Complex Care Support Team. Bridging the gap from Hospital to Home

Information for parents and carers

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Bridging the gap from Hospital to Home – PIAG 272 (107kB pdf)

Who are we?

The Complex Care Support Team (Formerly known as the Complex Discharge Team) work within the hospital to provide a holistic approach to preparing for discharge for Children with Medical Complexities (CMC). We are child/family focused and dedicated to ensure a safe and effective discharge from Alder Hey back, into their home and local community. Our aim is to ensure that the needs of the children, young people and families are addressed on a health, social and holistic level.

We work alongside the ward and medical teams, facilitating a safe and timely discharge as soon as it is clinically appropriate. This includes acting as a bridge between hospital and community to resolve any issues the family may be having in relation to housing, equipment, care packages and support.

Successful planning starts with the child and family with the right intervention early on, to ensure that children and their families receive the best possible hospital experience including on the way home, no matter the journey taken.

Who we support

We support any child or young person that has a long-term condition, or have two or more specialities involved, as well as one or more of the following non medical barriers to discharge.

• Emergency funding (in patient only).
• Vulnerable families e.g. parenting capacity, families in need.
• Unresolved housing issues, including rehousing and adaptations advice.
• Anticipated long term ongoing care needs within the community.
• Care package breakdown.
• Social care referrals required.
• Unresolved immigration issues.
• Repatriation and transfer difficulties.
• Legal cases.
• Challenge in coordinating clinical care.

Why we support

Evidence informs us that being home and living within the community is the best place for our children with medical complexity in order to maximise their development and remain as safe and as healthy as possible. With that, the focus of the team is to assist with facilitating an effective discharge for your children and young people at the earliest opportunity. The Trust recognises how integral parents are in the provision of care and endeavour’s to empower parents and/or carers so they may play an active role in their child’s care.

The team will prioritise the training, skills and ongoing support for parents so they are confident and competent in meeting their child’s needs and with that provide parents with increased empowerment and skills to ensure they are able to meet their child’s needs. The team may at times look to compliment the support with external carers for the home where appropriate, however priority will be given to parents first in order to facilitate the discharge sooner without unnecessary delay.

Meet the team

Mark McNulty – Lead Nurse. Mark is a dual qualified nurse/social worker and can provide support around early help Assessments, social care referrals and Continuing Care eligibility checklists and assessments for those children who are likely to require a care package to live safely at home. [email protected]

Jennifer Stevens – Complex Care Coordinator. Jennie is a qualified nurse and can provide support around early help Assessments, social care referrals and Continuing Care eligibility checklists and assessments for those children who are likely to require a care package to live safely at [email protected]

Cathryn Livingstone – Team Lead and Specialist Occupational Therapist. Cathryn undertakes Occupational Therapy assessments and planning, particularly in relation to any equipment or housing needs and provides advice regarding equipment and adaptations for the home. [email protected]

Sarah Campbell – Senior Social Worker. Sarah is a Social Worker who provides specialist social care advice and support in relation to the social impact of a child’s complex health needs on them and their family. [email protected]

Nicola Hughes – Administration Clerk. Nicola provides the day to day Administration support for the Complex Care Support Team, she also plays a key role in MDT’s and financial funding for our inpatients. [email protected]

Claire Bowden – Operational Support Manager. Claire provides the day to day operational support for the Complex Care Support Team, including the facilitation of MDT’s and strategic reporting for the Trust. She is the ‘Single Point of Contact’ for complex discharge. [email protected]

Contacts

Phone:
0151 293 3663 internal ext 3663
Email: [email protected]
Find us on Twitter: @CCSTAlderHey

Working hours: 8am – 5pm Monday to Friday

This leaflet only gives general information. You must always discuss the individual treatment of your child with the appropriate member of staff. Do not rely on this leaflet alone for information about your child’s treatment.

This information can be made available in other languages and formats if requested.

PIAG: 272