‘I wish this had been here for my Nan’: How the Jean Bishop Centre continues to transform care for the elderly
‘PATIENTS ARE HEALTHIER AND HAPPIER’: Consultant Community Geriatrician Dr Dan Harman. Pictures by Neil Holmes Photography
By Simon Bristow
When the Jean Bishop Integrated Care Centre opened in Hull nearly five years ago, it marked the beginning of a pioneering new era for the care and treatment of older people.
For the first time, the multi-disciplinary assessments of a patient’s needs and condition could be carried out on the same day under the same roof, doing away with the long-established practice of a series of appointments with different specialists in different clinical settings, often over a period of weeks if not months.
This vastly improved the experience of patients and their families or carers, reduced hospital admissions, and as new research shows, achieved better outcomes for patients. There have been more than 12,000 of them since the centre opened in May 2018.
And now the Jean Bishop Centre and City Health Care Partnership CIC (CHCP) is at the forefront of another innovation – delivering virtual wards, or “hospital at home”, in the community. This again is not only benefitting patients, it is providing welcome relief for a health service under extreme pressure, and perhaps offers a glimpse of the NHS of the future.
‘WE SAW AN OPPORTUNITY TO TRY SOMETHING DIFFERENT IN HULL’: Dr Dan Harman
The unique and award-winning building was built by development specialists CityCare, specifically to support the service model. The centre, which was the first of its kind in the UK, was named after the tireless Hull fundraiser Jean Bishop, affectionately known as “The Bee Lady”, who died two years ago aged 99.
“We’ve got Jean’s legacy and it matters, naming it after a person who epitomised ageing well and living well,” said Dr Dan Harman, consultant community geriatrician, who along with colleague Dr Anna Folwell, was integral to developing the service model.
Dr Harman’s professional input was also informed by his personal experience of how difficult the process of caring for someone with frailty could be before the Jean Bishop Centre model was available.
He said: “One of the reasons I got really interested in geriatrics was I was very close to my maternal Nana, and she developed dementia when I was still down at university and lived with dementia for about ten to twelve years and ended up in a care home in Hull in her later years. Trying to navigate that care system probably caused more stress than trying to support a person living with dementia.
TRANSFORMATIONAL: The Jean Bishop Integrated Care Centre in Hull, which has welcomed more than 12,000 patients since it opened five years ago
“And that’s nobody’s fault because there are brilliant teams working in mental health, in physical health, in primary care and secondary care and social care, it’s just not joined up, or it wasn’t.”
He added: “This is not perfect, there are always things we can be working on, but one thing we really have tried to work at is integrating those different care offers, and you know, I think if my Nan had been alive today and she’d come through this kind of model I think that the anxieties both for her and for us as a family would have been different.”
Explaining the thinking behind it and how it works, Dr Harman said: “We were acutely aware that older people across Hull were having relatively poor healthcare outcomes, often being cared for in the wrong place of care at the wrong time, and I think that was a problem that was replicated up and down the country.
“We were aware that we had an ageing population, an increase in the proportion of the population living with frailty, and multiple health conditions in the same individual, who often had various services interacting with them that perhaps weren’t talking to each other in the way you would anticipate your care should be delivered.
PART OF A MULTI-DISCIPLINARY TEAM: Occupational Therapist Kristina Brown, right, and student Occupational Therapist Steph Percival
“And we saw an opportunity to try something very different in Hull with it focused on the individual and their families and respecting choice around preferred place of care, and trying to bring a specialist team together in a one-stop shop – patients refer to this model as a bit of an MoT.
“So you will see multiple professionals from different disciplines, including social care, therapies, nursing and meds management, working together on an integrated care plan that’s shared with the patient, the hospital, the GP, so everybody’s on the same page, and most importantly the patient has agreed to that plan as well .”
He added: “ It's also really important that we can offer the same service regardless of place of residence. So if the patient lives in a care home then we take the team to the patient and complete the same assessment.”
Describing how the centre has changed things, he said: “If you go back to prior to the Jean Bishop Centre being opened, as a specialist, as a consultant geriatrician, I would see patients in a traditional out-patient clinic that had been referred by their GP with a very specific problem to answer.
“I would perhaps, if lucky, have a clinic nurse with me so we could carry out some nursing observations, some blood tests etcetera. I wouldn’t have anybody from occupational therapy or physiotherapy, wouldn’t have access to social care or carers’ support or the meds management in the pharmacy team.
“If I needed that involvement that care could occur over a period of weeks between different provider organisations, sometimes months even, and the same with things like diagnostics – X-rays and bloods and CT etcetera – so it’s nonsensical, really, to think you couldn’t improve the efficiency and the experience.
“By bringing things together we can make such a difference to that patient. Not having to attend five or six outpatient appointments is one of the things patients tell us is really different about this place.”
As well as improving outcomes for patients and easing the burden on hospitals, research has signalled this anticipatory care model could also achieve significant cost savings for the NHS.
PROUD LEGACY: A plaque commemorating Hull’s “Bee Lady” Jean Bishop at the centre which bears her name
Dr Harman said: “We could demonstrate that we reduced unnecessary emergency department attendance by between ten to twenty per cent for the patients under our care.
“But also, one of the things as a specialist frailty team that we do look at is medications, polypharmacy, five or more medications.
“As people age they can accumulate medications that various clinicians are prescribing, obviously for the right reasons, but as you age, the way that you absorb, break down and remove medications changes so you can get this sort of toxic build-up of medications that were started for the right reasons but now may be contributing to feeling unwell.
“So we can often make people feel a lot better, both physically and cognitively, by overseeing and reducing the medications that they’re on. And obviously there’s a cost association with that in terms of medication costs, so we can also demonstrate a greater than £100 per patient per year cost saving in just the medication costs alone, which is not insignificant for the health service.”
It is estimated this could save the NHS £53m a year.
TRANQUIL: The Jean Bishop memorial garden at the centre
The comprehensive geriatric assessment service, or anticipatory care, runs five days a week. The centre also provides a reactive care service, or urgent community response, seven days a week.
Dr Harman said: “This urgent community response isn’t just for frailty, this is for all adults aged 18 and above. But because we collate the data we know over 95 per cent of the calls are related to people living with frailty.
“We can get a visiting service out from our team, and we’ve tried to utilise digital wherever possible, so we do a lot of video consultations through that model because we’re covering a huge geographical area.”
This increased use of technology has led to investment in devices such as Tytocare, a digital stethoscope, which allows the deployment of clinic support workers, or healthcare assistants, who are trained to use them. Dr Harman said: “They will visit the patient in their own home and we can direct from our screen where to place the stethoscope on the chest so we can listen to heart sounds and lung sounds remotely.
“What that means is if you’ve got a doctor, which is an expensive resource, and a clinical support worker who is highly skilled, obviously we can employ more clinical support workers than we can doctors. We can physically examine patients remotely, making the care safer and more effective in terms of the decision-making and hopefully improve the patient experience, because the only other thing would be to get the patient to an urgent treatment centre or to A&E.
“So in terms of quality I think the safety, experience and effectiveness are all improved by utilising tools such as Tytocare.
“We also have urgent care practitioners who can go out and complete clinical examinations and we use point of care testing, which allows us to do near-patient blood tests which can give us rapid results, so we can decide around the safety of keeping somebody at home or do they need to go into hospital, for example.
“We are trying a raft of different treatments seven days a week to provide that urgent community response, and then if we feel, having delivered that, somebody needs to come into the proactive, anticipatory care model, we can get them in the next week, so we are trying to link the two models together.
SKILLED AND DEDICATED: Clinical Support Worker Deborah Bolton
“And the bit of the jigsaw that was missing in there is what happens if you’ve got somebody that needs maybe two or three days, ten days of ongoing support, wants to remain at home, and that’s where the virtual wards come in. Virtual wards are about delivering hospital-based interventions in the patient’s own home.”
Funding for the virtual wards was given last year and the service became operational in December. “There are two virtual ward models in Hull and the East Riding,” Dr Harman said. “One is the frailty model which CHCP run, and then there’s a respiratory model for patients with an acute lung infection which is run by our respiratory colleagues from the hospital.
“The way that we operate virtual wards is if somebody has an acute problem in the community, say infection, but their mobility has declined, they are going to need therapy interventions, they are going to need antibiotics, they might need some oxygen, and they need care that is not going to be sorted in one day.
“So we then admit them onto our virtual ward. It’s the same team caring for them but they get daily input, a combination of face-to-face input from our advance community nurse practitioners within CHCP and from our doctors through the advice and guidance and the urgent community response team, and the doctor can visit if necessary as well. But again you can see more patients through a virtual ward if some of this can be done distantly or remotely.”
‘IT’S VERY REWARDING’: Dr Dan Harman on the results of the recently published first academic research into patient responses
NHS England’s ambition for a population the size of Hull and the East Riding is to have 300 to 350 virtual ward beds – the equivalent of a virtual hospital. Virtual wards are operating across the country, with a lot of shared learning between areas and teams.
As well as supporting patients who need care to remain at home, which is often the wish of them and their families, the cost savings for the NHS as a whole are potentially huge. Dr Harman said: “There was a recent publication by the British Geriatric Society which found the cost of delivering the same care in home is about half of what it is in hospital, so it’s about a 50 per cent saving for the health system.”
An independent academic study focused on patient responses to the Jean Bishop model has provided the most encouraging results for Dr Harman and his colleagues, and for those far-sighted health and care leaders who helped bring it about.
The three-year study with the University of Hull was the first of its kind and looked at patient-reported outcomes from people who had experienced the Jean Bishop Centre model.
NHS OF THE FUTURE: The Jean Bishop Centre is also helping to deliver virtual wards, or ‘hospital at home’. Dr Dan Harman, left, with Senior Admin Assistant Heather Darley
Dr Harman said: “It was published in February and it demonstrates a sustained improvement in the emotional and physical wellbeing of people living with frailty who’ve come through this type of model.
“And so for me as a clinician, yes I’m interested in the numbers and of course I don’t want people to go to hospital if they don’t need to, but as important, or probably more important for me as a clinician, is how do patients feel going through this kind of care?
“So to conduct research with outcomes that demonstrate the positive experience of patients, that’s really rewarding.”
The Jean Bishop Centre and its virtual wards were featured in a recent BBC Panorama programme, The NHS Crisis: Can It Be Fixed? which can be watched via the BBC iPlayer here.
Humber and North Yorkshire Health and Care Partnership comprises of NHS organisations, local councils, health and care providers and voluntary, community and social enterprise (VCSE) organisations. We work across a geographical area of more than 1,500 square miles and serve a population of 1.7 million people. Our areas include the cities of Hull and York and the large rural areas across East Yorkshire, North Yorkshire and Northern Lincolnshire.
