Providing Care and Support to People in Hospital

There is a care management team based in the south block of St Mary’s Hospital. This team offer the same range of services supplied by the adult services care management teams based in your local Social Services Centres. The service extends to all adult in-patients at St Mary’s with the exception of the Children’s Ward and Sevenacres, which are covered by separate arrangements. The team also cover patients at the Orchards Hospital and offer a care management service to Earl Mountbatten Hospice at Fairlee.

There are also care managers based in the intermediate care teams at St Mary’s and Shanklin.

The office is open from 9.00am to 5.00pm Monday-Thursday, 9.00am to 4.30pm Friday. A duty officer is available every morning.

The hospital care managers may be able to help with planning your discharge. You may feel that you will need help with personal care, or practical tasks such as shopping, or you might need a period of “convalescence” or longer term residential care following your hospital stay.

When you are going through the admission form with your primary nurse on the ward, they will discuss with you whether or not you should consider a referral to the care management team, similarly if you are concerned about your discharge you can ask for a referral to be made. If a decision to make a referral is made the nurse will fill in a referral form on your behalf. These referrals are faxed from the wards on a daily basis and allocations to the care managers are made by the team manager. The care manager will then get in touch with you at a time which is guided by the nursing staff on the ward. The care manager can come to see you, or your family or carer, on the ward and give you information about a range of services available from the Adult & Community Services Directorate, they will also be able to give you more detailed information about the charges for such services. The care manager will talk with you about your needs and how they can best be met. This is called an assessment and will often be very straightforward. However, if you or your carer have complicated needs you may need a fuller assessment which, with your permission, can include information supplied by a range of other professionals such as your consultant, nursing or therapy staff etc.

If the care manager does arrange a service on your behalf you or your carer will also be given a copy of your “care plan” which will detail those services.

A very wide range of professionals work within the hospital setting and each has a different job to do. Your primary nurse will be able to explain the differing roles between the care manager, physiotherapist, occupational therapist etc. and the services they are responsible for and will ensure that the correct referrals are made to each person.

Once you leave hospital, if the care manager has arranged some services for you, they will keep in touch and will monitor that service, usually for a minimum of six weeks, though it can be much longer. If the service remains in place on a long-term basis, the hospital care manager will arrange to have your case transferred to the social services centre closest to your home and a new care manager will assume responsibility for your services.

If you need further information about any of our services do not hesitate to get in touch with us or ask your primary nurse for further help.

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Providing Care & Support to People in Hospital

Information on the Hospital Care Management Team based at St. Mary’s Hospital

St Marys Social Work Team - Telephone (01983) 524081

Local social services centres