NHS: Your NHS – on the doorstep

AT the end of January, the long awaited White Paper on Out of Hospital Care was published by the Department of Health. Our health, our care, our say: a new direction for community services describes the shift in the direction of NHS care from hospitals

AT the end of January, the long awaited White Paper on Out of Hospital Care was published by the Department of Health.

'Our health, our care, our say: a new direction for community services' describes the shift in the direction of NHS care from hospitals to more community-based services.

Life checks to assess people's fitness, guaranteed registration with a local GP practice and more support for carers are among measures designed to improve ways the NHS can meet local people's needs.

Allyson Broadhurst, chairman of East Cambridgeshire and Fenland Primary Care Trust, said "The White Paper was published following a nation-wide consultation exercise 'Your health, Your care, Your Say' and will pave the way for many changes to the care services people receive in the community, further developing and supporting people to access community health care services throughout all stages of their lives and in places and at times that suit them.

"The feedback received from the national consultation mirrors the views we have heard from the local people in East Cambridgeshire and Fenland PCT who have consistently told us of the need for improved access to local services, shorter waiting times and safe, high quality services which we have endeavoured to deliver."

The PCT's anticoagulation service - FANS - was recognised as an example of good practice in delivering Care Closer to Home. Ms Broadhurst said: "We are delighted that our FANS service received national recognition in the White Paper. It is an excellent example of how the local NHS is responding to patients' and providing care closer to home, rather than them having to travel to the nearest acute hospital."

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FANS was formed in August 2001 to address inequalities in anticoagulation care. The PCT funds the service. FANS now covers 423 square miles and is staffed by specialist anticoagulation nurses who see all patients who need medication to slow down the clotting time of their blood, within an agreed range.

FANS provides its services in a variety of settings - community hospital-based clinics, GP surgery-based clinics and home visits to the housebound and nursing home residents. Nurses can test patients on-site and will know the results within minutes.

Specialist nurse can then dose the patient's anticoagulation medication on -site using computerised technology.

Peter Carré is delighted with the service. "I've been taking anticoagulants since I had a heart valve replacement in 1975," he said, "and for most of that time I've had to make long journeys to hospitals and sometimes wait for hours to be seen.

"The new service is fantastic. My blood is tested on the spot, I'm in and out quickly, and when I had another heart valve replacement last June the nurse came to see me at home a few times until I was well enough to attend the appointments. This new system is so much more efficient - it saves time and hassle and has really changed things for me."

Development plans are under way to expand the service to prevent hospital admissions for patients suspected of having a deep vein thrombosis (DVT). The aim is to assess, diagnose and treat in the community hospitals all patients (who meet certain criteria), who have been sent by their GP, with a suspected diagnosis of DVT.

The White Paper also promotes a vision to make health and social care services as flexible as possible to meet individual needs.

Ms Broadhurst said: "In Cambridgeshire, health and social care services were integrated in 2004 and therefore we already have a head start in achieving the vision set out by the Department of Health. Integrated health and social care services for older people have helped us to provide initiatives such as the community access team, falls service and rehabilitation services for older people."

The community access team at the Prince of Wales Hospital, Ely, is proud of the increased level of service it has been able to offer to clients since it was established in July 2004.

This service encompasses intermediate care, palliative care and the out-of-hours nursing service. Since the introduction of the single access point to take all referrals, the service has become simpler to access and therefore more efficient. The level of referrals has increased, together with the level of care offered. The team can now support admission avoidance clients, the supported orthopaedic discharge scheme, intermediate care, including the provision of equipment and assessment of client needs, palliative care to meet the needs of clients at the end stage of their illness, and out-of-hours nursing needs.

The team has also welcomed the successful integration of the personal support workers from the home care service, further expanding the service we can offer.

It is hoped that with the development of the team into Fenland, there will be further expansion to include therapy services in the client's home, together with enhancing the links with the Carlisle and Trafford Units at Wisbech.

The PCT is also working hard with the discharge facilitators from the acute hospitals on the proposed development for intravenous therapy and blood transfusions. This will enable them to be administered at home and in the community hospitals by intermediate care staff.

The White Paper identifies five areas for change. Personalised care will be driven by better access and more funding following the patient. NHS walk-in centres will also be expanded. Services will be brought closer to people's homes through investment in community hospitals and facilities and shifting care safely away from hospitals.

There will be better co-ordination with local councils, improving the way information is shared between social services and health care providers, and increased choice will be underpinned by a direct payment or care budget for people to pay for their own home help or residential care.

PCTs will be required to act on the findings of regular patient surveys.

Prevention of illness will be targeted through several measures, including establishment of more healthcare teams to deliver better care across institutional boundaries. A new NHS life-check service will be introduced and a 'fitter Britain' scheme will be launched as part of the build-up to the 2012 London Olympics.

Practice based commissioning is also good for taxpayers. The accountability and support being put in place will ensure the best and fairest use of public resources. It is about engaging practices and other primary care professionals in the commissioning of services.

Ms Broadhurst said, "Through practice based commissioning, front line clinicians are being provided with the resources and support to become more involved in commissioning decisions.

"Practices will receive information on how their patients are using health services. This information can then be used to highlight services, which can be redesigned by front-line clinicians for the benefit of patients. Practice based commissioning will give clinicians greater flexibility to tailor services to the needs of the community.

Quality and choice of services will improve and patients will benefit from more services being provided with greater convenience in the community. In particular, patients with long-term conditions will be able to benefit from a more individualised service.