[00:09] – James

Hello and welcome to this podcast featuring the fantastic work of urgent community response teams and how we’re supporting people to stay well and independent at home wherever they live for as long as possible. We’re also going to be discussing how community teams are reducing the need for people to go into hospital. I’m James Sanderson, I’m Director of Community Health Services at NHS England and today we’ve got some great speakers from East Midlands Ambulance Services and Nottingham City Care Partnership. We’re going to be hearing stories of patients who’ve received support from urgent community response teams.

But first, let me give you a bit of background on urgent community response, or UCR services. So, the national introduction of urgent community response is a key commitment in the NHS long term plan to provide urgent care to people in their homes if their health or wellbeing suddenly deteriorates. Urgent community response teams provide urgent care to people in their own home, which helps avoid hospital admissions and enables people to live independently for longer. Through these teams, older people and adults with complex health needs who urgently need care, can get fast access to a range of health and social care professionals within 2 hours.

[01:16] – James

This includes access to physiotherapy and occupational therapy, medication, prescribing and reviews, and help with staying well fed and hydrated. We have successfully rolled out the two-hour urgent community response services since 2022, two years ahead of schedule. UCR services are available in every part of the country now, across all integrated care systems, and they operate from 08:00am to 08:00pm seven days a week. So here in the Midlands, Karen Davis, who works for East Midlands Ambulance Services, is going to tell us a little bit about the impact of UCR services, what it’s having on patients, and the impact also on ambulance conveyance to hospitals and A&E. So, Karen, can you introduce yourself and just give us an outline of why UCR is important in those regards?

[02:03] – Karen Davis

I’m Karen Davis, I do work for East Midlands Ambulance Service. I’ve worked there for 20 years. I am a frontline conveyance lead, but I am a divisional senior clinical lead and for the last twelve months I’ve been working on the alternative pathway role in conjunction with my current role. I’m still patient facing, and I believe we all recognise as clinicians how important it is that patients are treated at home. It’s far more appropriate than being transported to hospital, particularly elderly, where they’re at greater risk of deconditioning and becoming less mobile. So the collaboration with UCR is paramount as delivering care at home for these vulnerable people. The benefits are the impact on their quality of life promotes wellbeing, and in the frail and elderly are less likely to become frail. The UCR offer fantastic holistic assessment as well, so for not just the acute problem that they get called out to, but for ongoing support. We work in conjunction with Age UK Now and social services so it’s improving the care for these patients, not just at the point where EMAS contact UCR, but for ongoing care and support as well. It’s such a successful collaboration East Midlands Ambulance Service and UCR. It’s such a good collaboration that it just keeps growing every month.

[03:26] – James

So that’s a fantastic overview and amazing progress that you’ve made over the last year with expanding the service. You mentioned there that collaboration was of course really important with lots of key partners. What are your top tips for other ambulance services looking into developing UCR around that collaboration and why that’s important?

[03:49] – Karen Davis

I think it’s about promoting the service within your own trust. We do a lot of work collaboratively, going to hospitals, talking to clinicians, our own frontline clinicians to support it, giving good examples of where it’s worked and where it’s worked well.

[04:04] – James

So Karen, what would be your top tip for clinicians specifically?

[04:08] – Karen Davis

Call them. Call UCR. They offer not just a service, but they offer some support as to if they can’t offer, where you can get help from. So give them a call. They are clinicians so they understand what support you might need on scene. They know that we’re emerging service so they’re quite eager to assist us to get us a way to assist more people that need us. Give them a call, give them a call, give UCR a call. They’re a fantastic service.

[04:35] – James

I’m also struck by what you said around the benefits to patients of having the case reviews and those ongoing benefits. Do you think UCR’s played a big role in keeping people out of hospital on an ongoing basis, not just for that primary call that’s been made?

[04:50] – Karen Davis

I do, because they offer support for where care’s failed. So if somebody’s a main carer, if that care supports failed, they can come in and assist. If somebody’s got an acute medical problem, they will come in and assist. But like I said, the benefits are more than you could put down for people. This is about their own wellbeing and living well at home. And you can’t put a price on that. People live better at home, they feel more secure, it gets rid of the where we go to people and they’ve got a barrier to go to hospital because they get fed up and going. They don’t want to be sat at hospital. Nobody wants to be sat hospital deconditioning and not in their own environment. These people are being treated at home and are far, far, far better being treated at home than they are at hospital, where it’s appropriate and a lot of cases it really is.

[05:37] – James

So we’re now going to hear from Sarah, who’s the Station Manager, Beechdale Ambulance Station in the East Midlands. But recently, Sarah was working on the road as a technician. And you’re going to share some of your experience, Sarah, around how UCR’s supported people in situations where there’s been a deterioration of their care at home.

[05:55] – Sarah

Yeah, one of the standout cases for me was fairly recent, following the sudden death of a male who was the main carer for a lady, the lady that he lived with, his partner, who required care 24/7. We were able to refer to UCR, which was a really easy process, really comfortable phone call and they were willing to immediately come out and support this lady to ensure she could stay at home, and obviously deal with the fact that the person that she’s been with for 50 years has just died, who’s her main carer. And the panics round in that with the support of family and the urgent care, she was able to stay at home. Going back, I’ve been on the service for eight years, I can recall something very similar happening where we ended up taking this person into hospital, which wasn’t appropriate, but at the time there was no alternative pathway for her. And obviously, being in hospital is a stressful situation anyway, but having lost somebody very close to them, it makes it more stressful, I think. So it’s really nice to hear and I’m hearing a lot of positive responses as well from people on the road and I think that enhances the chances of people calling. If amongst themselves staff are able to speak and say, oh, I had a really good response from the UCR, they’re more likely to then call them in future.

[07:09] – James

I think one of the things that strikes me about what you’re saying is that we always think about urgent community response being for a single patient who needs support. But what you’ve outlined there is the opportunity for UCR to help a whole family situation, a whole household. So that wide impact is quite important. How do you think that impacts on the ambulance service in having that opportunity?

[07:33] – Sarah

It’s a massive impact, not only in the ambulance service, but also to the receiving hospitals as well. That person years ago was an unnecessary admission. They had no medical problem, but it was just to support them being unable to stay at home alone and having no family at that time immediately available to come and support them. So yeah, it’s another taking a patient to hospital. The time surrounding that, you then have to create a report form for them as a patient when really, it’s a more kind of holistic approach to be able to look after somebody at home with the support that they need.

[08:08] – James

Okay, so we’ve heard from Karen and Sarah who’ve shared their frontline experience of using UCR services. And now we’re going to speak to Daniel about how appropriate calls are referred to UCR and how they’re handled in control rooms. He’s senior clinical navigation lead from East Midlands Ambulance Service. He deals directly with the calls when they come in. Can you tell us about how calls are referred to UCR teams from the control room?

[08:34] – Daniel

Hello. So there’s a couple of ways that calls are referred to the UCRs in the control room. The first way is via the call takers. So when the call comes through and it’s coded, certain codings will automatically pop up saying pass to UCR and the call takers just click a button and the job goes through. The second way is via kind of face value, taking it off each call that comes through. So in the clinical assessment team, which is where I work, I support staff and monitor the stack and we encourage staff to use alternative pathways and for our low acuity patients and we review calls that are coming through. So for example, if it comes through elderly lady with career urine infection, confused, we could probably say that could probably just be dealt with by a UCR. And then we just ring up the UCR, pass the calls over to them talking to the clinician and we’d close the call down our end. So it avoids sending an ambulance out from that point. If there’s any problems, the UCR will always just send it back to us. So we’re kind of mitigating a risk there. We’re sending it for a thorough assessment, full holistic approach and being triaged by clinicians that deal with the urgent illnesses and like I say, if there isn’t a problem they just send it back to us and we’ll send an ambulance out.

[09:56] – James

It’s really good to hear about the various ways that people access UCR through obviously the tech being set up to advise call handlers but also that real importance of the clinical assessments as well and that clinical triage, in terms of the benefit of UCR to call handlers, do they feel confident about referring to the service now?

[10:19] – Daniel

So yeah, the call handlers do all kind of risk is taken away from them, the box just pops up on their screen and they just pass the call through automatically. It’s been a bit of a challenge from the clinical assessment team’s point of view, building that confidence up because we’re not with the patient and we don’t necessarily have to triage the patient, we can just take the call off face value so we don’t have to speak to them. We have had a few kind of knockbacks with passing a call through. Sometimes it can just take a while because of how busy the UCR is. But the hope is that we use our gateway in future. So we can just pass a call through instantly review the call and pass that call straight to the UCR, who will be then reviewed by the clinicians and then they can pass it back through the gateway if it’s not appropriate. Which means leaves that phone line free for crews on the road to phone up and have that conversation with the clinician.

[11:14] – James

So from a patient perspective, thinking about that, what do you think are the core benefits?

[11:20] – Daniel

A a lot of patients don’t know who to call. The easiest number to call is nine nine nine. It’s the number that’s on everyone’s mind and to be able to pass to an appropriate service that can deal with the ailments and the lower acuity calls which would reduce that risk of hospital admission. I’d like to say it works well and patients are trusting of it because they seem to ring us back as well for similar ailments and we pass that through the cycle, we pass it straight back to the UCRs.

[11:52] – James

In summary then if thinking about the wide benefits that you’ve outlined for both the call handlers and the ambulance service and for patients, what do you think the key goals are here?

[12:03] – Daniel

As a clinician, our goal is always to do what’s best for the patient. And this day and age, it’s not necessarily hospital. That’s kind of your last resort. First resort is care in the community and ultimately, it’s about getting the right care at the right time in the right place, which is what the UCR supports, so we can accomplish that.

[12:25] – James

Fabulous. Thank you. So I’m also really grateful to have here Sara Spruce, who’s an occupational therapist and clinical lead at the Urgent Community Response and Reablement team at Nottingham City Care Partnership. And Sara, you’re going to tell us a little bit about your work and what impact it’s had on the patients that UCR teams have treated. So can you tell us a little bit, firstly about your background and who you’ve supported through this service

[12:52] – Sara

Yeah, of course. So as a clinical lead and an OT, my time’s split between seeing patients, often more complex patients. But I’ve also been involved with lots of team development and training, working alongside other colleagues from city care, from EMAS, from the ICB and from the county areas UCR teams so that we could develop the processes and the training for our UCR team at Nottingham City Care. We’re a predominantly therapy led team. We do have more nurses joining the team, so it’s been quite a shift in perspective, really, for our team, but with all of the training and the processes, we just wanted to be confident to be able to take on those new referrals from EMAS and we’ll see any patient over 18 with the Nottingham City GP.

[13:37] – James

Fantastic. One of the things that Karen talked about earlier was the brilliant collaboration that has been between partners. What’s your take on that, how’s that really worked, working across boundaries.

[13:50] – Sara

That’s been really good. The meetings that we’ve had with EMAS and the ICB and County UCR have just been invaluable really one of the team leaders from County and I speak regularly if we’ve got any issues or if we want to find out how they respond to a certain call or how we chat on the phone. It’s just been really really helpful. As I say, it has been quite a shift for our team and it is a new service, so just having that backup on that collaboration has been brilliant, really.

[14:19] – James

Thank you. And I think you’ve got a few examples to share with us around specific patients and the impact it’s had on those. So can you tell us a little bit about Jean?

[14:30] – Sara

Yes. So the first patient’s given us permission to use her name and her story. So her name is Jean Talbert. She’s 88 years old. We had a call from EMAS. Jean had fallen, she’d been on the floor for a couple of hours, not injured, lived on her own but had a friend there with her. So I and a colleague actually went to see her. We got there within a couple of hours, expecting to lift her from the floor, but she answered the door to us, which was a bit of a funny moment. Her friend’s had helped her up. She’s usually very, very independent, she just wasn’t able to get up from the floor because of some stiffness in her spine and scoliosis. But she was really, really keen for us to go in and to check her over. We did all of her obs, which were fine. We did our holistic assessment, got her up and walking around, checked if she needed any support, any equipment, any ongoing referrals, anything at all, really, which she didn’t. But she really appreciated us attending and she said she would send us a card which did arrive at the office the following week, and in the card she said thank you to the Falls team who came to my rescue. Whoever thought of this service is a genius. The team really listened and understood how important it is for me to be independent at home. So although we felt like we didn’t actually do very much in the visit, we did prevent the need for an ambulance crew to go out. We went there quickly and we were able to reassure her. And when I spoke to her a few days ago to ask for a consent to share her story, she said that she told everyone she knows in her age group about the service. She wanted to reassure people that there’s help and support available. She’s doing really well and continues to value her independence.

[16:05] – James

That’s fantastic story and we’re really grateful for Jean agreeing to share it because it’ll be really helpful for other teams to understand the impact it has on patients. Do you have any other examples where the services supported people in perhaps different ways?

[16:23] – Sara

Yeah, so another patient, it was a Saturday, an EMAS crew actually made a referral to us from a patient’s house, 87 year old female. The crew were worried about her generally being unwell, reduced mobility, not so unwell that she needed to go to hospital, but really needed care, support. She wasn’t really eating and drinking properly, not really taking her medication. Family were just worried about her whole situation falling apart, really. So we visited within an hour. We did our full assessment. We set up four care calls a day, which started that afternoon, just to support with all those things. We got some mobility equipment, we got a trolley so she could carry food, which she was struggling with, which then impacted on her actually eating because she couldn’t carry the food to where she wanted to eat it. So, yeah, we got all that sorted out really quickly. And as we were saying you know, sometimes people do need to go to hospital. We can’t always, despite our best efforts, keep people at home and actually with this patient, despite the support, she did continue to deteriorate over the next couple of days. She developed a calf and then she collapsed. She was admitted to hospital and tested positive for COVID. So even though this did ultimately end in a hospital admission for this patient, the kind of collaboration between UCR, EMAS and family and the patient all working together to try and keep her at home safely was really good. It’s just in that circumstance, the right thing was for her to go and be treated in hospital.

[17:48] – James

And the great example there is just how you were able to look at her care holistically, including provision of equipment and sort of additional support for how she could remain independent alongside that obviously clinical intervention that was required for her with a condition that she got at that time.

[18:08] – Sara

Yes, and I think because we’ve got such a multidisciplinary team, we can look at all those things so we can put daily exercise calls in. We’ve got almost 60 rehab support workers that can do those care calls. If we have capacity, we can do up to four calls a day, we can go every day to do exercises for rehab. We constantly review and go back to progress people’s independence. And if someone has those care calls in place from us and they do need long term care, then we do that referral onto Social services to assess that and we stay involved until that’s set up because obviously a patient needs that care, we can’t just leave them after a couple of weeks. So, yeah, so we kind of do that whole thing, refer to Age UK for all sorts of other bits.

[18:50] – James

Excellent. So why is urgent community response important from your perspective then?

[18:55] – Sara

I think that our aim as a UCR and kind of joint reablement team is that we always want to help people to be as independent and as safe and well as they can be in their own homes. And I think that collaboration with UCR and EMAS and all the other services that are out there as well helps us to do that. I think it’s given our team the skills to know when someone does need to go into hospital and does need that more urgent medical intervention. But ultimately, we’re just trying to all achieve the best outcome for the patient and as we’ve heard already, most of the time, that is to be cared for at home where possible.

[19:36] – James

Thank you all for listening to this podcast. I hope you found it really useful and continue to support and raise awareness of the importance of Urgent Community Response. It’s been great today to speak to Sara, Sarah, Karen and Daniel about the brilliant work that they’re doing and also to hear the fantastic case study from Jean as well. To find out more, please visit NHS England’s website and search urgent community response or visit the future NHS website and search for community health services. Thank you for listening.

[20:14] – end