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WHEN Angela Body retired in 2013, she was anticipating a future filled with travel and time with her family.
But, two years after what she thought was the last day of her working life, a cup of coffee with Dr Nigel Minihane saw the former nurse and director of operations at the General Hospital return to a world of alarm clocks, routines and care.
‘I have always worked in care,’ explained Angela, who came to the Island in 1979 as a staff nurse at the General Hospital, before opening the facility’s day surgery unit in 1997 and then working in various management roles and eventually becoming a senior manager.
‘When I retired, I spent two years travelling and just visiting my two daughters fairly regularly.
‘Then I saw an ad and became a live-in carer for people in the UK, covering for staff holidays and I really enjoyed the role of working as a hands-on nurse again. That showed me the key relationships between the clients’ GP, homecare agency and district nurses and, in one particular case, how well this connected approach helped them manage some very complex care needs,’ she said.
‘From that, a seed was sown and, when I came back to Jersey, I met Nigel Minihane and asked why there wasn’t a similar arrangement in place here in addition to the important role undertaken by Family Nursing and Home Care.
‘With the support of two large GP practices, Castle Quay Medical and Indigo Medical, we went on to launch 4Health Homecare Agency in 2016.
‘We started out in a fairly low-key way, using one of the treatment rooms at Castle Quay when one of the GPs had a morning or afternoon off,’ she smiled. ‘The staff always knew when I’d been in because when they next came in, they would find that the printer wasn’t working.’
Despite the IT glitches and the lack of a permanent base, 4Health continued to grow, moving to larger premises at Castle Quay in 2019 and now employing around 84 people including registered nurses, carers and support staff who care for people across the Island and from all GP practices.
In keeping with Angela’s vision of a co-ordinated approach to care, 4Health still occupies a unique position in the Island. ‘We are the only homecare agency to be affiliated with GP practices. We have care overseen by registered nurses in the clinical setting and work closely with Family Nursing and Home Care and other healthcare professionals to ensure that each patient receives the right tailor-made treatment,’ said Angela.
‘These relationships are hugely beneficial to the patient. If, for example, we think somebody has a urinary tract infection, we can take a sample for a quick lab analysis, and there is no need for the patient to leave home or suffer any further upheaval.
‘Similarly, if a doctor has prescribed a certain treatment or has any concerns about a patient’s condition, our team can monitor the situation. It all comes down to teamwork and putting the patient at the centre of their own care.’
In many ways, this approach mirrors the aims of the Jersey Care Model, approved by the States Assembly in 2020, which is designed to offer people-centred care with a focus on prevention and self-care and working with partners to deliver more care in the community and at home.
‘I definitely support the theory and would love to see more work taking place in the community but, for this to be successful, we have to address the current issues surrounding capacity and availability of carers in the community,’ said Angela.
‘The drive is to get people out of hospital as quickly as possible because it is always very sad to see people who are ready to be discharged having to wait for the right community package. At the moment, though, capacity is very difficult and demand for care services is increasing to a point where it is outstripping supply, sometimes significantly.’
And, as Angela says, recruiting further staff to increase the demand is far from straight-forward.
‘Finding the right care for each individual is crucial and, to do this, you have to have the right carers,’ she explained. ‘This is where recruiting is sometimes difficult and training is essential because it is not just a case of bringing people in and checking their references and DBS checks. What you don’t see on paper is a person’s aptitude for care, and that is so important. While we all deliver care differently, having the right ethos, empathy and commitment is vital to all.
‘Some people might not think that caring will suit them, while others may been frightened by the type of care and the responsibility involved but I would encourage anyone who is interested to consider it seriously because it is a lovely profession to be in and it’s a real privilege to work for people in their own home and to support them to enjoy a safe and happy lifestyle.’
While finding the right carers can be difficult, another challenge can be persuading people to accept care.
‘As you get older, you realise that you are not as sharp, bright or mobile as you want to be and you don’t like that situation so you try to hide it both from yourself and from your family,’ Angela said. ‘I empathise with people who are feeling that way and it’s a difficult situation. It’s also very difficult for family and friends to have those difficult conversations and broach the subject of needing care.
‘However, if you notice a change in somebody’s habits – particularly around whether they are sleeping and eating properly – or see a change in their physical behaviour or notice any signs of memory loss, I would recommend acting as quickly as possible, as an early intervention can make all the difference.’
Not only, says Angela, can those early steps provide much-needed support from the beginning but it can also help to safeguard the individual’s later needs.
‘We know that capacity within the industry is an issue so if you start early, perhaps with just one visit a week, you can begin building the relationship with both the carer and the managers overseeing that care,’ she said. ‘Then, as the person’s needs grow, that relationship is already established and the carer can respond and increase the level of support accordingly.’
Offering a full spectrum of services from weekly visits or help with shopping and domestic tasks to 24/7 live-in care, the team at 4Health is committed to finding the right care package for each client.
‘Underpinning all of our care is finding the right client-carer mix,’ said Angela, ‘and then establishing the level of need which can range from live-in care or care on a permanent basis for those who don’t have the facilities for someone to move in – plus a variety of personal and end-of-life care.’
Further supporting Angela’s vision of integrated community care is 4Health’s relationship with Freedom Physiotherapy and Wellness Centre and Community Fit.
‘Because of the huge demand for the Health Department’s physiotherapists and occupational therapists, we have developed a partnership with Freedom and Community Fit which enables us to bring their experts to our patients to assess whether any changes are needed to their homes or to develop a programme of exercises to support them,’ she explained.
‘This is a new service for us and one which is hugely beneficial as their physiotherapists and occupational therapists then advise our carers on the best additional support to introduce for each patient.’
4Health is also working with Lilli Intelligence, a company which can deliver unintrusive digital aids to observe people’s daily activity patterns such as sleeping and cooking. Families can then decide whether any support, and if so what type, their loved one needs. While it is in its early stages, Angela says this work may provide extra insight into how to maintain the independence of loved ones.
‘Ultimately, all of the services that we introduce are designed to enable us to look after people safely in their own home and to ensure that they are happy and that all their needs are met,’ Angela continued. ‘A lot of people are keen to live at home for as long as possible and our goal is to facilitate that in a safe way, which keeps them well and out of hospital.’
To ensure that local home care agencies and care homes maintain high standards, the Quality Care Commission undertakes regular inspections of all suppliers and makes recommendations for improvement. These are all published on the QCC website, which shows that 4Health was one of the best in the Island.
