Children and Young People’s Continuing Care Service

The service is for people aged 0-18 who are registered with a Harrow GP and have:

  • complex health needs. These include behavioural, emotional, mental health or physical disabilities
  • health needs that cannot be met by existing universal, targeted and specialist local health services
  • a rapidly deteriorating condition that requires a care package to support end of life care

What does the service provide?

They provide specialist nursing care for patients with needs arising from disability, accident or illness that cannot be met by existing universal or specialist services alone.

The team works with staff across agencies such as social services and education. Together, they organise the provision of individualised care packages.

The service enables children and young people by providing them with:

  • a choice to remain in their own home
  • enable early discharge
  • access education
  • minimise the need for repeated hospital admissions

Continuing healthcare can also take place in a residential school, residential placement or hospice.

The continuing care pathway for children and young people with continuing care needs has three phases:

Assessment phase

This is led by a nominated health assessor. Areas considered during assessment include:

  • preferences of the patient and their families
  • holistic assessment of the patient, including carer assessment
  • reports and risk assessments from multidisciplinary teams
  • evidence and outcomes of the above are entered into the Decision Support Tool

Decision-making phase

After the assessment, a multi-agency forum, such as a joint funding panel, will make a decision about:

  • whether the patient has a continuing care need
  • whether there should be a social or tripartite arrangement
  • what proportion of funding should be provided

Provision phase

After a decision is made, an appropriate package of care is put in place. The package of care is under regular review to ensure that the child’s evolving needs are met.

How do I access the service?

One of the following will need to refer you:

  • social services
  • community nurses
  • key workers

A referral will be followed up by a full assessment to establish eligibility. Parents/carers or individuals can also request a continuing care assessment.