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Milestone Intermediate Care Unit

Watch Liz Marr and Rachel Kenyon discuss the Milestone intermediary care unit in Edinburgh.
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Hi, I’m Liz Marr and I’m the senior East of Scotland manager for Waverley Care. I’m responsible for the residential service that we have here at Milestone. And it’s where I met Rachel. And this is why we’re here today, to talk about the care of the people that use the service. Hi, my name’s Rachael Kenyon. I’m the service manager with the Cyrenian Hospital Inreach Team. It’s a new pilot service that started in February 2020, working with hospital patients who are experiencing homelessness. And at the start of the COVID lockdown, Liz and I, along with other partners in the NHS, came together to set up a new intermediary care unit here at Milestone House.
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So we’re going to discuss some of the challenges that the more vulnerable patients might face and how we, as workers, can support them through that and work with them. So we started by asking some of the hospital patients for some feedback on their experiences in hospital. And the thing that stood out the most for me is that most people described being really frightened and anxious. And I think we can both give some examples of how that shows in their behaviours, in terms of people being very frustrated– Mhm. –and potentially coming across as quite angry and aggressive. Whereas what’s behind that is more around fear and anxiety.
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Patients describe being terrified because they don’t know where they’re going when they’re leaving hospital. They don’t know what’s happening. And they just don’t understand their treatment and what the medical staff are trying to tell them sometimes. And I think we still experience that even out with the hospital environment here. Yeah, so many of the patients that we’ve worked with in the hospital environment describe being very reluctant to access health care because they feel that they will be judged. Rightly or wrongly, they feel that they will be judged. So they feel that their illness might be put down to drug-seeking behaviour, for example. And a brilliant quote from a patient was, if you want drugs, you got your dealer.
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You don’t go to hospital. That’s not where you get them. But people come feeling that they’re going to be judged in that way. People describe feeling like hospital staff or other staff in other settings don’t particularly want to engage with them because of their issues. And that just increases some of these defensive behaviours. And it increases their anxiety and their frustration. Whereas we find, working with patients in the hospital environment, they will very quickly– just having that five minutes, like you say, to spend just listening to them.
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Whatever it is they want to say, whether it’s relevant to their immediate health care need or not, if you just spend that five minutes listening, then they will trust you so much more quickly. Yeah. So much more quickly. I think we hear a lot of stories, don’t we, about people turning up at hospital, not really sure what’s going on for them and how they’re feeling, and being made to feel less than welcome or less than cared for. And some of that is the way that people present, because they’re angry, they’re anxious. They may be coming over as aggressive or shouty or demanding. And staff in a busy unit, understandably, don’t have time to sit and reassure people.
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But we know what lies behind that. And I think it’s so important that those first 10 minutes are spent with people trying to reassure them, trying to engage with them, and to stop that happening. And then I think the support then can start. Absolutely, because so many of the people that we work with are used to being excluded from services or used to getting a certain reaction from professionals because of their behaviour. So their defences are already up. And if we don’t show people right at the beginning that we are there to support them, then it makes the relationship much more difficult. Yeah, and it’s not easy to do.
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I mean, I remember in the early days of working here how anxious I would get. I would always personalise it and think that it was something about me that people had an issue with. And my first default was always to be very tight and very boundaried and challenge people. And you know, I think all that did was make the situation worse. And it took me quite a long time of realising that nothing was changing, nothing was moving on, and it was my actions that had to change.
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Yeah, it can be very difficult, especially when you have a role to fulfil or you’re perhaps asking something of somebody, and you feel that they are not listening to you or they are not engaging with you. It can be really difficult to keep that cool front but still be listening and being supportive. And I think it’s something that we’ve all struggled with. But I think many of our clients are so traumatised by their past experiences that it makes it much, much harder for them. We would all be stressed in that situation, going somewhere new, dealing with medical professionals. We’d all be stressed and anxious.
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But when people are bringing all this history with them, a history of trauma, a history of being excluded from services or feeling marginalised, then their defences are much, much higher. And I think sometimes it’s just recognising that these behaviours are a response to how they are feeling and not a response to necessarily how we are interacting or the situation we’re in. Mhm, and I think we’ve probably both got really strong examples of how tensions between statutory services and the third sector really put up a lot of barriers to effective support or effective service delivery. I mean, we’ve got countless examples of past cases that we’ve tried to work collaboratively with the NHS, but the NHS tended to hold people.
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And so you know, they have so many resources at their fingertips that they cannot send somebody to the dentist, or they send somebody to a dietitian. And you know, the third sector support seems to get lost somehow, that psychosocial support and that slower-paced support, I think, that engagement, the ability to build up the relationships. But one of the things that has happened with the intermediate services, some of those conflicts that we’ve had in the past, we’ve actually– because we don’t agree on everything. We’ve had conflicts about who should be staying longer and who should get kicked out, because some of the behaviours are difficult to manage. And they’re difficult to manage in a unit of 10 complex people.
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But I think what happens, if you’re willing to be open to the process of partnership working, is that you compromise and you find a way forward. And it’s the service user that is impacted on those conflicts. You know, at the end of the day, they’re the ones that we want to keep supported and given the best outcomes really. Yeah. Thank you for listening. And if you would like to contact us directly, our contact details will be in the attached material. So we look forward to hearing from you. Thank you.

In this video, Liz Marr and Rachel Kenyon discuss the Milestone intermediary care unit which consists of a residential service overseen by Liz and an in-reach team at a local hospital led by Rachel, which primarily deals with hospital patients experiencing homelessness. This video is a combination of clips from the full video which is available in the see also section.

Feedback from hospital staff when working with socially excluded patients mainly notes their frustrated and sometimes aggressive behaviour. This behaviour mainly comes from feelings of fear and anxiety due to not fully understanding what is happening as a result of past traumatic experiences. Other socially excluded patients who require healthcare are reluctant to receive it as they feel they will be judged for being marginalised.

Intermediary healthcare services have found that taking five or ten minutes to listen to socially excluded people about whatever they have to or want to say, builds trust much more quickly. Different services can form a working partnership, like Milestone, to make decisions that positively impact their service users.

Please remember this video is a combination of clips from the full video which is available via the Full Interview link in the see also section.
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