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As an out of hours GP, nothing can be more soothing to hear than the words “package of care”.
Think of the setting, the very familiar crisis of a long-widowed frail patient, living up until now independently, who tips over edge following a UTI, fall or similar event. Often in their late 80s, with no family nearby, who by product of their generation would not readily ask for, or accept, help. Typically, the patient doesn’t require a hospital admission, and is quick to tell you they do not want to be admitted if possible. If you are lucky, a call to a community assessment team, be it a nurse-led crisis team or rapid response service, leads to “thank you Dr Piggott, we will call around and assess the patient today and arrange a package of care”. I can say from repeated experiences locally to where I work, these services are excellent. They typically include an urgent home assessment and provision of carers and/or night sitters, and following on from this input from social workers, occupational therapists, physiotherapists and district nurses if required. Seeing the patient as I do, usually as a one-off encounter, it’s difficult to follow the journey the patient takes after this is, in regaining independence and wellbeing as far as possible.
This lead me to reflect on the very personal experiences over the last two to three years of older relatives that nearby to me, and yes, I did ask their permission prior to writing this article. The relative in question, after a good old bout of urosepsis, found in himself very much in the above situation. Incidentally, he had a nephrectomy in 1947 – I wonder if he was one of the first patients on the NHS to have had this operation? Moving on, the above mechanism for his home care worked smoothly and quickly, and a flurry of activity lead to our new favourite term; a “package of care”.
But what interested me were not just the clinical aspects of what my relatives immediately required, but what helped them, over a very long period of time, to reach a quality of life and level of independence they had previously enjoyed. They had effectively arranged a “do it yourself” package of care. There are so many things in our day to day lives that we take for vantage. Things so simple and second nature, we don’t even think about them, or perhaps until we are unable to do them. The immediate ones are obvious; cooking, cleaning, using the toilet. But how about clearing a garden, going to the dentist, or withdrawing money from a bank?
Slowly but surely, and with a little help along the way, they began to construct and arrange ways of returning to their independence. A neighbour recommended a trusted gardener, who even took my them to a hospital appointment (not bad, for £10 an hour). The Parish magazine directed them towards a chiropodist who would visit them at home. A friend suggested a local lady who did hairdressing in customer’s homes. In time, they had these, and a window cleaner, a coffee morning group, an odd job man and a visiting community optician for good measure. Once the acute illness had resolved, these almost invisible community services and networks restored their confidence and enjoyment of life. They certainly now have a more active social life than me.
Oh, and what of the author, this heroic young doctor ? Well; he takes the bins out every Thursday night.