This Christmas I spent until 1am on Christmas morning putting up a trampoline in the garden. I had started the process that morning, but ran out of time as we were out all afternoon and evening. Getting home at around 11pm meant working by torchlight to finish the job.
As I came back inside, I could hear running water. Stepping into the kitchen the noise increased, and I was confronted by water pouring through the ceiling via a light fitting.
Our boiler had burst. At 1am on Christmas morning.
As you can imagine there was a short period of panic until we managed to turn the water off and drain the system. Our children slept on, despite the boiler being in a cupboard in our 9-year-old’s room, but my wife and I were up until about 2am.
We were lucky though. We were at home and awake when it happened. We realised what it was, acted quickly and with the exception of the boiler itself (which I suspect needs replacing) there was no significant damage. Together, we worked out what to do, and made the house safe quickly.
I recently heard it said that just one simple question reveals all you need to know about how vulnerable someone is:
“If something went wrong at 4am, is there anyone you could call?”
Think about that for a moment – who could you call? I know I have friends and relations who I could call. I would hesitate to wake them, but I know they would want me to if I really needed them. In fact, I see it happening on social media – I see friends posting problems they have faced and people replying “you should have called me”. When I posted that our boiler had burst onto FaceBook I had several offers of meals and showers and even accommodation for my whole family. I am truly grateful and it was very humbling.
If you have that kind of network, it makes you more resilient. You are less likely to have a crisis, and when you do, you can get through it. You are less likely to need to call upon emergency services, who are there to help when needed but who will inevitably not know you or your family, who will be more likely to escalate if they can’t sort things out, and from this you are more likely to end up in hospital or some other place of safety.
We need to identify the people who respond with a “No” to the question above. We need to know who they are and what additional services they need to help them. To do this we need to work across multiple agencies. We potentially need information from GPs, hospitals, social services, police and more. Some will be known to third sector or faith organisations. Some will be known to none. And once identified, we need to work together to help.
This is the core work of Integrated Community Teams, of Primary Care Home and of Accountable Care. It is about identification and holistic multi-agency working and support. It is about putting the individual at the centre and doing all that we can to minimize the risks and plan for the unexpected. It is not enough for the doctor to decide that the health care needs are met and leave the rest to the social worker. We have to accept that people do not differentiate between health and social care needs, they just know that they have a problem. Life is too messy for us to separate things out like that. We need to integrate and look at all problems together.
I suspect that health and social care systems up and down the country are looking at doing just this. It is not easy. It requires the breaking down of barriers between organisations and the moving of resource around the system. To achieve it we need to move out of our organisational silos and work together.
I believe it is achievable though. We just need to work at it.
We didn’t need to call anyone when our boiler burst in the middle of the night of the one bank holiday of the year where pretty much everything closes down. There are people I know I could have called though.
And if you ever need me in the middle of the night, and have my number – please just call.
Dr Jonathan is a GP at Swanlow Practice in Winsford, Cheshire, and Chair of NHS Vale Royal Clinical Commissioning Group
Follow Dr Jonathan on Twitter @DrJonGriffiths