• M A Tatman, C Woodroffe, P J Kelly, and R J Harris.
• Wolfson Child Health Monitoring Unit, Institute of Child Health, London.
• Qual Health Care. 1992 Jun 1;1(2):98-103.

ObjectivesTo describe the first two years of a paediatric home care service.DesignObservational cross sectional study, 1989-91.SettingOne inner London health district.Patients611 children referred to the service; 50 children selected from those referred during the first year, whose parents were interviewed and whose general practitioners were invited to complete a questionnaire.Main MeasuresDescription and costs of service; views of parents and general practitioners of selected sample of children.ResultsIn its second year the team received 303 referrals and made 4004 visits at a salary cost of 98000 pounds, an average of 323 pounds/referral and 24 pounds/visit. This represented a referral rate of 3.2% (258/7939) of inpatient episodes from the main referring hospital between 1 December 1989 and 30 November 1990. Of all referrals to the service, 343(56%) came from hospital inpatient wards. The service was used by disadvantaged and ethnic minority families. The children's parents (in 28(61%) families) and the home care team did a wide range of nursing tasks in the home. Parents of 47(94%) children sampled agreed to be interviewed, and those of 43(91%) found the service useful; guidance and support were most commonly appreciated (33, 70%). Parents of 25(53%) children said that hospital stay or attendance had been reduced or avoided. Parents and general practitioners disagreed on clinical responsibility in 10 children, and communication was a problem for some general practitioners.ConclusionsThe service enabled children to receive advanced nursing care at home. Clinical responsibility should be agreed between parents and professionals at referral.

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