It is hoped that patients will in future be able to enjoy better care and a better quality of life when accessing the health and social care system, thanks to work that is delivering more ‘joined up’ care.

Ongoing initiatives commissioned by Birmingham and Solihull Sustainability and Transformation Partnership (BSOL STP) are bringing together health and social care professionals from organisations across the region to transform health and social care – making it fit for the future.

BSOL STP brings together all acute, community and hospital trusts in Birmingham and Solihull, in addition to its GPs and adult and social care in both local authorities.

The partnership looks at ways of delivering an improved health and social system for all, and has already found success in understanding the system’s need to form effective partnerships between agencies to encourage better working together with every patient’s best interest at heart. 

Clare Travis, Clinical Lead for Occupational Therapy at University Hospitals Birmingham NHS Foundation Trust (UHB), highlights the value of bringing professionals together from different services to support an individual, who is reliant on a wheelchair. 

Specialists were able to coordinate efforts to overcome challenges which meant a patient could head home just a day after surgery – rather than enduring a longer stay in hospital.

The patient, Tracy Scantlebury, lost the use of her legs after sustaining injuries in a road accident nearly 30 years ago. Tracy valued her independence and had adapted to a different way of life, including the reliance on her arms and upper body to stay mobile. 

Tracy’s latest challenge came after an operation on her hand which left her facing a lengthy recovery. While the recovery time is not unusual for this procedure, there were added challenges as it was clear she would be unable to use her upper arms to get in and out of her wheelchair. 

Jill Webb, a consultant in hand and plastic surgery at the Trust, predicted that the patient’s past medical history might delay her discharge, so she was referred to the occupational therapy service at UHB.

Clare explained: “An appointment was made for me to visit Tracy at home. This gave us an opportunity to assess her current ability. It was clear there would be increased care needs and the likelihood that additional equipment would be required.”

Professionals that were also key included Debbie Howell, manager for social workers at Birmingham City Council and hospital social worker, Kate Theo. 

Clare visited Tracy at home alongside the city council team and other colleagues, where they were able to discuss the practicalities needed to stay out of hospital. There the agencies involved were able to put in place a carer assessment and the correct equipment needed to enable Tracy to return home just one day after her surgery.

Other professionals that helped to ensure the care package worked for the patient included Nicola Kavangh, one of UHB’s senior occupational therapists. 

Nicola reviewed the patient in hospital to ensure the discharge was not delayed and the team on Ambulatory Care – where the procedure took place – were aware that this patient was fit for discharge as soon as any pain was managed and allowed. 

Susan’s other needs, such as financial support, was not forgotten. Pauline Mugridge (group manager for adult social care ) contacted Jane Putt, Head of Client Financial Services at Birmingham City Council, who was able to respond quickly and authorise on the use of direct payments. This enabled carers to start immediately when the patient was discharged.

Clare said: “It does seem that a lot of people were involved but through working together we were able to give the patient the very best care and support, and being able to get it right the first time, time and resources were saved which benefitted not only this patient but others waiting to access the service.”