What makes an outstanding healthcare trust?
PUBLISHED: 18:09 22 July 2018 | UPDATED: 18:18 22 July 2018
It is the only health trust in our county to be rated outstanding, as others are pushed into special measures and judged unsafe. Health correspondent Geraldine Scott visited Norfolk Community Health and Care to find out what the organisation was doing to get it so right.
The NHS can be unwieldy, divided into various providers, commissioners, bringing in charities and third parties - all of whom are rated for the care they provide.
So it is no great surprise that often people do not know who is behind the care they receive.
It is this which means community trusts, such as Norfolk Community Health and Care (NCHC), are often overlooked when it comes to praise, with many people assuming their care is coming from the bigger names such as the Norfolk and Norwich Hospital, or the region’s mental health trust.
When in fact it is community care, operated out of 70 different sites across the county, which is a true cradle to grave service, looking after everyone from babies to patients at the end of their lives.
“Our staff don’t sing and shout about it,” said Anna Morgan, director of nursing at the trust. “But they are what got us our outstanding CQC, the staff are really patient focussed.”
NCHC see around 1,516 patients in their own homes every day, plus another 664 patients in clinics.
Clinical staff spend 431 hours travelling to see patients, and spend 2,158 hours face-to-face with them
But they also care for patients on wards, including Peter Ellis, who had a stroke while gardening at home in Diss on March 26.
He had been in hospital for four months, three of those on Beech Ward, at Norwich community hospital, where he was being rehabilitated.
“It was the most terrible feeling,” Mr Ellis, whose left side had been affected, said.
The 58-year-old said: “You get very low periods where I think will I ever be able to ride my bike again, will I ever play the piano again? The personal care that’s been given is very good, but what’s been very noticeable to me is how kind and respecting they are. When you’re having personal care you feel very vulnerable and you can feel very unsafe.”
But Mr Ellis said staff immediately made him feel at ease by singing with him in the shower and making jokes.
Mr Ellis was one of the longer staying patients at the trust, who were keen for as many people to be treated in their own homes as possible, and for people to be discharged as early as was safe.
Karen Bradley, modern matron for quality, said: “For most people they are quite fearful of going into hospital.”
It is why the trust has embraced new initiatives such as Home Ward, where patients can stay in their own home and teams go in to look after them to the same level as a traditional ward.
Or the Norwich Escalation Avoidance Team (NEAT), a collaboration between different organisations, which swings into action when someone in Norwich is facing a health, social care or wellbeing crisis.
Multi-agency professionals have helped more than 1,000 people in its first year, helping them remain cared for safely at home when otherwise they might have ended up going to hospital or needing respite care.
“I’m new to Norfolk and we’ve broken down barriers to make this happen,” 45-year-old Mrs Bradley said.
“We are having to be quite innovative and resourceful with what we are doing.”
And the trust’s leadership were determined not to sit on their laurels, even with the impressive inspection rating, and recognised there were still things to be done.
Josie Spencer took over at the helm in May, and credits much success to her predecessor Roisin Fallon-Williams.
But she said: “One of the things I noticed when I first arrived here was a crystal clear vision of what the services were about.”
She added: “From a financial point of view the NHS is still struggling and that’s an issue for us as an organisation and also for us in a system working with partners, but I think from a patient perspective it’s the best quality patient experience it can be, and many of our patients are patients for life with us.”
Looking towards the future both Mrs Spencer and Mrs Morgan, both 53, said they saw more integration as the way forward, and a look towards primary care.
Mrs Morgan said: “We’re trying very much to get our partners to understand what we can do.”
Mrs Spencer said: “I’m not sure what different will look like but we know primary care is under pressure.”
And Mrs Morgan added: “That’s why I think community care is so important, my aspiration would be in those really small, local villages we will have people from all organisations who will work together to serve the people in those communities.”
‘Happy staff, happy patients’
Staff were integral to NCHC outstanding rating from the CQC.
Inspectors said staff were compassionated and dignity and privacy were embedded in everything they did.
And the importance of happy staff was recognised by staff engagement manager Laura Palmer.
Miss Palmer admitted that two years ago, the national staff survey of NHS employees showed not all staff were happy at NCHC.
But since she said there had been an overhaul in hearing “the good, the bad, and the ugly” through anonymous feedback.
And a drive to meet the “happy staff, happy patients” standard through ensuring leadership listened to those on the ground.
She said: “If we’ve not got staff who can speak up, we’ve got unsafe patients.”
Since, she said, staff survey scores had improved, and she put a lot of the success the trust has seen down to the hard work of staff.
‘It’s as much about the family’
Just one of the little-known specialities offered at NCHC is rehabilitation for traumatic brain injuries.
These very sick patients can come from all over the east of England and Colman Hospital in Norwich, where the service is based, is just one of eight across the UK.
John Raby, clinical pathway co-ordinator for specialist neurological services, said injuries could be caused by anything from a car accident to a suicide attempt.
He said: “When families hear they are coming here, often after a long stay in hospital, they’re so relieved because we have free parking, free TVs, because this can be a long process. It’s as much about looking after the family sometimes. And we just have to be prepared for everything.”
He added families would often visit the service even if their loved one had died to show support.
At the site there was also a service for non-traumatic injuries, an outpatient service, as well as the amputee rehabilitation base and palliative care.
An army of volunteers
Another string to NCHC’s bow has been their volunteers.
Jules Alderson, volunteer services manager, said: “We started as a new service over two years ago.”
And since a number of groups had been set up, including a newspaper group where patients can read and discuss the latest headlines, or simply a volunteer may sit with someone while they eat.
“And it’s a great way to get feedback too,” said Ms Alderson, 31. “And the feedback is often a lot more honest, normally it would be the person giving the care receiving it but because the volunteers have got more time it puts people at ease.”
She also said their volunteers were not all who you might expect, and many were young people looking to gain experience.
This was especially true at Cityreach, NCHC’s GP service for the homeless in Norwich, where volunteers often sat with people while they waited.
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