“I often like to tell the story of an elderly gent who was on an elderly ward for a hip operation who needed a hand rail on one of the stairs to get out and home.
“He didn’t need to be in hospital any longer but because the hand rail wasn’t there he couldn’t get out. We reduced his discharge date by three days because I was able to link in with one of the Armed Forces charities in the area and they came in and fitted the rail that day. This reduced his discharge date by three days, making a better patient journey.”
This story illustrates the support provided to members of the Armed Forces Community that the formidable double act of Shafiq Sadiq (Sid) and Fiona Lamb from East Lancashire Hospitals NHS Trust (ELHT) have had on their caseload, which has included providing support to their colleagues as well.
And if Fiona’s story strikes a chord, a favourite story of Sid’s reinforces the value of his role.
“Not long after starting this role, a gentleman came in. He had attempted to take his life and was not in a good place at all. I’d only been in the job three days. I didn’t really know what was out there, or what support, really. Because there were no mental health beds available, they admitted him on to one of our wards. I went to see him daily. We talked about old times and I looked into what was available and was able to refer him to Op COURAGE and its High Intensity Service. We also liaised with the mental health team and managed to eventually find him a bed. This gentleman came out the other side and he wrote a very nice letter which still brings a tear to my eye, thanking us for what we did because if we hadn’t helped him and been there for him he said he wouldn’t be here now.”
Alongside this, the pair have made sure the Trust is now a Gold Defence Employer Recognition Scheme recipient. And more importantly they are able to prove their value, not simply through such patient stories, but their work on admissions avoidance and reducing levels of delayed discharges of care has helped save the Trust around £117,610 since April last year.
Fiona and Sid’s skillsets complement each other.
An NHS Accident and Emergency and Trauma nurse by background, Fiona, is now the clinical site manager at Royal Blackburn Teaching Hospital and the Trust’s Armed Forces Veteran Lead.
She had met many veterans on the ward and one who took his life in 2019 captured her attention as to what the Trust actually did for this community. While it may have already signed the Armed Forces Covenant and had a Silver Defence Employer Recognition Award, she couldn’t see much colleague awareness about the Armed Forces Community and felt something needed to be done “on the shop floor” given that policies were already in place.
She went to the Trust’s Executive Board with a proposal that she would become the Trust’s Armed Forces Lead. They gave her carte blanche to proceed.
Fiona recalled: “To be brutally honest, nobody knew anything about it. Nursing and support colleagues didn’t know anything about the Covenant and didn’t know anything about the Armed Forces.”
The immediate win was to create simple information leaflets explaining the Armed Forces Covenant, what this meant for NHS colleagues, creating a simple alert system for veterans and members of the Armed Forces Community to be identified and a patient information leaflet for members of the Armed Forces Community.
It quickly became apparent that there were more veterans coming into the hospital than she initially bargained for, particularly when the work of Armed Forces Lead is not her fulltime role. Alongside this, she was developing Veteran Aware accreditation for the Trust with the Veterans Covenant Healthcare Alliance, which it gained in March 2021.
In short, she needed help and started looking for funding for extra support. At exactly the same time, the Armed Forces Covenant Fund Trust opened up a funding channel for bids for projects in acute hospital settings.
Her bid was for an Armed Forces Advocate, who would follow up referrals from the nurses, see the patients and find out if there was any add-on care that the patients needed on top of the medical care to help facilitate a discharge or to support them in the community. One of Fiona’s main criteria was that applicants should ideally have extensive military experience.
This is where Sid enters the story.
Sid served 22 years in the Royal Army Dental Corps, starting as a Combat Medical Technician but later on became a Dental Clerk Assistant and Medical Practice Manager. Following retirement in 2009, he carried out an array of jobs, including being a stay-at-home dad while his wife completed her service with the Queen Alexandra Royal Army Nursing Corps.
He was already working for the NHS for an Intensive Home Support Service team when he spotted Fiona’s advert in 2022.
It appeared tailor-made to his skills and personal circumstances.
“My daughters unfortunately have ongoing medical conditions. My wife and I moved married quarters 13 times, across five different countries, during the time that we were married in the military. That created a problem when it came to continuing medical care. Every single posting, we’ve had to start the referral from scratch every time, and the support for the Armed Forces Community out in the real world was pretty non-existent, even though the Covenant was designed to help facilitate education, finance, medical care, it didn’t really do what it said on the tin.
“So I jumped at the opportunity to become an advocate and help those who have been in the situation that my wife and I have been in. I wanted to try to help people with that kind of scenario because I’ve been there myself. I know exactly how bad it can be.”
The combined NHS and military knowledge the pair have works so well together that from seeing 202 patients in 2019, they now see more than 1,600 a year; in the year to date they have currently seen 1,608.
The pair decided early on to work on the internal and colleague processes first before thinking about external connections.
The major problem they identified, and one which is still a work in progress, is in making sure that the Trust’s 9,500 staff population, which is split between five hospital and multiple community sites, know to ask the question about whether a patient has served and to keep their training up-to-date.
The immediate win was to realise that ward clerks can aid in identifying members of the Armed Forces Community, thus reducing the workload on nurses, particularly when patients come on to the admission wards. Hence, reminder emails are often sent to this group of people. The pair has also visited every single department and contacted every colleague group explaining the point behind asking the question about the service, reminder posters were displayed, an Armed Forces email address was created and they recently launched an Armed Forces Network. Armed Forces Champions are present on most wards.
Veteran Aware training is now part of the corporate induction process for all new starters and modules have been added to the ELHT e-learning hub.
Sid also goes and delivers presentations to most departments on what a veteran is and how to refer.
There is also some steel added to the system, called a Nursing Assessment and Performance Framework (NAPF)
This is an internal nursing audit system based on the Chief Inspector of Hospitals ‘5 Key Lines of Enquiry’, which asks the question: Is the service safe, effective, caring, responsive and well-led. Within those key lines of enquiry, patients are now asked if they are a member of the Armed Forces Community. A failed audit can lead to a red flag rating.
Sid has also been working with the ELHT team that has brought in Electronic Patient Records to the Trust to develop a veteran identification element and a referral pathway.
In general, says Sid, identification of patients is still an ongoing process even after 12 months, but things are better than they used to be.
Externally, they have started attending local veteran breakfast clubs. The three big football clubs in the area, Burnley, Accrington Stanley and Blackburn Rovers all have veterans’ programmes, which the pair have presented to, reminding veterans of the importance of self-identification as a veteran if they attend hospital.
“It’s a pincer movement where we’re prompting colleagues to ask the question, but we’re also encouraging the veterans themselves and the Armed Forces Community to identify themselves if they walk through the hospital door,” says Sid, stressing the importance of identifying the armed forces patients and understanding the importance of this work.
The pair also work closely with a Burnley community interest not for profit company called Healthier Heroes, which promotes wellbeing support amongst former members of the Armed Forces Community, as well as help them overcome social isolation, homelessness, addiction and mental health challenges.
One avenue the pair has gone down is in the creation of information packs for patients, which grew out of a simple A4 sized one-sided information sheet but morphed into a much bigger beast providing veteran-related information on the national charities and local bodies that exist in the patient’s area. Funding for these packs came via the Armed Forces Covenant Fund Trust so many Trusts may struggle financially to replicate this idea due to cost implications, though there may be room for some experimentation.
Looking ahead, Fiona has submitted a business case to the Trust for funding for an expanded team to concentrate on veterans who access the Trust’s community services and to carry on with the acute hospital work, partly because the current funding from the Armed Forces Covenant team runs out next April and partly because the funding was explicitly for the acute hospital setting.
“I want to look at the veterans that are in the Community that are under Intensive Home Support or District Nurses and see if we can avoid admissions coming in that way.
“We do have what I call revolving-door patients and some of them are veterans that are lonely, that don’t have support in the community or they’ve got alcohol, drugs or whatever problems. They are coming in via the Emergency Department and then being admitted to the wards.
“Now if we can go and see them in the Community, I’m not saying we will be the ‘be all and end all’, but if we can add another facet to their care in the community, then we may stop some of those coming in and therefore avoiding admission is ultimately better for the patient. This approach saves the Trust money, so that would be a double whammy.
“So, my business case has to not only keep the team going and have a five-year and 10-year plan but have a community team aspect to it to try and stop those admissions in the first place.”
A final point to remember is that the Armed Forces Community can include colleagues, who may also require support. Recognising this the pair opened their service to include anyone within the ELHT workforce staff.
“Some of the nurses have brothers, aunties, uncles, fathers, husbands who have served who are all having different issues. We can help them. That’s what we’re here for,” says Sid.
What’s clear is that the pair are hitting the right spots and reaching those who need support. With more resource, they could support even more people. So far, they’ve made a good start.
“With our local knowledge, dedication and the support provided by organisations like VCHA, we’re making a difference, and that’s the important thing,” says Fiona.