1. A Belated Happy New Year to all our
friends and colleagues from the MERRIT
Hospital At Home Team!
We hope you enjoy our latest update on
how the service is developing - we'd
also be pleased to hear any comments
you have or suggestions for the future.
Email:
Patricia.Cantley@nhslothian.scot.nhs.uk
Hospital at Home
Update February 2016
From the Midlothian Enhanced Rapid
Response and Intervention Team (MERRIT)
All referrals to:
0131 270 8890
In this newsletter, we share
our latest graphs on who we've
seen and where they've come
from. Also some thoughts on
what's working well and where
some of the challenges lie.
The working hours for the
team remain the same as in
the autumn:
8am - 8pm Mon to Fri
8am - 4pm Sat & Sun
To contact the nurses outside
"office" hours - use their
mobile:
07773193921

2. The biggest change in the last few months for the team has been an increase in referrals
from the Royal Infirmary. The Medicine of the Elderly Dept in the RIE now have a
Consultant Physician based in the Acute Medical Admissions Unit every morning seven
days a week. On the "Frailty Ward Round" patients are identified who will benefit from
Comprehensive Geriatric Assessment - either as inpatients, or as patients in the "virtual
ward" of the Hospital at Home. Patients can also be referred to services in the community,
both in Edinburgh city and in Mid or East Lothian.
After review by the consultant, specialist nurse and therapy team, some patients are
referred for follow up by the Hospital at Home team, if they have ongoing medical
problems requiring daily input. The MERRIT nurse will take the referral by phone and
agree whether the patient is suitable and arrange the same or next day review.
At it's best this works well - but we're working our way through a development stage at
the moment. Some consultants refer to H@H more frequently than others! We also need
to be clear in the discharge letter for the GP so that we don't end up with the MERRIT
nurse meeting the GP on the patient's doorstep - as has happened on one occasion!
We think we'll see a lot more of these referrals over the next year...
The H@H Team:
Consultant Physician:
Dr Patricia Cantley
Nurse Practitioners:
Maureen Lucas Mackintosh
Sharon Dempsey
Nancy Warne
Brenda Halley
Laura Young
Clinical Support Worker:
Keith Dowson
Administrator:
Margaret Newlands
in addition to the fully integrated Rapid Response Team
of OTs, Physios, Pharmacist, administrators and care
workers.
What's
new in the
Hospital at
Home?

3. What're the
neighbours up to?
Or: "what's happening elsewhere in
the Lothians?"
There are similar services now up and running in
West and East Lothian, with Hospital at Home for
their residents. In South Edinburgh too, there have
been huge developments in services for older
people - with some overlap for Midlothian patients.
We work closely with our colleagues in these
services and meet with them every 3 months to
share good practice and learn from each other's
experiences.
Integrated Older People's Service!
In South Edinburgh, the Day Hospital at Liberton has been getting a makeover - and is
now rebranded as part of the IOPS! They too have Hospital at Home developing, and work
closely with their community nurses to manage patients with a variety of long term
conditions.
For Midlothian patients - a referral to IOPS is an excellent plan for patients who are fit
enough to travel for an assessment at Liberton. Suitable patients may include the
"traditional Day Hospital" clientele, but also patients who might need a medical opinion
and benefit from an assessment with X Rays, echocardiography and a full examination on
a couch (as opposed to one in their living room!).
We work closely together - so if you aren't sure, feel free to refer by SCI Gateway to
Liberton Day Hospital, or by phone to MERRIT and we can discuss the options available.

4. Recent
statistics!
Source of Referrals to Hospital at Home 2015:
Referral patterns vary from practice to practice - the practice in Imrie Place in Penicuik
remain our biggest users!
GP referrals to Hospital at Home Team 2015:
In the calendar year 2015, there were 302
referrals made to the team, of which 264
were accepted.
If we do decline anyone, we are often still
able to give advice and discuss options.
GPs remain the main source of
referral to H@H, but we're
seeing more and more coming
from the Royal Infirmary.
This pattern may change again
- watch this space!
We have been "full" on several
occasions recently - but are
working hard to maintain
turnover to avoid turning
anyone away for that reason.

5. Age of patients referred to
H@H team in 2015
Hospital at Home is a service designed and intended for the frail elderly. In Midlothian
we've taken on a range of patients - from age 51 to 103 years old in 2015.
As a guideline, patients will usually be over 75, but we are happy to take referrals for
patients under this age if they are frail - for reasons of ill health, deprivation or other
adverse circumstances.
Sex of patients referred
to H@H team in 2015
Reasons for admission?
Data from 2015
Infections
remain the
commonest
reason for
referral but
we also see a
lot of organ
failure - with
a peak in
COPD and
respiratory
disease over
the autumn
and winter.
Some require
IV therapy -
but many
simply need
support and
observation.

6. As the service becomes more established, we are working hard on getting the proper
processes in place for good Clinical Governance.
We have our own internal monthly meetings where we discuss any patients who were
admitted to hospital, and also any where a member of the team feels there are potential
learning points. We present cases every 6 months to the Lothian Hospital at Home Forum
meetings to share with colleagues from other areas.
Our consultant has just "Revalidated" and been signed off by the GMC for another 5 years
of practice and our Band 6 and 7 nurses are likewise going through similar processes. We
do a lot of teaching both in house and externally and all the team are working towards
maintaining and expanding their competencies. All the senior staff have now attended
the Good Clinical Practice course for working in research, and we hope this will enable us
to take part in the National Multicentre Trial for "Hospital at Home" in 2016.
We have had increasing numbers of students and trainees visiting us in the last few
months and welcome enquiries from anyone interested. This summer we are expecting
an elective medical student from Birmingham and we have hosted visiting doctors this
year from Spain (twice) and Portugal.
We are presenting work from Midlothian at a forthcoming conference on Integrated Care
in Barcelona in May 2016 - most H@H teams are an outreach from acute services, so the
MERRIT service is an example of a service that has grown from ground level straddling
both Health and Social Care. We are very excited about talking to an international
audience!
Clinical
Governance and
Research:

7. The Future!
What's next?
The big thing on the horizon for us is that we are hoping to expand, slowly and steadily, over the
forthcoming months. In the first instance we need more medical cover to support the awesome
team of nurses. An advert will be appearing shortly in the medical press for either available GP
sessions and/or a Specialty Dr. We are potentially very flexible for anyone who wants to work full
time or part time, and would also be interested to hear from anyone who can't start yet, but might
be available later in the year.
So, if you're interested......
Any questions about the job or the service - do
get in touch!
Email patricia.cantley@nhslothian.scot.nhs.uk
or call in to see us upstairs in Bonnyrigg Health
Centre.
And of course that number again:
0131 270 8890