>>Kath Evans: I’m Kath Evans, Community Nurse Lead in NHS England. Leading Change,
Adding Value is a framework for all nursing, midwifery and care staff and it’s a framework
which all staff can use whatever their role and wherever they work. I’m particularly
interested in the service as Community Nurse Lead to show the links between how acute care
can be provided in people’s own homes and how a community nursing service can support
that. The ‘At Home’ service at Guy’s and St. Thomas’ is a hospital substitution
service and it’s caring for people with quite complex acute illnesses in their own
homes. We spoke to several staff in Guy’s and St. Thomas’ as part of the ‘Hospital
At Home’ service.
>>Karen Titchener: I think the Guy’s and St. Thomas’ ‘At Home’ service is a hospital
substitution so it is providing an acute care that would otherwise be provided in a hospital
setting historically. Within the area that we serve as a service is Lambeth and Southwark
and 2 acute hospital Kings and St Thomas’. Within that area the practice population is
600,000 of which 45,000 are living with one or more chronic condition. Our service serves
patients that are 18 or over so were not just the frail elderly. And actually in this area
there are a lot of young people living with COPD for example, so the prevalence of chronic
disease is quite high in this area.
>>Anne Moger: Hello, my name is Anne Moger and I’m the Primary Care Nurse Lead in NHS
England. As Primary Care Nurse Lead I’m particularly interested in the ‘Hospital
at Home service because I think it demonstrates a huge opportunity for primary and community
care nurses to work alongside their colleagues in secondary care where there are different
skill sets that are apparent. Adam talks about how he has developed as a practitioner in
order to deliver the services that are required in the hospital at home service and how the
nurse leadership has enabled him to do this.
>>Adam Fitzgerald: Hello, my name is Adam Fitzgerald. I’m a Clinical Nurse Practitioner
with Guy’s and St. Thomas’ NHS ‘At Home’ service. As a result of this service from
a personal perspective I started within this service about 2 and a half years ago as a
Band 5 nurse I progressed to a Band 7 nurse through the educational opportunities and
support from senior colleagues and other staff within the team. I’ve completed my advanced
assessment course and I’m currently doing my advanced nurse practitioner training which
includes a prescriber course which I’m hopefully starting soon. With regards to the service
itself I’ve seen it grow in acuity and the amount of patients we see and positive results
from people in the community who now don’t have to go into hospital and are more likely
to seek out care.
>>Anne Moger: Jose gives us a great example how through talent spotting from nurse leadership
he was able to transition into a different clinical area using his transferable skills
to develop both own career and enable other to do the same.
>>Jose Facultad: The results that I’ve seen as a result of this survey is that there’s
really a big change and patient satisfaction – I’m leading on the evaluation of patients
satisfaction – I’ve grown very much well. I’m new to the community, I’m an acute
setting person and I’ve developed an autonomy, that knowledge, that skills, that competence
and confidence to look after patients in their own home in a very acute phase. And of course
I have also developed those skills to work with staff of different varied skills either
community background or acute background to work in this kind of service which is kind
of moving forward.
>>Kath Evans: We spoke to Karen about what she feels about the ten commitments and the
importance in her service.
>>Karen Titchener: With regards to commitment 4 where we centred the individuals experience
and high value, we work with the learning disabilities team. So these patients do not
like going into hospital and they’re out of their normal environment, they’re out
of where they’ve got all the equipment to help them. So they contacted me to say one
of our patients had a really good experience could we look at doing shared care so that
they stay with patient so the therapist is going to that patient do a joint visit with
us.
>>Anne Moger: When thinking about Leading Change, Adding Value it’s important that
nurses don’t feel that they need to change the world. Small changes at local level is
absolutely fine and with the ‘Hospital at Home’ service it was clear that a population
need was identified by a nursing team and they developed a service that’s enabled
them to keep patients in their own homes when they are acutely ill instead of admitting
them to hospital.
>>Karen Titchener: I feel very privileged to have set up this service. It’s kind of
in my DNA, it’s what I like to do. I like innovation and I like driving change. I think
really the thing it’s just you can never settle, you always have to think ‘what next?’