back to baseline

‘Do you know who we are? Has anyone told you what we do?’

I say it a lot. Almost as many times as I say ‘Do you have a yellow folder?’

Sometimes I feel like an actor in a long-running play, overly conscious of his hands in the middle of a monologue on a wet Wednesday matinee in February.

But that’s the trick, I suppose. Finding truth in the same old lines, even though you’ve said them so many times they’ve picked up a dodgy shine.

‘We’re an NHS community health team. We’ve got lots of people working for us – nurses, nursing assistants (that’s me), physiotherapists, occupational therapists… you name it!…We’ve got a small bank of emergency carers… we’ve even got a pharmacist!’

I like putting that one in. It makes us sound like a friendly high street, all the usual shops.

‘We work on a pretty tight schedule. Just three days. We get referrals from the GP, who might be worried someone needs a little extra support. We get referrals from the ambulance, who might have gone round to someone who fell, for example, and they want us to follow up to make sure everything’s okay. Or a referral from the hospital, because someone’s being discharged and needs help. That kind of thing. So we pitch in, see what’s what, and either refer the patient on to a more specialist health team like the Respiratory nurses, the Heart failure team, the District Nurses and so on. Basically we’re here to keep people safe at home and help them stay out of hospital if possible.’

Invariably the patient will interrupt on the second sentence of the spiel, though.
‘Three days! Is that all?’
And if they do, I’ll say something like: ‘Well – yes – we are what they call an acute service. We’re very short term and we do try to move people on as soon as we can. But the bottom line is, we won’t leave anyone in the lurch. We’ll keep patients on for as long as it takes for the other team to pick-up.’

Mostly that works. Sometimes they fixate on the three-day thing, and it takes a bit more reassurance. More often than not, though, they’re just relieved to have someone – anyone – coming through the door. Because a great many of the patients we see are struggling. They may have suffered a recent exacerbation of their health problems, an accident or an illness. Maybe they’ve suffered a change in their social circumstance, the death of the partner who was their main carer, or some other family breakdown. But although the specifics of their situation change, the basics stay the same: they can’t cope, and they need help to get back to coping, whatever that might look like.

There’s a phrase you see used a lot in the team – Back to baseline – a simple expression of the outcome we’re looking for. Back to baseline means getting the patient back to where they were before they needed all these interventions.

A simple plan. And like all simple plans it hides a world of negotiation, and difficult decisions, and compromise.

Back to Baseline.

‘Any questions?’