Services
Wellchild Nurse Care Coordinator
WellChild is the national charity for seriously ill children, young people and their families.
WellChild’s aim is to make it possible for children and young people with exceptional health needs to be cared for at home instead of hospital, wherever possible. WellChild currently fund the Nurse Care Coordinator post at Gloucestershire Health and Care NHS Foundation Trust.
The WellChild Nurse is embedded within the existing community children’s nursing team and their focus is on planning and coordinating the child/young person’s transition from hospital to home. They provide essential care and practical support to children and young people with exceptional health needs and their families and play a crucial role in enabling children to leave hospital and be cared for at home, reducing the practical, emotional and financial impact for families.
The WellChild Nurse works across organisations within the integrated paediatric teams to proactively manage, coordinate and support an identified caseload of children and young people with complex care needs. They are the nominated key worker to coordinate the child’s care once at home in particular facilitating communication between health, social and educational services.
The WellChild Nurse works closely with existing services and teams to ensure that all the health and social care needs of the child have been met. They maintain lines of communication across all services, communicating changes in circumstances to multiple service providers and speaking on behalf of children / young people and their families in an advocacy capacity as required. They liaise and build relationships with professionals within and outside of Gloucestershire to coordinate care and improve the experience for the child/young person and their family.
The WellChild Nurse will work with children with complex medical needs and will be responsible for:
- ensuring all health and social care needs are met to improve health outcomes and quality of life
- ensuring integration of all elements of care including across multiple providers both in and out of county
- improving the experience and choice of children, young people and families by;
- ensuring the voice of the child is paramount
- providing a consistent individual to coordinate all aspects of care across multiple providers and practitioners
- reducing the number of times the family have to tell their story
- improving safety by coordinating the multiagency team around the child
Referral criteria:
The Child/Young Person is either:
- Prolonged inpatient care at level 3/4 Tertiary care managed by 2 or more specialist teams; Tertiary care managed by 1 specialist team but with health complications
Or
- YP condition is complex to manage – organ transplant, complex multisystem condition, acquired brain injury, significantly life-limiting
And one of the following:
- No clear overriding diagnosis for which accounts for all the medical conditions and/or ongoing conflict around the assessment or care plan for the condition
- Requires a central point of communication to guide and support a family through transition points e.g. From hospital to home or between services
- Child/YP not engaging with education and/or no discernible consistent understanding of YP educational needs
- Social concerns such as housing, economic situation, or parental capacity to manage the condition
