Collaborative community care management enhancing homecare for people with advanced HIV disease: care planning between nursing and social care consultants, London, United Kingdom

Establishing, assessing and matching needs with available services and client expectations is the essence of joint community care planning, within the new United Kingdom legislation (1). Continuous audit and case review by two fieldworkers have described common themes and recurrent scenarios in community HIV care management within health and social care structures. This poster describes working scenarios, care management practice and care issues encountered by two HIV service consultants: Community Care Coordinator (CCC) and Clinical Nurse Specialist (CNS) within one inner London borough and the coterminous health district, respectively. The community care coordinator for HIV (CCC) within the Islington Neighbourhood Services department provides access to and advice about, the available social and housing services for people living with HIV-related disease. The postholder offers referral to other agencies, a dedicated casework service and an advisory role to field social workers, homecare organisers, community occupational therapists and various social services personnel. A specialist domiciliary home care team is available and operates within the borough's existing generic structure for domiciliary care. The clinical nurse specialist HIV/AIDS (CNS) within Camden and Islington Community Services NHS Trust, provides a consultant nursing service in association with and complimentary to, the existing generic nursing services. The postholder offers clinical support and advice to clients, health and social care professionals, in order to maximise the involvement of primary health care teams in homecare provision. Furthermore, education and training for health care professionals in clinical manifestations, intravenous therapy, treatments and psychosocial care is available within the CNS-led continuing education programme (2). Access to both postholders by field staff is increased through message pager aircall. CCC and CNS work jointly on casework, liaising with and working alongside their colleagues in health and social services structures to provide client care management (3). The case studies presented from monthly audit and case review are recurrent and typical of the workload together with the difficulties associated with trying to maintain quality care with cost-limited community resources, blending generic and specialist services for clients with HIV disease