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Characteristics of paediatric home care provision: the two dominant models in England
1Research in Health and Social Care Section James Clerk Maxwell Building (formally Waterloo Bridge House) London UK.
Aim:
To describe characteristics of paediatric home care teams
Background:
Home care provision is increasing and recent government initiatives such as support for Princess Diana Memorial Fund nursing teams will provide additional impetus to universal provision. However, little is known about the characteristics of paediatric home care teams.
Method:
A postal survey of all services in England (n = 137) listed in the 13th edition of RCN 1996 Directory of Community Children's Nursing Services was undertaken. A response rate of 85.5% was achieved.
Findings:
More than half (54.6%) of the teams had been founded after 1990. Most (72.2%) were managed through paediatric or child health directorates and most (77.8%) were based in hospitals. The size of teams varied enormously (range 1-22; median 3). Only a small (5.6%) minority of teams provided care at night although over a third (37%) reported making special arrangements for terminally ill children.
Conclusion:
The survey revealed two dominant models of paediatric home care: the community model with strong links to primary health care and other local provisions and the hospital outreach model with strong links to the hospital service. A number of weaknesses in current provision are identified: variability in geographical coverage; undesirably low core staffing numbers; poor 24-h coverage; and potentially compromised staff skills and knowledge. The need for research to clarify the strengths of the different models and their effectiveness is highlighted.