Future scenario

Maqsood leads a newly-established team in St Neots. It helps to keep people living independently by providing intensive nursing input at home – so avoiding hospital admission or enabling earlier discharge.

Maqsood knows that the research evidence is clear. Too often, on admission to hospital the care and support networks on which older people depend fall away and with it their ability to live independently. He helped to co-design the service as part of the Fit for the Future programme and has worked hard to develop his team, which brings together professionals across several organisations and focuses on each individual patient’s needs.

For example, Mrs Barlow was one of the team’s first patients after she was discharged from hospital much sooner than she would have been before it was in place. She was able to recover at home, at first with high-level healthcare and daily contact with support workers, then stepping down to every other day contact with a nurse. She even received home visits from the pharmacist to make sure her medication was correct.