Analysis Alamy
Video consultations for outpatient appointments in rural north Wales is one of the options being piloted
Innovative ways of working to tackle waste in hospitals Four trusts are designing systems around patients in response to a commission’s vision. Nick Triggle reports ONE YEAR ago, the Future Hospital Commission set out a radical vision for the way hospitals are run (Royal College of Physicians (RCP) 2013). The commission – set up by the RCP – was critical of the way patients were passed ‘unnecessarily and wastefully’ around the system. It called for care to be designed around patients, saying greater flexibility in the way services are organised and more integration with the community would be important. To ensure the vision is realised, the commission has now moved on to the next stage with four hospital trusts in England and Wales chosen to pilot new ways of working. Future Hospital project board chair Anita Donley says the aim is to ensure last year’s report does not ‘languish on a shelf’. But how are the trusts changing the way they work – and what does it mean for nurses? Betsi Cadwaladr University Health Board is seeking to harness the power of technology to improve care for older, frail 8
November 2014 | Volume 26 | Number 9
patients in rural areas of north Wales. There are three district general hospitals and a network of community centres, but patients can still find themselves 70 miles from consultants. From December the health board will start using video conferencing for outpatient appointments. Skype-style technology Community nurses and healthcare assistants will support patients during the consultations, which will use Skype-style technology, while GPs will also be able to join in. Chief of staff for primary, community and specialist medicine Olwen Williams says: ‘The NHS has not been that good at harnessing technology and the assumption is that older people may struggle, but that is not always true. If you think about iPads, they can be easier because of the touch screens.’ Pinderfields Hospital – part of the Mid Yorkshire Hospitals NHS Trust – is creating a seven-day frailty unit with short-stay
beds. It builds on the existing older people’s assessment service that is already in place. The unit will operate alongside the emergency department (ED) and acute medical unit with the aim of identifying older and frail patients who do not need to be admitted to hospital. This includes those who have had falls or fractures or have infections. Consultants are to be in charge of diagnosis, but care will then be co-ordinated by senior older people’s in-reach nurses. Senior elderly care nurse practitioner Cheryl Budby says: ‘We are working to try to identify those patients that do not need an admission so we can assess them, co-ordinate their care and arrange discharge.’ The goal is that patients will spend no longer than 72 hours at the unit, which compares with the nine-day average length of stay for frail inpatients. Worthing Hospital is developing a whole new area – the emergency floor – to ensure services are built around patients. The 67-bed unit will cater for most adult patients referred for emergency treatment by GPs or direct from the ED, which is located next to the unit. The idea is to end the situation – highlighted by the Future Hospital Commission – where patients are moved around hospitals during their stay. The treatment of each patient is led by one consultant who is supported by a multidisciplinary team. This team will include a range of nurses from those specialising in elderly care and dementia to those who work in urgent and emergency care. The aim is to provide early intervention to enable people to be discharged in less than 72 hours, although it is hoped a significant proportion will not even need to stay overnight. There is a designated ambulatory care area for those who need investigations, treatments and other support. East Lancashire Hospitals NHS Trust is an acute and community provider. It is working with colleagues across health and social care to provide a more integrated service for older people. NURSING OLDER PEOPLE
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Analysis
Promoting success The progress of the four trusts will be monitored by the Future Hospital Commission and any successes promoted across the NHS. This approach has been widely welcomed. British Geriatrics Society honorary secretary Adam Gordon says the ‘strong focus on optimising care for older people’ is essential to the future of the health service. RCN professional lead for the care of older people Dawne Garrett agrees. ‘These schemes show us the direction the NHS should be heading,’ she says. ‘It is about a real focus on the patient. Over the past 15 years we have moved away from that to concentrate on streamlining pathways and we have lost the person. ‘Nurses are going to be crucial in changing that. They are the ones who are closest to patients and should play a key role in improving the patient experience. ‘Good practice needs to be spread across the system. It is not just these sites that can innovate and look for new ways of working – it can happen anywhere.’ Nick Triggle is a freelance writer
Reference Royal College of Physicians (2013) Future Hospital: Caring for Medical Patients. www.rcplondon.ac.uk/sites/default/files/futurehospital-commission-report.pdf (Last accessed: October 8 2014.)
NURSING OLDER PEOPLE
Charity seeks consistent level of care for people with Parkinson’s Tim Geaorge
Five ‘virtual wards’ have been set up in the community and are led by nurse practitioners. They provide support to people in their own homes and settings such as care homes at times of increased need. The teams, which include a range of professionals, such as occupational therapists and social care staff, work closely with GPs. To complement this, the hospital is setting up a frailty service to identify those patients who could benefit from extra help outside hospital. The medical assessment unit is being overhauled so it has extra beds and multidisciplinary teams to assess and recommend care to patients who do not necessarily need to be admitted to hospital. Meanwhile, a co-ordination centre has been established to arrange step-up or step-down care between the virtual wards, care homes and community hospitals.
Nurses’ input will be vital to a network that aims to develop research and education into the condition, says Jennifer Sprinks IN ITS 2015-19 strategy, Parkinson’s UK has set out a vision that high-quality services will be available to meet the needs of people with Parkinson’s disease (PD) at every point of their journey. The charity envisages greater consistency in standards across the UK, so that wherever PD patients are treated in the country, they will receive the same level of care. The charity aims to do this by launching a network of health and social care professionals from next February that will operate across two tiers – a national oversight group complemented by regional executive groups. The network will look at enhancing PD education and research. In September, the charity appointed neurologist David Burn as clinical director of the forthcoming UK Parkinson’s Excellence Network. He is professor of movement disorder neurology at Newcastle University and honorary consultant neurologist for Newcastle upon Tyne Hospitals NHS Trust. Professor Burn says: ‘Not everyone with Parkinson’s is cared for by expert Parkinson’s clinicians; many patients are not given the information and support they need to manage the condition and not enough people are being enrolled in clinical trials.’ He says he would expect to see at least one PD nurse involved in each regional executive group. PD nurses could also apply to become regional leads or members of the national oversight group. ‘Sometimes the people who are the best academics in the country are not necessarily the best people to be involved at the coalface,’ he says. ‘Parkinson’s nurse specialists are absolutely essential and they are an untapped resource.’ Professor Burn hopes the network will ‘reach out’ to hospitals that are underperforming in PD care – such as those without access to physiotherapists or a PD
nurse – and to nursing homes where PD patients are not receiving follow-up care for their condition. Nurses’ core input in the network, he explains, will be in developing research into the condition; they could get patients to take part in clinical trials and also suggest topics to explore. He adds that they will also develop a mainly digital resource, or toolkit, containing best practice on PD care. One ‘embryonic idea’ for the network is to create an institution or university that specialises in PD to encourage post-doctoral research and continuing professional development of staff. Louise Ebenezer, a PD nurse specialist at Abertawe Bro Morgannwg University Health Board in south Wales, says health and social care professionals often have a poor understanding of how the condition affects patients. She says it is important they understand the four different stages of a patient’s journey, from diagnosis through to palliative care, so that they realise a patient’s capabilities and healthcare needs can change as quickly as the flick of a light switch. ‘It is the unpredictability of the disease which has a big impact on patients and their families,’ she explains. ‘For instance, they could get out of bed on their own one minute and the next they would need to be wheeled out so getting healthcare professionals to understand this can be difficult.’ See Features, page 16
Find out more tinyurl.com/ow7b952 Email: [email protected] November 2014 | Volume 26 | Number 9
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9
Video consultations for outpatient appointments in rural north Wales is one of the options being piloted
Innovative ways of working to tackle waste in hospitals Four trusts are designing systems around patients in response to a commission’s vision. Nick Triggle reports ONE YEAR ago, the Future Hospital Commission set out a radical vision for the way hospitals are run (Royal College of Physicians (RCP) 2013). The commission – set up by the RCP – was critical of the way patients were passed ‘unnecessarily and wastefully’ around the system. It called for care to be designed around patients, saying greater flexibility in the way services are organised and more integration with the community would be important. To ensure the vision is realised, the commission has now moved on to the next stage with four hospital trusts in England and Wales chosen to pilot new ways of working. Future Hospital project board chair Anita Donley says the aim is to ensure last year’s report does not ‘languish on a shelf’. But how are the trusts changing the way they work – and what does it mean for nurses? Betsi Cadwaladr University Health Board is seeking to harness the power of technology to improve care for older, frail 8
November 2014 | Volume 26 | Number 9
patients in rural areas of north Wales. There are three district general hospitals and a network of community centres, but patients can still find themselves 70 miles from consultants. From December the health board will start using video conferencing for outpatient appointments. Skype-style technology Community nurses and healthcare assistants will support patients during the consultations, which will use Skype-style technology, while GPs will also be able to join in. Chief of staff for primary, community and specialist medicine Olwen Williams says: ‘The NHS has not been that good at harnessing technology and the assumption is that older people may struggle, but that is not always true. If you think about iPads, they can be easier because of the touch screens.’ Pinderfields Hospital – part of the Mid Yorkshire Hospitals NHS Trust – is creating a seven-day frailty unit with short-stay
beds. It builds on the existing older people’s assessment service that is already in place. The unit will operate alongside the emergency department (ED) and acute medical unit with the aim of identifying older and frail patients who do not need to be admitted to hospital. This includes those who have had falls or fractures or have infections. Consultants are to be in charge of diagnosis, but care will then be co-ordinated by senior older people’s in-reach nurses. Senior elderly care nurse practitioner Cheryl Budby says: ‘We are working to try to identify those patients that do not need an admission so we can assess them, co-ordinate their care and arrange discharge.’ The goal is that patients will spend no longer than 72 hours at the unit, which compares with the nine-day average length of stay for frail inpatients. Worthing Hospital is developing a whole new area – the emergency floor – to ensure services are built around patients. The 67-bed unit will cater for most adult patients referred for emergency treatment by GPs or direct from the ED, which is located next to the unit. The idea is to end the situation – highlighted by the Future Hospital Commission – where patients are moved around hospitals during their stay. The treatment of each patient is led by one consultant who is supported by a multidisciplinary team. This team will include a range of nurses from those specialising in elderly care and dementia to those who work in urgent and emergency care. The aim is to provide early intervention to enable people to be discharged in less than 72 hours, although it is hoped a significant proportion will not even need to stay overnight. There is a designated ambulatory care area for those who need investigations, treatments and other support. East Lancashire Hospitals NHS Trust is an acute and community provider. It is working with colleagues across health and social care to provide a more integrated service for older people. NURSING OLDER PEOPLE
Downloaded from RCNi.com by ${individualUser.displayName} on Feb 03, 2016. For personal use only. No other uses without permission. Copyright © 2016 RCNi Ltd. All rights reserved.
Analysis
Promoting success The progress of the four trusts will be monitored by the Future Hospital Commission and any successes promoted across the NHS. This approach has been widely welcomed. British Geriatrics Society honorary secretary Adam Gordon says the ‘strong focus on optimising care for older people’ is essential to the future of the health service. RCN professional lead for the care of older people Dawne Garrett agrees. ‘These schemes show us the direction the NHS should be heading,’ she says. ‘It is about a real focus on the patient. Over the past 15 years we have moved away from that to concentrate on streamlining pathways and we have lost the person. ‘Nurses are going to be crucial in changing that. They are the ones who are closest to patients and should play a key role in improving the patient experience. ‘Good practice needs to be spread across the system. It is not just these sites that can innovate and look for new ways of working – it can happen anywhere.’ Nick Triggle is a freelance writer
Reference Royal College of Physicians (2013) Future Hospital: Caring for Medical Patients. www.rcplondon.ac.uk/sites/default/files/futurehospital-commission-report.pdf (Last accessed: October 8 2014.)
NURSING OLDER PEOPLE
Charity seeks consistent level of care for people with Parkinson’s Tim Geaorge
Five ‘virtual wards’ have been set up in the community and are led by nurse practitioners. They provide support to people in their own homes and settings such as care homes at times of increased need. The teams, which include a range of professionals, such as occupational therapists and social care staff, work closely with GPs. To complement this, the hospital is setting up a frailty service to identify those patients who could benefit from extra help outside hospital. The medical assessment unit is being overhauled so it has extra beds and multidisciplinary teams to assess and recommend care to patients who do not necessarily need to be admitted to hospital. Meanwhile, a co-ordination centre has been established to arrange step-up or step-down care between the virtual wards, care homes and community hospitals.
Nurses’ input will be vital to a network that aims to develop research and education into the condition, says Jennifer Sprinks IN ITS 2015-19 strategy, Parkinson’s UK has set out a vision that high-quality services will be available to meet the needs of people with Parkinson’s disease (PD) at every point of their journey. The charity envisages greater consistency in standards across the UK, so that wherever PD patients are treated in the country, they will receive the same level of care. The charity aims to do this by launching a network of health and social care professionals from next February that will operate across two tiers – a national oversight group complemented by regional executive groups. The network will look at enhancing PD education and research. In September, the charity appointed neurologist David Burn as clinical director of the forthcoming UK Parkinson’s Excellence Network. He is professor of movement disorder neurology at Newcastle University and honorary consultant neurologist for Newcastle upon Tyne Hospitals NHS Trust. Professor Burn says: ‘Not everyone with Parkinson’s is cared for by expert Parkinson’s clinicians; many patients are not given the information and support they need to manage the condition and not enough people are being enrolled in clinical trials.’ He says he would expect to see at least one PD nurse involved in each regional executive group. PD nurses could also apply to become regional leads or members of the national oversight group. ‘Sometimes the people who are the best academics in the country are not necessarily the best people to be involved at the coalface,’ he says. ‘Parkinson’s nurse specialists are absolutely essential and they are an untapped resource.’ Professor Burn hopes the network will ‘reach out’ to hospitals that are underperforming in PD care – such as those without access to physiotherapists or a PD
nurse – and to nursing homes where PD patients are not receiving follow-up care for their condition. Nurses’ core input in the network, he explains, will be in developing research into the condition; they could get patients to take part in clinical trials and also suggest topics to explore. He adds that they will also develop a mainly digital resource, or toolkit, containing best practice on PD care. One ‘embryonic idea’ for the network is to create an institution or university that specialises in PD to encourage post-doctoral research and continuing professional development of staff. Louise Ebenezer, a PD nurse specialist at Abertawe Bro Morgannwg University Health Board in south Wales, says health and social care professionals often have a poor understanding of how the condition affects patients. She says it is important they understand the four different stages of a patient’s journey, from diagnosis through to palliative care, so that they realise a patient’s capabilities and healthcare needs can change as quickly as the flick of a light switch. ‘It is the unpredictability of the disease which has a big impact on patients and their families,’ she explains. ‘For instance, they could get out of bed on their own one minute and the next they would need to be wheeled out so getting healthcare professionals to understand this can be difficult.’ See Features, page 16
Find out more tinyurl.com/ow7b952 Email: [email protected] November 2014 | Volume 26 | Number 9
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9
