Clinical Service for Older People, Barnsley Health District

Lead: Professor Stuart Parker

Services for older people at Barnsley District General Hospital are being developed in partnership with Barnsley Primary Care Trust. We aim to ensure "that people who are affected by services, in particular service users and carers and service providers are enabled to participate in planning, delivery and in assessing how good services are".

Services for Older People in Barnsley

1. Comprehensive Service for Patients with Stroke
2. Continence Services
3. Unexplained Falls and Syncope
4. Day Hospital
5. Inpatient Rehabilitation
6. Rapid Response
7. Hospital at Home

Examples of innovative work of the Service include:

Comprehensive Service for Patients with Stroke

Stroke is the leading cause of adult disability and third most common cause of death. Barnsley has a stroke mortality above the national average. There is good research evidence of effectiveness of intervention and service organisation in reducing morbidity and mortality for people with stroke. Stroke services in Barnsley have developed in order to provide optimum evidence based car to maximise the health of stroke patients and their carers. There is strong clinical and patient support for change.

Projects have included:

• Rapid Access Outpatient Clinic: Twice per week Rapid Access Clinic. Full medical and neurological assessment and investigation. Staffed by Consultant, Registrar and GP Clinical Assistant
• Acute Stroke Unit: Eight bedded with BDGH support nurses and therapist and regular MDT
• Stroke Rehabilitation Unit: Ten beds with full support nurses and therapist. On-site therapy suite. Clinical psychologists and other support staff.

Links with community services
Close liaison with Hospital at Home team. Good communication with GP through standard referral form to Rapid Access Clinic and stroke pack.

For further information please contact:

Dr M K Al-Bazzaz
Tel: 01226 777705

Continence Services

Urinary incontinence has considerable impact on quality of life. It leads to social embarrassment, restriction of social functioning and greater health needs. It is an important cause of carer strain and the second most common reason for families choosing long-term care. More than two thirds of those with urinary incontinence in the community can be cured or significantly improved with conservative management. "Good Practice for Incontinence Services" (PL/CMO/2000/2PL/CMO2000/5) recommended pro-active treatment of those with urinary incontinence and a reduction in the inappropriate use of in-dwelling catheters. Future services should be based around close co-operation between the community continence service and secondary care. This model of care should be available in all areas by 2004 as stated in the "National Service Framework for Older People".

Projects have included:

• A specific point of referral for older patients and patients with complex medical or neurological disease. Access to the clinic is by internal referral, referrals from general practice or directly from the community continence service. After initial assessment, further management is done in conjunction with the community continence advisors.
• In-patient assessment of acute medical patients at Barnsley District General Hospital, and rehabilitation patients at Mount Vernon Hospital to include management of continence as part of discharge planning.
• Together with Urogynaecology Services, and with the appointment of a Consultant Urologist with a special interest in Continence, we intend to establish joint assessment protocols, multidisciplinary working, and a single point of referral from primary care for complex patients.

Links with community services:

Established link with community continence advisors in primary care. Direct access for community continence services to secondary care.

For further information please contact:

Dr Susie Orme
Tel: 01226 777710

Unexplained Falls and Syncope

Unexplained syncope and falls is a major problem in older people. It is estimated that up to 10% of the over sixty-fives suffer from syncope and this increases greatly with advancing years. It is estimated that is may remain unexplained at initial evaluation in up to 50% of a series of hospital-based patients with syncope. To help in the diagnosis and management of these patients, and to help in the teaching of doctors, patients and relatives about different causes of syncope, a team was established in July 2001.

Projects have included:

• Syncope Clinic in the Day Unit. Patients with unexplained falls or syncope are referred by colleagues from the hospital or from the general practitioners and are seen in the Day Unit. Evaluations, including history, examination and basic investigations are done in this clinic every Wednesday morning.
• Tilt Testing Service. Patients who are suitable for tilt testing an/or carotid sinus massage are evaluated in the Cardiology Department every Friday morning. At present, two patients are evaluated every week. Patients who are in need of permanent pacing are referred tot he Northern General Hospital in Sheffield and there is good collaboration from the Cardiology Department there.

Future plan
It is the intention of this Service to develop and become a focus for further measures to help in the prevention of falls and recurrent syncope and to also provide a lead for preventive measures in the community.

For further information please contact:

Dr A E Eltrafi
Tel: 01226 777709

Day Hospital for Older People

The day hospital offers a multi-disciplinary team assessment, treatment and rehabilitation facility for older people who do not require in-patient care. Accommodation and facilities are provided on a five day a week basis between the hours of 0830 and 1700 hours offering up to 17 places daily, transport, lunch and refreshments are provided during the day. Each attendee is allocated a Consultant specialising in elderly care. An individual program of care is developed with multi-disciplinary review following each attendance.

Assessments
(Initial MDT assessment identifying aims and objectives. Physiotherapists, Occupational Therapist and Nursing)

• Mobility
• Balance/Posture
• Provision of Walking Aids
• Activities of Daily Living
• At Risk of Falls Assessment
• Provision of Functional Aids
• Cognitive, Perception, Depression and Memory
• Assessments
• Home Visits
• Nutritional Assessment
• Communication and Swallowing
• Tissue Viability Assessment
• Appliance Assessment

Rehabilitation

• Continuing Multi-disciplinary Reviews
• Co-ordination of Care
• Monitoring of Clinical Observations
• Medical Advice
• Medication Administration, Monitoring and Advice
• Pain Management
• Skin Care
• Continence Advice
• Falls Prevention Package
• Exercise Programs
• Group and Individual Activities
• Relaxation Management
• Health Promotion
• Involvement of Relatives/Carers

Other Services Offered

• Close liaison with Primary Care Teams
• Close liaison with Social Services
• Aids and Adaptations Team
• Podiatrist
• Dietetics
• Voluntary Services
• Support Groups (eg Stroke Association, PDS)
• Access to Hospital Chaplin for Spiritual Needs
• Hairdressing
• Mobile Hospital Shop Facilities
• Medical Review

For further information please contact:

Sister L Howison
Tel: 01226 777703

Inpatient Rehabilitation

A plan of rehabilitation will be set up by occupational therapy and physiotherapy to meet the individual needs of patients, working alongside other staff members, carers and relatives. During the rehabilitation process, equipment needs will be identified and provided to achieve a safe discharge.

Projects have included:

• Inpatient Rehabilitation: Assessment and treatment of patients with respiratory, orthopaedic, neurological and general medical problems
• Post Acute Care: Assessment and treatment by doctors and nurses during sub-acute stage, then further assessment by all MDT members, to commence rehabilitation.
• Palliative Care: Assessment and treatment by doctors, nurses, and MDT members in collaboration with needs of patients and relatives/carers. Consultation with McMillan service.
• Comprehensive Assessment and Discharge Planning: Assessment by a social worker and other MDT members to ensure appropriate, safe and effective discharge in consultation with patient and relatives/carers.

Links with other services/agencies
Community physiotherapy, occupational therapy and nursing staff, GP, dieticians, speech therapists, chiropodist, hospital at home, social services, inpatient occupational therapy and physiotherapy services, orthopaedic department, voluntary organisations, respite care service.

For further information please contact:

Mary Ellam, Physiotherapist
Tel: 01226 777835 ext 3204

Jill Millman, Occupational Therapist
Tel: 01226 777835 ext 3204

Ian Slater, Senior Nurse
Tel: 01226 777835 ext 3243

Hospital at Home

An interdisciplinary team of nurses, therapists and support workers based at MVH offering rehabilitation and support to patients in their own environment. This could be following a hospital stay or if ability to manage at home deteriorates.

Projects have included:

• Enabling people to reach their potential by providing appropriate rehabilitation, advice, support or equipment
• Facilitate a successful, timely and in some cases an early discharge from hospital
• Provide an ongoing assessment of individual needs to establish how much support will be required
• Choice to have rehabilitation and support in their home environment and enable needs of carers/relatives to be met, and that they are informed and involved in the care programme as appropriate.

Links with other services/agencies

GP, social workers, district nurses, chiropody, dieticians, speech and language therapists, community therapy, day unit for elderly.

For further information please contact:

Manager: Linda Barker
Tel: 01226 730000 ext. 3230
Continuing Care Co-ordinator: Jan Hawker
Tel: 01226 777953

Rapid Response

Rapid Response services have been set up which aim to provide a swift response to people's identified health and social care needs in their own homes.

Projects include:

• To stop hospital admissions (the one's which would be inappropriate) and carry out treatment/car in other environment, eg patients home, resource centres, nursing homes
• To prevent inappropriate long-term admissions to residential/nursing home care
• To devolve care assessment and management of these patients to primary care team, whilst developing further multi-agency fieldwork staff's collaboration and sharing of skills
• To identify local community care needs and utilise the extra resources to meet those needs

Links with Other Services/Agencies
Social Services, central call emergency duty social services, hospitals, Barnsley DG, Doncaster Royal Infirmary Montagu A&E departments, community nurses, specialist nurses.

For further information please contact:

Linda Barker, Colleen Carter, Sue Hazeldine, Chris Richards
Tel: 01226 773218

Further information on Clinical Service for Older People, Barnsley Health District

Professor Stuart Parker,
Clinical Director, SISA,
Community Sciences Centre,
Northern General Hospital,
Herries Road,
Sheffield S7 5AU.

Tel: 0114 271 4939

email : s.g.parker@sheffield.ac.uk