MARLBOROUGH NEWS ONLINE GOES ON THE ROAD WITH A NEIGHBOURHOOD NURSE:
The first call of the day was at a care home in West Overton where a young man had a pressure sore that needed attention. Nurse Mandy Rose calmed him down, changed the dressing, asked staff if there was anyone else who needed to be seen, said ‘good mornings’ all round – and we were on our way to her next call.
Mandy Rose works on the Neighbourhood Nursing Team based at Savernake Hospital. The service was set up some years ago by NHS Wiltshire – the Primary Care Trust – to spread and improve the treatment of people where they live rather than making them travel to hospitals or surgeries. It’s part of the Community Health Service for Wiltshire now run by the Great Western Hospitals Foundation Trust. They’re the modern equivalent of the District Nurses who were once employed by local doctors.
Altogether eleven teams cover the county’s more than eighteen hundred square miles. They are managed by seven coordinators. Cate Judd manages the Devizes and Marlborough areas.
They are only responsible for the healthcare of adults – that’s those over eighteen. And they are only contracted to provide specific care and treatments. Sometimes they are asked to do “non-contracted activities” which involves paperwork and cross-charging.
The team at Savernake has sixteen nurses – three of them full-time and the rest on shorter contracts. Alongside them, there’s a team of therapists who work in people’s homes and at the hospital – physiotherapists, occupational therapists and support workers.
The team’s area stretches from Rambsury to Pewsey to Vernham Dean to the edge of Royal Wootton Bassett – and sometimes follows patients to Hungerford and Andover. Mandy is one of five nurses who cover the more central part of the area around Marlborough. It is very important, she says, that patients know who is coming to see them – continuity of treatment helps ease worried or confused patients.
They cover an area served by five surgeries and at any one time have a caseload of about five hundred patients needing some kind of health care at home. Patients are referred to the team by GPs, hospitals, care homes, carers, dentists and opticians – “By anyone who comes across a healthcare issue.”
The nurses use their own cars – and get mileage payments. Whether these keep up with the price of petrol is a moot point. Mandy drives about four hundred miles a month – but if they are working weekends when there are fewer nurses on duty, it can add a hundred or so extra miles. Our next calls will be at Merlin Court on the edge of Marlborough Common.
There are hurdles for the nurses to overcome. One of the commonest is the pass-the-parcel argument about who pays for treatment at home – NHS Wiltshire or the Council. Mandy wishes the government’s health reforms had brought in an amalgamated budget for the elderly covering both health and care: “And just let us get on with it.”
A man who cannot sleep and needs a special wedge pillow: should the pillow be on the care budget or on the health budget? Mandy thinks it’s a health matter because not sleeping will undermine his health.
Then there’s the problem of people needing treatment in Marlborough who are registered with a doctor in Ramsbury. It’s hard to believe in these days of digital communication, but sometimes nurses have to drive to Rambsury to fetch prescriptions because the Marlborough surgery cannot provide them or dispense the drugs.
We arrive at Merlin Court and Mandy has two dressings to change, has to check the records of a new patient and tend to an elderly man who’s had an unexplained fall and knocked a bit out of his elbow. He wants to look at the damage to his elbow and is helped into the bathroom to see it in the mirror.
She finds time to talk to the staff to make sure her patients don’t need anything else and that the fall was not down to a medical condition like a urinary infection. And she makes time to chat with the patients too.
Mandy has been with the team for five years: “So far it’s my longest stay in one job. I’ve been very lucky to be able to go where there’s a job I want to do – and not have to just take the next job.” She trained at Portsmouth. Qualifying in 2001, her first job was at Bath’s RUH just when it had to bring in outside managers: “Not a good time.”
So she went to a nursing post in Guernesy and then to Salisbury’s famous burns and plastic surgery unit. But they could not provide the training she wanted. So she re-trained at Leeds as a midwife – and then NHS changes meant there were no jobs for new midwives. So she went back to nursing first in Birmingham and then to Savernake.
Now Mandy is two modules into a five module training to become a fully-fledged Band 6 District Nurse which will mean she can become a line manager and look after a full caseload and liaise with GPs. The GWH are supporting her course as they know the average age of the nurse population is getting older and they want to be sure that in the near future they’ll still have highly qualified and experienced nurses.
The injured elbow has been dressed and we are off again toward the other side of the patch. “It can be a bit tiring, a bit trying in some situations – by and large it’s not too bad.”
On the up side, Mandy gets to see the Wiltshire countryside in all weathers and seasons. “I was crossing over the hill to Stitchcombe on my way to Ramsbury and a deer just stood there waiting for me to pass.” And just the other day, one of her colleagues stopped to help get a bunch of lambs off the road and into their field.
The nurses are much appreciated by their patients. They and their families often make gifts in recognition of the quality of care they’ve had. This goes into general GWH funds. But one grateful woman left the nurses a sum in her will for them to have for themselves.
We reached the other side of the patch. This call was to a fairly recently confirmed terminal case. So I waited outside.
Quite a lot of their work is about dying. Mandy reckons about eighty per cent of her patients are over seventy. “We’ve had that shift. Years ago people wanted to die at home. Then they wanted to die in hospital. Now it’s come back to dying at home. And if that’s best that’s fine.”
But it can cause tough problems at a tough time. Few people realise how difficult it is to fit proper beds and lifting equipment into a normal home and few people realise how many ‘strangers’ will suddenly start ‘trespassing’ on their home territory as the proper care is provided. All of that needs the nurses’ special skills.
Equipment is one ever-present strand of the nurses’ lives. There’s new equipment to use and as more people leave hospital sooner, Mandy and the team have to get used to more sophisticated equipment. Recently they had a patient who needed chest drains and the manufacturers came and showed them how they must be used.
A ‘phone call to Mandy asked if she could bring some extra supplies to one of her afternoon visits, so we headed back towards Savernake Hospital to collect them.
The team at Savernake have an excellent relationship with the Friends of Savernake Hospital who have provided them with some vital equipment and new time-saving (and money-saving) gadgets like the almost-instant INR blood test machines.
Mandy is surprised at how many people are now taking warfarin and need frequent blood checks – and the compact INR machines save nurses time and save the GPs and hospitals money. Each machine costs about £500.
Over a coffee back at Savernake, Mandy discussed the future. They were still settling in under the GWH regime and now the GPs were going to be commissioning them. The worry is that this might well increase their workload and she hopes the GPs will draw up a precise contract or else the balance between what can be done at the surgery and what needs to be done where people live will be lost.
Her next two calls were to complex cases of palliative care, so we agreed I should call it a day.
That famous book about the First World War judged that the British ‘tommies’ were “lions led by donkeys”. On my way home I was cheered to think that on the NHS’ frontline the lions are doing famously and make one feel safe and secure – it’s the donkeys in Westminster and Whitehall that make one worried.
Mandy drove off to her next patient. Perhaps with me no longer asking her endless questions as she drove expertly through the lanes, she was playing one of her CDs – The Greatest Hits of The Cure.