Journal of Community Nursing - page 15

2013,Vol 27, No 4
Dementia cuts
across all health
and social care
Katherine Gowing, Associate Specialist
for Crisis Home Treatment, Dorset
University Healthcare Trust.
This is particularly important
where GP referrals to dementia
services often involve people
with comorbid conditions,
resulting in both physical and
mental health issues.
‘It doesn’t matter what the
cause of the behavioural and
psychological symptoms of
dementia are,’ Michael continues,
‘as the team can manage pretty
much anything. But, under
previous ways of working,
these referrals might have been
considered inappropriate.’
This acceptance of collaborative
working is also apparent in the
way that the service involves the
voluntary sector as part of
the team.
‘We’ve been successful in
integrating the voluntary
sectorinto secondary health
services,’ Michael says. ‘This is most
beneficial within the acute hospital
where dementia support workers
promote an improved care culture.
Rather than being viewed as a
threat by the doctors and nurses in
the hospital, they would like more
of them!’
The service’s seven dementia
cafes provide a mixture of support,
activity and social interaction,
with different disciplines visiting
to provide practical advice —
pharmacists or physiotherapists,
for example. Crucially, it is the
attendees — a mixture of people
with dementia and their carers
— who decide what they want in
terms of speakers and activity.
‘In my experience, most
support comes from meeting
with other people who share the
same experiences associated with
dementia, whether they are a service
user or carer,’Michael says.
He is keen to stress that:
‘Dementia crosses all health and
social care boundaries and staff want
to work together on these issues.’
It is not just in dementia care that
strides toward integrating health and
social care are being made, however.
Katherine Gowing, Associate
Specialist for Crisis Home Treatment
at Dorset University Healthcare
Trust, mirrors Michael’s comments
about collaborative working and
innovative thinking.
‘Collaborative working is now
almost generic within the service,
with social workers, occupational
therapists, doctors, psychologists and
nurses all bringing their own skills
so that the service almost becomes
homogenised,’ Katherine says.
‘The team in Dorset uses a model
where everyone brings something
specialised, be it mindfulness, advice
on nutrition, acupuncture, or hand
massage, for example.’
Katherine stresses that it is
important for day care services to be
portable, with the skills able to go
where the patient needs them.
Another vital aspect, she says, ‘is
developing good community links
so that you can call on services as
soon as they are needed, such as
people who know about housing
benefits, Alcoholics Anonymous
(AA) teams, or even nurses who
are happy to pet-sit when inpatient
care becomes necessary’.
Trying to anticipate a ‘crisis’
in the community involves every
member of the team thinking
around the problems so that the
right help can be put in place. In
Katherine’s experience, some of the
most valuable information comes
from seeing patients ‘out and about’
in the local community.
‘We might pick up on some
vital information just in passing
that will trigger the introduction
of another aspect of care,’ she says.
‘We all need to be alert to carer
strain and continually assess the
wider family and look at their skills
to see what they might have to
offer — thus taking collaborative
working a step further’.
What is obvious from the
examples above is that asking
health and social care teams to
work together is not always going
to be easy — there is a lot of hard
work, compromise and innovative
thinking involved. But, they also
show that some localities are
making inroads by putting the
old divisions aside and building
functioning models of care.
Perhaps one day, health and
social care professionals will look
back from the comfort of a fully
integrated service with no political or
budgetary divisions and marvel that
it took so long to get there...
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