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redesign services to meet ever-increasing standards of best practice and provide new, flexible and innovative thinking for holistic care at home.

The individual is the focus There are many other health care systems around the world facing the same challenges as Jersey and some have slightly different solutions, but they all share one thing in common. The individual being looked after is the central focus for all the attention in all successful systems.

It's not just a case of more skilled carers. Clients and families also need the skills to manage themselves, and they must have support with their own daily challenges and needs.

There is also no ‘one-size fits all’ solution. Some people will simply need help with dressing in the morning while others require quite complex treatment. Staff looking after them will have to deliver this while meeting strict quality standards. Current rules in Jersey are sometimes anachronistic, but primary care is undergoing a significant transition and it's important we get it right if we are to make a wider range of services more accessible and without any loss in quality.

Improving productivity A strategic focus is therefore on the education and guidance needed for staff to deliver professional care, and the productivity of the workforce at all levels has to be improved.

Jersey has already come a long way in delivering better solutions for people living at home. But there is still a long way to go. There are a considerable number of professional health care agencies providing high quality services at different levels of complexity. More will surely follow as demand increases. There is also a large number of people willing to work in these businesses who have widely differing qualifications and experience. The market will hopefully ensure that the two are matched successfully.

However, I know from early experiences in establishing 4 Health Home Care, that it is not easy to find the right staff who are motivated and willing to develop their skills. Above all else, they need to have empathy and a strong desire to treat their ‘clients’ as well as they would treat their own family. At 4 Health, therefore, we work very hard to make sure our staff are not only professional but caring.

So we are always on the lookout for carers from different backgrounds who have the necessary understanding and compassion. We will help them acquire the technical skills and offer them a worthwhile career even if it is just on a part-time basis. In return for doing what can be a very difficult job, our staff must be offered a conducive, safe working environment, support and respect from their colleagues, and an opportunity to improve their skills.

This approach seems to be working at 4 Health because I know that our staff are enormously proud of some of the comments that we have received over the past months from our clients. The clients appreciate the professionalism of our carers, but equally important is their caring and sympathetic attitude.

Maintaining Individualised Care Central to the management of care at home is the client’s GP. 4 Health Home Care is fortunate in that it has the backing and expertise of two of the largest GP medical practices in the Island - Castle Quay and Indigo Medical practices. The company's

directors include Dr Nigel Minihane, Dr Sanjive Paul, Dr Phil Terry and Dr David Howell who between them have many decades of experience.

It is important that clients have a choice which home care agency they wish to use. Our services are not restricted to patients of those two practices, and some of patients use other home care agencies, and we look after patients at many other practices.

The main aim of working collectively with GPs is to streamline the care clients need and improve on timely decision making. To help this process, 4Health is working on a system that allows GPs to electronically check on the latest information about their patients at home. That means the carer can alert GPs to any concerns relating to their patients so that a timely intervention can be made. As our company name illustrates, we can already deliver four important aspects of personalised and interactive care - pharmacy, nursing, social/personal care and GP management and involvement. There is no doubt that we will be required to expand on this as other aspects of care become essential elements when delivering comprehensive care at home.

Fortunately new technology is continuously being made available to help improve our methods of working. Eventually remote monitoring of client's health without the need for human intervention will be common practise and once it is a tried and accepted option, 4 Health will offer it.

Although established as a home care agency, 4 Health is also a registered nursing agency, so we can meet the requirements in Jersey law regarding expert care. Demand is obviously growing to provide nursing interventions at home by skilled Registered General Nurses, and as I have spent most of my working life as a trained nurse, I understand these requirements.

However home care has to provide holistic care that covers both physical and mental well being. The increasing number of people suffering from dementia, for example, substantially adds to the skills required by carers who have to take dementia into account when dealing with clients. The staff have to be able to alert clinicians to any changes in those they are looking after, and the close bonds between clients and empathetic staff can mean better communications and outcomes. 4 Health has recruited a carer trained as a dementia care mapper to work with clients and analyse what triggers certain changes in behaviour. We expect demand for this type of approach to grow considerably.

One of the advantages of bringing all of this expertise together is that we can break down some of the barriers that can exist between different services for people being cared for at home. Effective communication, working with other agencies, and learning together to develop evidence-based strategies will improve how care is delivered. However, there is no substitute for being served a nice cup of tea by a smiling carer who can help make life more comfortable in so many ways.

* Angela is an experienced registered nurse who has worked in the UK, Ireland, Beirut, Trinidad and the Channel Islands. For ten years she was in management at Jersey General Hospital, before

retiring two years ago as Operations Director, and establishing 4 Health Home Care last year.

An Ageing Island Page 31

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