How Pulse Independent Living provides integrated health and social care

  Jacky Stone, with help from Pulse care worker Claire Reeby, is learning to walk again after a motorbike crash nearly killed her

Staff agency Pulse offers an independent living service for which workers are trained to meet individual service users’ specific health and social care needs. Natalie Valios reports

Providing integrated health and social care for people with complex needs is often discussed, but not always achieved.

One service that has managed this is health and social care staffing agency Pulse’s independent living service.

Launched in 2008, it provides health and social care support to people with acquired brain injury, spinal injuries, physical disability, learning disabilities, mental health problems, and those requiring end-of-life care.

Referrals come from 35 primary care trusts in England and local authorities, although in most cases they are jointly commissioned and funded. Those referred are either already living at home but need extra assistance because their needs have changed, or are in hospital (or a rehabilitation unit) and preparing to return to the community.

The approach is person-centred from the start, says Jackie Lindsay, operations director for Pulse Independent Living.

“Our aim is for the individual to own and drive their own care. One of our care co-ordinators or community nurses will visit them to develop a care plan. First we address the clinical need – for example, how they like to be cared for, what time of day – then we concentrate on their aspirations and the outcomes they would like. It can be as small as being able to get out of bed on their own or choosing what they’re going to wear, to about going back to education or work.”

She says plans are reviewed and changed regularly as service users develop a better sense of what they want to achieve.

The next step is to put a team together to deliver the care package. Support workers are recruited and trained specifically for each package. Most of the service’s support workers have a social care background and all receive mandatory induction training in personal care, administration of medication, bowel management and manual handling.

But they are also trained in the clinical interventions that service users require such as peg feeding, ventilator care and catheter care.

With 90% of care packages requiring clinical intervention, you might think nurses would be better suited to the task, but Lindsay says: “We find that social care workers are much better at caring for our clients because they look at them holistically. If the care package was clinically led we would only look after the clinical need of the person, but we try to marry that side with looking at the emotional and psychological needs as well.”

It also makes the package cheaper, says Lindsay. “It would cost huge amounts of money to get a nurse to work 24/7 on a care package and many don’t want to deal with the social care side of things.”

The approach seems to be working. “We have reduced the number of unplanned hospital admissions and kept people independent for longer which saves money,” says Lindsay. “In one instance to keep someone in a spinal unit was £10,000 a week and for us to provide a care package it was £4,000.”

Julie Evans, NHS-funded care team manager, NHS Tameside and Glossop, commissions services for clients with continuing care needs. She has two clients with Pulse and two pending. “I chose Pulse because of their policies, working practices and recommendations from other PCTs – I’ve now recommended Pulse to other commissioners. “

CASE STUDY

Claire Reeby, Pulse support worker

Trained to offer social and nursing care

laire Reeby is one of three support workers helping Jacky Stone work to her physio plan. Stone nearly died in a motorbike accident in April 2009. As well as head injuries, she broke her hip, pelvis, wrist and back. After a period in hospital she moved to a rehabilitation unit for six months where she was assessed for a care package from Pulse to enable her to return home to her husband and son in Plymouth.

Stone has a supporting team of workers, of whom Reeby is one, from 8.30am to 4pm each day. She has been walking with help for a few weeks. “I wouldn’t have been able to do this without my support workers,” she says.

Reeby says: “We do as much as we can during the day, such as standing and walking exercises, and Jacky also has physio three times a week.”

Her support workers are helping Stone to slowly re-learn daily tasks such as making a cup of coffee. “We’ve started with getting the milk out of the fridge but then I struggle with getting the lid off the coffee as I’ve only got one hand I can use,” says Stone.

Although Stone needs no clinical intervention, Reeby has undertaken training allowing her to work with another client who needs catheter care. For her, being equipped to deal with all situations that a client faces was “like a breath of fresh air”.

➔ More on Pulse’s independent living service 

This article is published in the 22 July 2010 edition of Community Care under the headline “Putting social needs on a par with health”