Transactional to Collaborative

Working together as an integrated team, HSCPs (Health and Social Care Professionals) can achieve immediate meaningful change for patients by collaboratively influencing and shaping improvements in our services.

As the Senior Speech and Language Therapist in the Acute Stroke Team, I was acutely aware of the life changing impact early intervention from HSCPs has on patient outcomes. HSCP frustration due to the often lengthy process from admission to referral was the driver for my  team’s improvement project – which was progressed using the Rapid Improvement Event (RIE) methodology.   

Some background information

We set about turning around referral and assessment times in real-time, taking advantage of the supports offered through the Ireland East Hospital Group (IEHG) and Mullingar hospital management. The HSCP team provided unique insight into the inter-disciplinary interaction of a patient’s journey from admission to discharge, identifying value versus non-value steps throughout admission. We identified the causes of delays in the referral process to HSCP, which were leading to delays in assessing/treating our patients.  Inefficient/segregated non-prioritised referrals were the root cause.

What we did

A new HSCP integrated referral and screening tool was developed incorporating speech and language therapy, dietetics, physiotherapy and occupational therapy. When we implemented the tool, we continually sought staff feedback at 30, 60 and 90 day phase points allowing us to refine the pipeline further.

Bringing together a wide range of expertise enabled us to design a tool that reflected the specific  criteria that were important across disciplines. Coming together also facilitated communication about the new pathway across all wards and hospital teams.

The team I led in this project encountered various challenges along the way but their positive attitude and commitment of the team I led helped overcome challenges as we worked together to achieve a single referral system, shared prioritisation criteria and merged priority ratings and waiting times for patients.

The project was rolled out in two phases initially with a pilot site ward and subsequently to all wards across the acute hospital. To support the change in practice, we developed a communications package and an education programme.

In order to ensure that the project would be fully embedded in the hospital, we implemented a sustainability model assessment to identify the strengths and weaknesses of our plan increasing the likelihood for long-term adoption and sustainability. 

Benefits

The project has brought multiple disciplines together in a patient centric approach. It was supported by the wider hospital workforce and management and significantly reduced waste and transformed care while maintaining and improving quality of practice. Patients were seen according to priority and patients received care in a timely fashion. This reduced the patient’s hospital stay and increased wellbeing.  

The specific measured outcomes at the 90 day stage of the project included

Delivering high quality patient care is always the goal for a high performing HSCP team. Our patients now receive a more responsive, tailored approach and most importantly, receive services at the time they most need it by delivering better outcomes through safer, faster, better care.

My reflections

This approach has been readily adopted by sites across the IEHG as a model of good practice which speaks volumes as healthcare systems do not adopt practices that do not provide true benefits to patient outcomes. Our project also won the award for Best Innovation and Collaboration at the IEHG Adopting Lean for Healthcare Transformation Summit, Farmleigh House, Phoenix Park Dublin 2017.

I take great pride in the real successes of this project, the improved patient care and the positive feedback from the medical teams.

I would like to thank my MDT colleagues Grainne Flanagan, Dietician Manager, Miriam Dolan Senior Physiotherapist, Paula Sheridan Occupational Therapist, Cathal McKeon Multi Task Attendant, Lorraine Daly Admin, Suzanne Waldron CNM2, Mairead Carey Occupational Therapy Manager and Dr. Senan Glynn, Consultant. I also want to thank Anne Horgan and Anne Marie McKeon from the IEHG Service Improvement Team and Kay Slevin and Shona Schneemann from Regional Hospital Mullingar Management.

This Blog was written by Caroline Colgan, Senior Speech and Language Therapist Acute Stroke Team, Regional Hospital Mullingar.

Covid-19: is Psychological Safety our secret weapon in teams?

Covid-19 is a threat to most teams and particularly to those delivering health care. Healthcare systems depend on teams working interdependently to coordinate safe care within a complex, high stakes work environment. So what gives some teams an edge over others?

To understand this, we need to open the black box and recognise the nuances and complexities experienced by team members. Psychological safety, while not a new construct, is increasingly recognised to be the secret weapon for better team engagement and performance. 

What is psychological safety?

Psychological safety is being able to show and employ one’s self without fear of negative consequences to self image, status or career (Khan, 1990).  At a team level, it’s a shared belief that the team is safe for interpersonal risk taking.

Particularly noteworthy is the finding from Google’s four-year landmark study on team effectiveness. To their surprise, psychological safety was the #1 predictor of team success. Who was on a team mattered less than how the team members interacted, structured their work, and viewed their contributions.

But the absence of psychological safety can have grave consequences, especially in healthcare teams. A poignant example is that of Elaine Bromiley who died as the result of clinical error during a routine sinus operation. In Elaine’s case, two of the nurses present in the operating theatre had recognised the seriousness of the clinical risk during the procedure but medical colleagues had not listened. There was no culture of valuing team member contributions. (As an aside, as a result of his tragedy, Elaine’s husband, Martin, founded the Clinical Human Factors Group – www.chfg.org – which is well worth visiting.)

(Edmondson, 1999; 2008)

Current threats to psychological safety in teams

As we navigate the third wave of the Covid-19 pandemic, frontline staff are dealing with copious amounts of anxiety, fear and uncertainty never before experienced by most. Amy Edmondson, who coined the term psychological safety, has signalled the importance of psychological safety for teams to function, especially where uncertainty and interdependence exist.  

Beyond the frontline, many healthcare professionals are working remotely, isolated and  communicating virtually with their teams. Such environments can also undermine psychological safety, since social cues and non-verbal agreement are almost impossible. Colleagues can find themselves reluctant to offer ideas, critique the status quo or even ask questions and less trusting team relationships further reduce psychological safety.

Now, more than ever, is the time for questioning, sharing and inspiration while we deal with unprecedented challenges which require new thinking and approaches. Now is the time to optimise psychological safety in order to enable our talented healthcare staff to do their best work.

Creating the conditions for increased psychological safety in healthcare teams

I have chosen four aspects which leaders can apply to raise psychological safety in teams. Of course, these are not practices that apply to managers alone – everyone delivering healthcare is a leader.

1. Foster a culture of transparent communication

When the horizon is uncertain and complex, being honest about what you know and don’t know paradoxically increases psychological safety in teams. Honesty takes courage on the part of the leader and in return, trust, as the foundation in work relationships, can flourish.

2. Share power and model humility

In times of crisis, our tendency can be to exert control to make ourselves feel safer. Ironically, it is letting go of power that ultimately creates safety. A fully inclusive approach involving all team members cultivates collective leadership and in turn, enhances perceived psychological safety. When psychological safety is high in teams, people demonstrate two important key behaviours:

3. In times of uncertainty, let values be your compass

During uncertainty and in the absence of a clear plan, stay closely connected to your values while you sit with the mess. The role of leaders is to amplify the values of the team (Edmondson, 2020) so as to ensure they influence all decisions. By focusing on values, people are motivated to engage.

4. Foster psychological safety in virtual teams

Spending more time coming together as a team is associated with increased psychological safety. Online platforms therefore play a key role in these difficult times. Agile functionality such as polls, chat tools and break out rooms can be helpful but be wary of false positives when you invite feedback. Survey monkey can make it safer for team members to give voice to their views. Most of all, inviting engagement is key and works best when the leader is clear about the information needed and from whom. After meetings, managers can reach out to team members who were less vocal, creating the opportunity to give or seek feedback. We all need to be proactive and work much harder to maintain connections and optimise teamwork in a virtual world.

This Blog was written by Alison Enright, HSCP Development Manager, National HSCP Office.

HSCP Response During Covid-19

In acknowledgement and huge appreciation of the approximately 17,000 Health and Social Care Professionals who have given so much of themselves in meeting the needs of our population during the pandemic, we are delighted to share this HSCP poster.

The poster documents key work contributed by HSCP over the past eight months.

It is also intended that the format will raise visibility on the work of the HSCP workforce group as part of the collective health services response during this time. 

The poster, shared widely by email, also included a larger template which is suitable for printing to be displayed as needed. If you have not received the email, please contact us at hscp.nationaloffice@hse.ie.

This Blog was submitted by Mary Samuel, HSCP Development Manager on behalf of the National HSCP Office.

Journey to the Teledactyl?

In the wake of COVID-19, we have all adjusted our ways of working. Some Health & Social Care Professional (HSCP) services were in a position to turn to Telehealth using telephone and video to maintain service levels, keep up with demand for services and keep themselves and service users safe.

So is the concept of Telehealth new?

No, in fact as early as 1879, a Lancet article talked about using the telephone to reduce unnecessary visits to the doctor’s office.  In the 1920s, a magazine Science and Invention put forward the idea that doctors would use television and microphone and look after their patients via a “teledactyl” “a device with appendages that would respond to remote manipulation by the physician, allowing the doctor to feel his patient, as it were, at a distance.”

One of the most famous uses of hospital-based telemedicine took place in the late 1950s where a closed circuit television link was established between the Nebraska Psychiatric Institute and Norfolk State Hospital to facilitate psychiatric consults. No surprise that it was space research that made improvements and NASA first began performing physiologic monitoring over a distance in the ‘70s.

HSCP use of Telehealth – HSCP TH Survey

What you told us in a snapshot in time in April this year

• In April, 18% of HSCP had no experience of using telephone or video as part of their clinical work

– It is hoped that with access to supports such as webinars, training, communities of practice, equipment & licence roll out, HSCP will be empowered to give video enabled care a go!

• Only 3% of HSCP were using video enabled care pre COVID-19

– We anticipate that this will have increased by now and look forward to hear information from the Video Enabled Care Healthcare Professional Survey

• Just 21% of HSCP felt very or completely confident in using video consultations as part of their work.

– It would be interesting to take a snapshot at this point, six months on to assess any change … Supporting materials are under development.

So why does it matter?

HSCP who took up video enabled care were impressive in their ability to adapt at speed. Perhaps what amazed us even more, though, was how well service users embraced this new approach. Patient choice must be key going forward. Users of services cannot be expected to travel and leave work for every health problem when they manage most of their daily lives digitally. Service users deserve to have a choice.

In the recent physiotherapy webinar , it was heartening to hear colleagues say they will definitely keep this mode of delivery in their arsenal and how one of the many benefits of video enabled care is patient empowerment towards self-management – all done while keeping patients and frontline workers safe through reduced community contact and transmission.

https://www.ehealthireland.ie/National-Virtual-Health-Team/Video-Enabled-Care-Webinars/

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Indeed, perhaps the most endearing benefit from telehealth is how it strengthens rapport with our patients – seeing them in their pyjamas, “meeting” dogs and cats, and feeling amazed after a successful video consult session with a 90-year old.

Some of the benefits to the Health Services and by extension, to the populations identified are:

So we urge HSCP to seek out opportunities for video enabled care, access training, link with colleagues and join the community of practice that is emerging. Sustaining this new way of working will need to be underpinned by HSCP feeling competent and confident in use of Telehealth. Let’s keep abreast of the changes that are happening in so far as possible and avoid a Foil Arms and Hog “The Online Doctor” scenario!

Will we ever reach the Teledactyl?

Perhaps not but do we need to?

Surely, the measure of success will be when telehealth is simply seen as one way of delivering care, instead of separate from other interventions, and when it is embedded into workflow with service user choice and HSCP confidence & competence as central components.

We cannot underestimate the value in the ongoing surveys being completed by universities, professional bodies and our HSE colleagues. We need you, the HSCP voice, to continue engaging in these forums so that you can help us understand clinicians’ and service users’ experience and feedback in order to shape the future design of services.

One thing is certain – Telehealth is here to stay. The only thing we as HSCP need to figure out is how to continue to improve telehealth services for our patients and ourselves.

If you would like to share your work in Telehealth, please join the conversation below.

This Blog post was written by Marie Byrne and Siobhán Keohane, Telehealth Project Officers in the National HSCP Office.

Healthcare Education in the Time of COVID-19

The stark reality of COVID-19 hit as I, along with my classmates, were completing our final clinical placement, a moment that is usually seen as the beginning of the end of your physiotherapy degree.

Looking back on college in the time of this pandemic, there were definitely positives and negatives.

• Commute time was drastically reduced, affording students greater free time in both the morning and evening.

• Another positive for me was the availability of lectures online. This can only be seen to increase accessibility for students, especially those with disability/illnesses that may not be able to attend in-person lectures as regularly or with the same ease as others. 

• A definite drawback for me was the reduced level of human interaction, especially in the final few weeks of college from both a social and academic point of view. There was no ability to have so-called “water cooler conversations”, to bounce ideas off your peers or to ask for help with something you’re struggling with.

• As someone, who, at the best of times found it difficult to stay focused in lectures,  background distractions at home can be challenging. Having access to a physical library again in a central location will make it easier for remote learning if needed.

Another issue to consider is that of international students. Two of my classmates attended lectures at ungodly hours of the morning from the west coast of Canada. This was subsequently mitigated with recordings being made available online for later viewing. With physical attendance likely to be reduced in the future, will there be a reduction in the number of international students who begin courses in Ireland? And what impact will these changes have on non-EU student fees which are already far higher than their EU and Irish counterparts?

Can I see remote learning becoming a permanent fixture in Ireland? Definitely. I think the benefits of accessibility and inclusivity far outweigh any negatives deemed to be associated with remote learning. That said, heretofore, healthcare degrees have relied on face-to-face teaching, particularly for the practical elements of the training. Remote learning will not meet this need.  

The issue of clinical placements being organised in a time where Covid-19 is still circulating is one that I am sure has caused many headaches and will cause many more for the faculty. One has to imagine that over the next year, while healthcare and education changes from face to face to ‘blended’ versions, clinical placements will need to be reimagined.

Virtual physiotherapy appointments were, and still are, widespread during the height of the pandemic, alongside pulmonary rehabilitation and exercise classes. If this is to become part of our profession’s future, surely it is vital that these skills are learned and practiced while undergoing training as undergraduate students? 

Elite sport has been allowed since early in June this year. Given the routine testing of athletes across many sports in Ireland, it is likely that any outbreaks will be highly controlled, reducing the risk of spread. Might we see a higher number of physiotherapy students undertaking clinical placements in elite sporting contexts?

It is likely that the fallout from this pandemic will stretch beyond case numbers and deaths and there will be a large cohort of people who experience reduced physical capacity for many months. Should physiotherapy and other HSCP students expect to have larger placement allocations to the rehabilitation of these people and should placement allocations be more focused on the treatment/rehabilitation of Covid-19 given the world these students will be graduating into?

Clearly, in the coming months, many questions will need to be answered on the student experience of education in the time of Covid-19.

This Blog post was written by David Power, Physiotherapy graduate from RCSI.

2020: Stand Out Memories For Me

When we look back on 2020 in years to come, what will be our stand out memories? There will be a feature length episode of Reeling in the Years, that’s for sure! And there will be sad reminders of how many people lost their lives to COVID-19, how difficult it was for those working in healthcare and other essential services, as well as the fears and anxieties of those who contracted the disease and those cocooning at home. 

But I think there will also be positives that we can take from this time, and here are some of mine:

• We can implement change very quickly when we put our minds to it. Keeping our patients’ needs at the forefront of our minds and acting with a shared purpose and sense of urgency have proved the perfect conditions for pivoting from predominantly face to-face ways of working to largely digital methods.  From virtual consultations to team meetings and education sessions, HSCP adapted and embraced these new ways of working with a focus on solving problems and overcoming obstacles. 

• There have been significant advances in digital across the health service in recent months. Initiatives that would ordinarily take years to implement have been accelerated across the health sector.  This has included the rollout of telehealth – one of the recommendations of Slaintecare – and I hope that this is something that we evaluate, improve and continue to embed in our practice from triage to therapy beyond this pandemic.  Other initiatives including electronic transmission of prescriptions to community pharmacies, Healthlink-enabled ordering of COVID-19 swabs, remote monitoring of pulse oximetry and contact tracing apps are great examples of technology helping us to work more efficiently. As someone currently undertaking an MSc in Digital Health Transformation, it has been inspiring to say the least.

• There has been much greater recognition that it really does take a village to run our healthcare services with the important contribution made by all highlighted and appreciated across society.  In particular, fellow HSCP medical scientist colleagues have been recognised for the essential role they have played during the pandemic.  They excelled over a very short period of time to develop and implement, at scale, the new test required to diagnose cases of COVID-19.

• The teamwork and willingness to help, both within and across institutions and healthcare settings, overcoming traditional boundaries and with people sharing their experiences and solutions to common problems must be preserved into the future.

• The collective leadership shown in the initial months was evident at all levels of the health service – everyone working together, motivated by a common purpose and taking responsibility for the service as a whole during this pandemic.  We have seen that for leaders to be effective at this time of great uncertainty, we need clear, consistent and regular communication, empathy and compassion for  staff and public and measured interventions that are revised and adapted with emerging evidence and as the situation evolves.   

“By working compassionately, courageously and honestly, leaders can support and care for their staff so that they can save thousands of lives across our communities”

Michael West, The King’s Fund

Paul Reid has spoken of looking at how we deliver health services through a new lens now.  While my observations are not all necessarily new, sometimes it takes a global pandemic to see what was always there.

Himalayas visible in the distance in India (April 2020)

What will you remember most from this period? Let us know below.

This Blog was written by Claire Browne, HSCP Integration Lead, CHI.

The Impact of Covid-19 on a Disability Service – Part Two

Our first Blog described our experience of navigating the early stages of the pandemic and the critical work streams that needed to be established to enable us to begin responding to the challenges of COVID-19.

Now, as we move from the initial response into the phase of longer-term accommodation and slow easing of restrictions, our focus is moving to recovery and planning for the safe and gradual re-opening of day, school and clinical services and of residential houses for visitors.

We are also conscious of the need to remain vigilant and flexible, should there be a resurgence of Covid-19 during the reopening phases, which would require expedient and appropriate adjustment of our service response.

Work is underway to recommence essential face-to-face clinical supports, in line with public health guidance. Clinics, assessments and reviews are being arranged for those who most urgently need these.

It is clear that a multi-faceted approach to clinical services delivery will be required for the foreseeable future, in order for safe and effective clinical supports to be delivered to the children and adults who use our services.

That approach will need to incorporate a mixture of phone contact, video calls, face-to-face interventions and online training modules and other remote approaches.

Alongside the resumption of clinical services, the day support services that have been stalled are now also in a process of phased reintroduction. Outdoor and remote supports are expanding throughout the summer and planning is underway for a gradual increase in face-to-face and in-building day support hours as we move into the autumn.    

The realities of the longer-term effects of and learning from the pandemic mean that some of the ways we have ‘always done things’ will need to change. Some of the lessons we have learnt during this time and the new ways we have begun to work will be worth holding onto and developing into the future.

In other cases, we will need to find a way back to providing the much-needed supports that are currently on hold for the people we serve and their families. There will be a requirement for ongoing review, audit, research and learning.

New children are being born every week who will need our services and others are growing up, ready to make the transition from school to adult life.  

Now, more than ever, quality services are needed that promote the well-being of people with disabilities and support them to live fulfilling lives.

At St. Michael’s House, we remain committed to that work.

This Blog was written by Eilín de Paor, Clinical Manager for Adult Services & Caroline Howorth, Speech and Language Therapy Manager, St. Michael’s House, Dublin

E-mail: eilin.depaor@smh.ie & caroline.howorth@smh.ie

Twitter: @de_eilin & @HoworthCaroline

The Impact of Covid-19 on a Disability Service – Part One

The past four months have seen inordinate change for the people with disabilities and families who use the services of St. Michael’s House. Widespread closure of schools, adult day and training services and respite have placed huge pressures on individuals and families.

Clinical supports have been altered or ceased. Routines have been disturbed, much needed programmes suspended and contacts with familiar staff and peers restricted and in many cases, stopped altogether.

For the children and adults with intellectual disabilities who we work with, the reasons for these changes are not always understood. This has led to confusing and perplexing times for many.

For those living in our residential houses, the lack of contact with family and friends has brought particular sadness and challenges. For some, it hasn’t been easy to spend so much extra time with housemates when they usually all have other outlets outside the home.

Others are enjoying the extra time in their homes and as providers of day services, this gives us cause to pause and reflect on what these individuals are telling us and whether day service models may need to change into the future.

For the Organisation, keeping our core residential services running has involved reorganising our services and locations, managing the challenges of physical distancing restrictions in our small disperse facilities and being flexible and responsive to the changing needs of those we support, as well as to the impact of Covid-19 on our staff teams.

Staff and management have worked hard to be flexible and have tried to respond to the needs of those we support and their families. However, there have been limitations in terms of what we have been able to achieve and certainly in the level of contact and supports we have been able to maintain for those who normally use our schools and day services.

Many staff have taken on new roles and we have been called on to develop new procedures and services within tight timescales. Some of our main focuses have been:

• Supporting our frontline staff in their crucial 24/7 work in our residential houses, keeping them and the people who use our services safe and well

• Facilitating people to understand and ask questions about the changes in their lives – by preparing easy read information, social stories and other communication supports

• Preparing guidance for staff regarding ethical decision-making during the pandemic. People with disabilities are being asked to have swabs, to self-isolate, to cocoon and accept other restrictions on their daily lives. All of these require our staff to carefully reflect on what we are asking people to do, what their will and preferences are and what other options may be available to them and us

• Maintaining contact with individuals and families who are at home without day services and schools, through a system of key contacts

• Ensuring teamwork continues and is enhanced across clinical services, frontline services and management

• Piloting the provision of single discipline and team-based clinical supports in new ways whilst preserving physical distance e.g. telepractice, online training portals, virtual team meetings and even garden/window visits

• Supporting staff to take on new roles with appropriate training and induction –  swabbing team, clinicians’ residential relief panel, day to residential frontline staff re-deployment, Covid-19 treatment and rehabilitation roles etc.

• Upgrading our ICT systems to enable safe and effective remote-working

• Procuring and managing a stock of appropriate PPE to enable our staff to work safely with the people we support

• Establishment of an appropriate environment, systems and contingency plans for isolation, treatment and rehabilitation of those we support who contract Covid-19

• Developing an in-house Covid-19 testing service for those in our residential houses

• Working with HSE to ensure all our frontline staff are tested and with occupational health regarding contact tracing and managing self-isolation and cocooning requirements for those staff who need to.

This Blog was written by Eilín de Paor, Clinical Manager for Adult Services & Caroline Howorth, Speech and Language Therapy Manager, St. Michael’s House, Dublin

E-mail: eilin.depaor@smh.ie & caroline.howorth@smh.ie