Healthcare Commissioning Forum

In order to develop and facilitate the cardiologists incorporating seven day working into their job plans and taking part in the CoW rota, it was necessary to remove them from the acute medical rota. This was negotiated through discussion and assurances that the cardiology team would review all new cardiac referrals throughout the trust within 24 hours.

The development of the CPAU required additional resources and funding was secured, in part, through the South Central Cardiovascular Network and PPCI business case. This enabled the updating of the monitoring system and the provision of an additional four WTE band five staff nurses. The increase in staff numbers was required as the number of CCU beds increased, which led to an increase in workload for existing staff.

The changes also had an impact on junior doctors as the amount of cardiology decreased for those not on a cardiology rotation. In order to be able to carry out ETTs outside of the normal working hours, the senior cardiac physiologist agreed what the guidelines were and provided training for a nurse led ETT.

The current culture of the delivery of health care remains all too often 'do to' rather than 'work with'. There are challenges around widely shared expectations and behaviours:

The balance of power in encounters; "I don't know, you're the doctor."

That the professionals will 'cure' or at least 'fix' the individual.

That mental health issues are split off- people with mental health issues are less likely to be able to self-manage effectively and people with multiple LTCs are more likely to be overwhelmed by disease burden and become anxious/ depressed.

A problem-saturated view, where an individual's strengths and the assets in their community are not explored or acknowledged.

One of the core aims of encounters between people with LTCs and professionals needs to become the improvement of the knowledge, skills and confidence of the individual to self-care which requires a respectful partnership based approach: "Over 90% of people with LTCs say they are interested in being more active self-managers and over 75% would feel more confident about self-management if they had help from a healthcare professional or peer. Despite this, many people with LTCs have limited knowledge of, or influence over their care. Despite considerable efforts to tackle the most important area, namely the effectiveness, quality and focus of consultations between patients and clinicians, the most significant problem is the reluctance of clinical staff to provide active support for patient engagement. Unfortunately, shared decision making for example, is less common in the UK than in many other countries."

The DEMHOS research looked at the type of ward that people with dementia are admitted to. As expected, with a range of acute physical conditions being the cause of admission, people with dementia are prevalent in a variety of general medical and surgical wards. Indeed, 97% of nursing staff and nurse managers who responded to the DEMHOS research reported that they always or sometimes cared for someone with dementia.

The research also found that the prevalence of people with dementia varies by type of ward, as estimated by nursing staff. For example, 10% of nursing staff respondents said that they currently worked on an elderly care/acute medical ward. Of these respondents, 25% estimated that around one in three people on the ward is a person with dementia at any given time and 50% estimated that at least one in five people on the ward is a person with dementia.

• Elderly care/acute medical - 10%
• General medical ward - 9%
• Surgical - 9%
• Orthopaedic - 8%
• Rehabilitation unit - 6%
• Other ward/no ward mentioned - 58%