Community Nursing in Focus: How North Cumbria Supports Patients Beyond the Hospital

Speaker A: Community nursing is one of the most rewarding careers you can have. Helping some of our most vulnerable patients at, uh, um, home where they're isolated, they maybe don't see anybody keeping them in their own home, stopping them going into hospital, stop robbing them of their last days, maybe last thousand days of life. Every day is wasted in hospital. The community offers a huge opportunity to new nurses, both from a career perspective, a skills perspective, but real, genuine passion. Hello and welcome to the Connexion, where RL Datax's Chief Customer Officer Liz Jones and Medical Director Darren Kilroy are joined by leaders and colleagues from within the healthcare industry. In the Connection, we explore how people and technology in healthcare can come together to create great experiences and support patient safety. We hope you enjoy listening.

Speaker B: Hi, welcome to the Connection podcast here in Was it Sunny or Not? Birmingham. Um, at the Connected Health and Care Summit. My name's Darren Kilroy from Oral Datix

Speaker C: and I am Liz Jones, also from RLDatix. And we don't know if it's sunny because we've been locked inside for some time.

Speaker B: It was before, but we don't know now.

Speaker C: So we are, uh, we're joined by our, uh, guest, Sally Pilcher. And Sally, you're from North Cumbria, Cumbria

Speaker A: M Integrated Care Trust.

Speaker C: So lots to talk about in terms of integrated care and the 10 year plan and everything that's happening. But before we get there and for listeners, you've kind of just caught us when we were already halfway through this conversation, um, I had a massive fangirl moment with you on a teams meeting relatively unprofessionally, relatively recently, where I saw your name and I was like, this is the Sally Pilcher that does the cold water swimming. That inspired me to go and do the cold water swimming and therefore changed my life in many ways. So you started doing that for. Was it because you had long Covid or.

Speaker A: Yeah, it was. I caught Covid in the first lockdown, day before the first lockdown and then sort of, I wasn't progressing. Six months later I couldn't play golf. I was exhausted, a lot of nerve pain. And then we went on a picnic with our family to our local lake. It's only 15 minutes away and we had the kayak. I couldn't sit in the kayak cause of the pain. So I started swimming and realized that the pain had gone away. And then afterwards I thought, you know, actually I feel great. And, and so we did it again a couple of days later and then I, um, popped on social media do any of my crazy friends fancy doing wild swimming? And someone just went, ping, yes, me. And I went, when? And she went, 15 minutes, I'll put the iron off. And that's how it started.

Speaker C: Any, any excuse to put the iron off.

Speaker B: And I was just gonna mention like North Cumbria, of all the places where you'd wanna do cold water swimming, that's the place you'd be doing it, isn't it?

Speaker A: Absolutely. England's deepest lake. It's amazing. Just from a mind, body and soul perspective, it's been my lifeline.

Speaker C: So. Your lifeline. So generous in sharing that out on social media that you created lifelines for other people. And that's me included. So at the time I was having really big issues around anxiety and panic attacks and I was watching you on social media and then some of your friends and your network were talking about what they were doing and I thought, I'm gonna give this a go. I'm absolutely a terrible swimmer. But yeah, you've made a big difference to a lot of people.

Speaker B: Yeah. What is it about cold water swimming? That's the thing. As opposed to swimming?

Speaker C: There's a lot written about it.

Speaker B: Yeah. So is the cold water element of the swimming particularly important for you?

Speaker A: Well, I guess it's open water swimming, so being immersed in nature is really a good thing. There's a lot of research around. Green exercise, blue exercise, green space, blue space. I think for me, the cold water, it has that anti inflammatory properties, so 10 degrees or lower is ideal. But also you build up your adipose tissue which has got high mitochondrial sort of content that's really good for lowering your blood pressure, lowering your sugar. Just really good for a health perspective. And then the natural endorphins and the way it affects your nervous system gives you a real boost from that chronic fatigue. So I'm on the Queen's Nursing Institute long Covid network. I do tweet about it as well. And we've built a group of over 50 people that we swim with. Not all together but from all walks of life and a lot of people with long term conditions.

Speaker B: Fantastic. So North Cumbria, obviously it's north, it's a big area. Where does North Cumbria extend from and to, for those who might not quite know its boundaries?

Speaker A: Okay, so it is a huge area. It's rural, remote coastal communities. Goes up as far as Alston, which is one of the highest towns in England. It goes across to the Solway Firth and it goes down to Penrith and um, down to where I live, down in South Copeland. So It's a huge, huge patch.

Speaker C: It is huge. And again, for those that don't know what the difference is, what an integrated care organisation, could you tell us a little bit about what that really means in reality? What services that your organisation provides and to which communities?

Speaker A: So it's an integrated organization, Acute trust with community services. We've got two district general hospitals, one in Carlisle, one in my table, and then we've got a whole host of community services that come under my portfolio, along with my general manager and collaborative chair. Collaborative chair's an, um, ed consultant, which has brought really good synergy between moving

Speaker B: people, preaching to the convergence. I was an ed consultant for many years, so I'm totally with you on that.

Speaker A: It's just bridged that gap between the front door and, um, keeping people at home and has allowed us to take more risks. But in m my portfolio, I've got eight integrated care communities, I've got six community hospitals, a couple of day units in MPU and um, then all of the specialist services. So specialist palliative care, abi, physical health, psychology, sexual health, rheumatology, diabetes, endocrinology. So a whole host of services that we manage as a community collaborative.

Speaker B: Brilliant. So North Cumbria is so big geographically, there's such a lot going on in the portfolio. If you can, in simplistic terms, just what are the main health priorities that North Cumbria has to deal with? What are its main health outcomes that might be different to, say, a big city area?

Speaker A: I think we've got a high obesity area, who've got high coronary heart disease, high levels of stroke. I think they're probably the key areas, especially around the west coast, those coastal communities, really quite high areas of deprivation.

Speaker C: And again, quite often when you're talking about those kind of communities and issues, actually there's that, uh, link through to social care and to housing and to education. How connected is your organisation? Is it easy for you to be connected because the way you're structured through to the wider public sector in the region?

Speaker A: I think we've got really good relationships with our public sector and our local authority. I think we could be stronger and I think that's where the Ten Year Plan comes in. But our integrated care communities were built in a way that included both social care and our third sector. We've got some really good examples, examples of how that all integrates. But I think we need to take it a step further in the Ten Year Plan.

Speaker C: Interesting. And so, Sally, when you look at the 10 year plan and clearly the work that you do is central to one of the shifts of the three shifts, how much are you seeing that it is a blueprint for the progress you want to make or how much do you feel that you need to now work out what the blueprint is?

Speaker A: I think it's a total blueprint. I think we've been waiting for this moment and I think we've done an awful lot of what's in the ten year plan. So for us we're all already providing a lot of integrated care in the communities. So this gives us that opportunity to actually now stretch that and we're starting to formulate our community strategy and how we can have neighbourhood hubs and teams and take that further. We've just introduced a match hub which is our multi agency telephone coordination centre, which is there's a clinician in there. So people can ring up and say, I've got this patient at home. They're m really not well. We don't want to send them to hospital. What can we do differently? And that's connected to the ambulance service as well.

Speaker C: So it's quite empowering really. You feel that it's empowered you further with your ambition too?

Speaker A: Absolutely. Really exciting.

Speaker C: That is absolutely fantastic. And you obviously you're going to be talking about technology shortly, uh, at the conference, so could you tell us a little bit about what it is you have been doing around technology and productivity and care?

Speaker A: Well, so we've been on our uh, sort of four or five year journey with E Community now and that's given us a real opportunity to demonstrate what goes into care at home, what goes into a community. Nursing contact, AHP contact, a healthcare support worker contact. And a lot of the care that uh, happens behind closed doors at home is unseen and that can lead to it being unvalued really. So with E Community it's given us that data set to be able to really articulate and really celebrate what we do in the home environment, what the worth is of that contact.

Speaker C: And I think that's so incredible to think about it in terms of worth and the celebration is brilliant, but in terms of people valuing it. So have you got to the point yet where that visibility has made it easier to get investment or to shape services differently?

Speaker A: I think it's given us an ability to understand our own services first and foremost and where the inequalities may be. It's allowed us to move resources around. So we used to work very much in whilst we had integrated care communities, they were quite siloed. So we can now see where the demand is and where the capacity is and we can move that around, we can understand what care's not met. So we talk about corridor care in a hospital setting, deferred visits in E community, a corridor care at home. So we're able to articulate for the first time what the unmet need is or what we're having to step down because of the acuity at the other end. And then we're also able to then go back and look at those deferred visits and actually check if any harm's been occurring. So from a governance point of view. So we're celebrating the worth. We know our data, we can have different conversations with our commissioners, our partners, but we can also use it from a clinical governance perspective.

Speaker B: And I was going to pick up on that. In terms of, when you've got such a big geographical patch to cover, how do you manage the governance structure around that? You just mentioned it there. It's a beautiful example of that. So how do you escalate those governance concerns? What's the architecture that supports that? How does it work in plain sort of committee terms? How's the clinical governance of a big region like that organised?

Speaker A: So we've got a central governance team, but we've got devolved governance within the collaboratives. So each week I chair or one of my colleagues in the Triumvirate chair Quality and Safety meeting, we've got our matrons that come along and, um, they present the data. You know what the hot topics are. And I think from a technology point of view, Covid obviously took so much away and took so much away for me, but it gave teams and it gave connectivity. So actually I feel more connected to my teams out in a rural and remote area and more visible than I ever have been.

Speaker B: Yeah, that's funny. The ramifications of what we did in that time are still, you've got to capitalise upon m that because why not? As you say, it totally does give you that opportunity, doesn't it?

Speaker C: It is incredible. So we're getting really close to the end of our time. We've caught this time with you. One of the things I wanted to ask you, just as the last sort of question, is, if you were sitting in front of somebody now and they were thinking about going into a career, you're obviously a Queen's Nurse, so I guess it's your pitch for, you know, why would you want someone to go down the Queen's Nurse route if you were sitting in front of a 16 year old? Now, who was thinking, what am I going to do.

Speaker A: Community nursing is one of the most rewarding careers you can have. Helping some of our most vulnerable patients at home, um, where they're isolated, they maybe don't see anybody keeping them in their own home, stopping them going into hospital, stop robbing them of their last days, maybe last thousand days of life. Every day is wasted in hospital. So the community offers a huge opportunity to new nurses, both from a career perspective, a skills perspective, but a real genuine passion.

Speaker B: And ideally, come and do it in North Cumbria.

Speaker A: Absolutely. And as a Queen's nurse, you've got to be at the table and not on the menu.

Speaker C: Sally, an absolute pleasure to meet you and I, uh, look forward to hearing your session later. And we'll keep in touch with you maybe through the podcast to see how it continues to progress up in Northumbria.

Speaker A: Come swim with me.

Speaker C: Love to.

Speaker A: There we go.

Speaker C: There you go. Thank you so much. Take care. Bye.

Speaker B: Bye. Bye.

Speaker A: Thank you. Thank you for joining us on today's episode of the Connexion. We hope this episode has provided you with valuable insights on the role that both technology and people play within, um, the healthcare landscape. For more information and resources, visit rldatix.com don't forget to subscribe to the connection on Apple Podcasts, Spotify or any other podcast platform you use. Join us next time as we continue to explore how healthcare is impacted by connecting people and technology. On behalf of the Rldatix team, thanks for listening.