Too difficult…

The early morning sunlight blasted its way through the conservatory windows. It was as unexpected as it was welcome, as it was blinding.

What are you supposed to expect from the weather in March?

We pulled the curtains, sat in the shade and talked. Half a dozen of us talking about keeping people out of hospital. We met in a community hub, a repurposed community hospital. The conservatory, the dayroom.

If you want to keep frail people out of hospital, you have to move beyond the box-ticking of frailty indices. Once you’ve got your list, what do you do with it?

I can tell you, you have to pick-up people, early. Get into their lives, under the skin of how they live. See what they do and what they can’t do. Steer clear of what they shouldn’t do. Where the risks are.

It’s impossible… too difficult.

No it’s not. I’ve seen how they do it. Over a cuppa builder’s they took me through how, when people work together, stuff happens.

Even when software systems don’t talk to each other, when data rules get in the way and when multi-agency, means multiple agencies… like minded people, given the time and space to work together, can reduce risks and admissions.

Para-medics, geriatricians, therapists, commissioners and managers, can do it. Put the best, most experienced people in the front-line.

How did it happen? They couldn’t tell me… their best answer; it just seemed the right thing to do… right answer.

And a very wise commissioner; spend money now, save it later.

Doing the difficult thing was something of a theme. I moved on from the community hospital to the acute services, on the hill, with the machines that go beep.

Learning from people’s lives, now, how to learn from their deaths. What can you learn from death? A lot.

Enhanced mortality reviews, part of the Medical Examiner Programme.

Nearly half of deaths occur in hospital and 1 in 3 patients are in the last year of their life. There is a huge amount to learn.

In this hospital, every death is examined, every step in the pathway followed.

In a calm environment, of genuine enquiry, it’s been possible to reduce coroners referrals and support staff working under pressure.

The sepsis pathway has been improved, personalised care-plans promoted and a standard operating procedure for community hosptials. Starting with the death and working backwards. So much to learn.

The end of a life is the beginning of learning, about the next life.

Senior review of deteriorating patients, shared-care records with primary care and nursing homes, treatment escalation plans… improved relationships with relatives, these are all things you can do if you sit down and ask in the spirit of curiosity, what happened and why. What can we do better?

The medical examiner programme is a national initiative that is not properly funded, awaits a legal foundation and has been left to enthusiasts to pick-up.

The amount that there is to learn and the collegiate working it engenders, tells me all hosptials should do it.

A full roll out was signalled for this April but it is unlikely. It’s OK to make a fuss about faxes but the real issues of the life and death, the real mission of the NHS… neglected.

Too difficult.

In their own quiet, understated way this Trust is achieving great things. Taking on the ‘too difficult’.

The NHS faces two difficult problems.

Keeping people out of secondary care and finding ways to improve the quality of what it does.

Look at how this trust goes about its business and you may find it is not too difficult. They let in the sunlight. Nothing is ‘too difficult’.

Soon you’ll be able to see, on the pages of the Academy of Fabulous Stuff web-site, what Buckinghamshire Healthcare Trust is achieving. They have a lot to be proud of. Look out for it.

No fan-fare, no razzmatazz, just overcoming the too difficult.

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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.