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The 2015 Montgomery ruling created practical implications for how clinicians obtain consent and support patients to make decisions about their healthcare. The implication of the Montgomery ruling is that healthcare professionals must: clearly outline the recommended management strategies and procedures to their patient, including the risks and implications of potential treatment options discuss any alternative treatments discuss the consequences of not performing any treatment or intervention ensure patients have access to high-quality information to aid their decision-making give patients adequate time to reflect before making a decision check patients have fully understood their options and the implications document the above process in the patient’s record.

About the author Jo Mildenhall is a Doctoral Research Student at Manchester Metropolitan University; and Paramedic Team Leader, South Central Ambulance Service NHS Trust, Newbury Ambulance Station.

NHS Improvement are asking NHS organisations to identify, by June 2020, at least one person from their existing employees as their patient safety specialist. Training for these specialists will be based on the national patient safety syllabus being developed with Health Education England. Working with representatives from a few NHS trusts, patient safety partners (patient and public voice representatives) and clinical commissioning groups, NHS Improvement have drafted the requirements for a patient safety specialist to help organisations identify the most appropriate person(s) for the role. You can download the draft requirements here. NHS Improvement are inviting comments and feedback on this through their survey which can be accesed via the link at the bottom of this page. Consultation closes 12 March 2020.

'Scenario: Management of adults and children with post-traumatic stress disorder' covers the management of adults and children presenting with post-traumatic stress disorder. It includes guidance on how to manage the person whilst they are waiting to be seen by the specialist and outlines the treatments that may be offered.

The NHS Improvement web page outlines the eligibility criteria and application form. Please note: The closing date for applications has now passed. The scheme is not currently considering any further applications. The application process is anticipated to reopen on April 1 2020.

On a couple of occasions when myself or other key listeners have been in the process of supporting staff in the SISOS calm zone, there has been a knock on the door. This knock speaks far louder than you or I ever could. The knock in it’s intensity says, "I disapprove". These occasions are rare but they do happen. One comment I overheard was, "if you can’t take the heat you shouldn’t be here". My answer to this attitude is onwards and upwards. The location of the room is in it’s favour because it isn’t isolated and is easily accessible without the need to change into or out of scrubs. This makes it available to other departments and also to the support staff, such as chaplaincy who visit us fairly frequently when we request. This clearly has had a positive effect on take-up. The room itself is simply furnished and is in sharp contrast to the clinical environment. A small windowless store room, triangular in shape, has been transformed into a sanctuary of calm and psychological safety. The makeover consisted of a woodland scene wall mural, a Himalayan salt lamp, a reclining chair, a small side table, a coffee table and two regular chairs. I’m frequently asked, "Can we use the calm zone as a prayer room?" The answer is yes, because we must aim to support staff in their working environment and, provided one group or another doesn’t claim the room as their own, then why not? None of us can know what someone else’s journey has been like. When we put on our shoes and leave our homes to come to work we also put on our professional fronts often masking our private lives. This became very apparent to me in the first week and is shaping how the framework for SISOS is evolving and the breadth of support we are now providing. Originally set up to provide emotional support for staff centrally or peripherally involved in safety incidents, we recognised that these incidents are fortunately rare. However, you don’t need to be involved in an incident to be affected emotionally and most of our take-up is supporting staff for none-incident related events. We had one such event recently that affected a large number of our staff because of the circumstances and the age of the patient. Following this event, myself and another 'key listener' were relieved of our clinical duties and we were able to provide emotional support over a couple of days. This put our model to the test and I'm pleased to say it passed. These are work-related events. The other side to take-up involves staff who are distressed because of none-work related issues. We deal with this by signposting staff to other support structures, such as our Employees Assistance programme and our mental health First Aiders Hub. What we discovered was staff were not prepared to accept SISOS simply as a support for ‘second victims’. They demonstrated a need for other kinds of support, such as domestic abuse, money worries, bullying, and they wanted support for these issues. They weren’t prepared to differentiate. We have developed other pathways to support staff holistically. Staff come to us at a rate of approximately three per week (theatre department) requesting a ‘SISOS’ – meaning, I need to talk, and that can be on any topic. The anonymity SISOS provides, because of the confidentiality and trust, is impacting favourably and staff are opening up. Patients too. Our badge wearing listeners have attracted the attention of several patients who have felt safe enough to open up about domestic abuse. The SISOS team have supported three such patients and have taken advantage of that small window of opportunity to hopefully help them to change their lives for the better. SISOS is now part of a broader staff support model at Chase Farm Hospital and we are working on various new arms for it, including a student nurse support arm. This happened directly as a result of a student nurse needing support out of university hours after witnessing a distressing event. Read my other blogs on SISOS: Part one Part two Part three If you are thinking about setting up a similar initiative in your trust, I would be happy to discuss SISOS further with you. Contact: carolmenashy@nhs.net

As a second victim, on reflection, the two things I recognised that I had needed were peer support and a safe psychological space. A place where I could have been supported and my dignity protected. Over the years I’ve seen too many of my colleagues breaking down in the tea room, hiding in the sluice, or crying in the toilets. This is not acceptable. The NHS Constitution Key principal three states: "Respect, dignity, compassion and care should be at the core of how patients and staff are treated not only because that is the right thing to do but because patient safety, experience and outcomes are all improved when staff are valued, empowered and supported". Health Education England are now talking about safe spaces and psychological support. Our SISOS Calm Zone has been the most amazing achievement. Since the provision of our safe space, our staff talk about feeling valued. A member of staff who might have previously gone home because they had a headache, rest in this safe space and often are able to return to work safely within the shift. I talked about setting up a safe space where staff could go and rest and be support if needed and was promised that when we moved to our new hospital building a room would be provided. For the first six months SISOS functioned without a dedicated safe space in our old building and I faced the same old challenges that I’d faced as a member of the bullying and harassment support team many years ago. One of my roles then was to support staff who alleged bullying and the biggest challenge I always faced when I received a call was finding a suitable place to provide support. So often the support I gave was negatively impacted by an inadequate space. So I was very disappointed to find every door in our new department had a label on it and not one said SISOS Calm Zone. This was a challenge and I approached my manager and asked nicely but directly: "Where is the room I was promised?" "You’ll need to speak to orthopaedics," came the reply and so I did. "We have a lot of equipment", said the orthopaedic sister. "What’s more important, your crates or our staff?" I said. My words didn’t fall on deaf ears and our fabulous staff helped to clear the storeroom, relocate stock and also get rid of stuff we hadn’t used for years. The room is small, triangular in shape and windowless but the location is perfect. Safety is paramount and the room is located next to the tea room and so isn’t isolated and is easily accessible without the need to wear scrubs. This is important for staff who need support but also for anyone coming in to support staff such as chaplaincy, who frequently come up to support our staff when requested. Once we had the room I panicked a little realising that we would need to furnish it. I wrote to several charities, one of which was the Louise Tebboth Organisation. I was seeking confirmation that I was on the right track. This wonderful organisation not only supported our initiative but donated generously towards the purchase of a reclining chair. Realising that I wasn’t able to personally receive funds, I contacted our Royal Free Charity who took up the reins. They guided us and provided further funding for a woodland scene wall mural, a side table and a Himalayan Salt lamp. These simple furnishings have transformed the store room into a sanctuary of peace. My next fear was, "What if no one uses the room?" So I put in a wooden money box with bingo counters and a short note asking people to place a counter into the box if they had used the room and felt that they had benefited from it. I wanted to maintain confidentiality but needed to know numbers. We have eight theatres in our department and in the first week I counted 52 counters, the second week 56 counters. I carried on counting for a couple of months and the lowest count was 38. We knew for certain that the room was being used and it was being used appropriately and with respect. One consultant I work with classes himself as a SISOS frequent flier. He has a ten minute power nap during his shift. So the room isn’t only used to support second victims, fortunately that isn’t needed very often, but on a daily basis staff can zone out when they need to with or without support. We would highly recommend a safe space but if your department cannot provide any such space then look to see where a room might be found in another area that you can use to support staff. It is about planning and even if no room is available anywhere think about how you could set up a temporary safe space if needed. My next blog will talk about take up. Read part one and part two of this blog series