Sounds familiar

Some countries are said to be divided by a common language but,
if Wendy Lennon’s experience is anything to go by, there is still
plenty of common ground shared by the UK and Australia.

Lennon was in New South Wales’ second city Newcastle as the second
recipient of Community Care‘s Isabel Schwarz travel
fellowship 2003 to examine hospital discharge of older people. And
she was surprised to encounter the same values and issues as she
deals with home.

As senior social worker at Selly Oak Hospital, part of the
University Hospital Trust, Birmingham, for the past 13 months,
Lennon was keen to compare ways of working. Her role at Selly Oak
involves conducting care assessments, as part of a
multi-disciplinary team, on older patients when they are about to
leave the hospital.

Although she was impressed by many aspects of Australian practice,
the visit also provided a lesson for those cynics who assume that
other countries’ methods must always be better.

The issues of ageing, disability, ill health and social deprivation
have been the focus of Lennon’s work in social care. She wanted to
break away from the rut of “doing the same old thing” that she says
many working mothers find themselves in: “I am convinced my work
has given me quite a narrow view of the world and that sometimes I
can border on the grim side.”

After deciding to apply for the travel award Lennon spent two
months searching the internet for information before submitting her
proposal. She identified three areas to investigate: the
multi-disciplinary learning unit (MLU), based at the John Hunter
Hospital in Newcastle; the work of Australian aged care and
assessment teams (Acats); and how Australians deal with hospital
discharge from a social work perspective.

In Australia each geographical district has its own Acats based in
hospitals, community centres or health centres. The teams comprise
chiropodists, geriatricians, physicians, physiotherapists, nurses,
occupational therapists and social workers. Acats assess the entire
care needs of an older person, including their medical, physical,
psychological and social needs before making a care recommendation.
The teams assess about 185,000 people a year nationally.

Having won the £750 prize, Lennon contacted Kichu Nair,
professor of geriatric medicine at the John Hunter Hospital, who
set up the MLU as a two-year pilot. He put her in touch with Nicola
Hern, a senior social worker at the hospital’s elderly care
rehabilitation unit and it cascaded from there. Lennon was
connected to the Acats team manager, Lesley Hall, and the
hospital’s head of social work in medicine, Jeni Leprince. She
says: “I was really impressed at how obliging, friendly and giving
of their time everybody was.”

The MLU was modelled on a project that originated in Linkoping,
Sweden. It arose from the concern that doctors, nurses,
occupational therapists, physiotherapists, social workers,
dieticians, speech and language therapists all move in and out of a
patient’s life without understanding each other’s responsibilities.
This “can inhibit co-operative practice,” says Lennon.

Although the pilot project had ended by the time Lennon arrived in
Australia she was still able to meet Nair and Leprince to discuss
its operation. The MLU addressed the problem of different
practitioners’ approaches to older clients by allowing students
from various disciplines to learn together. All students worked in
the hospital’s geriatric evaluation and management unit for four
weeks, covering all shifts and roles. They also worked with other
students and practitioners from areas other than their own.

The main difficulty the MLU faced was over timetabling and juggling
the learning commitments of the different students. Despite this,
Nair reported that the experience was positive for students and
staff. Lennon believes such multi-disciplinary education should
reflect contemporary health and welfare set-ups.

When Lennon was planning her trip the hot issue in the UK was the
single assessment process and what it would mean for practitioners
in hospital teams. Having spent 15 years in hospital social work,
Lennon feels her team is at the forefront of multi-disciplinary
teamwork. Her team includes three community liaison nurses and 17
social workers, and she routinely works with all ward and therapy
staff. “I wondered how the Acats would be different and how this
would differ from the single assessment process,” she says.

The team Lennon visited was also in the John Hunter but is not part
of the hospital discharge service and sees itself as distinct from
it. Hospital social workers, GPs, staff from other agencies and the
public can refer a person to an Acat and the best person for the
job, regardless of their professional background, will deal which
each referral. Lennon says the nurses on her team at Selly Oak
cannot take on the whole case management of a client because they
are so swamped with work. She adds: “In our hospitals we are
working alongside each other rather than with each other.”

Attending a multi-disciplinary team meeting brought home to Lennon
how small the world is. “I was awestruck by the fact that I could
travel across the world and talk to practitioners in the same
professional language, with the same values and facing the same
issues.” The concerns facing Australians working with older
patients were familiar to Lennon and her team, the only difference
being that “the physio wore shorts”.

Lennon says the Australian model seems to minimise bureaucracy.
“There is evidence of a strong commitment to multi-disciplinary
team work as shown by the unit and the practice of the Acats. This
is crucial to the single assessment process.”

The Australian experience was not all positive. For example, she
noticed the lack of complex home support. The huge distances that
have to be travelled between clients can only be part of the reason
for this as half the population lives in medium sized or large
cities.

So would she recommend other social care professionals apply for
the fellowship? Most certainly. Going to Australia gave Lennon a
renewed sense of purpose about her practice and that of her
team.

“It has given me a lot of confidence in my practice,” she says.
“You can get into the situation of thinking the grass is always
greener somewhere else but seeing the practice in Australia made me
realise we have got good practice here and I am doing the right
thing.”