Back to list page

Guest blog: provide the right treatment, in the right place, at the right time

Written by: Anna Folwell and Daniel Harman - 31st March 2021

Our #NHSReset campaign continues with a joint blog by Anna Folwell and Daniel Harman, Co-Clinical Leads for the Community Frailty Support Team at Jean Bishop Integrated Care Centre. In the blog, Anna and Daniel talk about how a collaborative approach is vital to provide the best possible care to patients.

Because we care for some of the most vulnerable groups, most of our patients had to shield initially. We had to introduce some considerable changes to the way we delivered our services. We moved from a proactive approach, looking at unmet needs with a holistic approach to patient care, to a more reactive one. We reviewed how to deliver services safely to patients both in their own homes and in care homes. It was important to ensure we delivered appropriate treatments, in the right place, at the right time.

We set up the Specialist Frailty Advice and Guidance Line to support paramedics, other healthcare teams and social care teams looking after people with frailty. We also set up a dedicated Care Homes Covid Outbreak support team that was also supporting both care homes and primary care. The right IT infrastructure was vital to be able to deliver those critical services. Within a week from the onset of the pandemic, we were able to conduct virtual consultations, have shared access to patient records, and produce electronic advanced care plans.

This was all possible thanks to the collaboration of all the organisations across the whole system from local authorities, primary care to acute and community Trusts, care homes and Clinical Commissioning Groups. We had to redeploy staff to help man the support telephone line.

The guidelines that were developed supported healthcare teams to be able to care for patients safely. The help we received from hospital teams was invaluable. We were also able to align with other community services including oxygen teams, palliative care and community nursing and held regular meetings to identify and discuss any issues and requirements.

We also received some support to produce analytical data: a dashboard of activities that helped us to understand when we needed to step up, step down or where to target our resources.

Moving forward it is very likely that we will continue with the specialist advice line as this has proved beneficial, in particular for paramedics and other healthcare professionals who had direct access to a specialist consultant or geriatrician.

We have always worked with other organisations, but the need to respond rapidly to the pandemic and adapt services has pushed those boundaries even further and we will continue to maintain these collaborative working relationships in the future.

Learn more about the challenges faced by healthcare services across the North East and Yorkshire in a new article by our CEO Richard Stubbs