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Right Decision Service newsletter: April 2024

Welcome to the Right Decision Service (RDS) newsletter for April 2024. 

Issues with RDS and Umbraco access

Tactuum has been working hard to address the issues experienced during the last week. They have identified a series of three mitigation measures and put the first of these in place on Friday 3rd May.  If this does not resolve the problems, the second mitigation will be actioned, and then the third if necessary.

Please keep a lookout for any slowing down of the system or getting locked out. Please email myself, mbuchner@tactuum.com and onivarova@tactuum.com if you experience any problems, and also please raise an urgent support ticket via the Support Portal.

Thank you for your patience and understanding while we achieve a full resolution.

Promotion and communication resources

A rotating carousel presenting some of the key RDS tools and capabilities, and an editable slideset, are now available in the Resources for RDS providers section of the Learning and Support toolkit.

Redesign and improvements to RDS

The redesign of RDS Search and Browse is still on-track for delivery by mid-June 2024. We then plan to have a 3-week user acceptance testing phase before release to live. All editors and toolkit owners on this mailing list will be invited to participate in the UAT.

The archiving and version control functionality is also progressing well and we will advise on timescales for user acceptance testing shortly.

Tactuum is also progressing with the deep linking to individual toolkits within the mobile RDS app. There are several unknowns around the time and effort required for this work, which will only become clear as the work progresses. So we need to be careful to protect budget for this purpose.

New feature requests

These have all been compiled and effort estimated. Once the redesign work is complete, these will be prioritised in line with the remaining budget. We expect this to take place around late June.

Evaluation

Many thanks to those of you completed the value and impact survey we distributed in February. Here are some key findings from the 65 responses we received.

Figure 1: Impact of RDS on direct delivery of care

Key figures

  • 93% say that RDS has improved evidence-informed practice (high impact 62%; some impact 31%)
  • 91% report that RDS has improved consistency in practice (high impact 65%, some impact 26%)
  • 85% say that RDS has improved patient safety (high impact 59%, some impact 26%)
  • Although shared decision-making tools are only a recent addition to RDS, and only represent a small proportion of the current toolset, 85% of respondents still said that RDS had delivered impact in this area (53% high impact, 32% some impact.) 92% anticipate that RDS will deliver impact on shared decision-making in future and 85% believe it will improve delivery of personalised care in future.

Figure 2 shows RDS impact to date on delivery of health and care services

 

Key figures

These data show how RDS is already contributing to NHS reform priorities and supporting delivery of more sustainable care.

Saving time and money

  • RDS clearly has a strong impact on saving practitioner time, with 90% of respondents reporting that this is the case. 65% say it has a high impact; 25% say it has some impact on time-saving.
  • It supports devolved decision-making across the multi-professional team (85% of respondents)
  • 76% of respondents confirm that it saves money compared, for example, to investing in commercial apps (54% high impact; 22% some impact.)
  • 72% believe it has impacted already on saving money and reducing waste in the way services are delivered – e.g. reducing costs of referral management, prescribing, admissions.

Quality assurance and governance

  • RDS leads are clear that RDS has improved local governance of guidelines, with 87% confirming that this is the case. (62% high impact; 25% some impact.)

Service innovation and workforce development

  • RDS is a major driver for service innovation and improvement (83% of respondents) and has impacted significantly on workforce knowledge and skills (92% of respondents – 66% high impact; 26% some impact).

New toolkits

A few examples of toolkits published to live in the last month:

Toolkits in development

Some of the toolkits the RDS team is currently working on:

  • SARCS (Sexual Assault Response Coordination Service)
  • Staffing method framework – Care Inspectorate.
  • SIGN 171 - Diabetes in pregnancy
  • SIGN 158 – British Guideline on Management of Asthma. Selected sections will be incorporated into the RDS, and complemented by a new chronic asthma pathway being developed by SIGN, British Thoracic Society and NICE.
  • Clinical pathways from NHS Fife and NHS Lanarkshire

Please contact his.decisionsupport@nhs.scot if you would like to learn more about a toolkit. The RDS team will put you in touch with the relevant toolkit lead.

Quality audit of RDS toolkits

Thanks to all of you who have responded to the retrospective quality audit survey and to the follow up questions.  We still have some following up to do, and to work with owners of a further 23 toolkits to complete responses. An interim report is being presented to the HIS Quality and Performance Committee.

Implementation projects

Eight clinical services and two public library services are undertaking tests of change to implement the Being a partner in my care app. This app aims to support patients and the public to become active participants in Realistic Medicine. It has a strong focus on personalised, person-centred care and a library of shared decision aids, as well as simple explanations and videoclips to help the public to understand the aims of Realistic Medicine.  The tests of change will inform guidance and an implementation model around wider adoption and spread of the app.

With kind regards

Right Decision Service team

Healthcare Improvement Scotland

Domestic Abuse in Obstetric & Gynaecology settings (588)

Objectives

Other relevant policies:

Gender Based Violence Policy, Policy on Stalking, Health and Safety Policy, Forced Marriage Policy, Adult Support and Protection guidance and Procedures, Child Protection Procedures, Mental Health and wellbeing policy, Alcohol and Substance Misuse, Human Trafficking, Interpreting Policy.

Please report any inaccuracies or issues with this guideline using our online form

NHS Greater Glasgow & Clyde (NHSGG&C) recognises gender-based violence (GBV) as both a cause and consequence of gender inequality and acknowledges the evidence that it is overwhelmingly perpetrated by men against women and children, with the latter more at risk from men they know. As part of its Equality Scheme, NHSGG&C has produced several gender based violence action plans which identify domestic abuse as part of a wider continuum of abuse, which also includes child sexual abuse, rape & sexual assault, sexual harassment, female genital mutilation, forced marriage and commercial sexual exploitation.

GBV cuts across all boundaries of class, ethnicity, religion and age. At the same time women in marginalised groups can suffer discrimination in relation to ethnicity, (dis)ability, sexual orientation, poverty, migrant or refugee status which can increase and intensify their vulnerability to abuse and limit access to services. Given the health consequences and links with child protection NHS staff have a pivotal role in responding to this issue.

The Scottish Government defines domestic abuse as;

“perpetrated by partners or ex partners (which) can include physical abuse (assault and physical attack involving a range of behaviour), sexual abuse (acts which degrade and humiliate women & are perpetrated against their will, including rape) and mental and emotional abuse (such as threats, verbal abuse, racial abuse, withholding money and other types of controlling behaviour such as isolation from family and friends)

The purpose of this guidance is to assist staff (W&CD) in identifying and responding sensitively to women accessing services during their reproductive years, who may have current or past experience of domestic abuse. This applies to areas where routine enquiry of domestic abuse has been implemented and for all other areas within Obstetrics & Gynaecology.

Routine enquiry

  • Be aware of the indicators of domestic abuse & its impact on health & (Appendix 1) & www.gbv.scot.nhs.uk
  • See all women alone for part of the consultation to ensure that any sensitive information can be discussed safely & in confidence.
  • Always set the context prior to asking about abuse. (Appendix 2)
  • Follow this up with a direct question that requires a direct answer (Appendix 2)
  • Always discuss confidentiality & its limits (child protection and vulnerable adults).    
  • Follow NHSGGC Spoken Language, British Sign Language and Communication Support Interpreting Policy (2012). It is not appropriate to use family or friends to communicate except in an emergency situation.

Have information on support services available in the department in places where they can be picked up easily

Asking about abuse at other times

Examples of what to ask:

  • “I notice you have cuts/bruises…has someone hurt you?
  • Some of our patients who have these symptoms are living with an abusive partner…is that something that affects you?

Asking about domestic abuse will not always result in disclosure. Some women may choose to disclose at a later date & others will never access support.

Responding to Disclosure

The safety of the woman and any children is paramount and therefore it is crucial that health workers assess any immediate risk/safety issues following disclosure and follow child protection and vulnerable adult procedures where there are any concerns.

Key aspects to explore when assessing risk: 

  • How frequent and severe is the abuse?
  • Is she afraid for herself or her children?
  • Is she isolated and without support?
  • Is she being harassed or stalked?
  • Is there sexual violence, pressure or jealousy?
  • Are there any other risk factors such as drug, alcohol or mental health issues?

For many women leaving is the most dangerous point in the relationship, & any fears raised by the woman for her safety should be taken seriously. Women seldom exaggerate the risk of harm & are more likely to minimise the abuse.

Safety Planning

Following disclosure the health worker should explore options with the woman to help her focus on her current and future safety.

  • Help her identify a safe place she can go with her children i.e. friends, family, refuge or temporary accommodation
  • Discuss packing a bag with essential documents, clothes, money, medication, important phone numbers in case she needs to leave in a hurry. Store the bag safely where the perpetrator won’t find it
  • Offer her the Scottish Domestic abuse & Forced Marriage Helpline Number 0800 027 1234 –and  the opportunity to phone the helpline from a private room
  • Does she want to report the incident to the police? Advise her to dial 999 in an emergency or 101 at other times
  • Follow child protection and vulnerable adult procedures where there are any concerns.
  • Ensure a follow-up appointment is arranged where appropriate.

Risk assessment is not a one off event and risk may change over time; therefore ongoing risk assessment is required.

 

Documentation of Abuse

This is important health information which should be documented in the woman’s hospital notes, never in ‘hand-held’ records.  .

Document any disclosure using the woman’s own words and include any action or referrals and plans for follow up.

Resources

Scottish Domestic Abuse & Forced Marriage 24 hour helpline
0800 027 1234 www.sdah.org.uk– men women and children

For support and information on domestic abuse: 
www.scottishwomensaid.org.uk

Help and information for anyone who has been raped or sexually abused: 
www.rapecrisisscotland.org.uk

Website for perpetrators of domestic abuse looking for help to address their behaviour:
www.respect.uk.net

Support for male victims of domestic abuse: 
www.mensadviceline.org.uk

Advice and information for lesbian, gay, bisexual and transgender people experiencing domestic abuse:
www.lgbtdomesticabuse.org.uk
www.brokenrainbow.org.uk/help/helpline

Police Scotland Information and support for victims of domestic abuse: 
http://www.scotland.police.uk/keep-safe/advice-for-victims-of-crime/domesticabuse/reporting-domestic-abuse/

For further information on GBV
www.equality.scot.nhs.uk

A series of guides to support health workers on gender based violence is available at:
www.gbv.scot.nhs.uk

Support for Staff

Support for Staff can be obtained via:

  • Your line manager or Supervisor of Midwives
  • Employee Policy on Domestic Abuse - Staffnet HR policies
  • Occupational Health and employee counselling service
  • The Pastoral Care Team can provide/access religious, spiritual and emotional support.

For professional or personal support regarding Gender Based Violence contact the GBV Resource Unit 0141 201 9777 or e-mail: gbvunit@ggc.scot.nhs.uk  or visit our website on Staffnet.

Appendix 1

Impact on Health 

Table listing some impacts on health of domestic abuse

Possible Indicators of Abuse

  • Missed appointments and non-compliance with treatment
  • Frequent presentations to health settings or delay in seeking medical treatment/advice
  • Overbearing or overly solicitous partner who is always present
  • Denial or minimising of abuse
  • Injuries at different stages of healing or that don’t fit with the explanation given
  • Appears evasive, socially withdrawn and is hesitant
  • Children on the child protection register or referred to other specialists for behavioural/emotional or developmental problems

These lists are not exhaustive & there may be other causes.

Some women experiencing abuse may show no signs or indicators.

Appendix 2

Routine Enquiry

Setting the Context:

 “Around 1:4 women experience emotional, sexual or physical abuse, because we know this affects your health (and pregnancy), we now routinely ask all women……”

Follow setting the context by giving a short explanation of each of the forms of abuse e.g. physical abuse can be a push, slap or kick, emotional abuse may be your partner putting you down or not letting you see family or friends and sexual abuse could be your partner forcing you to do something you don’t want to.

Examples of Direct Questions: 

  • Have you ever felt afraid of a partner/ex or family member?
  • Has your partner/ex, ever physically hurt or threatened you or your children?
  • Has your partner/ex ever destroyed things that you cared about?
  • Has your partner/ex ever forced you to have sex when you didn’t want to?
  • Does he/she force you to engage in sex that makes you feel uncomfortable?
  • Does your partner/ex ever get jealous? If so, how does he act?
  • Does your partner/ex try to control you in any way, for example preventing you from going out or limiting contact with your family or friends?

These questions are intended as prompts, it is not necessary to ask all of them and they should not be used as a checklist.

Editorial Information

Last reviewed: 01/06/2016

Next review date: 30/06/2021

Author(s): Elaine Drennan; Mairi McDermid.

Approved By: Obstetrics Clinical Governance Group

Document Id: 588