 and welcome back to another vlog. My name is Claire Carmichael and I am a general practice nurse. So today I really want to talk about something really important. This is something I picked up on during my time as a student nurse and the more I think about it as a newly qualified nurse the more I want to put the message out there and protect our patients. So today's vlog is all about the CHC or continuing healthcare services which you might have heard as package of care when you're on the wards or the acute sector or primary care community wherever you're working. You might have heard the patients waiting for a package of care to be put in place. This is what this was all about and how to do it right to save your patient waiting so long for the right package of care for them. So NHS continuing healthcare is literally a package of care that is funded by the NHS completely free of charge to a patient or a person that might have a disability or illness or maybe they need that extra help that they didn't quite need before. There are a little bit less able bodies due to a whole range of different things. They need that extra support and that extra care and that could be from a healthcare professional, carers, anything like that some outside agency supports completely anything and they haven't got the funds to pay for it themselves so they need to apply for the funding. Now there is two parts to this. There is the NHS continuing healthcare which is the package of care that's put in place or there is something called the NHS funded nursing care or FNC for short and this is same as the package of care so this is fully funded by the NHS or a contribution to the from the NHS to a person to help fund somebody to live in a residential home or a nursing home if they need that as well. And it all just really depends on what the person needs like how much care and support they need. Do they need to go into a residential home or a nursing home? Can they cope at home on the road but they just need a little bit of assistance like a few calls a day from a carer to help sort of do cooking and washing and dressing and things like that. It just really depends on the person so it's really important that these are completely individualised to the person that really needs it. So what's really really important about the funding is that because it is free we don't have an endless money part of money to give out to everybody so this is why the assessments have to be really really thorough when you fill out your referral form. It has to be really thorough. Every single detail about that person has to go in there. It has to be so detailed so that they can understand the complex of this person's healthcare needs and what sort of level of care they might require because if that form doesn't have enough information on it, if it's not filled out properly, they're going to send it back. They're going to reject it and your patient is going to be maybe if they're in hospital they're going to be sitting around waiting for somewhere to go because they've got nowhere to go because they're not safe to be discharged. They're medically fit for discharge but they are not safe for discharge because they've got nobody at home to help them or look after them. So it's really really important this is the big message that I'm trying to send in this video. Make sure if you are that person filling out the form, if you're a student nurse, if your mentor is filling out the form, go through it with them and just look at the amount of detail that they're putting in there and if you don't think that there's enough detail please for your concerns and just say, do you know what, I'm really worried that there's not enough detail in here and I really don't want this to bounce back because that's what's going to happen and that poor patient is going to wait unnecessary in bed. They're going to be at more risk of hospital inquiries and infections. They're going to be under a lot of stress. Hospital is not an ideal place for anybody so really want to get them home as quickly but safely as possible. It's going to save that patient a lot more time. It's going to be done a lot more safer and it's just going to take the load off the nurses as well because the nurses are going to have a lot more work on their hands. They're going to have to refill out that form and it's just going to save unnecessary sort of distress to everybody involved I think. So it's really really important that you fill out those forms because I went with the CHC team for a day and I saw the types of forms that are being filled out and how how ruthless they have to be because they've got so many to go through. They need to prioritise the patients just like you will. You go with the person that needs the most and you start with that. So you want to make sure that those thing all of the details about that patient's needs, healthcare needs, you know, we're not talking about are they happy? Are they like artwork or do we don't want to know the list of hobbies and things like that? What needs to be on there is their health needs, you know, they can't wash and dress themselves. They are struggling to feed themselves. They're struggling to get to the toilet because of the mobility. They're completely bed bound now. They need turn in every hour. All these different things you need to put on there whether they've got a catheter, whether they've got any mobility aids, like literally every detail about this person health health wise you need to put on that form. If you need to write on extra sheets of paper, you write on extra sheets of paper because it's better to put it all in there than not have enough and that poor patient be denied funding as a result and you have to do a whole new referral. So why am I actually doing this vlog? So this is story time guys. This is where this is how I have been led to this point now and why I think that it's really important and the reason why I want to explain this is because it'll help you see the importance of this and getting it right for your patient. So I really want to make it stand out so that you can understand where I'm coming from. So first things first when I started out in healthcare I was a healthcare assistant this was 2005 and we had a patient that went into hospital and then they would discharge back but then they had a readmission and at the time I wasn't I was quite new to it. I was unskilled. I didn't really know what was going on at the time. Literally this was like my first mom's fair work in there. Never worked in healthcare before and I didn't think to question it. I just went okay she's got to go back to hospital that's fine and that was my mentality at that time. I have improved since I promise and that's how it was and then it wasn't until I started nursing. I mean my first year and second year I noticed that patients were either waiting around for packages of cares or they were medically fit to go home but they weren't sitting around and I was like well why are they waiting so long? Why why is this happening? They don't need to be here. They're medically fist for discharge. What's going on? So I was starting to think about why things were happening and so I I really wanted to look into this a little bit more. I wanted to know why it takes the length of time as it does. I want to know what can go wrong and how to put that right as well. So for the end of my second year I looked at going with the CHC team and just spend the day shadowing them to see what sort of assessments they did, how they run and how they did things from their end. Just to gain a lot more understanding so I can try and help in any way I can to put these things right and it was wow it was an eye opener. I think I briefly talked about this in a previous vlog but I didn't go into that much detail I don't think. It was amazing. It was amazing to see that the littlest things that are wrong on these forms they have to put it back to the nurses because or the doctors or healthcare professional whoever's filled this in because they need every detail possible. Not only that but once it's completely assessed and they say okay it's then finding them the needs that they need so if it's agency staff or carers or NHS sort of staff that needs to go and visit them at home for example sometimes people just need three calls a day and that's okay for them. It's finding it's working out the pricing of things it's I mean it is funding it is free funding so they have to work around what's cheap and what is the best thing for that person as well it's sort of weighing the options up it's not just about okay let's give them this person it's about really redoing their research and finding the best cheapest way to help this person which is really really hard and sometimes it does take a little bit longer and that's why the patient is sometimes waiting around for a little bit longer because once they found find a right service for that patient they have to contact that person they have to do their own referral then to that place it could be a nursing home residential home it could be an agency it could be an NHS service whatever services are needed they have to refer them and then they have to okay it and go through everything and it's a really long process guys so it's really really important that you get it right from the start it's really important that you fill out that form from the start to prevent any further delays because it's already a bit of a long process. So then I went on I went out onto my district nursing management placement in my final year of a student nurse life and I noticed a lot of discharges that were either unsafe they had to be readmitted or it was just completely wrong basically and the one that really really stands out that I'm going to share with you now really hit me I think because I just saw how wrong it could have potentially have gone so we had a patient who shall not be named for confidentiality reasons and all of that anyway she got this is a lady who she only had a couple of carers look after her and it wasn't an all-day thing they would just pop in once or twice a day and that was it that's all she had and she wasn't coping at home anyway she was constantly having falls and things like that and she was bouncing back and forward from hospital readmission after readmission because of her care needs weren't being met at home and the last time she got admitted to hospital they found a load of other problems going on with her and she was actually end of life however she didn't want to die in hospital she didn't want to go to a nursing home she don't want to go to a residential home she wanted to go home and they respected that fair enough they did respect that and they said okay she has capacity we have to respect her wishes she needs to go home and we're going to put in a package of care for her so they did the referral process all of her needs I mean this lady was completely bedbound she had a grade three pressure sort she needed hourly turns basically for that pressure sort she was unable to feed herself anymore she couldn't get up to go to toilet she was completely immobile really really went downhill while she was in hospital and the package of care came back and it said that she was on for four calls a day but these calls were only like 20 minute calls it wasn't a long period of time and me and my mentor sat and we looked at it and we were just like this isn't enough like this lady is end of life she needs constant turning she needs assistant with meal times and she needs a continent's assistant she needs so much like this lady deserve more and she needed more this wasn't safe to discharge that patient with just four calls a day and nothing in the night this was just a daytime calls and we really struggled with this so my mentor got on the phone to the nurses and the first thing she said was do you know what this package of care entails yes it's four calls a day okay do you know how long those four calls a day are no and she spoke to a number of nurses and the ward managers and nobody knew what a package of care meant nobody knew what it entailed they just knew it was four calls a day that's okay for that patient and they didn't have a clue what was going on and my mentor said you know what this is really unsafe like this is almost neglect you're neglecting this poor patient who is end of life they haven't got enough care to meet their needs and you're about to send her home really really unsafely and the other person they couldn't see it because they didn't know what involved they they weren't aware and what we think happened we never got down to the bottom of it but what we think happened was they just didn't put enough information on the form we suspect that they didn't put that she was end of life for a start they think that they just put the minimal things on the form when actually this lady needed a lot more and so we fought hard for this patient unfortunately this patient was sent home anyway with these four calls a day so as district nurses we popped in extra we were doing extra visits this person visits that weren't scheduled they weren't necessary but we cared about this patient so we were going to make those calls she was on everybody's list every every day to check and just while we were waiting for the extra care package to be put in place and eventually we finally got it into place that this patient got the needs that they needed they they had 24 hour carers coming in they had a night sitter it was it was a bit amazing she actually got the care that she needed in the end but it just I just wanted to show that if you don't fill out that form correctly if you leave the slightest little things that patient's going to get the completely wrong care package for them and it's no one's fault it's not the CHC's team because they can only go with what they were working with the nurses on the wards assumed that that would be okay because they didn't really know the patient they didn't know what she was like at home whereas the community nurses did because they cared for her quite a lot anyway in the community and it just seemed like there's this missing link somewhere connecting everybody and this is why now because I've been recently talking about these things with colleagues and package of cares and things and it's reignited that passion that I had and this is why I'm doing this vlog today I want I want something done and I'm not too sure what it is I'm not too sure but I thought doing a vlog about it will raise awareness writing about it will raise awareness and hopefully spread that message that just be careful be mindful of when you're doing your referrals know what a package of care is know what those four calls a day entail get that information from the person at the end of the phone and work together with people if this patient has district nurses and is known to the district nursing team speak to the district nurses speak to their GP get a whole picture of this person because it's holistic care this is what we're taught in university you need to treat this person as a whole you can't just work on what this person's like in hospital because that person hospital is completely different to how they are at home trust me I know I've been in all these different settings this person is completely different so you really need to do a whole assessment yourself and yeah it is going to take that little bit longer it's going to take you a lot of writing your hand's going to ache with the amount of information but you know what it's going to save a whole lot of trouble it's going to save readmissions it's going to save this person waiting around in a bed that could potentially be used for somebody else it's going to save you a lot more of a stress on the wards if you're on the wards it's going to save a lot of hassle guys so just put that little bit of time in to protect your patient because that's what it's about it's about protecting your patients making sure they're safe making sure they get the care that they need and deserve making sure their quality of life is improved as a result of it and just it could actually save a life if that woman was discharged and nobody left and nobody took initiative to do anything about it she could have died she could have tried to get out of bed and fell over she could have been lying there for a long time without anybody knowing there could have been a whole lot of things going wrong for that patient so it's really really important that things are done properly that we don't get too busy that we're neglecting our patients and it's just really really important to protect the well-being of that patient as well sorry I feel like I've gone on a bit of a rant guys so I know there's amazing people out there they fill out the forms beautifully and it's not often or it's not every day that this happens but it does happen and it happens frequently frequently enough for me to notice and for me to say you know what something needs to be done about this and this is from years ago this isn't just a new thing and looking at the statistics and stuff as well you only have to google hospital readmissions to see that people are readmitted unnecessary because there's somewhere there's a discharge problem or the package of care hasn't been put in place as properly as it should be there's a whole lot of reasons why people get readmitted to hospital so this is why it's important not just to look at the package of care but to look at your discharge is it a safe discharge ask that question one in four people commented saying that they never got asked the question how is it at home do you have enough support at home are you managing at home so it's really important to ask these questions to your patients even as community and GP nurses have to ask these questions are you managing I asked it last week to a patient because all of a sudden they couldn't walk as far as they could and I had to have that conversation with the patient you know what do you have any support are you okay cooking for yourself and getting yourself washed and dressed it do you need an extra support network and luckily enough they said they were okay with that sort of thing but they know that they can contact me and they know that that support is there if they need it so it's about making people aware as well and a lot of people are especially in sorry I don't mean to label people or anything like that I'm sorry if this offends anyone but especially in the older generations the older generations can be from what I've noticed and just my own observations they can be quite proud they don't want any help they want to keep their independence their mind is still over 21 year old and this can be really really difficult to have those conversations and sort of get them to think differently so it's about knowing your patient as well and having those conversations with them and communicate it in a way that they can accept it and say okay this is okay and yeah I'm going to stop talking now because I keep talking and talking and talking this can be really boring and you've probably switched off but I hope you've took something out of this I'm going to leave a loaded links below please follow the links there is a website below that I've got through the NHS as well that you can register for a CHC toolkit to help you sort of understand it so please register for that and it's just going to make a massive difference I think so yes I'm going to leave it there look at the links below in the details and I shall see you next time guys thank you thank you so so much for tuning in as always and go out there make a difference protect your patients one safe step at a time