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Read about our Community Liaison Team who help patients flow from the acute hospital setting to the community.

Based at Norfolk and Norwich University Hospital is a small office housing what is known as the “face of NCH&C at NNUH”. The Community Liaison Team (CLT) is made up of six nurses and admin support. The team runs a seven day service as part of an Integrated Discharge Hub, directly supporting community admissions to NCH&C inpatient units and admission avoidance from NNUH outpatient clinic and A&E areas. They also provide a point of contact between the acute/community inpatient services ensuring a flow of information and coordinated response to critical demand levels.

They have to be one of the most assertive teams in the healthcare system, “sitting” in the middle of acute and community services, liaising on which services are most appropriate for the patients they see. The team have a built a really good rapport with our Discharge Coordinators across NCH&C which is helping to keep things moving.  At the same time, they are also promoting their moto of “always think home first”.

From 8am it was all go, liaising with all the inpatient community units, finding out the bed state/ what type of beds were available (male, female, side rooms etc.) and checking to see if any patients have been readmitted from our community beds.

Patients who are referred to CLT are deemed medically fit and ready for transfer to community services. CLT assesses all patients referred to gain insight into their needs and understand which services would be appropriate, especially if they require rehabilitation, and whether they have been engaged in therapy in the acute setting.

As well as assessing patients, the team have to be involved in system conference calls titled the Silver Call. This is chaired by the CCG and system partners including NNUH, the Ambulance Service, 111, NSFT, Social Services, the Systems Ops team at NCH&C, ERS, the complex discharge team at NNUH and other community pathways.

I observed many assessments of patients who had been referred. The team advocates a“describe” rather than “prescribe” approach to what patients need, ensuring they receive the most appropriate care and support.

Ian Bell, Head of Learning Disability Services at NCH&C tells us a bit about working in LD.

“A learning disability is a global impairment of cognitive function. It’s a lifelong developmental disability which will always affect someone’s ability to learn and function independently as an adult. These disabilities will have been present since before the person was 18, and usually from birth. A learning disability is permanent and affects a person’s entire life and differs from specific difficulties such as reading and writing problems, Dyslexia, Autism and Asperger’s.The person may have a medical diagnosis already such as Asperger’s Syndrome, Autism or Cerebral Palsy, but this does not necessarily mean that the person has Learning Disabilities.

“Norfolk County Council Adult Services Department and NCH&C work together to deliver a single service for people with Learning Disabilities in Norfolk. Our team of Health & Social Care Professionals work to provide specialist healthcare and support to people with a learning disability, as well as their families, to help them live a fulfilling life.

“We provide specialist health and wellbeing input to adults with learning disability whose needs cannot be met by mainstream services. Dependent on need, the team may offer direct intervention, indirect work with carers and families or joint working with other professionals and signposting to, or support to, access mainstream health services. We assess an individual’s needs and the risk factors to produce multidisciplinary care plans to reduce the risk while promoting independence, dignity and quality of life.

“There are many roles in the team, including: Community Learning Disability Nurses; Occupational Therapists; Social Workers and Assistant Practitioners; Clinical Psychologists; Health Care Assistants; Speech and Language Therapists; Dietitians; Transition Workers; Physiotherapists.

“Why consider a career in Learning Disabilities? It offers you the chance to make a difference, a high degree of flexibility and a career with excellent employment prospects.”

Find out more about a career in Learning Disabilities click here.

Epilepsy is a condition that affects the brain and can start at any age. There are many different types of epilepsy – sometimes people have it for a limited time with the seizures eventually stopping. For others it is a life-long condition. When someone has epilepsy, it means they have a tendency to have epileptic seizures. Anyone can have a one-off seizure, but this doesn’t always mean they have epilepsy. Epilepsy is usually only diagnosed if a doctor thinks there’s a high chance that the person could have more seizures.

To raise awareness of this often misunderstood condition and to mark #EpilepsyWeek, Laura Palmer, Staff Engagement Management, spent the morning with NCH&C’s Epilepsy Team to find out more about the brilliant work they do.

NCH&C has both Children and Adult Specialist Epilepsy Nurses covering the whole of Norfolk. Both teams are part of the ESNA; Epilepsy Nurses Association, a professional organisation whose membership consists of nurses and other health professionals working to support people with epilepsy in the fields of adults, learning disabilities and paediatrics. Some of the team are also part of The Eastern Paediatric Epilepsy Network, which supports clinicians with an interest in childhood epilepsy from across the Eastern Region.

NCH&C’s Adult Epilepsy Specialist Nurse Service sees patients from the age of 16, working closely with the Epilepsy Specialist Nurses from the Children’s team as patients transition over to the adult service. They offer help, support and information to patients with epilepsy, families, carers and friends. Each patient has a personal care plan to help manage their seizures, with support and advice also given to colleges, universities and employers. The team also provide specialist epilepsy advice to health and social care teams.

Patients are seen in a range of settings: home visits; residential homes; ward visits; telephone contact; and nurse led clinics. I had the chance to observe a nurse led “transition” clinic, with Lisa and Colleen, with two patients moving from children’s to adult services.

At the clinic, the patient and their family could talk through many aspects of their epilepsy including current medication; how to manage symptoms, seizures and aspects which trigger one; diet; and practical support with driving, starting higher education courses etc.