L to R: Caterina Speight, clinical nurse lead, integrated primary care team, SCT, Sue Elliott, Immaculate Lagat, social worker, Brighton and Hove City Council
L to R: Caterina Speight, clinical nurse lead, integrated primary care team, SCT, Sue Elliott, Immaculate Lagat, social worker, Brighton and Hove City Council
SCT team supports Better Care Plans for Brighton & Hove patients
19 January 2015

SCT team supports Better Care Plans for Brighton & Hove patients

Our Brighton and Hove integrated primary care teams are part of the new approach to looking after Brighton & Hove’s most frail and vulnerable residents. The new local NHS and City Council’s Better Care Plan has just been given government go-ahead.

The Better Care Plan is Brighton & Hove’s response to the new requirement for councils and the NHS to provide joined-up health and social care services from shared local budgets from April 2016.

What makes Brighton’s approach different to other Better Care Fund plans across the country is the broader range of people it aims to support. Rather than just focus on older people who are ‘frail’, Better Care in Brighton & Hove will address the needs of people who are living with multiple long-term health conditions, such as diabetes, asthma or dementia, people with mental health problems and our homeless population.

The aim is to provide a more co-ordinated approach to supporting these people in their own homes and in the community and to reduce unnecessary admissions to hospital and care homes. There will be an emphasis on minimising the time people spend in hospital and on providing people with the support they need to recover and return home as soon as they are ready.

GP practices will be at the heart of co-ordinating care, supported by multi-disciplinary teams (MDTs) that will include specialists from a range of local services, including community nurses, occupational therapists and physiotherapists from our integrated primary care teams, together with social workers, mental health experts and substance misuse support workers.

Each ‘frail’ person will have a designated care co-ordinator drawn from an MDT who will be responsible for co-ordinating support for all their physical and mental health needs.

Case study

Sue Elliott from Brighton has diabetes, a knee injury and suffers from depression. As a result she has mobility issues and is often in pain. A care plan is now in place for Sue so that she can get the care and support she needs to help her manage her conditions at home, helping to avoid visits to hospital.

As a result, Sue’s health is more stable, as she explains: “I really value the support I receive from the health care staff who visit me on a daily basis. They help me to monitor my conditions and reduce pain levels. It’s wonderful that the different teams work together so well. I really do feel like I’m receiving the right care from the right people. Caterina is a wonderfully caring nurse and I know that I can contact her anytime I need support or advice. It’s very reassuring and has certainly reduced my need to visit A&E.”

Caterina Speight, clinical nurse lead, integrated primary care team, Sussex Community NHS Trust, who is supporting Sue, said: “By working together with teams from social care and voluntary agencies we can provide the most appropriate and timely care for our patients. Our aim is to make sure our patients get the care they need in the most appropriate place, which is mostly at home.

“Each patient has a carefully monitored care plan in place and members of the MDT meet regularly to make sure each patient is getting the support they need.

“I’ve already seen improvements in Sue’s health. I know that she is benefiting from the range of care she’s receiving which is reducing the need for emergency visits to A&E.”

Find out more about Brighton and Hove’s Better Care Plan.

Find out more about SCT’s integrated primary care team.