Les Elliot & Heidi Usher Listening

lineIssue Three – March 2019

From the Governors of Guy’s and St Thomas’

NHS Foundation TrustAlice Jedzinska, Heidi Usher & Jessica Trigg

Yasmin Kamara, Alice Jedzinska &

Heidi Usher

Dr John Balazs

Please let us know what you think of Listening line, and send us your ideas for future issues.

Listening Line is published on behalf of the governors of Guy’s and St Thomas’ NHS Foundation Trust. © 2019 Corporate Affairs department, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH, UK. For enquiries, contact governors@gstt.nhs.uk. Reproduction in whole or in part without written permission is strictly prohibited. All information is accurate at time of going to press but is subject to change.

Welcome to the third issue of Listening line.

EDITED BYDevon Allison

SUB-EDITORAïsha Diomandé

PATIENT GOVERNORSDevon Allison

Heather Byron

Jonathan Farley

William Moses

Placida Uzoamaka Ojinnaka

Giuseppe Sollazzo

Mary Stirling

Yu Tan

PUBLIC GOVERNORS Marcia Da Costa

Annabel Fiddian-Green

Margaret McEvoy

James Palmer

Prof John Porter

Samantha Quaye

Jenny Stiles

Peter Yeh

STAFF GOVERNORSDr Tahzeeb Bhagat

Prof John Chambers

Dr Tony Hulse

Anita Macro

Vicky Rogers

Bryn Williams

STAKEHOLDER GOVERNORSCllr Jacqui Dyer (Lambeth Council)

Cllr Alice Macdonald (Southwark Council)

Dr John Balazs (Lambeth Clinical Commissioning Group)

Dr Robert Davidson (Southwark Clinical Commissioning Group)

Dr Jane Fryer (NHS England)

Prof Lucilla Poston (King’s College London)

Sue Slipman (King’s College Hospital)

Prof Warren Turner (London South Bank University)

Dr Matthew Patrick (South London and Maudsley NHS Foundation Trust)

Listening line

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Join the Trust: www.guysandstthomas.nhs.uk/membership

March 2019 March 2019

Call the neighbourhood nurseNot long ago, the only nurses seen riding bicycles were on “Call the Midwife”. But for the past two years, the Guy’s and St Thomas’ neighbourhood nursing team has been on their bikes, becoming a familiar and popular sight in a corner of north Lambeth.

The uniforms are gone, but the bikes, bags and local knowledge are very much in evidence as the Trust has tested a new approach to community nursing. Developed first in Holland, neighbourhood nursing is earning praise from patients, GPs and the nurses themselves. These small, tight-knit nursing teams serve areas that are genuinely neighbourhood-sized, transforming care for the home-bound and transforming the ways nurses work with each other and within the NHS.

Because neighbourhood nursing seems to work so well we went to learn more.

In his 80 years, Les Elliot has seen many changes in health care, including the creation of the NHS. He remembers the days of home visits from the doctor, and while he is not about to call any system perfect, the new neighbourhood nursing programme has earned his full support. “You’re their patient,” he says, “and they really look after people. You can call them, any problem, and they’ll be around really fast.” The programme has brought some old-style personal care back into the system.

Les knows that management of his condition requires sustained, careful attention, and his life can be difficult without proper help. The big difference with neighbourhood nursing is that “it’s a team thing”, where the team includes his GP, as well as the small group of nurses. Being looked after by nurses he knows is excellent. “Having the same person is more important to me than how many times they come,” he says. It is also reassuring that the nursing team, available on the phone any time, has strong links to his GP surgery and to the hospital trust. Les is confident that his nurse can rapidly get him referred for further support if that’s what he needs.

Les appreciates that his local nurses are in charge of the new programme, noting that “locally they’re self-managing, and they are very good at ringing and fitting in with your needs, so they give as much flexibility as possible to the patient, freeing up my time.”

The inspiration for the new programme came from Holland, where its name, Buurtzorg, means neighbourhood care. The model gives nurses more freedom to manage the care of their patients and, by organising in neighbourhoods (patients must be within a 20 minute walk of the nurses’ station), more time for care. Experience is showing that the neighbourhood model can empower people with care needs to live independently with less formal support.

When reflecting on traditional district nursing, Les observes that “it’s very specific, as the district nurse is sent on a particular service—it’s short-term, not ongoing.” The frequent changes of nurse within a very large team can leave a sense of instability and insecurity for patients. And of course the long distances travelled by district nurses can make appointment times hard to meet.

Open lines of communication play a core part in neighbourhood nursing, creating a greater and stronger bond of trust between people who need care and their nurses, GPs, and other specialists. Les reflects that “it takes a long time to work out a relationship” and build a connection based on trust. In the long term, Les believes that “neighbourhood nursing needs to be expanded...it needs to be integrated” within the NHS system at large, so that even more people can benefit from its uniquely tailored approach.

This issue features an innovative community nursing programme, called out for praise by a member attending the Trust’s annual public meeting last autumn.

And what a wonderful programme neighbourhood nursing is, as you’ll see. It is bringing fresh benefits to patients, doctors, and to the nurses who are in charge.

My great grandmother, whose life spanned mule-drawn plows and rockets to the moon, liked to say that there is nothing new under the sun. The Trust’s neighbourhood nursing programme seems to illustrate the essential truth of this saying. It’s a major innovation away from the way care is provided in the community today, but many Trust members will recognise its style and spirit from days gone by. This is innovation that could be called “Back to the Future”.

The world of digital communication, also featured in this issue, can seem dauntingly new. Or it can be seen simply as the latest, innovative way to communicate and store complicated information. Almost all of us have embraced much innovation in this fundamental human arena, and there is more innovation coming. We invite you to have your say about how the Trust can use digital technology to help you.

Change to the new, even if in some big sense the new is not so different after all, can cause a lot of stress, including for Trust staff. Under pressure, it can be exhausting to learn new skills and approaches. Change has some costs, so it’s important that its benefits far outweigh these.

Luckily for all of us, the Trust has a proud tradition as an innovator in medicine, and a commitment to innovation based on the fundamental values of care.

This issue is all about what can happen when the Trust unites common sense, creativity and a commitment to the values of care in an innovative new programme for our community.

Enjoy! All the best,

Devon AllisonPatient governor, lead governor0207 188 7346 | governors@gstt.nhs.uk

ASK THE DOCTOR

For Dr John Balazs, the neighbourhood nursing teams bring welcome innovation, and, partly, a familiar way of working where “whole person care” and “patient facing time” are prioritised. With decades of experience as a Lambeth GP, he has seen the stresses on the district nursing system multiply and the need for change is clear, for patients and for staff.

Nationally, high district nurse vacancy rates make it hard for nurses to find the hours to meet growing care needs. The effects of this pressure can be painful: less time for staff to listen to and care for each patient, less partnership between nurses and GPs, less continuity of care, and a system that can be very stressful and unsatisfying for nurses and patients alike.

For home-bound patients to receive help, district nurses are currently allocated via registered GPs, so nurses serve large geographical areas, and, in congested London, a large number of nurse hours are spent in cars, travelling between patients. A key to neighbourhood nursing is saving this travel time, freeing hours to get to know patients, work with a small set of GPs, and provide reliable, informed, holistic care. “With continuity and time, nurses can deal with more than the patient’s immediate problem,” according to John. There can be greater satisfaction all round, as the nurses feel accomplishment and the patients feel listened to.

There are pressures within neighbourhood nursing too, and it will be vital to build the right skills for the new style of nursing, while monitoring the potentially higher costs of maintaining the service. John is keeping an eye on overlaps with social care, which has its own unresolved cost issues. Plus, many NHS teams will need to collaborate going forward, especially in sharing patient information.

Yet neighbourhood nursing is helping to overcome some of these issues, with increased collaboration easing the flow of care, and providing a highly empowering experience for nurses, doctors, and patients.

YOUR VOICE

There is plenty of evidence that digital systems can make health services much better: they enable integrated workflows by allowing the transfer of patient records between wards; they facilitate second opinions and remote consultations; they create time savings and efficiencies by avoiding paper-based communications among health professionals, and between doctors and patients. Doctors can get access to patient records, and patients can monitor their own tests, medications, and medical history wherever and whenever they wish. What’s not to like?

And yet, there can be discontent between the two groups that digital health services purport to serve: patients and health professionals. Patients complain about awkward, clunky websites, while medics lament slow systems that produce tons of paper, and still can’t talk to each other.

As governors, we are taking digital transformation seriously. We have been monitoring the Trust’s programme to introduce a new Electronic Health Record (EHR) system. Governors want a system that empowers staff to deliver the best care to patients. Equally, we want the system to improve patient engagement, while mindful that some patients may not have access to digital devices.

We are confident that the Trust is carrying out great work in the area of digital services, but we believe that the views of patients should be heard, in a way that enables the development of effective systems that are easy to use, and help improve services. Patients should be involved at the early stages of digital transformation. If you have used digital health services and would like to raise concerns, report good or bad practice, or generally tell us your story, we would be delighted to hear from you. Please write to us at governors@gstt.nhs.uk

Giuseppe Sollazzo Patient governor

Back to the future

Devon Allison

Listening line

March 2019

“ When I was training this is what I thought I’d be doing as a nurse and I’m doing it!”

At the heart of the changes, neighbourhood nurses Yasmin Kamara, Alice Jedzinska, and Heidi Usher are full of enthusiasm for their new way of working, and how it works for patients.

Neighbourhood nursing requires a fresh mindset, based on partnership and trust, rather than a chain of command. These partnerships are between nurses in the team, GPs, and people receiving care. Families and carers can also be included. “You don’t waste time going round and round,” Yasmin says. “Bureau-crazy”, if not a thing of the past, is at least much reduced.

These nurses spend far less time on the road, but they also benefit from stronger, streamlined relationships, so the care needed for a patient can be accessed rapidly. The team is so close, according to Heidi, that “you trust each other, you know it will get done, you can pick up the phone and call, we all know the patients and the GPs.”

Alice notes that the “patients feel a lot more secure”, because they are looked after by familiar nurses. “I go in to see the patient, I have all the details there, and I have my colleagues ready to take my call,” says Heidi, so she and the other nurses also feel supported and secure. Their leadership at the hospital trust helps too: the senior nurse responsible for the whole programme is always available to the team, just as the team is to the patients. Having that security actually means the phone rings less.

One of the most rewarding aspects for Alice is how “it’s a lot more empowering for the nurses and the patients...because there’s a continuity of care.” Heidi observes that it is easier to deal with “complex cases, as we see the big picture”. At work, she feels at ease with her team, as “there is a holistic approach and you see the whole process from start to finish.”

Yasmin emphasises that “time is of the essence” as nurses begin building rapport

with a patient. With neighbourhood nursing, “you have more time for common sense things like exploring what’s the main issue and how to deal with it”, including what resources are available to help each person make progress, and this is “what nursing should be about.” Also important, according to Yasmin, is that “We care for one another. This is collective work. If one person is affected all are affected. How do you support your team, your network, to give holistic care? That’s what we want.”

As a self-managing team, neighbourhood nurses rely on solution-oriented meetings in which everyone votes and unanimity is required. “If I have an idea, I feel fine suggesting it”, Alice says, and this is true for all nurses in the team. “Voting after discussion, it just seems so fair,” Heidi added. “If we can’t agree, we can leave it and come back to it later. But we are solution-based. We ask ‘so what’s your solution?’ and ‘what can you live with?’ so we don’t waste time.” They system includes a role for coaches and for ongoing training. Most importantly for Yasmin, with neighbourhood nursing “there is much greater support from within—you share the burden, you don’t carry it.”

It isn’t simple, or easy, but neighbourhood nursing gives great satisfaction. Becoming part of a neighbourhood, getting to know patients well, getting to see the results of care, which can include helping family members help patients themselves become fully independent again…these are all benefits that have convinced Yasmin and her nursing team that they are experiencing a better way to work.

“I love the neighbourhood nurses.... We have a very collaborative relationship with them, communication flows, and they are highly skilled. Patients generally love them. They provide an excellent service…Their relationship with us (GPs)…has continuity and challenge and mutual respect.” Dr Judith Ibison, GP

Interviews by Devon Allison and Aïsha Diomandé Jessica, Heidi & Alice

Heidi