From making sure frail and older patients spend as little time as possible in hospital, to anticipating their needs in the community to avoid illness, the NHS in south west London is helping improve the experience of people and their families – as well as freeing up space in busy hospitals.
“I find specialising in Frailty really rewarding. This is a group of people who are really quite vulnerable when they come to the emergency department and the hospital – they need a lot of care, and they need that care in a timely manner. My job is to help patients get back on their feet and home, with the right support and treatment, and in the way that they want.” Says Towhid Imam, Consultant Geriatrician at Croydon University Hospital.
Towhid heads up the frailty same-day emergency care assessment area, which sees patients experiencing frailty. His team work hard to keep people both out of A&E, but also to get them home as quickly as possible – often the same day they come in. The team work very closely with London ambulance crews, care homes and other support services in the community too.
Towhid explains: “A typical day starts by going to A&E at 9am and meeting my team of Frailty practitioners. We’ll be looking for patients experiencing frailty who are currently in our very busy A&E. For any patients we identify for the frailty same-day emergency care assessment area, we will transfer patients there. It’s a lot quieter and easier to assess people. It also allows them to recover from an acute illness in a better way.”
“Once I’ve assessed patients, we make decisions about what support to put in place for people, such as physiotherapy or carer-support. Hopefully we’ll then get people home the same day to recuperate and recover there.”
The patients the service typically cares for include people who have recently had a fall, or are having issues with walking. Patients often have arthritis, cognitive problems or another medical condition, which could mean they are losing their independence at home. When seen by the frailty service, people might also have other medical problems that they haven’t seen a doctor for previously, or they’ve been unable to see the right professional.
The relief that they feel when I’ve delivered that care is what makes it worth it.
Towhid explains how the service joins the dots for people: “When people come into the frailty same-day emergency care service, the team can unpick a lot of their problems, by taking the time that person needs to get them back on their feet and address all their issues.”
“The best thing about my job is when I’ve seen a patient and their family or carers, and they’re just so grateful that someone who has got the right skills and experiences, has been able to speak to them and taken the time to address things that might have been wrong for a while. The relief that they feel when I’ve delivered that care is what makes it worth it.”
Other hospitals in south west London also have similar approaches – focusing on patient needs and ensuring their journey through different services is as smooth as possible. This also includes work led by GP practices to proactively identify patients who might be at risk of developing health conditions which, if not prevented, could lead to hospital admission. In Kingston this is called ‘proactive anticipatory care’.
Consultants like Towhid are making a huge difference to people’s lives on a daily basis – he explains his passion for working in the NHS “I’ve always wanted to work in the NHS. It’s a family affair. My mum used to work as a GP receptionist and my dad was an accountant for St George’s Hospital. What’s quite vivid in my mind is the care they’ve received over the years. My dad, when I was quite young, was critically unwell at one point, and if it wasn’t for the hard work of St Goerge’s and the Royal London Hospital he wouldn’t be alive today. So, for me it’s an honour to work for the NHS, to help people in such a meaningful way and give back.”