Dr Nick Tupper blog: Lindsay blazing a trail with care at home

3155585150One of the top objectives of NHS Doncaster Clinical Commissioning Group is to bring more services ‘out of hospital and provide them at home or closer to where people live’.

It’s a phrase we use all the time within the NHS, but it occurred to me Doncaster people may not understand what it means, so I’ll explain.

Prior to the launch of the NHS in 1948, many services that later became centralised at district hospitals were delivered in community settings, such as GP surgeries and cottage hospitals.

Infection controls weren’t as good as they are now, so there were problems with carrying out some procedures out of hospital. But advances in medical science mean we are now able to provide much more healthcare at, or near, your home.

So procedures that, until not too long ago, were only available in hospital are now being routinely carried out by trained community based staff. We want to do much more when it is safe, efficient and practical to do so.

A good example of this is a new service we’re funding to help men who have an emergency bladder problem, who previously would have gone to A&E in an ambulance for treatment. One of the first Doncaster people to benefit from the service – currently on trial – was Lindsay Odell, aged 79 from the York Road area. He woke early one morning and had excruciating pain every time he went to the toilet to try to wee.

He said it was the worst pain he ever experienced, he couldn’t pass any urine and there was no let up from the agony. He contacted his GP, my colleague Dr Marco Pieri, who quickly saw him and diagnosed a serious acute urine retention problem. Dr Pieri arranged for nurses from Doncaster’s community-based Unplanned Care Team to come to his home, and they arrived in just over one hour.

They inserted a catheter and drained off nearly two litres of urine. He said the relief was instant as the pain disappeared straight away.

In the past, Mr Odell would have rung for a 999 ambulance, would have been taken to A&E and may have been kept at hospital for a while. But he is a full-time carer to his disabled wife Gwen, aged 78, so he couldn’t have just gone and left her without any support.

But by being treated at home, with the Unplanned Care Team on hand to carry out follow-up visits, including making arrangements for the local district nursing team to take over any catheter care needs, he didn’t have to leave her. Historically, caring for Mr Odell would have cost hundreds – if not – thousands of pounds in ambulance and hospital care. Importantly, he has had the same quality of care delivered at home, illustrating that it is possible to make healthcare savings without cutting standards.

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