When physio met homecare
Sometimes, when two things come together, special things happen. Such was the case when you my physiotherapy skills unexpectedly collided with the homecare industry. This is the story of how I decided to set up what turned out to be an Outstanding-rated, physio-led homecare company…
As a mature student at the grand age of 30, with four kids in tow, I only ever expected to work in the NHS. And for several years I did, learning much and meeting many wonderful people in the process, but I felt stifled.
For me, the frustrations of the NHS were that I could not make a structural or political change to the overall ways of running the department or the team. I had responsibility but no power. So the first step was to make the leap into private practice and to find a way of working which allowed me to offer my expertise, developing business skills alongside clinical ones and building a reputation as a safe person for advice on injury and ill health.
Being as I have part of the local community for a very long time, from school at St Bernards in Westcliff to having a family growing up in the area, it doesn’t take long before the clinical work that you do is embedded in the population and makes you easy to find by recommendation and referral from other health professions, from A&E to GPs and other physiotherapists.
Creating a private service involves adapting your knowledge to the needs and demands of patients who do not use the NHS and take control of their own health in a different way. I worked in a small clinic or made home visits to those recovering from surgery or neurological conditions and ill health. Along the way I started to build up a trusted circle of families who would call me for advice with older relatives, patients who had new diagnosis of difficult conditions such as Parkinson’s disease or dementia. Being available to offer support and guidance became integral to my practice.
Meeting Janet
Once sunny afternoon in 2009 I headed out to do a home visit to a new patient, referred by a retired friend who was a social worker. All I knew before arriving was that this person wanted help following a “bad year”. The bad year had involved retirement followed by a spell in hospital and rapidly and seriously deteriorating mobility which had come to a point of no more walking. Janet wanted me to help her walk again. A physio’s role is not to peddle false hope but to maintain morale and positivity. So with a firm handle on reality but with an eye on the determination that I have often seen in people facing “hopeless” situations, I set about creating a treatment plan to address the balance, strength, stamina and pain management it would take to get Janet on her feet.
This is where the collision of physio and care happened and changed my life and my direction.
The local authority commissioned care company who provided four visits a day to Janet, with two carers at each visit, refused to assist with simple exercises or even slight but significant changes to how they worked with Janet. Deeply frustrated, I called around other care providers to see if they could work closer with me on this. Whether commissioned by social care or paid for privately, none of them was open to working alongside a physio. The logic of incorporating small changes at every visit, 7 days a week, was completely outside the scope of their thinking. Remarkably, their goals for Janet were lacking any insight into how she could regain mobility, leaving a static situation in which she would either rely on some magical healing through unprecendented health improvements or leave her in inevitable decline.
When I reported this back to Janet she simply told me to set up the right care company to make it happen for her and, she assumed, others like her!
So the collision between the two worlds was the result of another frustration at how the status quo simply did not serve the people I had been trained to help.
A new adventure
Entry to the home care market is a challenging mix of compliance, registration and business planning, along with a health dose of stamina and a sense of humour. Like most things in life, you don’t know what you don’t know until it bites you on the bum. And you start wondering what on earth you’ve done!
Finding business partners to complement my strong clinical leadership was critical and, in the first of what have become known to us as “Doris Moments”, my accountant Laura and her husband Austin agreed to join me on this adventure into the unknown. So, not only did physio join social care so did accountancy and marketing consultancy. Between us we worked out strategy, policy, recruitment and software and got started in 2011.
What I have learnt along the way could not fit into one article, perhaps it is a book, but safe to say the clinical experience of physiotherapy fits very well in the social care world. Physiotherapists are trained to problem solve. First of all you listen closely to the person in front of you and establish what their problem means to them. Then by using objective measurements and clinical reasoning based on evidence and research, you create an assessment of the situation in a holistic way and move to a plan of action that can map and account for changes along the way.
This training is why Cara and I, in leading the care and support we offer at Doris Jones, are good at what we do. It is also why we encourage other health professionals to look more deeply into the social care sector. Our offer to the university of Essex to host undergrad physiotherapy students is one way of showing our own profession just how well suited home care is to developing physiotherapy skills. The way we train our staff is grounded in the principles of physiotherapy, our constant review of each person’s independence, skills and progress means that we offer a dynamic service aimed at maximising the return on the investment of care visits. We know the cost of care is a significant factor in choosing a care provider and we aim to offer the very best version of it. Adding our physiotherapy knowledge to everything we do has proven after 14 years of successful growth, that it really does make us different to other care companies.