In the vanguard of new care

In our latest blog marking World Continence Week, a GP explains how the work of the Sutton Home of Care vanguard – part of the national new care models programme – is benefitting patients and making communication easier between clinicians.

The Sutton Homes of Care vanguard has a progressive and inclusive approach to the care of frail, elderly and vulnerable patients.

This is based on the programme’s principle of promoting proactive rather than reactive care.

This principle is being embedded through an approach that aims to “do with and not do to”. The care of our residents is integral to our programme, and making a difference to the care, health and wellbeing of residents, as well as staff, is of paramount importance. A core principle of the vanguard’s programme is to embed into nursing and care homes the six Cs: Care, Compassion, Commitment, Courage, Communication and Competence.

People taking up residency in either residential or care homes are typically around 85 years old, with an expected average stay of 18 months to two years. Many are suffering from multiple chronic conditions, and in some cases are in their last years of life, and utilise NHS services as a result of their health conditions.

Sutton Homes of Care vanguard has created a ‘red bag’ initiative  – hospital transfer pathway – where each care home resident requiring an overnight stay is sent into hospital with a transfer bag that includes standardised paperwork, personal effects, medicine and clothes. We have found that this leads to better communication between care homes and hospitals at all points of the resident’s journey.

Some care home residents may at some point need to have a catheter fitted during or following a hospital stay. The Sutton Homes of Care vanguard champions safe and responsible use of catheters.

To this end, a catheter care pack, which has been created by the Health Innovation Network and Age UK, is currently being rolled out across our Sutton care homes. The catheter care pack consists of two booklets; an advice booklet for those living with catheters and a ‘patient record’ for health care practitioners to document every catheter related interaction. This pack is included in the ‘red bag’ when patients go into hospital and is intended to improve communication, service user self-management and care provision across health services.

Patients living with a catheter are vulnerable to complications and health care practitioners often find that documentation related to a patient’s catheter is incomplete.

The catheter care pack was introduced to make sure that any problems and subsequent follow ups are recorded. It will also improve communication across healthcare boundaries, such as from community care to the emergency department, or to outpatient clinics or wards. The pack is also designed to meet older service user priorities and to encourage catheter independence, and empower patients to practise self-care and enhance their overall catheter knowledge.

The ‘red bag’ scheme has increased the quality of care for patients, by providing health professionals with the patient’s clear and detailed clinical needs. It has also made it possible to discharge residents back to their care home with greater care and dignity, as patients have their own clothes and important belongings with them.

The inclusion of the catheter care pack also ensures that patients know what to expect from their catheter, as well as giving practitioners a clear catheter care history, so unnecessary stress can be avoided.

  • Get updates on the Sutton Home of Care vanguard on Twitter: @SuttonHoC
  • NHS England’s Excellence in Continence Care is a practical guide for commissioners, providers, health and social care staff to put into effect the best care for patients. It also provides information for the public.
Dr Stephanie Machin

Dr Stephanie Machin is a GP at the Robin Hood Health Centre in Sutton.

She is originally from Newcastle upon Tyne, where she graduated medical school in 2010. After completing her foundation training posts at Chelsea and Westminster NHS Foundation Trust and then London North West Healthcare NHS Trust, she joined the St Helier GP Vocational Training Scheme in 2012.

Stephanie qualified as a GP in 2015 and stayed on at her training GP practice in Sutton, where she is now a salaried GP. She has a special interest in care of the elderly and mental health, and is the practice lead for palliative care.