1. ‘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

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

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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

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