Patients and staff hail service which treats patients at home – and eases pressure on hospitals

A community-based service providing bespoke clinical care to patients in their own homes has been praised as ‘better then hospital’ by a Swansea pensioner.

Grandfather-of-six Derrick Jobson had earlier undergone minor surgery, but couldn’t shake a sickness when he returned to his home in Swansea.

Later, he would learn that in addition to Covid, he had an acute kidney injury and urinary retention, with further complications with his chest.

The 87-year-old urged his wife to call an ambulance as the nausea took hold, but none was immediately available.

At one time this combination of conditions would have meant a hospital admission. But Mr Jobson was instead offered the alternative of being treated by a team of healthcare professionals at home instead.

He said: “It was a perfect service as far as I was concerned. The nurses that came to see me were all very pleasant and considerate.

“I’m sure I had a better service than if I’d gone to hospital, as there staff have to divide their time amongst multiple patients, but with this service I had them to myself.“

The Acute Clinical Team (ACT) service takes that care directly into people’s own homes.

It provides medical and nursing care for adults in their own homes, most of them older and frail. They are able to carry out traditionally hospital-based assessments and investigations, including point of care blood tests, IV treatments or organising home oxygen.

And from a quiet start in 2005, the service has expanded and grown over the years, and in the last year alone prevented around 6,300 hospital admissions, saving around £12 million.

The first ACT team opened in Cimla in 2005 to prevent unnecessary acute admissions, as well as speeding up the process of being discharged from hospital. Its success led to the formation of a second ACT team based in Bonymaen nine years ago.

Feedback from patients like Mr Jobson has been very positive.

Recalling his ACT support last December he said: “I had felt really sick following my operation and my wife called for an ambulance, but we were told they wouldn’t be able to send one that day.

“I was getting worse, and the doctor told us about the ACT service, which I didn’t know anything about at that point.

“They sent people round to check me out and they did everything; blood tests, blood pressure, tests for water retention. I was eventually diagnosed with Covid.

“They kept coming to see me for a few weeks. Sometimes if it was necessary someone would come a couple of times a day.”

He added: “It was a fantastic service – I could not expect any better and I’m very grateful to them.

“The team who looked after me were there when I needed it most.

“I know they saved my life, and I am grateful for that. Being cared for in my own home was the best option that I could have wished for.”

By helping thousands over the years in their own homes, the service has avoided the need for hospital appointments, as well as reduced demand on other front-line services.

Advance practitioner lead at Bonymaen Clinic Sarah Osmond said: “The ACT team in Neath had been going for six years and had worked very successfully, and showed us what could be done.

“We want to able to provide equitable care across Swansea Bay, and because there was limited room in hospital, this clinic was opened with around 40 staff.

“Sometimes people do not recover as well in a hospital environment, so this enables us to provide an alternative.

“It can make a real difference in how quickly they recovery, as well as expedite their discharge from hospital.”

Since the beginning of January 2022 alone the two ACT teams are estimated to have prevented 6,299 hospital admissions, making savings to the health board of around £12 million.

But it is the service provided to patients which motivates the ACT teams.
Community staff nurse Sharon Price added: “Patients appreciate it so much. When they go to hospital they may be so anxious they don’t sleep or eat, sometimes they might develop bed sores.

“In the privacy of their own homes they are more relaxed.

“It is also a position of trust for us, to be invited into their homes, where we can help them get better.

“It is better for the family as well, as they don’t have to worry about getting to the hospital every day, so it is more convenient for them.

“They are always able to ring here if they need someone to talk to, and if they need a blood test we can get it done urgently for them, and if there is a problem we can get the relevant professional sent out after us to see them.
“The convenience of being seen at home is just amazing, and I am proud to be part of this team.”

Staff have also hailed the working environment.

Nurse practitioner Nick Howcroft returned the ACT at the Bonymaen Clinic after a three-year break in an alternative post.

He said: “I find it very rewarding compared to other roles I have undertaken. You are keeping patients out of hospital and helping them on their journey.

“If they recover you have done a great job, but sometimes if they are on a palliative pathway you do what you can to make sure they are comfortable and to respond to their and their family’s wishes. You are providing a hospital level of care in their own home.”

Community Staff Nurse Louisa Jones added: “It is better for patients and better for their mental health.

“I usually get itchy feet in a job after four years, but I absolutely love working with ACT. It is massively uplifting for patients.”

Dr Mikey Bryant said: “Patients love this service because it means they don’t have to go to hospital.

“They get a longer with a doctor on a ward who might have to be dealing with a number of patients at one time. It is a holistic approach with the home situation being considered, and which has huge financial implications by preventing hospital admissions.

“They also stepped up in an extraordinary way during the pandemic, particularly with the care given to nursing homes. It is quite a remarkable team.”


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