The merry-go-round

In Rotherham this week (well, Wednesday to Wednesday) we are running something called ‘Rotherham Reset’ which is an attempt to give the entire health and social care system a shake-up to find new ways of working together, collaborating, undoing the knots of pathways and process to help pick ourselves (and our different services up) and get moving again.

We are just seeing the start of better times in the hospital with the numbers of inpatients who have Covid dropping for the first time in months. Still many patients are living in uncertainty because of cancelled operations or fear because of the ongoing menace of Covid that dominates all our lives.

Here is an attempt to re-frame a little part of the pathway and perhaps take some steps in the direction of talking, engaging and squeezing out of our silos.

 It used to be said that getting in to hospital was easy – all you had to do was be old and fall over.

The world has changed a little over recent years and thanks to the work of teams in the emergency department as well as staff in the community, more people are being turned-around at the doors of ED or being supported in their own homes.

Despite these changes, it has always been difficult to leave hospital, especially if you are old and you have been falling.

Interestingly, hospital can be the least-safe place for older people, with home being what most want and with far fewer hazards such as the risk of institutionalisation, over-medicalisation, polypharmacy, falls and a host of other healthcare associated ills.

Getting out of hospital requires, at least in the UK in 2021, a doctor, often someone with lots of experience to determine you are ‘medically fit for discharge’ – translated into ‘MFFD’ or as I recently discovered ‘MSFD’ which is perhaps more accurate as ‘stable for discharge’ this latter acronym is used, as for many of our patients, especially those with severe frailty and multi-morbidity ‘well’ is only an aspiration.

The problem with our system is that MFFD or MSFD is dependent upon the doctor’s knowledge of how well or how sick a person can be to be allowed home.

Sometimes we have to accept that better is more achievable than well particularly when there is little room to improve, for example when someone has a condition that is deteriorating.

To know how unwell you can be to be at home requires a knowledge and understanding of all the services that can support a person in their home.

Rotherham has a fantastic community service, which is for the most a replica of our acute hospital without walls serving a population of 260,000.

Patients in the community are supported by GPs, community and district nurses and matrons, teams specialising in rehabilitation, continence, neurological, cardiac and respiratory disorders, there are even consultants like me who try to do our bit.

Essentially, you can be very unwell and be well supported outside of hospital.

We need our hospital teams to link-in with their community counterparts, as a quick phone-call to a patient’s community matron or GP can unravel confusion, avoid unnecessary tests and treatments and reduce length of stay; this interaction works both ways – we need more integration!

This blog has been written to coincide with our Rotherham Reset week.

Let’s re-set hospital and community, shake up our relationships and discover that together we can provide care that outstrips anything we can do alone.

Dr Rod Kersh, Consultant Community Physician and Divisional Director of Community Services

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