‘We didn’t need you, but it was good to know you were there’ SETTING UP A ‘STANDBY SERVICE’ FOR HANDS-ON HOME CARE Sophie Thomas – Matron Buffy Wheatley – Deputy Matron Sharon Jones - CNS Linda Hier – Care co-ordinator Joan James – Care co-ordinator

We provide ‘hands on’ care to those living with a life-limiting illness enabling people to die at home if that is their preference.

SERVICES For patients: Hands on home care Standby service Equipment loan For patients and carers: Support service Befriending Service Complementary therapies service General enquiries

BACKGROUND A new service – started in July 2008 For people not yet in need of home nursing care but otherwise eligible for the home nursing service Provides: Information 24 hour contact numbers regular contact

STANDBY SERVICE Aim: That patients who may need our care know that they can contact us at any time – 24 hours a day, 365 days a year

REFERRALS Anyone can refer with the consent of the patient Any member of the care management team can take a referral If the patient does not wish to consent but their family carer is anxious to have contact we will provide appropriate support to the carer

ASSESSMENTS Patients will be contacted within 48 hrs of referral - unless otherwise agreed Patients are offered an assessment date within one week of referral A full ‘standby’ assessment must include: A visit to the patient’s home Undertaken by a Registered Nurse

THE SERVICE Explanatory visit to patient includes verbal and written information regarding: PSF services including 24 hour contact details Red Cross Carers Emergency Card Scheme Fire Service Referral Card Pembrokeshire Carers Centre leaflet Other services thought appropriate following discussion

THE SERVICE We agree contact arrangements with the patient - How often - By whom Full referral details and any other information available is then added to the ‘Standby Service On Call File’ With the consent of the patient the referral form is faxed to OOH, the District Nurse and Macmillan nurse are then also contacted The CMT member will have the file with them throughout their period of ‘on call’ Person on call will make necessary contacts on a Friday – pre-empting potential weekend crises

BENEFITS Benefits for families: Aware that care is available at short notice Time to assimilate information about PSF Relationship already built up when care is started Paperwork in place so care can start very quickly when needed

BENEFITS Benefits for the Foundation Much quicker and easier to arrange short notice care Care not requested before it is really wanted – better use of resources All members of CMT have some knowledge of patient when care starts

ENDING SUPPORT Patients are discharged from the standby service if: They are receiving regular home care from us It becomes clear they do not meet our criteria for home care It becomes clear they will not need our home care service eg they are admitted to a nursing home Patients with whom we have had no contact for 2 months will be contacted and asked if they wish to continue with the service

FIGURES In a nine month period 71 referrals – from a wide range of referrers 22 from DNs 16 from friends or family Remainder from Macmillan, GPs, wards, social services 40 eventually needed hands on care 31 never needed hands on care

QUALITY MEASURES We intend to conduct a survey at a time of year when there are 10 or more standby patients to determine: Whether the patient has retained the information given The patient’s level of satisfaction with the service

‘We never needed to call on you, but it was so reassuring to know that you were there if we needed you.’