Background: Handover aims to achieve the efficient communication of clinical information when responsibility for patients is transferred. The Royal Edinburgh Hospital (REH), a specialist hospital serving the Lothians, has repeatedly received “red flags” (ranked in the bottom 2% of benchmarked areas) on the handover section of the Scottish training survey (STS) and GMC national training survey of doctors in training (DiT).

Aims:

• • Survey DiT to understand their experience of handover.

• • Introduce a new structured handover process.

• • Re-audit parameters after intervention.

Data from REH DiT were extracted from an anonymised handover survey, disseminated to all psychiatry DiT in Scotland in January 2023. Multiple choice and free-text questions covered handover timings, format, structure, and attendance. The survey was repeated after intervention. In addition, data from the STS were analysed. The intervention consisted of altering shift times to include protected time for handover, introducing a dedicated room, training in the use of an electronic system to record tasks, involvement of senior doctors, and dissemination of the new changes to procedure.

A total of 12 survey responses (25% response rate) pre-intervention (25% FY2s, 17% GPSTs, 58% core trainees) and 14 post-intervention (14% FY2s, 14% GPSTs, 71% core trainees) were analysed. The proportion of respondents reporting that handover always happened at times of shift change increased from 7% to 93% post-intervention. The proportion of those reporting that there was protected time for handover rose from 0% to 50%, and the use of a predetermined structure/format increased from 0% to 43%. After intervention, 86% of DiT felt adequately supported during handover (compared with 17% pre-intervention) and 93% of respondents felt handover ‘allowed for the efficient and effective transfer of information to protect patient safety’ (33% pre-intervention). Prior to the process change, 83% of DiT felt there was no clear senior leadership at handover; this fell to 21%. Post-intervention the use of WhatsApp/texts to hand over information fell by 100%. The new system was welcomed by trainees, but teething problems were identified.

The new process led to improvements in the frequency, consistency, format, recording, and senior support of handover. Issues with the use of video call software and electronic medical records systems have been identified, and work is ongoing to address these in an iterative quality improvement process. Good clinical handover benefits patients (fewer mistakes and increased safety, better continuity of care, improved satisfaction) and clinicians (improved communication skills, increased accountability, feel more informed, improved job satisfaction).

Mental ill-health is one of Scotland's most pressing challenges, with an expectation of increased workload for health services. There are substantial vacancies in psychiatry specialties. Fill rates for core psychiatry training in Scotland have improved dramatically, filling at 100% since 2020. However, higher training fill rates have remained lower, with 68% filled in 2022. In response, the Scottish Government established a working group to examine the issues, both common and unique, to the whole psychiatry pipeline from training through to the consultant workforce, over two phases. The group aims to:

• • Set out the current landscape.

• • Consider the factors which influence recruitment and retention.

• • Collate and analyse quantitative and qualitative evidence.

• • Develop a set of recommendations.

A representative group was convened, including SG Health Workforce and Mental Health Directorates, NHS Education for Scotland (NES), the Royal College of Psychiatrists Scotland, Health Board representatives (Associate Medical Directors, Clinical Directors, Directors of Medical Education) and trainee doctors. Representatives offer first-hand experience of training and working in psychiatry, knowledge and expertise in training programme management, workforce modelling data analysis, experience of a range of approaches to improve health workforce recruitment (including the use of financial incentives). The group has met 4 times since May 2023, with SG Health workforce directorate providing secretariat support.

Through the formation of this group, several areas affecting recruitment and retention were, and continue to be, addressed: enhanced exposure to psychiatry via FY1 simulation training, and increased number of FY2 psychiatry placements; the design and recruitment of clinical development fellow doctors; flexibility of training posts and the expansion of run through training programmes; using data to better support workforce modelling; trainee support, including tailored IMG support; the use of attraction campaigns and incentives in other devolved nations/specialties; alternative ways to provide clinical supervision; examining diversification of the MH workforce; international and domestic recruitment options.

Several actions have been identified and progressed as the work of the group develops. Work is ongoing, and its impact will take time to emerge. This cross-functional group encouraged connectivity, conversation and network-building, striving to amplify differences and reduce power differentials, challenging traditional views. However, as with groups of this nature, there could be internal conflict where members fight strongly for ‘their corner’. Such a broad membership affects the development of a cohesive identity. Membership is largely voluntary, and so competing demands from the members’ existing responsibilities adds time pressure and stress, impacting commitment and productivity.

Tackling Scotland's drug-related deaths and improving outcomes from substance misuse treatments, including residential rehabilitation, is a national priority.

To analyse and report outcomes up to 4 years after attendance at a substance misuse residential rehabilitation programme (Lothians and Edinburgh Abstinence Programme).

In total, 145 participants were recruited to this longitudinal quantitative cohort study of an abstinence-based residential rehabilitation programme based on the therapeutic community model; 87 of these participants were followed up at 4 years. Outcomes are reported for seven subsections of the Addiction Severity Index-X (ASI-X), together with frequency of alcohol use, heroin use, injecting drug use and rates of abstinence from substances of misuse.

Significant improvement in most outcomes at 4 years compared with admission scores were found. Completing the programme was associated with greater rates of abstinence, reduced alcohol use and improvements in alcohol status score (Mann–Whitney U = 626, P = 0.013), work satisfaction score (U = 596, P = 0.016) and psychiatric status score (U = 562, P = 0.007) on the ASI-X, in comparison with non-completion. Abstinence rates improved from 12% at baseline to 48% at 4 years, with the rate for those completing the programme increasing from 14.5% to 60.7% (χ2(2, 87) = 9.738, P = 0.002). Remaining abstinent from substances at follow-up was associated with better outcomes in the medical (U = 540, P < 0.001), psychiatric (U = 273.5, P < 0.001) and alcohol (U = 322.5, P < 0.001) subsections of the ASI-X.

Attending this abstinence-based rehabilitation programme was associated with positive changes in psychological and social well-being and harm reduction from substance use at 4-year follow-up, with stability of change from years 1 to 4.