Meet the Community Resource Team at Wrexham Maelor Hospital

With large numbers of medically fit patients occupying beds at the Maelor, huge queues of ambulances waiting to handover patients and huge demand in A+E and across other departments, getting hospital admissions right is crucial. 

Enter the Community Resource Team (CRT). 

CRT is made up of two parts. One works in the Emergency Department at the Maelor, to review and discharge patients that can be seen quickly or don't need to be admitted, but may need some extra support at home.

The other team works more in the community to help prevent admissions coming in, for example, a GP may refer the patient to the team who will visit the patient at home to see if they can treated or supported at home, rather than attending the hospital. 

On the whole, the team is set up not to stop people being admitted to hospital, but to free up capacity by dealing with patients that may not need to take up a bed at the Maelor. 

The Maelor Hospital

CRT is headed by Maria Peters-Newman, who discussed the current challenges faced by her team and the rest of the staff at the Maelor. 

She said: "We've got an ageing population, and there's just not enough staff, funding or resources to deal with it all. 

"There's medically fit people ready to be discharged but the provisions aren't in place for them at home, which then causes the big waits in A+E and so on.

"We'd love to extend our teams here and we probably need to, but it's just about funding."

 "Ultimately it comes down to funding, social care is the biggest issue at the minute, because there is not enough capacity for the population."

Cara Jarvis works in the community team of the CRT, her main role is to visit people in their own homes and ensure the correct measures are in place to prevent any need for further hospital admissions. 

As touched on by Maria, the ageing population creates further demand on resources, and with community hospitals closing as well as other social care services, the workload often ends up with hospital staff. 

Cara said: "The majority of stuff we see in the community is with the elderly, trying to get the provisions in place for them to be cared for in their own home. 

"There's just a lack of social care which makes it difficult. We can have between four to 14 referrals a day, but depending on the needs of the patients they can sometimes take the same amount of time. 

"Things like community hospitals have closed, luncheons have closed and other services like that for the elderly, so they can become reliant if they do end up in hospital. 

"We often see issues with medication, where patients forget what medication they need and when because they're being given it by someone else for so long during their stay in hospital."

Cara admits there has been a shift in the type of cases they are seeing since covid.

She added: "Covid has had a huge impact.

"We're seeing more dementia cases because people aren't going out, they're not seeing people or speaking to people, so the decline can be massive.

"Again, because of the closure of services and facilities people are now deconditioned which can often lead to falls or UTI's (Urinary Tract Infections), which then causes them to be waiting in the back of an ambulance or in A+E. 

"So if we can get out and treat people in their own home, then we can hopefully reduce the chances of that. 

"We do cover a large area which can sometimes make it difficult. We might get a list of the visits we need to make, the first one could be in Glyn Ceiriog, next we're up near Llangollen, then Overton and Coedpoeth, it's difficult fitting that in with the timings we've got. 

"We often get 15 minutes to get to each appointment, that can be tricky."

In a bid to ease the pressures faced by covid, a team of Advanced Nurse Practitioners (ANP's) were set up to try and assist the high volumes of people coming through the door at A+E. 

Since then, their role has progressed into assisting the CRT in dealing with patients that may not need to go to hospital. 

Karen Buckley is the team lead for the ANP's and says the main approach is to help people and make them feel comfortable at all times. 

She said: "With the ANP team we deal mainly with frail patients, those who have had falls or need palliative care. 

"We're relatively new having only started after covid. We were initially brought in to help deal with the high numbers coming through the door in A+E, but the role and department has developed since then. 

"Our key aims are to be speaking with the families, to understand what patients want during their final days. Once they've been assessed, can they go back home and see out their final days there?

"Or for those not needing palliative care, is the best course of action for that person to take up a bed on a ward in hospital for a week, or can we get them back home, with a care package sorted for them?

"Without that, patients would just be put on a ward, taking up a bed when perhaps they don't want that and it could be better all round if they are just at home. 

"One big thing we've seen is since covid, people are deconditioned, and people don't often think about that. They've stopped moving and going out, so they are losing muscle and the ability to be stable on their own.

"That sort of thing isn't really thought of, but there is a knock on effect from it. It all comes down to taking a pragmatic approach to certain situations and dealing with it from there.

"We're looking to make our team bigger to fit the demand, but the issue is you have to show that there is extra capacity and more staff is needed, and we can't do that at the moment, because there's not enough staff."