Integration in action at Midlothian’s Hospital at Home Service

“It’s a whole community thing rather than just a health and social care thing”

Integration can be transformative, making such a positive impact on the lives of those who benefit from partnership working. Midlothian’s Hospital at Home service is one such example. Designed to provide an alternative to hospital admissions for particularly frail elderly people, the service is offered as an option for those that can be treated at home, reducing the need for admissions.

Midlothian Health and Social Care Partnership wanted to do something different for frail older people and gave the team setting up the service a freedom to design the service. Taking its first patients five years ago in the summer of 2014, Hospital at Home was built up slowly following a stock-take of similar set ups Scotland-wide.

The core team, made up of Dr Patricia Cantley, a consultant physician, Dr Lizzi Boyce, a GP and a team of highly trained nurses, now work closely with a variety of services across the area to make the service work smoothly and efficiently for those who use it.

Dr Cantley says “integration is our unique selling point. We work in addition to a multidisciplinary Rapid Response Team and we remain closely linked with them. We have a community base.”

The team liaises with the main area hospital and the community hospital and works closely with psychiatry colleagues, who are especially involved with dementia patients and who are based in the same building as the core team. Co-location is a key concept and as Dr Cantley notes, “computers don’t talk to each other, but people do.”

District nurses also work in tandem with the team, with Dr Cantley pointing out that the simple act of sharing a lunch break builds relationships that impact positively on the work with shared patients. The service is one based on human contact and collaboration.

Senior nurse Sharon Demspey points out the success of Hospital at Home in terms of the benefits to those who access the service. “Most people actually like the idea that they can receive care in their home environment, it takes out that worry. Patients are amazed at how much we can do and like the fact that we’re at the end of a telephone.”

The service is continually evolving with a further partnership with the Red Cross in action, whose staff are now seen as a key part of the team. They work on everything from helping people access benefits to resuming their hobbies and improving their general quality of life.

In terms of the future, Dr Cantley is ambitious for the service. “People we would like to do business with a lot more are the Paramedics and the Ambulance Service. We would like to receive calls from them and take referrals in the future, if they think the patient could be manageable at home.”

Dr Cantley’s vision of integration is wide ranging. “I see integration as health and social care, family, voluntary services, ambulance services… it’s a whole community thing rather than being just a health and social care thing.”

Hospital at Home provides a prime example of best practice in integration, with strong working relationships being a key to success. It will be interesting to chart the development of the service and note its growing impact on the local community.