Intended for healthcare professionals


Eligibility criteria improve children's access to long term ventilation at home

BMJ 1999; 318 doi: (Published 19 June 1999) Cite this as: BMJ 1999;318:1699
  1. Sian Snelling, Consultant community paediatrician
  1. Alder Hey Children's Hospital, Liverpool L12 2AP

    EDITOR—Jardine et al comment that funding and home carers are common obstacles to discharge home for children on long term ventilation.1 Liverpool has a scheme which largely overcomes these obstacles.

    Liverpool Health Authority and the local authority have agreed on eligibility criteria for joint funding for children with complex needs, which has removed the delay previously caused by funding negotiations. The eligibility criteria are based on a discussion document produced in 19942 which aims to define childhood disability by producing a functional grade of severity. Impairment of function is assessed in 10 categories that cover mobility, sensory impairment, physical health, learning, and personal care. We have added an 11th category, vulnerability, to include technology dependent children such as those on long term ventilation. Children who meet the jointly agreed criteria are eligible for joint funding split equally between social services and the health authority for a home care package, or three ways with the education department if the package includes school support.

    The joint funding scheme has been in existence for 18 months. We have had two new children on long term ventilation during this time. It took 6 weeks after initial referral for the health authority to confirm joint funding with social services, with a further 4 weeks for an additional educational agreement to funding for one child.

    Home care is provided by lay carers supported by a qualified paediatric nurse. The carers are employed by the Royal Liverpool Children's (NHS) Trust, which is responsible for recruitment, training, and supervision. Training is patient specific and is delivered both in hospital and at home by the support nurse, assisted by high dependency unit and special school nursing staff. The main delay in the process is recruitment and training of carers, with a minimum training period of 6 weeks.

    We currently have three children in Liverpool on long term ventilation at home, supported by 10 carers. The annual cost is £108 000, which covers the care packages but not the capital cost of equipment. We have estimated, based on experience over the past 6 years, that there will be two new children a year requiring long term ventilation at home.


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