The Handover with NCH&C

Season 1: Episode 4 The Handover - NHS Staff Support, Service Innovations, and Celebrating Community Care

• NCH&C • Season 1 • Episode 4

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In this episode, host Lydia, our Communications and Marketing Assistant, takes us through key campaigns and projects from October and November. 

  • We join Nick and Chioma during Freedom to Speak Up Month as they discuss the importance of NHS staff having a voice that counts, and share how they celebrate and support staff across the organisation.
  • Rowena and Philip from our Wheelchair Assessment Service team, and Kimberley from the Service Improvement Team, provide updates about the service improvement project.
  • In honour of Community Health and Care Day, colleagues share why they love working in community health and care, highlighting the dedication and passion behind the work they do every day.

Hello, welcome to The Handover.

I'm Lydia from the Coms and Marketing Team, and this is a podcast for all staff at NCH&C.

In particular, The Handover is all about handing over updates and information to our frontline teams.

That's both us to you and you to us.

This podcast is created for the aim of being an excellent two-way platform for having a conversation with colleagues.

This time on The Handover, colleagues tell us why they love working in community health and care as part of Community Health and Care Day.

And we talk to our Wheelchair Assessment Service team and patients about improvements to the service.

First, though, every October, the National Guardian's Office highlights the importance of NHS staff having a voice that counts through its Speak Up Month campaign.

This year's theme was Listen Up and focused on the power of listening and encouraging people to feel confident to speak up.

Our Freedom to Speak Up guardians, Nick and Chioma, have hosted a number of events across different locations throughout October.

I visited them while they were at Deerham Hospital to catch up on what they have been doing.

It's a little bit nameless, but he's sort of, he loves every, he loves all the ideas.

I'm Nick Bowman.

I'm a Freedom to Speak Up Guardian and a Learning Disabilities in the Trust.

Hi, my name is Chioma Goodchild.

I am the Freedom to Speak Up Guardian for the Trust, and I also work as a Podiatrist in the West.

Well, October's always Freedom to Speak Up Month, so this month we go around to as many places to see as many colleagues as we can, and as well as that, in Deerham Hospital we've been having an afternoon tea event with free tea and coffee for as many staff and colleagues that want to come get free cake, but also to hear about Freedom to Speak Up.

Why is speaking up important?

It's important to hear people's voices.

It's important to be able to listen to people, to make sure that everybody's voice is heard.

The mother, what banding you are, and the mother, where you come from.

We want to make sure that you feel comfortable in the working environment where you work.

What can you speak up about?

So you can speak up about anything, Lydia, that you want to, and then we'll work out a plan as to what we do with whatever you've told us.

What we encourage you to do is email us or phone us if you have any concerns, and even if we're not the right people, we can help signpost you to where you get the right level of support.

How do I speak up?

You can speak up through telephone.

You can call us on the phone.

If you see us in person, you can always try and speak up that way.

We have an app where you can raise your concerns through that way.

You can email us.

You can find us on Teams as well.

We also have champions around the trust, freedom to speak up champions who you can find on the loop and you can speak up through them as well.

Anyone who's working in the trust can speak up.

So whether you're the chief exec or you're taking the bins out, it doesn't matter if you're a student nurse, you can speak up.

Agency workers, bank workers, if you're doing something in our trust, you can come and speak to us.

Quite a lot of laughing going on.

Hi, I'm Catherine Duffield, Wellbeing and Inclusion Lead here at NCH&C.

Wellbeing and Inclusion come together with freedom to speak up on a monthly basis.

We come together to deliver the Civility, Compassion and Respect Working Group, which is to support all staff members across the trust, deliver a kind and compassionate workplace for everyone.

So with that, we've got a really good relationship and allyship with Freedom to Speak Up.

They always support wellbeing and inclusion with our projects, so it's really, really important that we come along and support them in return.

Hello, I'm Amy.

I work for Otten Court.

I'm an Admin Support Assistant 2D Award Manager who's in charge and also supports the band Sixers.

From experience from working in the NNN, I had a member of staff come to me and inform me that they wanted to end their life that morning, so which I'd upon myself to speak to them and just ask how they were and I took it higher than to them, to obviously the band Sixers, the band Seven.

And I joined Dogden, I saw the posters up for people to speak up, and I thought, well, Otten hasn't got anyone there who is a champion.

So I thought that would be something that I'd be interested in doing.

To be that person where someone can trust and know that they're safe in obviously speaking about how they feel and to know that they can do it in confidence and know that it will only be taken further if it's felt needed to, if it was something quite serious.

Thanks to Nick, Chioma and everybody else that I spoke to.

The event was super welcoming and very informative.

If you want to find out more, there's lots of information on the loop.

Just search Freedom to Speak Up.

Now about our Wheelchair Assessment Service and the Improvement Programme underway to reduce waiting times.

NCH&C has delivered Wheelchair Assessment and Repair Services in Norwich for more than 25 years.

In 2018, NCH&C agreed to provide the service in West Norfolk when the provider went into reservorship.

We established a service within four weeks.

During this time, it became apparent that there was a considerable volume of unmet need.

The NCH&C Wheelchair Assessment Service aims to aid mobility, independence, well-being and quality of life for individuals who have a long-term disability or medical condition that significantly affects their ability to walk and is likely to limit them for at least six months.

Hi, I'm Kimberley Jordan and I'm a project manager with the SIP Team working with the Wheelchair Redesign Project.

So, the Wheelchair Redesign Project has been set up in a bid to recover the service.

The service has been breaching its 18-week RTT since, I think, 2018 when we took on The West.

What's an RTT?

Referral to treatment when we took on The West.

There were quite a lot of different wheelchairs that were being used, lots of different brands, and I first did some work with the service a couple of years ago when it was deemed that it would be necessary to try and rationalise a lot of the equipment that was stored over here at Redhouse.

So I believe when the service took on the patients in The West, there was no particular asset management system in place.

I don't believe the service actually knew who had which wheelchair.

So what was going on was there was a lot of equipment stored over here which was actually obsolete.

So in the past year, the ops manager and some of the other staff within the service have been exploring various different ways of redesigning and improving in order to recover the service and get back to that point where patients are seen within the 18 week referral to treatment.

The service has worked closely with a private provider called OpCare and around about, I believe, the beginning of this year, the ops manager and clinical lead and some of the admin staff and engineers went across to Leicester to go and have a look at how OpCare were managing the wheelchair services in that area.

And what they found was that OpCare have some admin personnel issue quite a lot of their wheelchairs.

They are currently delivering a service within their 18 week RTT and our service clinicians and management decided to scope out what could be done to redesign the service in Norfolk and enable our admin personnel to issue wheelchairs as well.

So the project aims to adopt a direct issue basis for standard wheelchair referrals and amend the staffing profile to support the change in the service and to tackle the backlog of waiters and create a more sustainable business as usual model for the future.

So how does that differ to how it's done now?

At present, all of our patients are seen in clinic with senior occupational therapists.

What we have done is we've created two pathways.

The first pathway is our senior clinic pathway, which effectively all of our patients are currently on.

We are enabling our admin staff to have the autonomy to provide wheelchairs to some of our less complex patients.

We are doing this by creating a couple of different tools.

These have been devised in-house alongside our service clinicians.

The first tool is going to be used by the admin personnel at RSC.

That tool will enable the admin personnel to identify which of our two pathways would be the most appropriate for the patients being referred.

Once they have identified that, they will be able to allocate patients to one of two waiting lists.

The first will be for the senior clinic waiting list, and that will be specifically for our complex patients.

The second cohort of patients will be allocated to our direct issue waiting list, and they will be internally referred over to our procurement assistants based at Red House who are working alongside the engineers and who will be working under the guidance of our senior clinicians.

The procurement assistants at Red House are going to be using a second tool.

This tool has also been developed in-house also with the support of our senior clinicians and effectively is going to remove the clinical responsibility from the procurement assistants and enable them to identify the appropriate chair for each patient.

Hello, I'm Philip White.

I am the team lead for Wheelchair Retail Services.

I'm refurbishing and setting up a wheelchair for a patient.

How long have you worked in this service?

Just over five and a half years.

Do you love it?

I do, yeah.

What do you love about your job?

You're helping people.

I've always liked working with my hands anyway and with this role, you get to do both.

So you get to help people and work with your hands.

It's a win-win really.

What did you do before you worked here?

I worked in the community, installing ceiling track hoists and repairing stairs.

I think it's very positive.

It takes out the bottlenecks at the start and the end of the process, because as well as the clinicians not having to see the patients for the initial referral, it does eliminate potentially them having to hand over a low wheelchair.

So it just speed up the pathway.

So it will be beneficial to the patient.

My name is Rowena Pfeiffer-Florence, and I'm the Business Support Manager for Wheelchairs.

The Wheelchair Services is a mixed team of specialist and support staff.

We provide wheelchair services to all of Norfolk, but not including those on the East Coast.

The team is made up of occupational therapists, rehab engineers, workshop and field engineers, store staff, delivery driver technicians, procurement assistants and the admin team.

In addition to the assessment service, where patient need is assessed by OTs and rehab engineers, we offer a drop in service at the workshop for patients who need a repair done to their wheelchairs.

The delivery driver technicians support the service by delivering and collecting wheelchairs and servicing basic wheelchairs across Norfolk.

The field engineers are also working across Norfolk to carry out annual servicing on the higher spec equipment and also carry out repairs and support patients in their homes.

Patients who use our service are adults and children.

Children are aged 36 months plus.

Wheelchairs are provided based on clinical need and the need is determined by regionally and nationally agreed criteria.

The department services patients with a registered Norfolk GP, but as I mentioned previously, this doesn't include those on the East Coast who come under a different provider.

Primarily, we provide equipment to those with a permanent long-term condition who need a wheelchair to support mobility in their own home and have either a significantly reduced ability or are not able to walk at all.

Types of patients supported by the service might have a degenerative condition such as motor neurone disease, have congenital physical disability or physical disability due to injury.

They may suffer reduced mobility due to onset of a life-limiting condition or be in palliative care.

They might also have reduced mobility due to stroke or other neurological injury.

I joined the department in October 2023 and initially worked across clinical engineering and wheelchair services.

And then for a few months, January to May, I mainly supported clinical engineering.

That was due to staff shortage really.

Then I returned to wheelchair services full time in June.

What do you like about this job?

I enjoy supporting services and people through change.

As long as I know what the change is about and what the planned improvements are, I feel able to support people and services through change.

Do you feel positive about this project?

I do.

I feel that it's going to a really good impact on the service, both for patients and for staff.

It's going to change ways of working, which will lead to much reduced waiting times for our patients and it will reduce the number of patients waiting for clinical triage and free up our clinicians to see more of those patients who need clinical intervention.

For our admin staff, it will improve processes and save time, and it will also lead to improved quality of referrals into the service so that all the information needed to help patients sooner can be provided at the point of referral.

And I guess morale as well, because it can't be easy working for a service that you know has got such long wait times.

Yeah, that's really difficult.

It's difficult for the clinical team, because they're probably under the most pressure.

But the admin team are having to take some very difficult calls and handle some very difficult calls, because as you would expect, patients and their families are struggling with our long waits.

Yeah, and I think the other thing that I've heard is that you struggle to recruit into the service.

Like, it's a very specialist area, isn't it?

And doing the wheelchair modifications and repairs.

Yes, and we've had significant lengths of time where we've been short staffed, sometimes in the clinical team.

In the engineering team, we've had some really long periods of being down on people.

But we're now looking at going forward with our full capacity in the workshop, which is really good.

That's going to really improve things to help us to turn over more equipment and be ready in a more timely way with our wheelchairs.

Thanks Rowena, Kimberley and Philip.

Shortly after Vicky's visit to Red House, the Wheelchair Service held an engagement event for patients, their families and carers at our Rehabilitation Service Centre at Julian Hospital.

The 1st of November is Community Health and Care Day.

This national day is an annual celebration of community health and care and an opportunity to raise awareness of what we do.

Community Health and Care Day is a registered awareness day launched by NCH&C in 2020 on the Trust's 10th birthday.

Although community health and care makes up one-fifth of the NHS workforce, it is often overlooked.

Community care doesn't have the visibility of a large hospital or ambulance iron, yet it is firmly at the heart of every health and care system.

We believe that people are better looked after locally and this belief drives us to work hard to bring our expert care to patients in our community hospitals, within GP surgeries and in their own homes.

The theme for Community Health and Care Day 2024 is Focused on the future, building better community care.

We went out and about to get some staff views about why they love working in the community.

Hi, my name is Eden, I am a nurse in the community.

I joined the Urgent Community Response Team in January this year.

Initially, it was going to be the virtual ward and then kind of changed into Urgent Community Response.

And now we've got the virtual ward element to it as well, which is great.

Before I did work in the community, but it was for a GP surgery doing their home visits.

So there's obviously a bit of a divide between nursing, like community nursing and what we could do in the GP surgery.

So I wanted to actually join the community team to have access to all the other services that before I was just being able to refer into but not actually being part of.

So my name is Louise Nicholson.

I'm an Occupational Therapist.

I've worked for the Trust for four years.

I've worked in Urgent Community Response for the last two years.

We've seen a lot of change in the team.

We've gone from admission avoidance and needs to taking on the virtual ward.

I chose to work in the community because I feel that we can really make a big difference to people in their own homes.

Person-centred care.

Before working in this team, I was at North Warsham Hospital, which I loved, but it's many discharge planning.

Actually, seeing people in the community, what we can provide is very specific to that person.

I do feel we do make a difference.

My name is Jason.

I've been with the Community Trust for about a year and a quarter now.

So I've just started my new role today with the North Norfolk team, but I was a part of Norwich UCR team for the last year and a quarter.

And the reason I chose to work in the community was like, I came newly qualified into the community, but throughout my placements, I was trying to explore different areas.

So most of my placements were at the acute hospital, but the most interesting one which I found was when I came for a placement with NCH&C, where I felt really well supported and I just felt like there's always been a misconception that communities are in a very slow pace kind of thing.

But the year I started with the placement there, there was a lot of new services which is coming in, like one of them being the Urgent Community Response, and we have the IV therapy team, which we know, which is quite recent as well, which they weren't doing that before.

So all these new additions to the community, they'll be able to provide, as my colleagues said, a lot of holistic assessment.

I also felt like as nurses and therapists, we have a lot of control over our patients, that we can initiate therapy referrals and everything, and we can refer to GPs, and I just felt very satisfied in doing that, because I feel like I could make a change, so that's why I chose the community.

Do you think community care gives you a unique perspective on patients?

I think that, like Eden has said, that the people we have referred into our service is very bearable.

We do have a lot of end of life, but we also have a lot of falls.

We also take calls off the ambulance stack.

So, our skill set as a nurse and an occupational therapist, I would say is probably wider than people, probably not in a community, different trust, but in an acute setting, or how people maybe perceive the role of an OT or a nurse.

So, it might surprise people that OTs in this team, we don't just hand out commodes or toilet frames.

We were trained by the nurses to do those clinical observations, and then feed back either to the GP or to our wider team.

Sometimes I wish it was just a commode.

But unfortunately, the people that we see are complex.

It's not just about always keeping them safe.

So, is it a package of care that could be safeguarding or domestic abuse?

So, our role is very, very varied.

That's why it's important to have the support of the wider team.

I think also, when people are in hospital, and you see them as a nurse or an OT in that environment, it's very difficult to understand what else is influencing them.

You don't see a patient in the hospital in crisis point, because they're in hospital, so they've already got people looking after them, people providing their meals for them, people providing their medications for them.

Whereas we can walk into a situation where actually someone has not eaten or drunk or taking the medications for two, three, four days.

So, you're truly walking into a crisis situation, and you don't have that immediate support of being able to pull an emergency bell, and everyone comes running, you have to really be able to think when you fit in.

And that can be quite scary for some people, but it is really satisfying to be able to be that autonomous and have the skill set to actually be able to deal with that situation when it arises.

What is something that might surprise people about working in the community?

So, the patch that we cover in the north is large.

So, we cover from faking them GP practice through to ACAL GP practice.

So, when we're trying to allocate patients, we always have to look at the locality and obviously prioritize those referrals.

So, people we discuss this to, the patients who are trying to book people in, they are quite surprised about the area we cover.

Another thing is the acuteness of some of the patients that we see.

That we now have got the virtual ward up and running.

We're visiting patients and we've all had training and have been up skilled to be able to do IV cannulas, to give IV fluids, IV antibiotics, and all of those things.

I think people very much think, oh, that person needs to go into hospital to have that.

Even some of our colleagues in the community with GP practices, they still quite outdated, I think, in what they think that we do in the community and what we actually can do.

So I think that's their own, obviously, we're gonna try and get more skills and just about everyone else in healthcare kind of keeping up with what we can do in the community and use in our services.

If somebody was thinking about a career in community health and care, what would you say to them to try and convince them?

If I had to convince somebody to work within the community team, I would say that it's a beautiful area and that when you're driving between patients' houses, that is a really important time to reflect and also manages my well-being really well going in between patients.

That isn't something that the acute setting can offer with those constant emergency alarm buttons or call bells going off in the background.

The travelling between patients is a time to reflect.

Something I would say to somebody who might be looking for a job in the Community Trust would be to not underestimate the skills and the variability of the role.

I've come from A&E and I actually don't feel like I'm de-skilling by being in the community, and I think that's a bit of a myth.

I would urge people to join and just be part of what is going to only get bigger and better as the years go on.

If someone wants to join the community, if you think that you want to look after your patient, not just physically what they need, but also can make a big change in the socio-economic aspects, which does affect their health as well, our community is the way to go because you have access to multidisciplinary teams where you can make a real change in that aspects as well.

What do you feel is the best part of your job?

We have a fabulous team here at UCR and we're only getting bigger with more nurses and more occupational therapy roles.

We do work as individuals in the community, so going to patients' homes, you do have to have the confidence to do that.

But there's always a colleague on the end of the phone.

That's a big part of why I love working for an urgent community response.

Equally, a lot of the patients, you can make a difference in their lives, not only for the patient but also to their families.

I think it's the variety within the role, especially from a nursing perspective.

I've never had a job that's quite so varied.

One day we can be in the office and doing the triaging, which can be backed back with ambulance referrals, GP referrals, referrals from our colleagues in the community.

All of those people are looking for help because they don't know way to turn with that patient.

We have so many options that we can provide.

It's just really satisfying to know that you can actually find a solution for these patients.

Then the next day when you're on shift, you can be actually out on the patch and traveling across North Norfolk, seeing the patients.

It could be anything from spending 20 minutes with a patient to two hours with a patient.

It just is totally dependent on what they need and what you can provide for them.

It's very satisfying.

I would just like to add about how I get to give my 100 percent when I'm with a patient.

That's a very big thing about the community.

When I'm with a patient, I got 100 percent of my concentration and my time with that.

I could think elistically and provide care for my patient.

The other thing is, as a part of my role, I really enjoy doing end-of-life care.

I felt really privileged to be able to be let inside someone's house, trusting me and me being for them, not just me as well, but along with our team, able to provide everything the end-of-life patients need to make their last few days or weeks of their life comfortable, not just for the patients, but also for the family members.

That is the best part of my job.

We really hope that you have enjoyed all the subjects we have covered in today's Handover.

As ever, we really appreciate everyone who takes the time to talk to us about things that matter to them.

I know it can be daunting when we show up with our recorder to chat to you, but as ever, there's so much amazing stuff happening across the Trust, and we hope you all have found what we've talked about today interesting.

Further information about everything we've featured on this episode can be found on the webpage for this podcast.

Don't forget to send us your ideas and thoughts about The Handover.

If you have an idea for a feature or would like to host a segment, please get in touch.

We hope you join us again soon for The Handover.

Bye for now.