Responsive Services in Crawley
16 November 2016

Developing Responsive Services in Crawley

Supporting people with acute health needs to be cared for outside of hospital

The below information has been provided by Emma Page, Deputy Operational Lead:

 

Our Responsive Services Team in Crawley was established in 2015 when a number of services were brought together (Admission Avoidance Team, the Intermediate Care Team and Interim Beds) to work as one team.

Responsive Services is a multidisciplinary Team providing a 7 day service. We provide:

  • A rapid response to people in the community who are experiencing acute episodes of ill-health.
  • A supported discharge service to facilitate timely hospital discharges.
  • Support for people who require assistance with activities of living.
  • A rehabilitation service including a range of therapies.

The team respond to referrals for patients who are at risk of being admitted into hospital, within a two hour response time. With our rapid intervention, we aim to prevent acute admissions. In addition the team work together with colleagues at both community and acute hospitals to discharge people back home when they are medically fit and are awaiting ongoing support from social care providers. Following assessment the team put in place appropriate care and support. Our Responsive Services Team also provides rehabilitation to people who have occupational therapy and physiotherapy needs and agree goals with patients, carers and their families.

Since Responsive Services was established, our staff have undergone numerous changes: to staffing and management, the introduction of mobile working via SystmOne (I can't praise this enough - we have access to real-time information at the touch of a button and enables us to update notes on the go), the number and types of patients we care for with increased complexity which previously was only provided in an acute hospital (for example administering sub-cut fluids to restore hydration), how assessments are carried out and many of the day-to-day aspects of running the team. The aim has been to introduce a consistent way of working to release more clinical time to spend with patients and thus improving patient outcomes.

The team is now working together more closely with other community teams, GPs, other health and social care professionals across different providers and voluntary and third sector organisations such as Age UK West Sussex, British Red Cross, Carer Support Services and Meals on Wheels.

All referrals to Responsive Services come through our OneCall service to ensure people get the right care, first time and quickly. This process has streamlined how we work to provide a much more efficient, effective and seamless service. Referrals come from GPs, paramedics, our Clinical Assessment Unit, social care and some from local people.

We work in a challenging health environment and balancing this with strategic changes has not been easy but the team have worked relentlessly to continue to provide a high level of care. The team as a whole remains positive and work together to support each another. We appreciate that change is constant and we are an ever expanding service which will enable us to provide a more effective service to the patients in our community.

The vision is to standardise Responsive Services across the Trust. The introduction of the Calderdale Framework aims to enhance the skills of our workforce which will provide flexibility and continuity to our patients whilst maintaining quality of care and allow our workforce to develop further.

 

A case study of a typical patient we care for

Referral into the service

Mrs Brown has been referred to Responsive Services via OneCall following a chest infection diagnosis by her GP. She has been prescribed antibiotics and hasn't been improving.

Initial action

The referral is received by a Responsive Services Coordinator via SystmOne (electronic system) who allocates a Lead Clinician to visit Mrs Brown within a two-hour response time to complete a full initial assessment of her needs.

Care provided

Mrs Brown is supported for 48 hours with three visits a day by a Health Care Assistant who supports her personal care needs, maintaining nutrition and hydration, and ensuring medication is being taken.

A Registered Nurse visits daily to clinically review Mrs Brown.

A physiotherapist visits daily to assist with chest clearance techniques.

After the initial 48 hours Mrs Brown responds to treatment and over the following 24 hours visits are decreased.

Once Mrs Brown regains her independence she is discharged from Responsive Services back to her GP.