‘Innovations in your Specialty award winner helped save my life’
Diane Palmer developed a care passport to ensure veterans receive holistic, joined-up care that met their needs. It won her the Innovations in your Specialty award at this year’s RCNi Nurse Awards
‘Diane has given me strength and courage when I had nothing more than suicidal thoughts and, slowly but surely, she has helped me to piece together my life,’ says Simon Peacock.
‘She did this by keeping her word. She believed in me. She followed up referrals. She listened.’
Mr Peacock, who was serving in the Royal Anglian Regiment when he was seriously injured by friendly fire in 2007, feels he has got his life back thanks to the support of Veterans First clinical manager Diane Palmer, as well as scores of professionals including nurses, psychiatrists, social workers, psychologists, welfare officers, lung specialists, knee specialists, employment mentor and welfare advisers.
‘Diane supported me with my tribunal. More importantly she made me human,’ he says. ‘Before that I was a robot – someone who responded to order, with no feelings or emotion. All I could ever do was scream, but the screaming stayed in my head.
‘Without her, I simply would not have coped and no doubt would have killed myself.’
Prompted by her concerns about the amount of professionals involved in the transition from military to civilian life and the risk of duplication of work or miscommunication, Diane created the veterans universal passport (VUP). This patient-held multi-agency record of care promotes collaborative working with primary, secondary and tertiary care, and addresses the mental health, physical health and social needs of veterans.
It won her the Innovations in your Specialty category at the 2017 RCNi Nurse Awards, the profession’s top accolade.
She says: ‘I also felt veterans should have more autonomy and control over producing their care plan and crisis plan.
‘I am delighted to win an RCNi Nurse Award in recognition of the VUP and the way it is supporting our veterans to access joined-up health, social and welfare support.
‘As a nurse it is a great privilege to be able to make a difference and I am proud to uphold my profession. This highlights the difference one small idea can make to the lives of many.’
‘I am so grateful to North Essex Partnership University NHS Foundation Trust for funding the first 100 copies of the VUP for a pilot, and NHS England for its support, Prince Harry for his personal interest in the project, my Veterans First team colleagues and, most importantly, my inspirational patients and their families who are of course the real heroes.’
‘Without Diane, I simply would not have coped and no doubt would have killed myself’
The passport is a full, running record of care to be used by all professionals involved. It includes a risk plan, a holistic care plan and veterans’ task list – a to-do list in which veterans set tasks and monitor their own ability to achieve goals.
‘Importantly it helps veterans get priority treatment in accordance with the Armed Forces Covenant by proving their veteran status,’ says Diane. ‘A military history and summary of needs ensures that wherever they go, they are not forced to retell their trauma story over and over again to each professional.
‘Some people said that it wouldn’t work, as people would have to carry it round with them, but women carry their maternity notes around with them and we have the red book child health initiative.’
The VUP is the result of Diane’s extensive experience working with veterans. A qualified nurse, social worker and therapist with 24 years’ experience in health and social care, she also worked in mental health for eight years at the Ministry of Defence, managing medical discharges.
As clinical manager of Veterans First (see box below), Diane led a multifaceted approach to tackling the issues veterans face in NHS services and beyond.
She says: ‘Everything is done for them in the military. They rarely fit neatly into secondary care criteria due to nature of their mental health condition.
‘They are too complex and high risk for IAPT (improving access to psychological therapies) standard psychological services and can have complex and multiple trauma injuries. Other barriers include long waiting lists for psychology services.
‘There is a lack of knowledge of the support available and how to access it. And there is stigma. Stigma and barriers to engagement are huge in mental health and huge in young men. In macho military veterans it is even worse.’
She says NHS services can lack understanding of military culture and the language used. ‘It is difficult for healthcare professionals to deal with veterans’ complex problems, which can include comorbid substance abuse, physical conditions and injuries and chronic pain. And veterans may be socially isolated.’
North Essex Partnership University NHS Foundation Trust deputy director of operations (inpatient services) Ian Carr says the passport is ‘just one of a long series of creative solutions and commitments Diane, with her team, has made at the trust’.
‘The innovative VUP has been enthusiastically received by professionals and veterans alike. It provides an opportunity for clinical and personal information to be shared consistently and concisely no matter where the point of care is, and importantly allows for real ownership and involvement in their care by the service user themselves.
‘Diane is doing something extraordinary. She is in a different league’
Head judge Caroline Shuldham
‘This idea sprang from Diane and her long experience navigating the complex worlds of healthcare and the military, a level of experience that few in the NHS possess. Her passion, drive and commitment to deliver high quality services to this vulnerable group is evident in her day-to-day practice and a credit to her, the trust and the people she leads care for.’
The RCNi Nurse Awards judges praised Diane as ‘a great and proud ambassador for nursing’.
RCN Nurse of the Year 2016 Venetia Wynter-Blyth, who was on the judging panel for this year’s awards, says: ‘The VUP is a phenomenal piece of work. And the nursing ethos shines through.’
Nurse awards judge and RCNi editorial advisory board chair Caroline Shuldham agrees. ‘Diane is doing something extraordinary, which is so wide-ranging across health services, the Ministry of Defence, plus social services. She is in a different league.
‘She has consulted widely with the veterans and military community. She took a draft passport to Veterans First support groups and drop-in sessions to gather feedback from veterans and carers. She also sent draft copies to all the heads of the military charities and the local staff we work with.’
Diane hopes that the passport can be used for other vulnerable patient groups, such as people with learning disabilities. ‘This is so adaptable,’ she says.
In the meantime, a formal evaluation by Anglia Ruskin University’s Veterans and Families Institute looking at its impact on veterans, carers and stakeholders is being funded by NHS England and is due to report in November. Diane was invited to a private meeting about the initiative with Prince Harry, who has said he will support the passport if this evaluation is positive.
‘As a nurse it is a great privilege to be able to make a difference and I am proud to uphold my profession’
Veterans First is currently expanding and regrading to become the Midlands and East Veterans Service, and the VUP will be rolled out across the area. A team is also looking at whether the passport can be replicated as an app.
A national roll-out would help other veterans like Mr Peacock ‘to live a life and be like everyone else’.
He adds: ‘I can now proudly say I have a job as a Braille teacher and have achieved my ultimate dream – a stable relationship with my beautiful wife. Through Diane’s constant ongoing support and belief in me, I have become me, Simon Peacock – soldier, veteran, human. I wouldn’t be where I am today if it wasn’t for her and her team. I owe her my life.’
Veterans First is an NHS trust-wide community mental health team based in Colchester but covering Essex. It provides support to serving personnel in their last six months of military service to help them make the transition to civilian life, and supports veterans, defined as ‘anyone who has served a day in Her Majesty’s armed forces’.
It has provided support to 500 veterans and their families.
In October 2015 Veterans First launched an innovative and collaborative partnership to treat complex post-traumatic stress disorder, comorbid substance misuse, unemployment, comorbid physical health conditions and improve the support for carers.
Clinical lead and nurse Diane Palmer and her team of nurses, associate practitioners, therapists and employment mentors set out to improve the health and well-being of veterans and their carers through a holistic approach to their assessment, support and treatment.
The service offers physical check-ups, smoking cessation and onward referrals, and liaison with GPs, acute trusts, physiotherapists and pain specialists. The service also works with drug and alcohol charities and nutritional advisers.
There are three multi-agency support groups and a peer-led breakfast club.
The team raised awareness of veterans’ needs among health professionals and beyond by delivering more than 250 training sessions and through media and poster campaigns, a TV documentary and social media.
They have also used a wide range of strategies to draw in veterans. Diane says: ‘The activities lead and clinical nurse specialist ran climbing groups, fishing, archery, football, horse riding and falconry sessions to develop rapport and promote engagement. We would grab them “for a quick check-up while you are here”.
‘The physical health lead ran physical health checks for all veterans and carers in their homes and at support groups and engaged with primary care on their behalf.’
Support and assessments
Carers’ assessments, supportive counselling and signposting are combined with the physical health checks.
Diane and the team’s psychologist created a five-day intensive anger management group and the carers’ counsellor provided sessions for partners.
It has been challenging to coordinate the different agencies and to meet veterans’ needs with a team of five, plus administrative support, she says. ‘We have had to beg, steal and borrow. We have students, trainees and volunteers. We have six different lots of funding, but the reality is that it is a small world and you have to work collaboratively.
‘A key ingredient is the cultural understanding of veterans. But its success is due to the passion of the team.’
The Innovations In your Specialty Award is supported by Nursing Standard