A new team that swings into action when someone in Norwich is facing a health, social care or wellbeing ‘crisis’ is celebrating its first birthday.
The Norwich Escalation Avoidance Team – known as the NEAT – has helped more than 1000 people in its first year, helping them remain cared for safely at home when otherwise they might have ended up going to hospital or needing respite care.
The NEAT team celebrated its first year milestone at their base within the NHS 111 headquarters, on the Broadland Business Park in Norwich.
The NEAT is a group of NHS, social care and voluntary sector professionals drawn from the community services provider Norfolk Community Health and Care NHS Trust,, the mental health provider Norfolk and Suffolk NHS Foundation Trust and Norfolk County Council. They are able to co-ordinate and mobilise support and services offered by any of the partners and also voluntary organisations working in the community.
When NEAT receives a referral from a GP, paramedic, social worker, mental health specialist or other professional, the NEAT team swings into action.
By pooling their expertise they arrange the most appropriate package of care or support to meet the needs of each patient, to ensure their problem is quickly resolved. They also put in place plans to avoid problems in the future. This might mean carefully co-ordinated visits by several health or care professionals working together, and it might involve asking a local voluntary group such as Age UK Norwich or Voluntary Norfolk to provide some befriending or social support.
If people need to go to hospital they will, but in most cases they are helped to stay at home where they want to be
The work of the NEAT was brought to the attention of the Chief Executive of NHS England, Simon Stevens, by two senior staff last week. He was in Norwich on a private visit to speak with the Norwich GP alliance OneNorwich. Nick Pryke from Norfolk County Council and Norfolk Community Health & Care NHS Trust and Claire Leborgne from NHS Norwich CCG were invited to speak about the NEAT, to demonstrate the close partnership working that is transforming health and care services in Norwich.
Nick Pryke said: “NEAT enables people to stay in control of their health and wellbeing and, with support, to quickly recover from a crisis and continue to live their lives fully in their local community.”
The Chair of NHS Norwich CCG, Tracy Williams added: “NEAT has been an innovative approach in caring for people in the right place by the right health or care professional in a timely way when they have hit a crisis. The NEAT has been instrumental in developing the service this past year. I congratulate and thank the whole team for this great achievement.”
Most people referred to the NEAT have multiple health problems, or social issues such as loneliness and isolation; fifty per cent of referrals into the NEAT are for people aged over 80 years old, very often they are frail and may need befriending or social support to help them remain independent.
NEAT also supports people to be discharged from hospital when they no longer require acute care, but need a period of extra help when they return home.
Because the NEAT operates efficiently in the background, it is likely that most patients or clients are unaware of the NEAT’s existence or had arranged the stepped-up package of care they received. But local health and care professionals who referred them into the NEAT have certainly appreciated the service.
Feedback from local clinicians included:
• “I think on 2 occasions it helped people to remain at home who otherwise may have been admitted.”
• “NEAT has been useful particularly with sudden crisis with two of my service users (both palliative conditions). These have been admission avoidance and were successfully managed in the service user’s Preferred Place of Care.”
• “It has reduced revisiting for GPs and reduced subsequent phone calls from worried relatives.”
A real example of how the NEAT team made a difference to one person
An elderly patient was referred to the NEAT by their GP. They have serious and ongoing health problems but can normally live independently with some support. Carers who visit the patient several times a day called the GP and advised that the patient's illness was getting worse. The GP realised the patient would need to be admitted to hospital unless an integrated package of support could be put in place.
The NEAT held a multi-disciplinary discussion and the patient’s existing package of support from both community nursing and social care was increased. Different teams of health and care staff who had contact with the patient were consulted to make sure the right medications and support were in place.
This avoided a hospital admission, reassured the GP that the patient’s care package was now sufficient to meet their needs and, of course, meant the patient was stabilised and able to stay at home.