My name is Fran and I am a Senior Care Navigator-more of that later.
I work in the Community Health team in the South West locality in Tower Hamlets. I have been working in this role for 14 years and am proud to say I was employed in the original pilot when we worked for Tower Hamlets Primary Care Trust.
My day starts at 6:15am unless Derek my cat decides otherwise. The priority is to feed the cat then myself and have the all-important cup of tea. Then off to join the dreaded commute on the Central line and, without delays, arriving in our Wapping office for 8am.
Getting to the office for 8am gives me the opportunity to check emails and phone messages before the phones start to ring, catch up on any outstanding ‘inputting’, not to mention being able to savour a steaming Cappuccino from the local coffee shop.
Being part of a multi-disciplinary team, I take part in the morning Triage meeting to review referrals. Throughout the previous day and overnight, referrals arrive from local GPs and various professionals requesting input for patients. Each new patient is discussed and the appropriate discipline is assigned that patient.
But what about the role of the Care Navigator? And how do we fit into the multi-disciplinary team?
A Navigator is defined as someone who steers a ship and charts a course through stormy seas. Charting a course through the stormy water between health and social care is not for the faint hearted.
It is challenging to describe the range of patients that find themselves on my caseload. There’s the dementia patient with lung cancer whose family needed a lynchpin to co-ordinate all the visits from professionals, and a shoulder to cry on. Supporting family and carers is always essential. Being at the forefront to coordinate meetings with professionals and families is a common occurrence. You sometimes need to be creative - on one occasion, I ended up dancing with a patient as I could see he was becoming agitated!
When assessing a patient in their home, I will try to gather a picture about their health and their social situation. But I am also trying to capture the things they are not telling me. Sometimes it can take a few visits to try to instil a sense of trust. I like to enter into a partnership with the patient and together we will get the right services involved and make the journey less fraught.
I try to always make my visits to and from a patient on foot. It gives me the opportunity to think about the next visit or plan what referrals I need to make for the patient, and it is the only exercise I get!
Poor housing, hoarding, anxiety, loneliness, isolation, coping with a long term condition - all these issues as we know can lead to poor health and admissions to hospital. My role is to think creatively to find solutions that do not always include statutory agencies. A current patient with communication difficulties is becoming isolated. He needs stimulation so I am taking him to a local history walking group that takes place once a week.
It is difficult to plan too far ahead. Back in the office there is always the phone call from an anxious patient, worried because their carer is late, the patient who has been turned down for a benefit and is frightened, the family member who has been up all night caring for their loved one. A response of some kind is required, whether that is a reassuring voice or an unplanned visit later that day.
Crucial to my day is liaising with other professionals, requesting urgent responses, and agreeing to joint visits. Ensuring that communication is on-going and that the left hand knows what the right is doing, is essential to the role. Once a month we attend a multi-disciplinary team with the GPs, building close relationships with the GPs has always been paramount to our role. Taking advice is also important. Often my colleagues will offer a suggestion to get me over a particularly large hurdle.
Over recent years we have noticed an increase in patients with mental health issues - depression, anxiety and dementia. We are fortunate to have a mental health liaison nurse who works alongside us and her advice and support is invaluable. I have also noticed an increase in palliative patients (people who need symptom management) without any family to support and be with them. We strive to support these patients by coordinating their care, being a listening ear and also working alongside St Joseph’s Hospice which is a privilege and I continue to learn so much from them in relation to the care of the dying.
Like many health care professions, no two days are the same. As I write this my planned day has changed. This morning I had intended to catch up on some emails and phone calls and finish this commentary on my day. However, a call from an anxious patient who has received a letter from a well-known company threatening to cut off her phone requires me to visit and try to relieve her worry. On the surface, this may seem inconsequential but when you live alone with multiple health issues, an unpaid bill can impact on you physically, seriously affect your health and possibly result in a hospital admission.
When it is time to go home, my thoughts walking to the tube station are on what could have gone better today and what I can do better tomorrow. Derek greets me at the front door, insists on being stroked and demands feeding. Like many I try very hard to turn the work switch to the off position by gluing myself to my armchair and watching the TV.
Despite any apprehensions I may have as to what tomorrow will bring, I still think this is ‘the best job in the world’, unless of course I get to run a Cattery!