No Place Like Home: Thumbs Up For New Ways of Working One Year On
Personalised care for people in their own homes by enhanced teams of nurses and therapists, keeping people well at home and out of hospital, has won a vote of confidence from people who have used the re-designed services.
One year on from changes to the way that community hospitals provide services in Exeter, Seaton, Honiton and Okehampton – including the closure of 71 inpatient beds – patients, their carers and GPs have broadly welcomed the way that care services are working together to improve the health and independence of those who would previously have been admitted to, or spent longer in hospital.
Those who have recently received the care services at home are backing them, with all those recently surveyed saying they would recommend them to others.
Latest figures show a significant increase in the number of community nurses – up as much as 50 per cent since 2010 in East and Mid Devon – rising from 170 full time equivalent posts to almost 260 in 2017/18.
Community nurses in these areas now carry out more than 17,000 home visits every month.
Community Conversation events have recently been held in Honiton and Seaton, bringing together a wide range of local representatives, including patients, carers, doctors, nurses and community groups, to discuss how well services are working and how communities can lead further developments for their areas. A drop-in event is planned for Ottery St Mary in June.
Dr Simon Kerr, a GP at Ottery St Mary and Chair of NEW Devon CCG’s Eastern Locality, told the Seaton event that GPs were working closely with the Royal Devon and Exeter Hospitals NHS Foundation Trust to “bring the hospital to the community”.
“The RD&E is providing exceptional care for our community,” he said. “This means not just good care in hospital but getting people home as soon as possible. This has meant a step change for our community teams.”
Em Wilkinson-Brice, Deputy Chief Executive and Chief Nurse at the RD&E, said:“We see people who become more frail if they are delayed in hospital once they have received the acute care they need. We are working to wrap services around people in their own homes, where we know they get better sooner and can lead a better life.”
Now the Royal Devon and Exeter NHS Foundation Trust has released a new film, called Let’s Get You Home, encouraging people to plan ahead when they are in hospital. It showcases how local people are being expertly supported at home.
The film features TV presenter Angela Rippon, who says: “Getting better faster at home isn’t just because you have your loved ones and pets around you.
“In familiar surroundings you will find it so much easier to get back to your normal routine and get active, and being active is the best possible recipe for recovery.”
The film shows how stroke patient Kevin Butler and his wife Maggie are supported by specialist nurses at home in Devon.
Kevin says: “The stroke team provided nursing care to meet my needs on the day Iarrived home. It was like being in hospital but at home.”
Another patient, Doug, 81, received care at his home in Seaton. Doug said: “I’ve always been an active and independent person. However, since 1999 I have undergone nine knee replacements and unfortunately it became necessary to have an above the knee amputation last year which has had a huge impact on my life.”
Doug spent two weeks on an acute ward before being referred into the care of the community team. They worked to understand what Doug wanted to achieve and were able to work together to ensure that the right rehabilitation plan and mobility equipment was in place. Initially, he had regular visits from community nurses and an occupational therapist. Doug can now self-refer to these teams when he feels he needs some extra help or support to prevent any decline in his condition.
“My ultimate aim is to return to driving and thanks to the continued advice and support from the RD&E mobility centre and community physiotherapists I know I’ll get there.
“I cannot praise enough the wonderful care and treatment I have received right through from the surgical team to the community healthcare professionals. The skills and attention to detail they have shown is remarkable and it has been a pleasure having the community team in my home.”
Tailoring care in the home is also greatly valued by families and carers. For example, June is full-time carer for her husband, David, 70, in Exeter. David was diagnosed with Dementia with Lewy Bodies, and June was concerned that he was developing bed sores because of his reduced mobility. Their GP arranged a visit from an RD&E community nurse who works closely with the practice. The nurse identified that June and David needed some urgent support to improve conditions for them to stay safe and well at home.
David can get frustrated and confused in hospital settings so it’s important him and June to be able to stay at home. June was doing a fantastic job caring for David but she didn’t realise the help that was available to make her life easier and reduce the pressure she was feeling.
June said: “I don’t feel so tired now or so anxious. I was worried about how we were going to carry on. I do everything so if something happened to me David would probably end up back in hospital which isn’t good for him or where he wants to be. I didn’t know all this help was there, it’s great. Life’s a lot better now.
Roger Trapani, community representative for the Eastern area on Devon Health and Care Forum, said: “The new model of care is very much a success story.
“Despite people’s initial fears about losing beds in the community hospital, things have moved on. What we didn’t have before was any plan for when people went home; now we see services working together to get the best for them and this is making a big difference.”
The new care model is a system-wide way of working, brought about by closer links between local health and social care partners who are now collaborating to ensure that more patients can get the care they need without leaving home.
Specialist nurses at the RD&E now work to prevent admissions where possible and enable people to return home with packages of care that support them and prevent readmission.
Modern healthcare means the role of the hospital is changing, so that only the most seriously ill need to be admitted to hospital and for the shortest possible time. This not only delivers best value but is known to be better for people – and in line with their preferences – as they recover more quickly and stay well for longer at home.
This also ensures that vital NHS hospital beds are kept available for those who need them most, such as emergency patients and those booked for planned surgery.
Lorna Collingwood-Burke, Interim Deputy Chief Officer and Chief Nursing Officer at NEW Devon Clinical Commissioning Group, said: “It is great to see that we have more community nurses and other therapists delivering a wide range of high quality, personalised care that people welcome in their own homes, enabling them to stay as independent as possible for as long as possible.
“This is a first class service that also helps ensure that hospital beds are used