I will start with an update about my mum. Those of you who have read my blog in the past will know about my mum and the problems she faced last year. She is 94 next week and has escalating problems with dementia.
We as a CCG are also lucky that our local authority are developing extra care
Last year she had the classic story of a series of falls, increasing anxiety and three unnecessary urgent admissions at a hospital because there was nowhere else for her to go and in the end was placed in a nursing home as a place of safety because being home was no longer manageable.
Having visits for 21 different carers a week and then probably 15 other people popping in with meals, medication, monitoring her falls risks and her mental state was just too much for someone already confused and frightened by her confusion. It could so easily have ended there but we were lucky.
She lives in an area where there is extra care. I now realise this isn’t universal so we as a family have been lucky. We as a CCG are also lucky that our local authority are developing extra care at pace across the county.
So what is extra care? My mum still has her own flat, her own front door. She is still home. A team of carers work in the building and mum has got to know them and to trust them. Although that did take time. At first she wouldn’t shower or wash, but then why should it be easier for her to get naked with a stranger just because she is old?
She showers now. At first she was rude and difficult with the carers lecturing them about their educational achievements and that they should try harder. She was a teacher. It was excruciating to witness but the carers managed her with kindness and tolerance and gradually as it all became more familiar she became calmer.
Many extra care facilities keep people even when they have severe dementia
She has meals with all the other residents at midday and her other meals prepared by the carers in her flat. A team of people do her shopping, washing and cleaning. When she falls, night or day she calls them and they are there on the premises, they assess her and then pop her back in her chair or into bed. No 999, no A&E.
As long as her behaviour remains manageable she should be able to stay there as her memory shrinks further. She is content. Her aggression is very much linked to anxiety so hopefully now everything is familiar it won’t be a problems although of course you never know.
Many extra care facilities keep people even when they have severe dementia. Technology allows monitoring of wandering, falling. My mum is also no longer lonely. The carers and other residents have become part of her world rather than strangers and although she doesn’t talk to them much they give her a sense of community and belonging.
As a CCG we are working with our local authority to develop integrated health
I was at a public meeting locally when someone in the audience said they would hate to live in a place like that - ‘a rabbit hutch for old people’ - and yes I can see why when you look in from the outside it might seem like that but what I have learned from watching my mum is that her needs and aspirations have changed as she has aged and whatever I may think about it, she is content and that is what matters.
As a CCG we are working with our local authority to develop integrated health and extra care models to jointly commission facilities where frail older people can be supported to be independent but access the care and the companionship they need.
Maybe a community hospital co-located with an extra care building with shared staff and more importantly shared ethos. We could also add housing for younger people living with serious chronic illness or disability, who need nursing and care support but are keen to live independently.
These new developments will take time and will need our public to be along side us. For now we are working with the local authority to get the best out the ones already built so that we maximise joined-up input to keep residents as healthy as they can be for a long as possible .
We can manage more of the people at home who are currently on wards
This morning I was discussing with one of our local physicians from our local acute trust the recent experience of his pilot in our local A&E where he and a colleague work two shifts a week to trial consultant assessment at the front of house.
Yesterday evening he saw eight patients, sent six home with the much improved community and social care support that we have been developing over the last year including night caring, integrated neighbourhood health and social care teams, better resourced social care assessment and fast response.
One of the two who were admitted clearly could have been managed at home with the right more enhanced home care so we will work to provide that. So that is six patients who would have found their way into an acute bed able to go home and have their treatment and care there.
Last year our urgent admissions reduced by 3%. He is convinced that because we have good primary and community care we can manage more of the people at present on his wards at home.
With investments we are making this year, we can do it better and for more people. We just need the collective will and the confidence to do it. We are developing a ‘hot clinic’ in our community hospital run by physicians, therapists, social care and community nursing to urgently address the needs of older people who are becoming frail before they hit a crisis.
It is all good stuff. Is it big enough? Well, you could look at each initiative and accuse CCGs of playing at the edges, not being strategic or ambitious enough.
Or you could see each scheme as part of a much bigger picture and acknowledge that CCGs are making changes on the ground; changes that mean better services for individual patients and their families; changes led by local doctors, nurses ,social workers and therapists; changes that are there to address the difficult issues no one in the past has had the will to sort out, changes that will add up to a better system, a system that is better than the sum of its parts.