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Autumn 2008 Care Professionals Newsletter

Welcome to the Autumn 2008 Edition of our Care Professionals Newsletter

In our third edition of this newsletter we continue to explore the issues our clients are faced with regards to funding of care and the battle to be given the right to choose a care provider. Many of our clients come to us with stories of previous experience of being given care from a provider with little or no experience in spinal cord injury.

Our first article looks at Continuing Health Care One Year On and what lessons may have been learned.

In our second article we explore the continued issue of bowel management for clients with a spinal cord injury, the problems professionals are faced with when trying to gain and maintain their own competencies in this area and the reality of the individual being admitted to a general hospital who is unable to provide bowel management.

This is a fundamental aspect of our clients lives and an issue that we are faced with on a daily basis , as a care provider who trains its PAs to undertake bowel management we are often faced with very differing opinions throughout the country on whether this role is purely nursing or can it be delegated to a PA.

I always find this subject quite thought provoking as in many cases it is acceptable for family member or a privately employed carer to take on this role. The introduction of the Royal College of Nursing Guidance has assisted specialist agencies in evidencing that it is accepted practice to delegate this role to someone who has been trained by a competent qualified practitioner however, as you can see from our second article Shedding Light on the Problems of Bowel Management in the General Hospital Setting the issue of gaining and maintaining competence is wide spread.

If you have any comments on the articles in this newsletter or would like to suggest any future subjects for discussion , please do not hesitate to e-mail me at angela.wicks@activeassistance.com

Kind regards

Angela Wicks, Lead Care Service Manager

NHS Continuing Healthcare - One Year On

(The following article first appeared in the August 2008 Edition of Forward, the magazine of the Spinal Injuries Association).

Over the last 18 months there have been a lot of developments in the funding of domiciliary care packages, particularly in relation to NHS funded care. For those people moving to NHS funded care there remain some challenges.

Firstly, those in receipt of 100% NHS Funded Continuing Healthcare cannot currently receive these monies in the form of a Direct Payment. This may represent an unacceptable loss of control, especially for those currently employing their own care team. For the time being at least, NHS funding will require using a registered care provider such as Active Assistance. The situation with joint funded packages (i.e. funded jointly by the Local Authority and the NHS) is a little less definitive, although SCI people in this situation should probably expect the same outcome as for those with 100% NHS funding.

Secondly, the NHS is inexperienced in commissioning homecare services and there have been some examples of them either selecting inappropriate care packages or, where a service is already in place, requiring that the individual change their provider. My advice is always for clients to decide what solution best suits them and to fight for what they want. Afterall the current agenda is all about personalisation!

Thirdly, some have expressed concern that once NHS funding has been secured it may be difficult to revert to Local Authority funded care. This is probably true as undoubtedly it would only happen if there was an improvement in condition.

Finally, the treatment of NHS funding under the new Personal Budgets (sometimes referred to as Individual Budgets) scheme has been unclear. However it is now predicted that NHS monies may form one of the funding streams that an Individual Budget aims to bring together. For people on Direct Payments, this may offer the best solution for retaining control whilst accessing NHS funding. This is because the Local Authority holds the money rather than the individual.

Indeed Lord Darzis Final Report on NHS Reform published on 30th June 2008

stated on Page 42 that;

" ..& we will go even further in empowering individual patients. Learning from the experience in both social care and other health systems, and in response to the enthusiasm we have heard from local clinicians, we will explore the potential of personal budgets, to give individual patients greater control over the services they receive and the providers from which they receive services. Personal health budgets are likely to work for patients with fairly stable and predictable conditions, well placed to make informed choices about their treatment; for example, some of those in receipt of continuing care or with long-term conditions. With a view to national roll out, we will launch a national pilot programme in early 2009, supported by rigorous evaluation. This will enable the NHS and their local authority partners to test out a range of different models".

Notwithstanding these points, NHS Funded Continuing Healthcare is a huge step in the right direction, enabling those SCI people with a primary health need to access NHS funding that is not means tested.

As you are aware, the primary tool that is used to determine a primary health need and therefore NHS funding eligibility, is the Decision Support Tool. This was published as part of the Department of Healths National Framework for NHS Continuing Healthcare in June 2007. One of the Departments primary goals was to introduce a common approach to needs assessment. Effectively to eliminate the so called postcode lottery.

One year on there is little doubt that the Framework has been very successful, not because it has totally removed regional variation in assessment outcomes, but because for the first time people eligible for services have full transparency of the eligibility criteria. As a result they can prepare more effectively for their assessment, actively participate in the process and ultimately challenge the outcome if they do not agree with it.

References

For an electronic copy of the SIA Academys Continuing Healthcare Information Pack please click here to visit the SIA website.

For more information on the National Framework for NHS Continuing Healthcare visit the Department of Health Website by clicking here.

For more information on Individual Budgets visit the Website by clicking here.

To read Lord Darzis Final Report: High Quality Care for All: NHS Next Stage Review please click here.

Andrew Allan, Managing Director, Active Assistance

Shedding Light on the Problems of Bowel Management in the General Hospital Setting

(The following artile first appeared in the February 2008 Edition of Forward, the magazine of the Spinal Injuries Association).

As one of the nursing team at Active Assistance, I become quite concerned when I hear the stories spinal cord injured people relay about their experience of bowel management in general hospitals. It is often described as non-existent with nursing staff having no concept of what is required in relation to bowel care needs in spinal cord injury.

However, I am not surprised and I might be able to shed some light on this.

I worked for many years (too many to mention!) on general medical and surgical wards as a staff nurse.

In the general hospital ward setting, it is possible to never care for a patient who requires medical or surgical treatment and has a spinal cord injury. This means that there is little or no knowledge of what is required and the consequences of failing to maintain the patients specific bowel management routine. Mention bowel management to a nurse in a general setting and they will probably administer some laxatives or give an enema and leave nature to take its course! Of course, this works fairly well for the average patient but as you all know, it is not likely to be sufficient for someone with a SCI.

Then there is also the subject of competency. These days nurses are being asked to take on more responsibility. For instance, they now undertake cannulations and blood taking, a job previously done by doctors. Each new task requires theoretical learning, observation and then observed practice until deemed competent by an approved assessor. I don't think the public would want it any other way. As nurses, we have to back up practice with proof of training to protect ourselves and bowel management carries the same requirements.

In the area I worked there was not a dedicated member of staff to roll out training in this procedure and teach the potentially harmful outcomes of failing to complete it.

The National Institute of Clinical Excellence (NICE) issued guidelines in June 2007 which recommend that people with problems of bowel incontinence have a right to be offered care that can be managed by healthcare professionals who have relevant skills, training and expertise.

The National Patient Safety Agency (NPSA) also issued information as long ago as September 2004 after stating that patients with an established spinal cord lesion are put at risk if admitted to acute trust hospitals. They came up with some good solutions but in my opinion these aren't yet being effectively implemented. One of the actions the NPSA wants is to increase awareness and knowledge and indeed NICE supports this by suggesting a programme of local training, professional development and review of competencies. So how do we start to address this problem?

Where can training first be accessed? By way of an example I recently did a study day on this very subject at a spinal unit, the perfect place to learn bowel management but I was not then allowed to practice competency there!

It would be ideal if nurses who specialise in spinal cord injury could to go into general hospital areas and provide theoretical training and increase knowledge in this subject. It would also require an offer of a place to gain competency. If one nurse from each area could spend time becoming proficient in completing bowel management, they could then cascade the training to other members of staff.

Quite often clients will have to rely on their PAs to come into hospital to complete their bowel routine but this doesn't help to address the problem of training more nurses to become proficient and its not a reliable solution as care packages will often be suspended during hospital admissions, rendering the PA unavailable.

As a spinal cord injured person, what would you say if you were asked by your district nurse if she could bring along a nurse to practice bowel competencies on you? Does anyone have any thoughts on a solution to nurses gaining practice in order to be deemed competent?

Of course, nothing is simple but this is certainly a subject that in my view requires prompt action.

Samantha Cole, Care Service Manager, London and the South East

Meet Two More of our Care Service Managers

I completed my nurse training at the Luton and Dunstable Hospital and qualified as a Registered General Nurse in 1989. Soon after qualifying I got married and moved to Southampton.

I spent the following 18 years working in the hospital ward setting. I had a love of surgery and gained experience within several general and specialist surgical settings colorectal, vascular and breast cancer care. I also spent a few years as a staff nurse on a medical unit working in both acute admissions and on a chronic illnesses ward.

I completed several post registration education courses and found an interest in Infection Control.

In 2007 I decided to take the plunge and leave the NHS, not an easy decision to make after all those years! I joined Active Assistance as a Care Service Manager covering the South East of England. I have always wanted to work within a very specialist field. This role has helped me to achieve that within the world of spinal injuries and physical disabilities. It throws up daily challenges, no two days are the same and I am continually learning new things.

I joined Active Assistance in May and my background is predominantly within the speciality of Spinal Cord Injuries. Before joining Active I worked as ward sister on the acute section of the Princess Royal Spinal Injuries Centre in Sheffield.

My experience is within the rehab setting, nursing people acutely injured with multi trauma, specialising in respiratory medicine and ventilation.

Since joining Active I have now trained as a Moving and Handling Trainer, having recently completed the course with RoSPA. I am now thoroughly enjoying seeing how complex care packages can work in the community setting - something that was not always visible to me whilst working at the Spinal Centre.

In addition to my work commitments I very involved with one of the spinal injuries charities called the Back Up Trust. They challenge and motivate people who have suffered spinal cord injury with the aid of outdoor activities and sports. I ski with Back Up in Sweden every year, working with people to push their personal boundaries and realise their capabilities and strengths.

Opportunities at Active Assistance

Are you interested in joining the team at Active? Bookmark our Management Vacancies page - you can find it here