Page 200 - HA Convention 2015

Corporate Scholarship Presentations

CS1.3 Rehabilitation Services 09:00 Room 228

Inspiration of UK Experience in Integrated Care Nursing in Long Term Care
Tse DLK
Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong

Tuesday, 19 May Integrated Care

HOSPITAL AUTHORITY CONVENTION 2015 According to the World Health Organization European office, integrated care is a concept integrating input, delivery,
management and organisation of services related to diagnosis, treatment, care rehabilitation and health promotion. It aims to
improve services related to access, quality, user satisfaction and efficiency (Grone & Garcia-Barbero; 2001). Integrated care
is implemented in different countries including Hong Kong. However, the delivery model may be different and further in-depth
exploration is needed.

Long Term Care in UK

Patients with chronic conditions may suffer from more than one medical conditions requiring constant medical and social
care. In United Kingdom (UK), general practitioners (GP) are the core persons for health services and triaged patients to
other services, e.g. Transforming Adult Community Services (TACS). TACS is a multidisciplinary team including nurses, allied
health and generic workers. TACS includes three core services: Single Point of Assessment (SPA); Rapid Response Service
and Intermediate Care Beds

SPA is a 24-hour hotline service taking referral from health professional or social workers. SPA triages and coordinates
patients to appropriate community services.

Rapid Response Services is a 24-hour service aiming to reduce hospital admission and support the patient’s safety at home.
If urgent response service are needed, the outreaching services will be arranged within two hours.

Intermediate Care Bed Services provide supporting services and rehabilitation to elderly who are unsafe to return or remain
at homes. The elderly should be assessed by Rapid Response Service, and admission to intermediate care bed will be
arranged if necessary.

A Comparison of TACS with Hong Kong Health Services

Patient Support Call Centre (PSCC) is a hotline service similar to SPA. Patients will be triaged to appropriate services if
necessary. However, PSCC is not a 24-hour service when compared with SPA. The delivery model of Integrated Care and
Discharge for Elderly Patients (ICDS) is similar to TACS. ICDS is also a multidisciplinary team which collaborates with non
governmental organisation (NGO). ICDS refers elderly to intermediate beds provided by NGO. However, ICDS is not a 24-
hour and seven-day service, and the ICDS only takes referrals from the Hospital Authority hospitals. In addition, ICDS does
not provide rapid response services to elderly who requires urgent assessment and intervention within hours.

Reflection of the Integrated Services in UK

(1) UK had built a strong matrix of care network in health and social care to patients at home.

(2) The services are easily accessible, well-coordinated and free of charge.

(3) GP acts as a core person in the healthcare system.

(4) Single assessment from multidisciplinary team to avoid duplication.

(5) Nurses in UK have high competence and autonomy.

(6) Rapid response and 24-hour support in community services.

Inspiration of the Integrated Care Service in HK

(1) Expand the scope of ICDS as a Single Point of Assessment and Referral System in Accident and Emergency Department
and Specialist Outpatient Department.

(2) Extend the ICDS nurses’ referral to other services, e.g. speech therapist, dentist etc.

(3) Develop Ambulatory Care Geriatric Day Ward for non-complex or semi-urgent cases, e.g. drug titration, blood
transfusion and ad hoc condition.

(4) Develop Rapid Response Team to provide timely assessment and intervention for those with chronic conditions during
symptoms exacerbation.

(5) Strengthen the ICDS services to seven days a week.

(6) Enhance PSCC service to cover wider range of older adults.

(7) Introduce license system or entry requirement for case management professional.

(8) Integrate the concept of integrated care services into all basic professional training, e.g. doctor, physiotherapist,
occupational therapist and nurse.

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