Every year winter causes added pressure on our NHS services. The colder weather can intensify some of the symptoms of longer term conditions such a as Chronic Obstructive Pulmonary Disease (COPD) and heart disease, dark nights and icy pavements make it harder to get out and increases the risk of falls, and increased levels of viruses such as influenza are circulating.
This year, with more NHS services in the community than ever before, the NHS in Cumbria has plans in place to help people stay healthy and independent in their homes. For those who need admitted to hospital, we want to ensure they are given the right treatment and services in a timely way.
There really is no place like home and we know that people get better much quicker when they are in their own homes with familiar surroundings and family and friends close by. By community teams and hospital teams working together we can make sure that people are only in hospital when they need to be, and that, where possible, people are supported with the right care to get well in their own homes.
The NHS has introduced a number of initiatives which ensure that people are either; supported to stay at home first, admitted into hospital appropriately and in a timely way or discharged in a timely way.
Health and care organisations across the county are also working together to ensure that people are aware of how to look after themselves during winter and give them access to information about how to get help and support.
So what are we doing?
In A&E – we are putting a number of plans in place to ensure people are seen and treated as quickly as possible
Enhanced staffing levels – We have trained a cohort of healthcare assistants with specific skills to support and therefore free up the time of the medical and nursing staff who work in the emergency department.
Improvements to increase Rapid Assessment and Treatment capacity – In August we introduced a Rapid Assessment and Treatment (RAT) team to the Emergency Departments to provide early senior assessment of specific patients.It also allows for the rapid discharge / onward referral of patients who do not need to be in the Emergency Department. There has been an extremely positive impact therefore, ahead of winter, staffing will be reviewed to allow this service to be delivered across seven days and this is expected to be fully operational by the end of October across both West Cumberland Hospital and the Cumberland Infirmary.
Acute Medical Unit – For those patients who have been admitted to A&E or referred by their GP and need ongoing treatment – this may be further tests or a short stay – we currently have our Emergency Assessment Unit. This will soon be known as the ‘Acute Medical Unit’ at both West Cumberland Hospital and the Cumberland Infirmary and will be reorganised with the aim of providing faster access to a doctor
Expansion of A&E at the Cumberland Infirmary – Work will soon begin to expand the A&E department at the Cumberland Infirmary to allow Cumbria Health on Call (CHoC) to work more closely with the A&E team. This already works well at West Cumberland Hospital
Specific screening and support of those with COPD – Patients who arrive at A&E with shortness of breath will be screened specifically to ensure that if an admission is not needed rapid support is mobilised through their local Integrated Care Community (ICC) hub to support the patient at home.
Home first – Although this initiative has been in place at the Cumberland Infirmary and the West Cumberland Hospital for some time it will play an important part in ensuring our patients are cared for in the most appropriate way through the pressures of winter. The Home First team work with patients as soon as they come through the door in Accident and Emergency department, (A&E), to make sure that if discharge is possible the most appropriate therapy and support is available for them to go home.
In hospital – more people will be working to get assessments completed more quickly and get patients up and moving to get patients home sooner where appropriate – there’s no place like home.
Increased numbers of discharge navigators – discharge navigators are administrative staff who free up nursing time by coordinating the discharge of patients from wards. They work with the patient’s local ICC hub and the multi-disciplinary discharge team to ensure that patients can be discharged safely and in a timely way
Additional mobile CT scanner at the Cumberland Infirmary – The CT scanner is an important piece of diagnostic equipment often used to determine the cause of unexplained pain. An additional mobile CT scanner will be in place from November 2018 until March 2019, seven days a week. This will be used for outpatients, freeing up the permanent scanner for urgent cases and inpatients.
In the community – we are all working together with health and social care professionals, the ambulance service and pharmacies to keep more patients at home – there’s no place like home.
Frailty coordinators – In every Integrated Care Community there are frailty coordinators who are professionals working within the local community teams to assess patients’ frailty and give specific support to prevent falls
NWAS pathfinder scheme – If ambulance crews see that a patient could be managed in a different way, other than being transferred to hospital, they are able to contact the ICC hub and speak to the professional of the day. A discussion to determine the support that can be provided takes place and the ambulance crews are able to hand over to the community teams without the stress of the patient going to hospital.
Respiratory, frailty and cardiac pathway management – Where patients in the community fall into these categories they are prioritised during winter by the local ICC. The team will ensure the patient has the best management of medicines and understand how they can help themselves to reduce the likelihood of deterioration in their condition. They will also make sure the patients understand signs to look for which means their condition is worsening so that rapid home treatment can be actioned.
All pharmacies in Cumbria provide a minor ailments scheme – The pharmacists are trained to provide advice, guidance and identify treatments for a range of conditions that avoids patient having to go to GP practice. For example coughs, colds, constipation or a mild allergic reaction.
Flu vaccinations– Along with our partners, we are encouraging people who are eligible to get their free flu vaccination. Pregnant women, children, people over 65 and those with long term conditions are particularly vulnerable and are advised to get their free flu jab to protect themselves and others. All health and care staff are encouraged to get their free flu jab as well to protect themselves and their patients.
ICCs supporting GPs to reduce avoidable admissions – Each ICC has a local hub which is supported by a senior coordinator, support staff and a professional of the day with access to a full community team and additional capacity to support more people at home. GPs are able to refer in to the hubs for all patients who require community services
Home first team – This is a team which consists of different kinds of medical professionals who have very close links with the community teams and local ICCs hubs. Through these links they can arrange the necessary support that will enable particularly elderly and frail patients who do not need to be admitted to be discharged home. This support is available at the West Cumberland Hospital and the Cumberland Infirmary
Step into work – This is a six week programme which will support nine people who have been unemployed long term, to work towards their care certificate. On completion they will be supported to apply for an interview as a Health Care Assistant on the bank. The programme starts on 5 November and as well as helping the individuals, it aims to strengthen our workforce for winter
Across all health and care services we will be supporting the national campaign ‘Help us help you’.
The campaign helps people understand how to use the correct services at the right time. By following this advice, people can work in partnership with the NHS to:
- stay well
- prevent an illness getting worse
- take the best course of action if you have an urgent need
- get well again sooner