Children's Continuing Care Team Portsmouth

About the service

The team consists of registered nurses, health care support workers and an office administration team who work with colleagues across agencies to facilitate the provision of individualised care packages.

The team delivers individualised packages of care to children, usually provided in the child’s own home, though care may also be provided in other settings, such as in schools or nurseries. Where care is provided in these settings, the team can support with transport.

Care packages may be delivered at any time throughout the 24 hour period, predominantly covering weekends, evening hours and overnight care for the child in order to allow parents to sleep through the night.

What we do

The Children’s Continuing Care Team aim to deliver an individualised high-quality support service to your child and the family which includes:

• enabling children and young people with complex health care needs to have an improved quality of life by providing them with a choice to remain in their own home, enable early discharge and minimise the need for repeated hospital admissions
• providing personalised care packages to individual children based on an assessed care need
• supporting discharge from hospital of children with complex health needs
• establishing and maintaining clear channels of communication with families at all times
• ensuring that packages of care are delivered by healthcare support workers who have received specific training and preparation for their work with individual children
• regularly review care packages to ensure that they continue to meet the needs of the child
• a Home Care Agreement which parents or guardians are asked to sign.

Accessing the service

Referral criteria

All children and young people referred to the service must be registered with a GP in the Portsmouth and South East Hants areas.

All referrals are triaged by a clinical member of the team and a decision is then made as to whether to progress with a full assessment.

A health professional will arrange an assessment, most commonly when an infant, child or young person is discharged from hospital and needs support with their healthcare in order to live at home.

The child or young person’s needs are assessed against agreed criteria, the assessors will ask for input from the family and any health professionals who work with the child or young person, as well as from education and social care professionals.

Assessments for children and young people are made according to the Department of Health National Framework.