View report page

In the beginning the hospital met the whole cost of the experimental scheme from its
endowment income, the Council's contribution being restricted to the provision of home
help and the loan of equipment where necessary. From 1 November, 1959, however, the
Council assumed financial responsibility for the nursing staff salaries through the agency
of the Paddington-St. Marylebone District Nursing Association. The hospital authorities
continue to meet the other expenses (medical staff, transport, etc.) and from voluntary
monies have agreed to reimburse the district nursing association the seven per cent. of the
expenditure by the district nursing association on nursing staff salaries which does not
rank for the Council's grant.
The aims of this home-care scheme are to:
(a) avoid the separation of the sick child from its home environment,
(b) improve liaison between the family doctor and the hospital,
(c) prevent cross infection,
(d) reduce the cost of treatment while maintaining a high standard, and
(e) educate the families in preventive methods.
The team consists of a paediatrician and three nurses. A part-time physiotherapist and
an almoner are available. Student nurses and medical students can be attached to the team
for experience. The nurses, who in addition to being state registered nurses hold certificates
in sick children's nursing, carry out treatment, assist with technical procedures, instruct
the mothers in bedside nursing and infant feeding and keep the usual nursing records.
They are available for night duty, which is reassuring for parents, although seldom required.
The catchment area for the scheme includes most of Paddington and part of Marylebone,
some 28 square miles of mainly working class development with a population of more
than 75,000.
When a family doctor wants to use the scheme he telephones the hospital. A consultation
between him and the paediatrician is then arranged in the patient's own home, or the
patient is visited by the paediatrician and the situation is discussed over the telephone.
An important point about this scheme is that the patient remains under the care of the
family doctor throughout, although specialist investigations and treatments will be carried
out by the doctor attached to the home-care team. Most of the diagnostic and therapeutic
resources of the hospital can be made available in the patient's home. Between 300 and
400 children are cared for in their own homes each year under this scheme, thus preventing
admission to hospital and separation from parents at a time when the experience could
be highly traumatic.
The most suitable groups for home-care have been found to be:
(a) infants with medical conditions such as feeding difficulties and gastric enteritis,
which provides for education in preventive measures,
(b) children under five years with acute illnesses,
(c) older children with chronic or incurable illnesses who would otherwise be parted
from their families for long periods.
This scheme also enables children who have had to be admitted to hospital for, say,
surgical operations, to be discharged home earlier and remain under supervision.
Nursing at home—The district nursing service and the home help service are always
available when the nursing of the child at home is possible as an alternative to admission
to hospital. Vital considerations are the presence of the mother, her aptitude and the
willingness of the family doctor to treat the child at home. The mother who must go out
to work for economic reasons can be helped to nurse her child at home by the offer of
employment by the Council as a home help in her own home. The standards of care given
to each child by the various services involved does depend on each individual concerned
being aware of the need, not only to do his or her part, but also to bring in other services
promptly and for each to keep the other informed of important developments in the case.
61