Nurse-led complex care at home
Professional Partnership with Case Managers
We work collaboratively with case managers to support planned transitions from hospital to home, with clinical governance, clear documentation and transparent communication.
How We Support Case Managers
Our professional approach, clinical governance, and commitment to collaborative working supports case managers arranging complex discharge planning and community care packages.
Rapid Response
2-hour response for urgent referrals, 24-hour response for standard referrals during business hours.
Clinical Governance
Robust governance frameworks with NMC-registered clinical leadership ensuring safe, effective care.
Seamless Discharge
Streamlined discharge planning with hospital liaison teams and comprehensive care continuity.
MDT Collaboration
Active participation in multidisciplinary meetings with clear communication and transparent reporting.
Comprehensive Documentation
Detailed care plans, regular reports, and incident documentation meeting all professional standards.
24/7 Clinical Support
Round-the-clock access to our clinical team for advice, escalation, and emergency support.
Referral confidence for respiratory packages
SHNC works with referrers, families and community teams when planning respiratory care at home, so clinical risks, equipment and escalation arrangements are clearly understood.
- Assessment includes the person's airway, respiratory equipment, home environment and escalation arrangements.
- Case managers can expect collaborative communication as care plans and competencies are reviewed.
Our Referral Process
A clear referral process designed to support timely decision-making, clinical review and safe care planning.
Submit Referral
ImmediateComplete our secure referral form or call our dedicated professional line for urgent cases.
Initial Review
Clinical reviewClinical team reviews referral and confirms suitability within agreed timeframes.
Assessment Arranged
Timing agreed after reviewClinical assessment scheduled at convenient time with patient/family and referrer if required.
Care Plan Development
Following assessmentComprehensive care plan created incorporating medical history, current needs, and goals.
Service Commencement
As agreedCare begins with detailed handover documentation and emergency protocols established.
Ongoing Reporting
OngoingRegular updates, incident reports, and care plan reviews as per agreed schedule.
Our Service Level Agreements
Clear standards and commitments that you can rely on for consistent, professional service delivery.
Referral Management
- Clinical review of each referral
- Assessment timing agreed after review
- Mobilisation plan confirmed after acceptance
- Care commencement: As agreed
Clinical Standards
- NMC-registered clinical oversight
- Individual risk assessments
- Evidence-based care protocols
- Regular competency assessments
Communication
- Incident reporting within 24 hours
- Weekly progress reports available
- MDT meeting participation
- Direct professional contact line
Quality Assurance
- Monthly quality audits
- Continuous improvement processes
- Regulatory compliance monitoring
- Staff supervision and training
Documentation & Reporting
Comprehensive documentation and transparent reporting to support your case management responsibilities.
Care Documentation
- • Comprehensive care plans
- • Daily care records
- • Medication administration records
- • Risk assessments and reviews
- • Equipment monitoring logs
Incident Reporting
- • Immediate verbal notification
- • Written reports within 24 hours
- • Root cause analysis
- • Corrective action plans
- • Learning and improvement actions
Regular Reporting
- • Weekly progress summaries
- • Monthly quality reports
- • Care plan review meetings
- • MDT meeting contributions
- • Discharge planning updates
Emergency Support & Escalation
Comprehensive emergency protocols ensure patient safety and professional communication at all times.
Emergency Response
- 24/7 clinical advice line
- Immediate clinical assessment
- Direct hospital liaison
- Emergency service coordination
Professional Communication
- Immediate notification to case manager
- Detailed incident documentation
- Follow-up action plans
- Learning and improvement feedback
24/7 Professional Support Line
0208 050 0098Professional Referral
Refer a patient for nurse-led home care services. All referrals are reviewed by our clinical team.