Across Mansfield, Ashfield, Newark and Sherwood, eight multidisciplinary Local Integrated Care Teams work with patients, families and carers to provide more care at home to help patients live well with their health conditions.
Peter and Sandra Elliott, from Mansfield in Nottinghamshire, tell their story about the invaluable care they’ve received from the Local Integrated Care Team and the difference it’s made to their health and well-being.
Peter and Sandra’s story:
Husband and wife, Peter (65) and Sandra (59), both suffer from complex long-term health conditions. Sandra has asthma, high cholesterol and type 2 diabetes. Peter has Chronic Obstructive Pulmonary Disease (COPD) and angina, a condition which can cause chest pain. The couple were regularly in and out of hospital.
Sandra’s GP originally arranged a visit from Hiedi, a respiratory nurse specialist with the Local Integrated Care Team after identifying that she was increasingly calling for an ambulance at times when she could probably manage her asthma, with support, at home.
“Hiedi referred me to an Asthma Specialist at King’s Mill Hospital” says Sandra. “She taught me how to manage my blood levels and inject myself with insulin for my diabetes. I now have a better understanding of my conditions making me feel more in control; Hiedi has been invaluable.”
Peter is also supported by Hiedi for his COPD, and Katrina, Community Matron, for his angina.
“During a routine visit Hiedi tested my breathing, as a previous diagnosis of Asthma didn’t fit in with my symptoms” said Peter. “The results confirmed I had COPD. I was prescribed medication and my breathing has significantly improved.
“Katrina’s visits have really built up my confidence too. She talked through my angina symptoms, making me more aware of the warning signs and when I needed to get help. This was an important step in helping me to know when it was appropriate to call for an ambulance.”
The team also offered support when Sandra spent six days in hospital with pneumonia.
“Hiedi picked up on the pneumonia during a visit and arranged for Sandra to be admitted” says Peter. “It was very worrying but Hiedi was so reassuring. She visited me at home too, making sure I was ok. It’s the little things that count.”
Falls and occupational therapy (OT) specialists also visited Sandra after she had a fall, providing exercise and equipment which helped maintain her independence and prevent further hospital admissions.
“The Integrated Care Team has really helped us get to where we are now with our health” says Peter. “We know we can phone them or they will visit us and we don’t have to ring the GP or go to A & E. We’ve hardly attended hospital since receiving support from the team.
“Our illnesses do get us down at times. But we try not to let it stop us from doing the things we enjoy. Sandra loves to feed the birds, I like going to football matches and gardening. Katrina has put me in touch with a Self-Care Advisor, who is also part of the Integrated Care Team, as I’d love to do some voluntary work involving computers.”
“Hiedi has also referred us both onto a six-week Pulmonary Rehabilitation Programme which provides exercises and advice on managing our symptoms. We are looking forward to that” adds Sandra.
Katrina and Hiedi have been visiting Peter and Sandra for the past year and spoke of them as “very sociable and a pleasure to look after.” “They are always appreciative of our input and show a willingness to work with us to manage their health” Katrina says. “We have watched them both grow in confidence when making decisions regarding their health.”
Hiedi adds, “Watching our patients understand and manage their illnesses has been one of the most rewarding parts of my role. I always leave them with a smile on my face.
“Being part of the Integrated Care Team allows me to deliver a patient-centred and co-ordinated service to our patients, and enables them to access other services they may not be aware of.”
Local Integrated Care Teams are made up of nurses, occupational therapists, physiotherapists, community matrons, specialist nurses, healthcare assistants, falls specialists, mental health workers, social workers and self-care advisors.
Integrated Care Teams form part of Better Together, a programme developed to join up health and social care services across Mid-Nottinghamshire.
For more information about Better Together visit www.bettertogethermidnotts.org.uk