‘Getting the balance right’ – latest nursing blog

Getting the balance right- Nursing leadership in a digital age.

As we move into the winter months in a year that has presented challenges beyond anything ever faced, we must refocus and ensure that we learn from what has happened. Challenges are also opportunities to do things differently and collaboratively and can result in positive change.

In this last month when we have been informed of an investigative review alongside the push for a national care service. There is undoubtedly real concerns on how this will impact the sector, especially when sustainability is already fragile for many providers. Some may dispute that the timing of this review is not best placed and will not serve to support the future stability of the social care sector.  The real hope for such reviews is that they allow a collaborative approach which provides choice and control for the people of Scotland and to ensure the future of health and social care integration.

We understand the care sector is extremely complex and tightly regulated to ensure that care is delivered in a way that edifies the safety of all residents and that the care delivered within a framework through real professionalism by meeting all standards around personal outcomes. Ensuring personalisation is central to realistic care and is something the care home sector prides itself on, and rightly so.

For a mutual agreement to happen it is key to ensure mutual respect and understanding exists. Many of the frustrations the sector has felt have been as a result of not working in sync, making changes at one end with little regard on how this may impact across the care sector.

The mutual aid and care assurance provided by NHS boards and HSCP’s was initially viewed by some  with skepticism, however in the main this has now been shown to be supportive in nature and also provides a recognition of the professional care being delivered across our care at home and care home services. Despite the inequalities that have existed in relation to accessing PPE, testing for staff and residents, alongside visiting restrictions there is a real desire to get problems resolved as quickly as possible to reduce the risks to residents and staff, especially round stress and distress.

 It is completely understandable that we must be stringent and inspected to protect against the risks of spreading infections as we care for the most vulnerable groups and have come through the greatest loss of life. The care sector requires prompt and workable guidance, and this has not been the case over the last several months, often being left in a state of limbo, spinning plates until the next piece of guidance or legislation is advised, which often conflicted with the previous guidance.

So, it’s important to concentrate therefore on what we can control.

It is people that make things happen and therefore we must ensure that there is leadership that will be strong and appropriate to take our staff through and out the other side. Staff are without question our greatest asset and as such we must ensure we prepare them to work to the top of their roles and that they are fully supported to understand their responsibilities alongside promoting a creative environment to enhance change to best fit the needs of our older people, who make care homes their homes, either through need or choice.

One thing that has been paramount during these last few months is that our care homes are our residents’ homes, their homely settings, not a hospital ward and as a sector it is important that this continues to be raised in relation to impractical, unworkable guidance and to protect people’s human based rights.

This is reliant on our professional care home managers feeling empowered and ensuring the needs of residents and families remain the key priority. This requires resilience demonstrated through leadership and professional integrity.We fully understand that transformational leadership in care homes can improve staff job satisfaction and retention and enhance the delivery of effective care for residents but this needs to be future proofed including in the context of the new digital age in order to succeed. Leadership needs to be promoted at all staff levels as part of ensuring the development of healthy work cultures and behaviours. Throughout this pandemic the words all in it together have been mentioned often and are truly the way to promote true compassionate leadership.

As we understand and learn from the effects of unhealthy work environments and the detrimental impact these can ultimately have on care outcomes then we must focus on leadership that is compassionate, is empathetic and supportive. This style of leadership is what provides trust and safety for staff to develop and to feel motivated and valued and ultimately drives service improvements and best value.

The wellbeing of staff therefore needs to be at the fore-front and this is as important for managers just as it should for all other staff. Managers can often feel isolated and pressured to feel like they are coping when they may be struggling. The need for self -care therefore needs to be recognised as a key determinant to ensure stability during a time of uncertainty.

Leadership historically is viewed through a lens of a ranges of styles, which may be interchangeable to enhance and ensure safe practice, and should promote access to information resulting in a motivated high performing efficient and effective team.

Over the years we have seen a leaning towards a more empathic style of leadership (humanity based) which ensure the manager and the staff are integrated in the aims and ambitions of the team through a mutual trust and open culture. Gone are the days of traditional bureaucratic leadership of command and control within a hierarchical approach. As we develop a transformational approach to service redesign so does the leadership style transform. Therefore, based on this it seems natural that our leadership style requires to be mindful of the gains that leadership could have by the use of e-health, social media and digital progression.

There has been a real push for the development of digital platforms to ensure live information around care and the conversion from paper-based processes to digital. This has been escalated during the pandemic to ensure tighter safeguards. An example of such is the introduction of the daily digital safety huddle management tool, rolled out to care homes in line with the platforms used by NHS nursing staff. The purpose being to be able to deliver excellent care and take appropriate escalation procedures around staff and patient safety and monitoring. During the last few months we have witnessed visually and in practice the real benefits in the use of digital platform to access information and deliver services through virtual technology such as Near Me. Although for some scenarios the preference would still be to be a face to face conversation, it definitely allows for a speedier decision making process and ensures better time management.

So, to lead into the future it is important our staff embrace the technology and make it intrinsic to their working practice whether this is through teaching, providing clinical supervision or promoting e-care planning, or rostering to ensure a capable workforce. This will require financial support and time invested to rectify digital poverty across the sector to ensure national equitable approaches which do not put our residents at risk. It also requires enhanced knowledge and skills to be developed around data analysis and quality improvement processes. The sector has innovative staff but requires this collaborative consideration to achieve a meaningful vision for care home nursing.

When I took up the post of transforming workforce lead for nursing, I didn’t envisage how the term transforming would truly be brought to life, during this exceptional year of the nurse. What a year indeed. The speed and pace of work has been exceptional and has managed to move nursing to the forefront of the future integration plans, with the true value of nurses recognised through their resilience and compassionate care. On a personal level until last year I had never written a blog nor was I an active participant on social media however the professional benefits gained by keeping updated and reflective practice are priceless and I would recommend all nurses to let your voice be heard.

I truly believe all nurses are transformers and leaders, we all have a journey, some just starting off and others nearing the end of their professional careers with a legacy to leave and be taken forward. Lead by example, be true to yourself and your patients/residents and ensure you advocate to ensure care is never compromised and our communities have the opportunities to thrive and our vulnerable receive the best care possible through leading from the heart.

Jacqui Neil

Transforming Workforce Lead 


Test & Protect – Protect Scotland App Launch

The free Protect Scotland App from NHS Scotland’s Test and Protect is now available to download on protect.scot and via the App Store and Google Play

The free Protect Scotland App is here to help keep Scotland safe from coronavirus.  The app is the next step in stopping the spread of coronavirus and complements existing contact tracing measures, helping us to determine contacts that we may have otherwise missed, and allows us to alert people at risk far more quickly so they can steps to reduce the risk of infecting others. 

How the App Works

This app uses tried and tested technology developed by Apple and Google and is already working successfully in other countries across Europe. It works in the background using minimal data and will automatically alert you if you have been in close contact with another app user who has tested positive. And if you test positive, the app can quickly alert those you have had close contact with. The app uses Bluetooth technology, so it never knows your identity or location.

Campaign Information

The Protect Scotland App launch will be supported by a 4 week campaign across TV, radio, press, social media, digital, PR and partnerships activity. The  campaign will direct to the new protect.scot website, where you can learn more on how the app works, information on privacy and data and FAQs.

Ø  View the TV Ad Here

Ø  View the Explainer Video Here

Campaign Assets

Available campaign resources will include: Posters, social media, editorial copy, app screen shots and explainer videos.

How to Help

Please post on social media, discuss within your organisation and share the campaign information across your networks. As we see the rate of infection increase it’s important that we all download and use the Protect Scotland app. The more of us using the app, the better it will work. 

Stakeholder Toolkit

Scottish Care’s statement on insurance concerns

Scottish Care has recently held talks with the insurance sector as a result of concerns being raised by our members. These primarily relate to a reduction in the number of companies willing to provide public and employee liability insurance for the care home sector.

We appreciate that the insurance sector has been affected by Covid-19 and has suffered a negative financial impact, but we hope that this will not result in exorbitant price rises for the social care sector in Scotland.

We have become aware that there are a number of insurers who are not willing to take on new clients which is making it very challenging for our members to shop around and get the best deal for their organisations.

We continue to monitor the situation closely because we are very concerned that there are very real risks to the survival and sustainability of the care sector.

CEO Dr Donald Macaskill said:

“It is very important in these challenging and hard times during the pandemic that the insurance sector supports care homes as they have traditionally always done. Care providers need to provide assurance to both residents and staff that they are adequately protected by insurance and I hope that the insurance sector will work closely with ourselves and care homes to get the real picture of what life is like. Yes there have been really challenging times but our journey back to what is closer to normal will not be helped if the insurance sector pulls the rug from underneath the care sector.”

Tickets now available for Homecare Festival – 7-9 October

We are delighted to announce that tickets are now on sale for ‘Homecare Festival’, a virtual event taking place from Wednesday 7th to Friday 9th October.  

Tickets are priced at £45 + VAT and will give attendees access to all 3 days of the event.

The Homecare Festival is an important opportunity to recognise the crucial role of care at home and housing support services in supporting our older and vulnerable citizens.

There will be a series of online sessions over this three-day period, bringing together a range of speakers and panellists to highlight challenges faced by the care at home & housing support sector and to discuss the future of homecare.

Each day will have a different theme: 

Wednesday 7th OctoberRe-shaping homecare: issues of vision, sustainability and practice

Thursday 8th October: Maximising potential: the critical role of the homecare workforce

Friday 9th October: Home is where the rights are: homecare and human rights

 A full programme for these three days can be found below.

The Homecare Festival will end with an Awards Evening on Friday 9th October to celebrate the dedicated workforce in the independent homecare sector and all the extraordinary work that they do. This will be a separate event, tickets will be available shortly. Find out more about the awards here.

Taking risks cautiously: a personal reflection.

This weekly blog is a day later than normal. I spent yesterday cutting a hedge or to be more accurate doing the manual labour when my suitably qualified and certificated brother used two vicious large petrol hedge cutters! This happens about twice a year – it is a big hedge! Conditions were not ideal – a sharp wind and not so occasional showers but the job is now completed  – even the tidying! Only when I put the machines away do I realise what dangerous and risky pieces of machinery they are.

I have been thinking a lot about risk in the last couple of days. Risk is part and parcel of everyday living. There is no context which is completely risk free. The way in which we grow from children into adults usually teaches us how to manage and deal with risks, having been protected from them as children to a greater or lesser extent. We learn strategies for dealing with risk, we develop models and systems and we fashion an internal risk management system! For there is, in reality, no such thing as total safety but rather there are degrees of safety and levels of risk. Risk is therefore a given of human living and relationships.

It is also a truism that risk is highly personal. I may make judgements and undertake activities and consider them normal and safe e.g. going skiing or mountain climbing but another person may consider those to be highly risky and never to be touched.

The influencers on how we manage our approach to risk are numerous. The way we have been brought up, the extent to which we have taken risks and things have worked out well, the impact of our behaviour upon others, especially those who are important to us – all are factors which influence our approach to risk. But by in large, part of adulthood is that we develop strategies that enable us to have a healthy approach to risk and to develop an acceptance that safety is often illusory and subjective.

Life is all about risk and risk is all about relationship. As someone who worked in both child and adult protection and having trained hundreds of staff in safeguarding I have always been acutely aware of how important it is to get the management of risk right. The failure to analyse and assess, to take action, to guard and protect can be literally a matter of life and death. But equally there are dangers of over-protection and risk avoidance which can result in care and support which suffocates with kindness and which serves to limit individual autonomy and personal control.

In conversation last week with colleagues from around the United Kingdom I reflected that where we are now in our current response to Covid is all about risk management. How we manage the obvious risks around us and the decisions we make and take will have a profound impact on the way we control the disease and also the nature of the communities and societies we are forming in that response. But whilst risk may frequently be an individual decision and action, it is influenced by and in turn affects relationships. I can make and take decisions which are appropriate for myself but when those decisions are impacting upon others or are made on behalf of another for whatever reason then the management of risk needs to be forensically examined and transparently justified.

The debate which is for so many of us the most critical and crucial discussion we are having these days is how do we improve and increase the access to care homes to allow families to get back together. In essence that debate is all about risk and how we manage risk. It is far from an easy consideration, in fact it is heart-breaking.

Yesterday’s Big Interview in ‘The Times’  newspaper was on Prof Sir David Spiegelhalter from Cambridge University, who has impressed me every time I have seen him on television during the last few months. But he is also someone whose work I have known for some time because he is an ‘expert on risk.’

Spiegelhalter a long time before the pandemic said:

 “The media want to make things exciting and usually alarming, so there’s a tendency to present figures in a way that makes them look dramatic, and we should be able to take these stories apart…it’s important that it’s not just left to the very senior people to draw attention to the misuse of evidence or statistics.”

And how true has that been in the last few months! –  don’t we all know the truth of the deception of statistics and the perversion of data.

In his book, The Art of Statistics,  Spiegelhalter argues that there is an onus on scientists like him to explain risk to the general public in a way that achieves the appropriate balance between informing and causing alarm. He appreciates that we all understand risk in  an often very individual way and even two scientists looking at the same data may come up with a diverse interpretation because of the moral paradigm of risk that they are working with.

At the present time we are witnessing an alarming increase in daily cases in Scotland in no small part generated by the risks which those of a younger age have taken around house gatherings and behaviours in hospitality settings. There are so many ways in which I can understand their behaviour. The data seems on the surface to present the risk of Covid to them as one which is relatively low and so the accompanying warnings that it is still a virus that can result in crippling long-term damage to young people are not heard. What dominates is the desire to get back to normality, to live life to the fullest, to reconnect and to enjoy. All perfectly understandable. But as Spiegelhalter states:

“The point is that risk is not just risk to yourself it’s risk to others as well,”

The challenge is, in part, that our understanding of risk as a younger person is palpably different from risk as we deal with it when we are older. At times I think the psychology of our public messaging has failed to appreciate that risk really does feel different dependant on the age you happen to be. So rather than an emphasis on risk the narrative should rather focus on our mutual responsibility one to the other not in order to ‘guilt out’ folks but in order to tap into the altruism and humanity which so many showed during the depth of the pandemic in the spring. For me in the last few weeks the biggest impact on local lockdowns has been on our older population and especially those families prevented from visiting residents in care homes which have had to close to indoor visiting just as they were beginning to open up. Individual actions can lead to a real desolation for others at this time perhaps to a degree that individual risk-taking has never impacted on others before. But I am not convinced those taking ‘risks’ truly understand the consequences upon others.

When we consider the issue of care homes I think we are getting to the heart of the risk debate that many of us are daily struggling with. The continual debate I have with clinicians and advisors is how do we get the balance right between protecting people from the virus and enabling them to have a quality of life which is enhanced by contact with their families and the wider community.

Spiegelhalter states:

“This whole crisis has turned into an issue of risk management. That means perpetually a balance of potential harms and benefits. There’s no such thing as safe, there’s no such thing as right or wrong. Everyone has to carry out that balancing act.”

As we move into winter and face the challenges of weather and potential increased instances of lockdown we need to find a better risk balance to enable people to be reconnected. I think we can learn some lessons from the world of safeguarding as we pursue that balance. At times I fear that maybe not surprisingly during a pandemic we have become automatically risk avoidant rather than risk enabling. We need to correct that imbalance.

In ‘normal’ times in health and social care a traditional risk aversion approach has gradually been replaced in the last few years with talk about enabling risk, and with the development of new models and ways of working which enable individuals to re-develop strategies for risk-talking and managing risk even in situations and contexts where familiar securities are no longer there, such as post illness or with declining capacity.

A major Department of Health consultation ‘No Secrets’ examined their approach to adult safeguarding and risk, and stated:

‘A balance needs to be established between empowerment and protection and between the rights for self-determination and the duty to ensure safety of people… We want to support people to be citizens and take risks that they understand. ‘

Good adult protection and safeguarding is about balancing risk. We all live within environments which are not risk neutral, but we have developed the skills and tactics to minimise, control and live in the face of such risks. That is part and parcel of what good support should be.

Risk enablement is about proportionality. It’s about nurturing within those who might be more vulnerable the insights and abilities which enable us to live in the world.

During a pandemic and especially now it is as we struggle to get a better and more proportionate balance between risk avoidance and risk enablement that I think we need to appreciate that for those who are at the end stages of their lives that seeing family, being able to be held, being together  – all with appropriate protection – trumps an approach to  risk which is in danger of adding to the number of days lived but diminishing the quality of those hours to a point at which they cease to have any real value. There really is more to life than chronology; more to our life than mere existence. There are no easy answers but simply asserting data and science as the sole predicators for decision-taking on risk is no longer sufficient or responsible, not least as it fails to value the rights of individuals.

I will let Spiegelhalter have the last word:

“Experts aren’t always right, they disagree, scientific disagreement is an integral part of science. When I hear a politician saying, ‘We are following the science’, that is when I start screaming at the radio. You do not follow science because it doesn’t tell you what to do. It is sitting there beside you humming and hawing.”

Dr Donald Macaskill

Media Statement on Care at Home Testing

Media statement on Testing:


Scottish Care has been arguing for the testing of all homecare staff on the same basis as care home staff for some considerable time. 

Regretfully this has not been progressed 


Whilst we recognise that testing resource requires to be prioritised it is our belief that homecare staff are an essential service s as and deserve equal treatment. 


CEO Dr Donald Macaskill said: 


“The women and men who work in homecare support thousands to live independently at home. A typical day involves frequent visits to different people and it is therefore critical especially now that the presence of the virus seems to be on the increase in our communities that we start to urgently test all homecare staff. We owe it both to keep this dedicated workforce safe and to protect those who they care for.” 


Anaphylaxis learning module and guidance for registered nurses in health and social care

All registered nurses in health and social care can now access anaphylaxis training via a landing page on Turas Learn. This is not specific to care homes but for use across NHS and social care.  If staff are not already registered they can use the link below. This is an elearning module provided by NHS Grampian and can be used as an educational resource and will provide a print off completion certificate. This is not a competency certificate therefore current local arrangements would apply, as with any training. Hopefully this will assist staff training in advance of the commencement of the flu season however if staff have already undertaken the relevant training then there is no need to complete this module.

To register for a Turas Learn account in order to be able to access the NES resources including the anaphylaxis please click on https://bit.ly/3k8M4kz.

Please see below for more information on this module.

Anaphylaxis: Learning module and guidance for Registered Nurses in health and care settings  

  • By undertaking this module, you agree to read and consolidate the information below, which highlights important considerations in the context of your work place. 
  • NHS Grampian have kindly shared open access to this resource, developed to enhance staff knowledge in responding to acute needs when a person develops anaphylaxis.  

Learning Aim: 

Recognition and treatment of anaphylaxis is required to ensure that people receive a high standard of care from trained and competent practitioners, in line with legal and professional requirements. 

Learning Outcomes:  

  • Define the term anaphylaxis; 
  • Identify triggers that could cause an anaphylactic reaction; 
  • Describe the signs and symptoms of an anaphylactic reaction; 
  • Describe the management of a patient with an anaphylactic reaction; 
  • State the dose and route of adrenaline (epinephrine) to be administered to an adult; 
  • Know how and where to gain safe and appropriate access to  Adrenaline.

Successful completion of this learning module indicates you have met the learning objectives.  It supports increasing your knowledge regarding how to deal with an anaphylactic reaction in an adult.  You may wish to discuss the associated learning outcomes alongside any local, relevant issues with your peers.   

This resource should be viewed in tandem with local policy in the facility within which you are based and in conjunction with standard guidance for managing a deteriorating person/ cardiac arrest.   

Links at the base of this page can guide you to supplementary resources. 

In this context, it is important that a registered nurse in any health and care setting 

  • Always functions within their scope of professional practice
  • Can respond effectively in a potential emergency, following local protocol to manage an emergency situation
  • Is current with recommendations for access to and administration of emergency medication such as adrenaline within the facility they are based
  • Knows where and how to access such medication 

This eLearning module was developed by NHS Grampian, in accordance with guidance from the Resuscitation Council UK.  It refers to NHS Grampian regarding access to medication (Adrenaline) and administration in an emergency situation. Any such references should be replaced by  local policy in your care facility. 

Useful learning resources: 

  1. Resuscitation Council UK: Emergency Treatment of Anaphylactic Reactions   https://www.resus.org.uk/sites/default/files/2020-06/EmergencyTreatmentOfAnaphylacticReactionsPPT.pdf 
  2. Recognising a deteriorating person; guidance regarding how to respond when an adult deteriorates can be found at the following link

Guidance for GP practices on ACP Conversations with People with Dementia living in the Community during COVID-19

The Chief Medical Officer has issued new guidance for GPs and primary care practitioners on managing Anticipatory Care Planning conversations with people with dementia and their families and carers.

Please see below for letter and guidance.

Chief Medical Officer - final version - SGHDCMO(2002)24 - ACP guidelines - 11 September 2020

Dementia - COVID-19 ACP guidance

Webinar: National analysis of hospital discharges into care homes – 17 September

Public Health Scotland are undertaking a review of hospital discharges into care homes (March-May 2020), commissioned by the Cabinet Secretary for Health Secretary for Health and Sport.

This work will identify those who were discharged from an inpatient hospital setting into care homes during this period, describing their COVID-19 status and relationship between discharges and COVID-19 outbreaks and mortality.

The data included in the publication will be aggregated and reported at Health and Social Care Partnership or Healthboard level.

The team are keen to engage with care staff, managers and providers about the work which is underway and future potential insights, sharing their methods and plans moving forward.

The team provide a short presentation and welcome dialogue to answer any questions during this webinar.

This webinar session will take place on Thursday 17 September, between 10 – 11 am and will be hosted by our CEO, Dr Donald Macaskill. He will be joined by:

  • Scott Heald, Head of Profession for Statistics, Public Health Scotland
  • Fiona Mackenzie, Service Manager, Public Health Scotland
  • Jenni Burton, Clinical Lecturer, University of Glasgow

This webinar is for Scottish Care care home members, details to join are available on the Members Area of this website.