When a diverse range of health and care professionals work in tandem to deliver person-centred care, amazing things can happen.
In an exclusive interview with Neuro Rehab, Charlotte Robinson, Complex Adult Nurse at Alcedo Care, shares her company’s vital role in supporting Multidisciplinary Teams (MDTs) across the North of England and Wales to facilitate patient rehabilitation at home.
From ensuring seamless transitions from hospital to home and facilitating communication between patients and professionals, to translating clinical goals into daily routines and ensuring consistency in therapy - not to mention delivering an array of complex care services - Alcedo Care is helping to transform the lives of individuals with neurological conditions.
What are some of the services that you provide to support people with neurological conditions at home?
We provide a wide array of complex care services, such as bowel management and catheter care, which are vital, particularly to people suffering from spinal cord injury. We offer ventilation support, including non-invasive ventilation, as well as nutritional and hydrational support. Some people may have a PEG tube in situ or a gastrostomy, gastrojejunostomy, or NG tube – lots of different types of tubes – and our care staff are trained to care for each individual type. Our staff are also trained to recognise seizures, how to respond safely and follow specific seizure management plans.
But we don’t solely deliver clinical complex care – we also help maintain and promote people's independence. We teach individuals to use moving and handling equipment and how to care for it themselves. And even if they're unable to care for it, we talk them through what we're doing and why we're doing it, so that they have a level of understanding.
We also provide emotional, wellbeing and psychological support, as well as things like talking therapies and counselling. For me, the focus should always be on improving quality of life. So, for example, if somebody has dysphagia and it’s unsafe for them to swallow food and drink, we can support them to use Biozoon, which is a medical device that speech and language teams roll out. It turns liquid into foam, so that users can still enjoy the flavour without risk of aspirating.
Complex clinical care is not something all home care providers deliver. Have you provided these services since the start of your journey? And what were the key motivations for doing so?
Not since the start, no. Alcedo opened in 2017, and we developed a really strong reputation as an exceptional domiciliary care provider. We were meeting all the right needs, but we realised that there was a huge gap for complex care when we were doing our assessments. We were also approached by commissioners and case managers to deliver complex care after building our reputation for quality services.
So, in 2020 we registered for the regulated activity of the Treatment of Disease, Disorder or Injury with the Care Quality Commission and rolled out our services from there. It’s been a vital and beneficial change to both the business and local commissioners. It’s also helped us to maintain those professional relationships with the individuals we care for as their needs increase.
How do you support people with neurological conditions to transition from hospital to home?
Alcedo employs a big team of nurses, some of whom have an extensive background in intensive care, ventilation support, palliative care and district nursing. And because we have such extensive experience within the nursing team, we've been able to support people to get people home quickly.
We start the process by doing a thorough nurse-led assessment of current needs, including clinical, wellbeing and emotional needs. That takes place either in hospital, at home, or wherever the individual needs us. From there, we conduct a mobilisation. That involves identifying needs and highlighting the training and competencies that are required.
Later, we’ll do things like meet and greets to ensure carers and clients are well matched and feel comfortable with each other. While that’s going on, we’ll roll out the training. Our nurses deliver the training in-house in a classroom setting. Once a care professional has completed the training, they’ll then undertake supervised practice before they are assessed and signed off as competent to deliver complex services.
Our nurses will then delegate the activities that are required and the operational teams will deliver a care plan that is specific to individual needs. We’ll also order the consumables that people need to be able to live at home, such as medications, and ensure that all the equipment they need is serviced. It's a really robust plan and it works fantastically.
How do you collaborate with MDTs to support a person’s rehabilitation?
Initially, we would seek to recognise which MDTs are actively involved in the patient’s care. We build a rapport with those teams and then work with them to identify the needs of the individual.
We recently supported a lady who was under the care of an occupational therapy team. The therapists showed our care staff the exercises she needed to complete, and we then cascaded this training to the rest of the team so the MDT wouldn’t need to repeat the instructions with every staff member.
We also monitor changes in individual conditions and escalate any concerns to the MDTs. It might be that the client has a respiratory care plan in place, so we would carry out clinical observations and then record any changes outside of those baselines. If there are changes, the MDTs may then do a home visit, potentially preventing their patient from having to go to hospital.
We also support individuals’ mobility goals and if there’s any changes in their mobility, we’ll reach out to physiotherapists, who might do a home review and roll out a new moving and handling plan. They might also train our care staff on new specialist techniques, that we’ll then implement into our daily tasks. Each care plan is very much tailored around the MDT support that their patient receives so that we can continuously provide that support at home.
It sounds like your work is crucial to the MDTs. Do you think they could do their jobs without the support of your care staff?
I think it would be very challenging because there's not enough financial support or resources to enable MDTs to deliver the high level of care and support that people deserve. If you're an OT, for example, you want to be able to support the person you care for whenever they need you, but when you're responsible for so many individuals in the community, that’s realistically impossible.
Our teams are in people’s homes day in, day out, which means we can put MDTs’ care plans into practice, encourage people to attend appointments and engage in exercises, monitor their progress, and provide feedback. The MDTs really appreciate this level of support. So, we definitely work in tandem to increase patient safety and improve outcomes.
Could you provide some real examples of how your collaboration with MDTs has made a measurable difference to the lives of individuals?
Absolutely. One individual who we care for is living with motor neurone disease. They have vast complex care needs, including bowel and bladder needs, and are dependent on 24/7 ventilator support. They had spent a long time in an intensive care unit and, sadly, many care providers were unable to meet their needs, until we stepped in.
We did the risk assessment in hospital, rolled out the training and were able to get that person home. During their time in hospital, their care had been so clinical that their emotional wellbeing had been overlooked. Now, that person is thriving. They have even been out in the community and engaged in social events with the support of our care staff. It’s meant that they’ve been able to enjoy life again.
We have another individual who is living with spinal cord injury. Shortly after the injury occurred, they could only move one finger and were told by a consultant that it was very unlikely that they would walk again.
We worked in collaboration with the MDT, who rolled out a care plan for intensive
physiotherapy, which we were able to implement into daily visits. We’ve been delivering this care for a year and a half now and that person is actually able to walk with a Zimmer frame. This is so wonderful to see and reminds me that caring for others isn’t a job, it’s a vocation.
What are your thoughts on how home care providers should be better supported by the government, given its desire to move complex care services out of hospital and into the community?
There's clearly a national ambition to deliver more care within the community, but for this to succeed sustainably, home care providers need greater recognition and integration within the wider healthcare system. We also need long-term funding models to deliver complex care at home. This would allow providers to support more people, retain their staff and invest in clinical training.
I’m not sure the government really understands how integral healthcare assistants are. They care for tracheostomies, provide long-term ventilation support and much more, but that recognition isn’t there, and it should be, because those professionals are worth their weight in gold.
MDTs must be incredibly frustrated because they have patients with healthcare needs that they know need addressing, but they simply do not have the time or the funding to be able to meet those needs. That’s where companies like Alcedo step up to recognise what’s needed, advocate for patients and make sure those individuals receive the care they deserve.
Where do you see the future of complex clinical care heading to support people with neurological conditions in their own homes?
I think we have started to slowly see some of the changes that are required to help keep people safe at home. Services like virtual wards and rapid response teams are integral to this.
Long-term ventilation teams are also vital. Their work includes reviewing the settings on a ventilator, taking blood gases and tailoring prescriptions for medications like steroids that can be administered at home. We also use GP Connect, which allows us to access information from a GP home visit in real time. The GP may have left an instruction, for example, that if there’s no sign of improvement after 24 to 48 hours, we should re-escalate our concerns to them.
That’s all happening, but funding and resources need to grow in abundance because MDT collaboration prevents hospital admissions and eases pressures on the NHS. I recently visited the home of an individual and we did a FaceTime meeting with a specialist in long-term ventilation, a speech and language therapist and a GP. We were able to share ideas, address any concerns and request what we thought we needed. That kind of collaborative working is vital for individuals, and we need much more of it.