It is a new concept of healthcare for the 21st century - instead of patients being in hospital, the hospital comes to them at home. In the second of a three-part series on the biggest NHS shake-up in Wiltshire for years, reporter TRISTAN CORK hit the road with the district nurses to discover how it really works
The lights flickered and then went out as Gordon and Isabel Gross looked warily from their window at the storm raging outside.
The wind swept across the flat land around their home in rural Wiltshire. Somewhere, a power line must have blown down.
But then the concerns of this elderly couple abated as a procession of cars pulled up.
First, a senior occupational therapist Donna Pearce came to help Mr Gross with his recovery, then Gabrielle Tilley, a district nurse from Devizes came to see to Mrs Gross’ legs.
The elderly couple - Mr Gross is 92 in June while his wife celebrated her 86th birthday on Monday - still live together at home when many would expect them to be too frail.
It is, they said, a daunting prospect that if it was not for the two “angels” braving the gales, they would probably be separated now - he in hospital perhaps, she in a nursing home. And the chances are they would find it difficult to even see each other.
This feisty and humorous couple are the classic example of the kind of patients PCT bosses talk about when they talk of a philosophical shift in the way the NHS works.
Ten years ago - or even now - they might both have been whipped into hospital to be cared for by nurses. But now, the presumption is that they should stay at home unless they need to come into hospital.
Hospital chiefs in Wiltshire say half of the patients on general wards do not need to be there and would be more comfortable at home or in a nursing home.
So they plan to hire nursing teams to treat them in the community, paying for it by closing down hospital beds they say will no longer be needed.
Malmesbury, Bradford on Avon and Westbury have already shut, with the future of Devizes, Melksham and Trowbridge to be decided on Tuesday.
Protesters are not convinced and say that much-loved and needed local hospitals are being lost without an adequate alternative in place. But Wiltshire’s PCT say they are breaking the mould with a 24-hour ‘hospital-at-home’ scheme to replace the wards and beds.
Mr Gross has experienced much of the NHS in the past six months. For four of them, he sampled the delights of the RUH in Bath, then Chippenham and Warminster hospitals. And of the three, he is in no doubt where he would rather be - none of them.
“Good heavens, I would rather be at home,” he said. “I’ve realised that much of it is just old age. If it wasn’t for these angels coming around here I’d have to be somewhere, a hospital or a home or something.
“In hospital, it was hard. I suffer from bad hearing and I found it difficult to carry on a conversation. There’s nothing like being at home,” he added.
Isabel’s poorly legs are tended to by District Nurse Gabrielle, who visits regularly from her Devizes base.
“Mrs Gross will have a clearly defined care package which is regularly assessed,” she said.
“We’re always on the end of the phone and the aim is to try to prevent the need for an admission to hospital. While it might not be the case here, there is the danger that elderly patients in particular go into hospital for a short time but end up staying because they become almost institutionalised and can’t go back to looking after themselves.”
Mrs Gross agreed: “Yes, that’s true,” she smiles. “Gordon would’ve been like that if he’d stayed in any longer.”
She and the occupational therapist come free. Other care the couple receive from private agencies and the social services comes at a cost, and an expensive one at that - Mrs Gross said her other carers cost £430 a month for an hour-a-day’s care. The worry among union leaders, politicians, campaigners and staff is that this ‘hospital-at-home’ idea is the edge of a slippery slope.
The boundaries of what constitutes social care and medical care are blurred: is changing bedding social care, or changing dressings medical? Those campaigning to save hospitals fear that while the patients who will find the hospital coming to them for free at first, could find themselves being shifted to costly social care instead.
Preventing that, health bosses and council chiefs agree, depends on both sides working together - something that Wiltshire has not got a great track record for.
The couple’s nurses come from Devizes, a town which still has its hospital, but the doors could close there this summer.
A few miles away in Calne, district nurse Julia Searle explains how vital her role is in a town that has not had a hospital for years. “Our team only operates from nine-to-five, and hopefully these changes will mean an extended service, a real round-the-clock operation,” she explained. “In a typical day I might do 12 visits, some take 10 minutes, some an hour - it all depends on the patient’s needs.”
The first call of the day is at Margaret Hiscock’s home. The 66-year-old has a range of health complaints and has to use a mobility car to get around.
She recently spent six weeks in Swindon’s Great Western Hospital after an operation, and rather than being discharged to a community hospital, she was discharged to Julia’s care in her own home.
“The care in the hospital was wonderful, but the staff were so busy and the food was awful,” she said.
“I lost a couple of stone because I couldn’t eat it,” she laughed. “It means everything to be at home.
“In hospital, you’re stuck in one room and I couldn’t even get out of bed to look out of the window. I got so depressed, I actually ended up crying. It’s so much better being at home.”
At first, Julia’s visits were every day for at least an hour. As she recovers, it’s only a few minutes a week now. “District nursing is a specialist service,” explained Julia. “The aim is to bolster the teams so there is a range of staff for a range of care.”
A key fears of campaigners against hospital closures is that extra nurses and extra community nursing teams will not be there before the beds are closed.
PCT bosses have promised a lengthy and gradual timetable to transfer from hospital buildings to mobile care teams - but time will tell if it works.
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