Care centred around the patient: discontinuing the lack of continuity of care

PrintDr Mark Temple is the Future Hospital Officer at the Royal College of Physicians (RCP), overseeing the implementation of the Future Hospital Programme. The aim of the programme is to take the recommendations of the Future Hospital Commission report from page to clinical practice. The BGS is a partner supporting this programme.

While being interviewed by BBC Radio 5 Live, recently, I was rendered speechless by an angry carer whose elderly mother had moved wards five times during an acute admission, one of which included a transfer to a different hospital site. This is indefensible.

Lack of continuity of care is the number one concern amongst physicians. Patients and carers express this as a lack of ‘joined-up’ care, characterised by multiple ward moves and general bewilderment about ‘who is in charge?’

The RCP’s Future Hospital Commission report identified that the frail older patient with multiple co-morbidities is now the NHS’ ‘core business’. Sadly, examples of these patients’ needs not being met by consistent standards of care, including continuity of care, are all too readily available.

Further, what is deeply troubling is the pervasive philosophy amongst some NHS colleagues that “this patient is not my responsibility and shouldn’t be on my ward!” Extreme displays of this philosophy include specialists who define their practice by describing in great detail the patients they don’t see. Or the five word entry in the case notes reflecting the sum total of a specialist review by a consultant led-team of an 80 year old with reduced GCS, following an episode of syncope, “this is not a stroke”.

Approximately 40% of the general internal medicine inpatients that I see on our shared nephrology and medical ward have dementia. While I’m not a dementia specialist, I do know when to seek specialist help. Sadly, I have also gotten to know many community-based services – which could help unlock timely discharge – that dive for cover when straight questions are asked about their provision of patient-centred care seven days a week.

The recommendations of the Future Hospital Commission centre on the importance of ‘care organised around the needs of individual patient’. Patients will only experience ‘joined up care’ when all the staff involved in that care coordinate and communicate their activities, and the contributions of generalist physician teams are valued as much as specialists. This often means going the extra mile – extending the entry in the case notes to make the management plan more explicit, having a lower threshold for phoning a consultant colleague and at all times seeking to ‘add value’ that will impact on the quality of patient care.

The Future Hospital Programme now has four development sites, Betsi Cadwaldr in North Wales, Mid Yorkshire Hospitals, Royal Blackburn Hospital and Worthing Hospital, working with RCP support to deliver quality improvement projects aligned with Future Hospital principles. Two sites are looking at aspects of integrated working between community teams and geriatricians and two other sites looking at enhanced early assessment with CGA of frail elderly patients in hospital. Although the clinical interventions are not radically different from existing best practice – what is novel is the aim to standardise evaluation across all four sites and value patient experience as much as clinical outcomes. In addition patient representatives have been integral to the project teams since inception, working with enthusiastic specialists and together seeking to push forward the frontiers of truly patient-centred care.

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