Recently I went to the Jean Bishop Integrated Care Centre.
In Hull, this recently constructed state of the art health and social care facility is leading a new revolution in the ways in which care, support, diagnosis, investigation and treatment can be delivered outside the walls of a traditional acute hospital.
I won’t make this negative by running-down big hospitals; they are incredible – temples to medical science.
(As an aside, did anyone watch the programme on TV last week with surgeons in Birmingham? It was stunning. Here is the link).
This TV programme actually brought something quite relevant into focus; that the two worlds of support for older people living with frailty and complex medical and social conditions and the sophistication behind replacing a 70-year-old woman’s aorta are quite separate.
Each requires skill, knowledge, passion, excellence, but of a different type.
Not to get too graphic; this kind of thing:
I am getting ahead of myself. I haven’t told you about the Jean Bishop Centre.
Situated in a housing estate in Hull, it was built on the site of the former David Lister School.
The centre provides, amongst other things, a one-stop-shop for older people, providing a holistic, multidisciplinary, health, wellbeing and social care assessment.
Dan, the doctor in charge showed me round and explained the ethos, which focuses on identifying those people living in Hull who are older, with complex health needs, often with associated frailty, providing a thorough assessment and support plan.
I’ll give you an example.
Say, Doris (this is made-up), visits her GP after having fallen at home. She is 88, lives alone and has a long-list of heath conditions – diabetes, osteoporosis, atrial fibrillation, asthma, hypertension, heart disease, previous cancer; this kind of thing. She takes 20 different tablets.
She lives in a 1920’s terrace house; the stairs are steep, the kitchen small.
Her one son lives in Hastings.
Three of her closest friends have recently died.
Under normal circumstances, utilising a bizarre referral management system in place across the UK, Doris wouldn’t qualify to attend the a fall’s service, where there would be detailed assessment into why she fell, how to prevent another, that kind of thing.
In some areas Doris would have to fall twice more before meeting the criteria for ‘frequent faller’ and hence attend the clinic.
Doris of course could be less fortunate and break her hip. This would be terrible for her, it would risk her future independence, let alone all the risks of surgery, pain and so on. She would however meet a multidisciplinary team of surgeons, physicians and therapists, albeit in an acute hospital as they put her back together again.
Not really what anyone wants.
The GP will only have a maximum of 10 minutes to sort-out Doris’ fall, medicines, social isolation, pain, anxiety; not enough.
At the Jean Bishop Centre, Doris is proactively identified by a nominated GP in the local practice who then using various assessment measures refers her to Dan’s team.
Doris is reviewed by a social worker, wellbeing officer, physiotherapist, occupational therapist, nurse, pharmacist and doctor – sorry if I have missed-out anyone.
A care plan is created online, shared with Doris and her doctor.
Including her preferences for what to do in case; this is part of a new NHS document called ‘Respect‘.
Half of her medicines are stopped as they were required when she was 50 with high blood pressure, but now with the passage of time, are actually contributing to her risk of falling. Bendromefluthiazide, Nifedipine, Betahistine, Iron, Aspirin, all now unnecessary and removed from the repeat prescription.
She is provided with a home assessment which identifies that she would benefit from better lighting, a new cooker and maybe a weekly visit to the local social group.
The team discuss Doris in a multidisciplinary meeting, working out if they can reconcile Doris’ priorities of care (What Matters to Her) with the health and social care landscape of Hull.
Doris even gets lunch as the assessments take a few hours.
There is more to the centre than this, but hopefully you get my gist.
There are different ways of providing health, social care and linking with voluntary sector organisations beyond dragging people to the big hospital with its parking charges, confusing signage and echoes of past misfortunes.
We have been so stuck in our ways within in the NHS, assuming that things must be a certain way, particularly outside the high-tech world of innovation and biomedical engineering, that doing what we have always done seems the only option; ward rounds, outpatient clinics, repeat prescriptions, risk registers, and on, and on.
The world in the past ten years has changed more than in the past thirty, or forty. And the rate is accelerating.
What is OK now will likely be positively harmful in another ten years.
We need to keep-up with change, adopt an agile philosophy towards treatment and care, play to patient as well as staff preferences; use our cultural, community and social assets to realise that we have a wealth of expertise and support in our next door neighbours, in local teams of workers and volunteers.
All it just takes is vision, collaboration and I guess, Dan and his team would say, lots of hard work.
Hard work, when translated into a vision that makes a significant difference is itself transformed, it becomes meaning, its return on investment is not necessarily financial, it is something more profound and longer-lasting.
Doris might be provided a new lease of life with independence, friends and meaning; this better than a few miserable years declining in a care home as so often happens.
This is no panacea.
You see, it is complicated.
Those in the know see that this is complexity.
Future developments might fail and, I know I am getting on to a different subject; it is what matters to Doris that matters.
Patient preference is paramount.
Pathways, processes and flow might support the critically ill on intensive care; for older people, they are more often than not associated with a different image, that of being swept away down-stream, especially if your needs or wants are less consistent with the anticipated norms.
The Jean Bishop Centre demonstrates a fascinating point in the journey of the NHS; between individualism. Me. And the collective, Us.
Economics might prefer we ignore Me and focus just on Us.
Yet, you, who are reading this is a Me.
Us and Me can be reconciled.
It just takes a little imagination and passion.
To meet Jean Bishop, follow this link.