I was up early this morning, and was listening to the news, in particular the broadcasted issues around the “Better Care” initiative, which has been reported today in the national news as the fund which “ has helped to join up health and social care”
To give you a little background, I am a RNLD, and Registered Manager of a 33 bedded Residential Nursing Home, caring and supporting for individuals complex mental health conditions and dual diagnosed Learning Disability. We are a specialised private service, who work at the acute end of these types of diagnoses’, and generally have a client base who do challenge service and care delivery in many differing ways, as a result of their diagnosis. We have a highly skilled nursing and care team, with three branches of nursing working collaboratively, to deliver holistic person centred care, in a therapeutic and nurturing environment, and are classed as “ good” across the 5 sectors of CQC regulated service inspection.
I wanted to share with you some of my experiences with the “Better Care” initiative, in particular in trying to avoid hospital admissions for the people within my care, and will share a particular example of why I don’t believe that this initiative is working for us - and will obviously respect confidentiality at all times. I will however also highlight some positive news also, as I have experienced some changes also. Some of you may know of the work myself and a fellow student carried out a few years ago, that looked into the power and benefits of networking – I will say that without people to actually drive these types of initiatives forward, they are doomed to fail. I will highlight some of these types of issues as a ramble on.
We recently had a “customer” (hate using this word) that we were caring for, who has an acquired brain injury, and associated aspects of behaviour as a result, that required imaginative and creative thinking in the delivery care, and in order to meet this persons needs. Unfortunately, this individual was also diagnosed with a laryngeal cancer whilst in our care, (which was firstly noticed by our amazing nurse team), and led to some required hospital admissions. (There is a whole blog waiting to be written about how hospitals care for those with complex behaviour – which I will write another day).
Anyway, this person required a planned hospital admission, we supplied the receiving ward with all of our documentation, which includes a “rainbow care plan” - all the ways in which you interact with this individual, and support them with all the activities of daily living, and manage aspects of behaviour. It is very easy to criticise hospital staff, but the reality is, that they are just not geared up or trained to work in this way, two big burly security guards in black tee shirts does not make me feel relaxed and stress free, which how the hospitals seem to cope with behaviour that challenges, perhaps Social Services and the CHC could fund hospital packages , and pay to have familiar people around at times of hospital admissions, there is another story to tell.
Anyway, to cut a long story short, the hospital admission did not go very well, and the “customer” was discharged at the earliest convenience. We were asked as a service…”can you meet this persons needs in the community?” We asked for a suitable discharge plan and care pathway, we have suction machines, nebulisers, and can change and maintain inner cannulas without to much problem, as we have a skilled nursing team, so, after consult with provider and team, we accepted the discharge.
All went well for a few days, until this customer decided that they did not want to have the tracheotomy fitted anymore, and decided to pull it out, meaning a 999 call and a trip to hospital, to have it refitted, and consternation from acute services saying that we were not able to meet this persons needs in the community. Well, this got my attention - I have to say. Investigation into exactly who should be re-fitting tracheotomies led me to the discovery that even respiratory nurses, working in a respiratory ward, DO NOT change or re-fit tracheotomies, it is done by the “higher ups” with in acute services, or the very experienced Respiratory District Nurses in the community.
So, the obvious thing for me to do, was to source the community nurses, and seek their help, so that we could avoid further unnecessary hospital admissions, and manage this aspect of care in the community. I was sure that they would come and support us, give us the training we required, in order to keep our customer safe, in the home, where care was given in an appropriate and person centred way. The answer…….We are not allowed to come into Residential Nursing Homes, and give training ……very short sighted by those who are managing things higher up within the NHS. I suppose one could argue that we as a provider of care, should have appropriately trained nurses, however, I challenge you to find this type of training in the private sector.
The Better Care Initiative did not work in this case, and as a result, led to numerous stressful hospital admissions for this person. This particular case has led me to be far more wary of accepting complex patients into our care. The hospitals appear to want us as providers of care, to become an extension of the hospital ward, by taking on more complex cases, but leave us with the responsibility of ensuring that we are competent and trained, but appear unable to allow us to access training at the local hospitals…. To me this is not “ joined up thinking”
On the plus side, we have recently engaged with the “Care Home Support Team” locally. The power of networking and sharing is bearing fruits; we are putting pressure upon this local NHS team to provide us with training and support, and to open pathways into the training at the local hospitals. I believe that this way of working collaboratively will improve outcomes for the people we care for, and that providing a “unified approach” will ultimately work. The time for being precious with information and resources is passed, we need to learn how to work together in these difficult times, we need “ trailblazers” in both the NHS and Private Sectors to drive these initiatives forwards, and the people who live in the higher echelons on management, need to come and see how difficult things really are. Our job ….it to look after people…..I am pushing hard to change things on a local level…..what are you doing?? What are your experiences ??
Better Care - NHS England
Local Government Association
Kings Fund - Perspectives of Integrated Care