https://connectingtopatients.blog.gov.uk/2013/10/08/guys-st-thomas/

Five days felt like five weeks

Pic of Sam Lister
Sam Lister

Five days connecting felt like five weeks – such was the pace and variety of experiences during my time at Guy’s and St Thomas’s.

My contact with the service was essentially two parts of a care pathway – stretching from the care provided to people coming into St Thomas’s busy A&E to the services provided in the community allowing patients recently discharged from hospital to settle back into their homes.

I spent the first half of the week in the Emergency Department, including at the Emergency Medical and Resuscitation Units and the Urgent Care Centre. I shadowed the work of the nurses on the front desk triaging people arriving – from the overly stoical patient who had struggled in unassisted with a serious kidney complaint to the elderly woman who came in by ambulance for a back twinge, and who needed no more than a check-up with the in-house GP.

Many patients moved into the Emergency Medical Unit, where the team of consultants and nurses worked meticulously through a relentless procession of patients who would either become a hospital admission, or be discharged within a few hours. Many were elderly, and many could be described as regular attendees (including one patient who was checked into the emergency ward for the 217th time). There was also a steady stream of younger adults with drink and drug problems, and a noticeable number of people with mental health issues.

Rapid response in the community

The second half of the week focused on the other half of the care pathway, working with a community support rapid response team in south London. The team helps those discharged from hospital to adapt to their health conditions at home during the first six weeks, or takes referrals from GPs for those needing support. The skills deployed by community teams ranged from providing nursing and re-enablement services to also helping families adapt to changed and challenging circumstances. The impact of loneliness and a positive mental attitude on the prognosis for elderly people returning home was striking.

This care pathway provided a valuable context for the communications campaigns we are currently working on in the Department of Health – including support for vulnerable older people and our focus on compassionate care in our response to the Francis Inquiry report. It also provided insights into issues we discuss frequently in the Communications team, such as how the 4-hour standard in A&E is being met, and the efficient management of patients needed to do so.

What insight have I gained?

I came away with dozens of different insights – examples of challenges being tackled, pressures being felt, innovative thinking and energising engagement with issues that will be happening week-in, week-out in the NHS around the country.

My experience also covered some cross-cutting teams – from the front desk and portering to patient complaints services and the hospital mortuary – and these provided sight of the broader functions in a big teaching hospital. This illustrated the vital softer skills deployed across these teams that are formative to patients’ experience of care.

The staff were inspiring and engaging – approachable, accommodating and highly professional, but also had the confidence to be honest about how the Trust worked, and the challenges it faced.

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