Stuck at the Border

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As part of our ‘What If’ series on change in the NHS, we spoke to Head of System Resilience Jayne Tunstall and asked her: “Putting all politics aside, if you could change one thing about the NHS, what would it be?”

If I could change one thing…

It would be around the “connectivity of care” and effective seamless “handovers” – or dare I say it, have no “handovers” at all!

It is widely known that with every “hand off” at least 1-2 days delay are inbuilt into the patients journey – which can lead to more mistakes, confusion around who has done what already, deterioration of the patient, re-reviewing patients and Community out of-hospital staff having difficulty locating and receiving patients. The result is that patients remain in hospital unnecessarily, putting them at considerable risk.

From personal experience, I know how vital it is for patients to get home as quickly as possible and for doctors and Nurses not be so risk averse when discharging – it’s amazing what people can do once they are back home in their own familiar environment.

However, the support network required is vital upon initial discharge – maybe a couple of nights ‘night-sitting’, just to give patients and their relatives a chance to gain some confidence, so that they don’t resort back to dialling 999 when they feel unable to cope. If the care and support is front loaded and then the appropriate care given thereafter (but reviewed regularly), it can promote independence.

It might seem an expensive approach, but I can guarantee many savings can be made further down the line, together with the ability to speak to someone who is familiar with the patient (not 999).

My dad is 89, has dementia and lives on his own with family support and carers twice a day for 1 hour. He is happy, safe, clean and in some ways quite independent. Usually, we are too quick to put in “heavy” packages without fully assessing what people can actually do in their own home.

So, how could this be achieved given the financial constraints?

The way I think this continued seamless care could take place successfully is that every patient who is not self-caring, be assigned a Care Pathway Coordinator who is with them in Hospital and then follows them home. Care can decrease quickly if not needed, releasing care givers, or increased if it avoids the need to attend hospital. Nothing new you might say, but nowhere I know does this happen consistently and sustainably.

Adopting this would definitely keep more patients safe at home – reducing demand on care establishments, promoting independence and providing assurance to loved ones who do feel the stress of ever changing patient care plans. Having confidence that the service is responsive, rapid, appropriate and timely, could prevent major financial losses, but more importantly, prevent patients going into care unnecessarily. We thought Dad wouldn’t be able to stay at home after losing mum. Oh how he has proved everyone wrong…! He has been given personalised appropriate care tailored to his individual requirements (what he wants), that can be responsive and adjusted as required.

It’s priceless to see someone having a good quality of life. If only a bit more time was given to the individual in our business – what a difference we could make.

About Jayne

Jayne has over 26 years’ senior management experience, including as an NHS Acute Trust Executive Director, and is known for taking troubled Acute Trusts from a struggling position to one of high performance. She’s run hospitals in both the NHS and the independent sector and has specialised over the last few years in system-wide resilience and urgent care transformation across primary, acute and community service providers.

About Practicus

Practicus provides problem solving and recruitment. To find out more about the company, see here