“This isn’t a job for me, it’s a duty and doing it in Portsmouth is a real pleasure. It’s the home of the Royal Navy, a Tri-Service City, almost everyone here is either married to the military, has family connections to or knows someone in the Military.”
Keith Malcolm is Portsmouth Hospitals University NHS Trust’s Armed Forces Covenant Lead Nurse and the Lead Recruiter of former serving military and spouses/partners of those serving.
He has been a nurse for 34 years and counting, which included nearly 15 years in the Royal Navy, serving on a Medical Facility off the Iraqi coast. As a result of his service, he has an underlying mental health condition.
The Armed Forces Covenant Lead Nurse role created at the acute hospital trust was the first such role of its kind in the UK and has been recognised by the Veterans Covenant Healthcare Alliance as the benchmark for an Armed Forces Aware model as it exceeds their manifesto points.
Since its launch in January 2020, Keith has overseen an increase of 88 per cent of recorded admissions to the Trust of veterans with known monthly presentations of veterans now more than 100, though he suspects the true number to be much higher.
“Veterans have always been here. It’s just that as a Trust we are better at asking the question “do you…or have you served…?” and recording the information,” he says.
On a daily basis veterans make up between 3% – 6% of inpatients at the Trust – hardly surprising given that around 9,000 veterans live in Portsmouth and another 7,000 live on the nearby Isle of Wight.
Just over 40% of veteran patients have at least one long term health condition, the most prevalent being:
- Mental Health
There may also be specific health issues related to their time in service such as depression and substance misuse.
A substantial part of Keith’s role is raising awareness of local support and services available as well as how he can provide more individualised support to patients and staff.
He said: “I deliver Veteran Aware training to our staff and it is also part of staff induction as it is really important that staff know what support they can access for their veteran patients and to ask any patient if they are in the military community.
“Through training sessions, posters and leaflets staff now routinely ask the question – or a version of it – “Do you serve in the military or have you served in the military?”
After veteran patients are identified, they are then added to a system called BedView. This is the Trust’s Bed Management and Discharge Management tool; it also supports Nursing and Doctor’s handover.
This is used by a wide range of staff, including nursing, admin, operational management and external partners, to ensure the most appropriate care can be provided throughout the patient pathway.
Keith receives this BedView data automatically and aims to see a newly admitted patient, identified as part of the Armed Forces community, within 24 hours of admission for an initial meet and greet- unless the Veteran is admitted over the weekend, then they are seen on the Monday.
He said: “This is a fundamental part of this role. The key is knowing how to connect, in knowing the right pathways for the patient and knowing the local resources. The use of Armed Forces banter is often a way of breaking down any possible barriers.
“This is why I’ve used the idea of the medal ribbons as part of my uniform. People will be able to see I’ve served.”
With growing demand, Keith has also piloted a befriending service – the Veterans Volunteers Service. Around 12 volunteers frequently monitor the bed management tool and visit veterans who have come in for care.
“That way it shows they’ve not been forgotten,” he says.
To help veterans, both patients and staff, can connect through monthly events and, often, there are talks from local Veterans’ and Forces’ support charities.
Case study #1
Thanks to Keith, one patient who had his discharge delayed due to an equipment issue as part of his ongoing community care, was able to be discharged safely.
As the patient had been identified as a veteran, Keith was able to secure funding from the Royal British Legion which enabled the patient to be moved to the next stage of their care in the community.
Keith added: “By involving the Veterans Service in a timely fashion, we can potentially reduce the time a patient spends in hospital which in turn will have a positive effect on their mental health and general wellbeing and also a financial saving.”
Within his role, Keith supported a ward with a veteran patient, who due to his dementia and memory loss, often became confused and tried to leave the ward unsupervised, creating a potential danger to himself. Keith also gave direct support and advice to his family when the patient was moved to his next care placement.
The family said: “It’s been a great help having Keith around whilst dad was in hospital. As he has just been diagnosed with dementia it’s been a lot to take in for us all.
“Keith has been very patient with us, helping us understand the process of what to do next and has also been very caring towards dad by visiting him every morning to help and try to keep him attached to his normal life and surroundings.
“I feel I have someone I can reach out to even though dad has now been moved to temporary accommodation.”
Prior to Keith creating the Veteran Service, he supported a young family who had just arrived in the city. The husband had broken his leg while on exercise and the couple had a newborn.
Keith signposted the family to Armed Forces charity SSAFA for support with accommodation, childcare and food.
He said: “The next morning the wife approached me saying that after a couple of phone calls and an hour later everything was sorted, and they were very happy. I am so pleased to be able to help in anyway I can.”