Posted on Tuesday 16 January 2018
Joan Norris and neighbourhood nurse, Yasmin Kamara
Plans are being put in place by Guy’s and St Thomas’ to adopt a “radical” method of community nursing after an independent report showed that patients, carers and nurses are positive about its impact. The Trust is the first NHS organisation in England to test a scheme which uses key elements of the Dutch nursing model known as Buurtzorg.
Guy’s and St Thomas’ will continue to deliver the new service in its test areas, while considering different options and how it can be rolled out further.
Neighbourhood nurses, who are supported by a coach rather than managers to make decisions, provide patients with substantial nursing and personal care.
The level of care, which can include giving medicine, dressing wounds, washing, dressing, meal preparation and shopping, reduces over time as patients become independent and take control of their care.
An evaluation report by the Centre for Health and Social Care Research at Kingston University and St George’s, University of London found that patients and carers were positive about their experience of this new approach to community nursing.
However, researchers noted that further analysis of the differences between the neighbourhood nursing model and district nursing is needed in order to make a final judgement on the effectiveness of either type of nursing.
Joan Norris, 92, a former nurse and midwife from Brixton, has been receiving care from the Neighbourhood Nursing team at the Akerman Health Centre since October 2016.
Joan, whose primary carer is her son James, had a stroke in May 2015. She also has multiple long-term conditions including kidney problems, lymphoedema (swelling of the arms and legs), macular degeneration (eye problems), and arthritis.
James says: “Mum had a stroke, which meant that she couldn’t live on her own anymore. I was constantly phoning her GP because she had pressure sores and one infection after another, which left her confused and debilitated.
“Mum has been to A&E several times with kidney problems and a blood clot in her eye because of the medication she’s on.
“We had the nurses from the @home service (who provide short-term intensive clinical care at home, much like a hospital ward) and physiotherapists who were very good, and the district nurses came for two or three months.
“But when the GP referred us to the neighbourhood nurses it was revolutionary. They came in, carried out an in-depth assessment, and put things right.
“Yasmin Kamara, Joan's neighbourhood nurse, and the team got mum an appointment with the stroke consultant at St Thomas’, sorted out the right incontinence pads, and helped me find carers who could do basic cleaning around the house.”
The nurses, who see patients with several complex conditions like heart and kidney problems or people who are nearing the end of their life, co-ordinate the care provided and work closely with other health professionals.
Yasmin Kamara says: “It's every nurse’s dream to work in this way. Working like this means that most of the time we have is spent purely with the patient. We take as long as is needed with them, until they feel empowered to become less reliant on health and care workers and can begin to take control of their own care. For many of our patients we become like a family to them. It’s very rewarding.”
Key findings from the report by the Centre for Health and Social Care Research at Kingston University and St George’s, University of London include:
patients and carers reported a positive change in their nursing care as nurses had more time to devote to patient care
neighbourhood nurses were positive about their experiences, particularly in terms of professional development and job satisfaction, but encountered some challenges like adapting to working as self-managing teams
the neighbourhood nurse teams provided short-term personal care and meal preparation (traditionally delivered by local authority funded care workers), which continues Guy’s and St Thomas’ plans for joined-up working between health and social care
the report’s authors were unable to consider the cost of fully implementing a Buurtzorg style model of nursing in England because of the differences between healthcare funding in the UK and the Netherlands.
Cepta Hamm, Head of Nursing, Adult Community Nursing, says: “We're doing something quite radical here but we are not doing this alone. We don't have all the answers yet and we will need to work closely with our partners like social care colleagues to make this happen.
“This is an important step towards finding a new way of caring for people in our community, so they can stay at home longer and out of hospital.
“It's about putting the patient and their carers at the centre of what we do while ensuring that this new way of working helps us to recruit and retain highly motivated and satisfied community nurses who are given the time to care.”
Professor Vari Drennan MBE, lead writer of the report from Kingston University and St George’s, University of London says: “This model of community home nursing offers real potential for addressing some of the challenging issues facing patients, carers and nursing staff.
“It empowers neighbourhood nurses to be able to have a real impact on patients’ lives. Having more time to spend with those they care for allows these nurses to build relationships that enable them to understand and address the health issues most important to patients. They are then able to put in place joined up packages of care tailored for each individual.”