Letters

The NHS plan highlights that most current arrangements between the NHS and the private sector are ad hoc and short-term.

A recent joint-working party report on the health and care of older people in care homes (Royal College of Physicians, July 2000) has identified 10 action points and defined a crucial role for the specialist gerontological nurse. These recommendations are to be welcomed, but where do you start? Action is required now, but must be consistent with the long-term goals outlined in the report.

We believe that getting it right at the care home/hospital interface is the first step. We now have the benefit of five years' experience of a care home liaison service, and believe that our model provides a realistic starting point.

The system is based on the follow-up of individual patients discharged from hospital wards, both medical and surgical, to care homes. Following the initial ward-based assessment, we recommend a routine one-week follow-up visit to new care home placements.

Communication difficulties can be reduced by introducing a care transfer form. Crucially, the liaison team has access to a wide range of specialist practitioners and can respond immediately to problems.

Direct contact with care home staff has greatly facilitated training and education, with the sharing of clinical guidelines and best practice. Care home staff will often seek advice about other residents or issues. A direct telephone helpline is available for advice and support for all staff, and regular nursing home matrons' meetings are held, which liaison nurses attend to share information and address areas of concern. These initiatives have helped to facilitate early discharge from hospital, prevent unnecessary admissions and enhance relationships.

The system operates with two part-time liaison nurses responsible to the senior nurse - continuing care, with support from a consultant geriatrician in an area with 3,000 care home beds. This is a realistic starting point for other trusts. In the longer term, more comprehensive outreach schemes must be developed, supported by trained and experienced specialist gerontological nurses working to benefit the whole care home population.

J Paul Milnes, consultant physician Sue Cochrane, senior nurse - continuing care Emma Snee, liaison nurse Dawn Blackburn, liaison nurse Airedale trust Keighley West Yorkshire