Clinical Service for Older People, Northern General Hospital, Sheffield
Lead: Professor Ian Philp
This is a large and complex service, led by a team of medical, nursing, therapy and general management staff. Support and partnership is provided by University staff (from SISA) and staff from Community Health Sheffield, Central Sheffield University Hospitals, Sheffield Health Authority, Sheffield Social Services, Age Concern Sheffield and the Sheffield Church's Council for Community Care, amongst other organisations.
A mission statement for the Clinical Service was written in 1994.
- To be recognised as a national centre of excellence for clinical practice, training and research in health care for older people.
- To promote staff development to help them to achieve their full potential
- To help undergraduate students understand the challenge of health care for older people
- To be at the leading edge of innovation in health care for older people, and evaluate services through research, audit and patient opinion, in order to meet patients' individual needs and improve quality of life.
Substantial progress has been made in relation to these objectives. Formal recognition for this was obtained when the Service received the prestigious Hospital Doctor Care of the Elderly Team of the Year Award for 1998.
Examples of innovative work of the Service include:
The Diversion of Admission Scheme
The Diversion of Admission Scheme, which was developed in partnership with the voluntary sector, social services and community health services to offer frail older people an alternative to admission to hospital from the A&E Department to an augmented home care scheme with the back-up of an early consultant-led multi-disciplinary review in the Day Rehabilitation Unit. In the first five months of 1998, over 400 patients admissions were prevented, many disorders were identified and satisfactorily treated on an outpatient basis, and patient satisfaction appears high. The service has attracted national attention.
The Community Rehabilitation Scheme
The Community Rehabilitation Scheme, which has provided an option for early hospital, discharge. Its careful development, involving many stakeholders, has ensured high standards of care and satisfaction with the service. Professor Enderby has conducted the first national study of a similar schemes to compare with our service. A national experimental trial is planned to formally compare the service with a comparison group, which will provide purchasers with clear information about the cost-effectiveness of this model of community rehabilitation.
Orthogeriatric Services
Orthogeriatric Services which have been developed by ensuring input from geriatricians in pre-operative screening, liaison on surgical wards, the care of patients on a specialist orthogeriatric rehabilitation ward, and following on specialist outpatient clinics. Preventive activity has been developed through geriatrician input to the osteoporosis service.
A comprehensive service for patients with stroke
A comprehensive service for patients with stroke, which builds on one of the country's first established stroke rehabilitation units. Although the unit used to provide excellent care, it was unable to meet the needs of all stroke patients admitted to the Northern General Hospital. Staff undertook a major transition in working practice to provide a much more flexible and comprehensive service, incorporating a stroke assessment unit, two wards with expertise in stroke and general rehabilitation, able to respond to the changing demand for in-patient rehabilitation, with seamless transition with the community rehabilitation teams and day rehabilitation units for on-going specialist rehabilitation. Developments were evidence-based, influenced by the involvement of the Community Health Council and by audit and patient satisfaction surveys.
A transitions in care facility
A transitions in care facility which was created to provide a suitable environment and expert staff to care for patients awaiting nursing home care. The service has avoided the danger of becoming a low status Òdumping groundÓ by the commitment of senior management and professional staff to the service, and the involvement of University staff in its development and evaluation. Nursing staff have been developed to assume greater responsibility and authority for the service, with increasing opportunities for further innovation based on in-depth research with patients and their families about their experience with the service.
In the health and social care of older people, a focus on single areas of excellence (eg stroke, osteoporosis, community work or psychiatry) is inadequate to the task of improving health care for older people. Rather, a systems-wide approach embracing a range of hospital and community activities is required. The leadership and team working challenges are therefore immensely complex.
In times of great threat to the integrity of health services for older people, the service is proud that it has kept faith with the philosophy of a needs-based service, continually adapting and innovating in response to opportunities and threats. The Service continues to expand its work to identify need and deliver high quality care.
In 1994, elements of good practice were increasingly isolated from events affecting the rest of the hospital. The Service now reaches out across the hospital, shaping the work of most departments and supporting them in their activities. Its influence extends into the community where close working with partners in community health, primary carer, social services and the voluntary sector is helping to provide a comprehensive health care service for older people in Sheffield.
For further information, please contact:
Professor Ian Philp,
SISA,
Community Sciences Centre,
Northern General Hospital,
Herries Road,
Sheffield S7 5AU.
Tel: (0114) 271 5124
email : i.philp@sheffield.ac.uk