The Dudley 'model of care' is a collaboration between GPs, social services, community nurses and the hospital. The aim is to support patients in their home and so reduce the numbers that have to go into hospital, Today reported. Extra money has been invested in community nursing teams who make regular home visits to elderly people and people with chronic illnesses.
A joint press release from the local authority and the primary care trust follows.
Patients and carers are at the very heart of our model of care with
the emphasis being to provide care at the right place, at the right
time by the right people. We started this journey two years ago when
our doctors and nurses- with the help and input from patients and
carers- designed a revolutionary new model of care that aimed to
prevent people going into hospital unnecessarily by providing more
services closer to home.
The cornerstone to our model has been the introduction of a
nurse-consultant led service, which has focused on those patients with
long term conditions who have traditionally found themselves going in
and out of hospital on a regular basis. Our nurse consultant and our
team of assertive case managers provide patients with a personalised
package of care, you can see this example and others here.
Claire Old, director of nursing, quality & commissioning said:
'None of this would have been possible without our partners in social care at Dudley Council who have been key to us being able to provide patients with a seamless service that meets all of their health and social care needs.'
Valerie Beint, Dudley MBC's assistant director for older people
and people with Physical Disabilities, said:
'The key to success in Dudley has been the strong commitment to
robust partnerships between health and social care. We do challenge
one another but we share the same aim which is to provide the right
level of health and social care services which support people to live
'What is different in Dudley is that intensive short term services for
people in a crisis are provided at no cost to the client. These
services, such as the primary care response 72 hour service and the
reablement service (at home or in a residential unit), are free
because we believe that the right help at the right time in the right
place is what matters most to local people in keeping them independent
and as well as possible.'