An evaluation of the costs and consequences of Children Community Nursing teams

Aims Recent years has seen an increasing shift towards providing care in the community, epitomised by the role of Children’s Community Nursing (CCN) teams. However, there have been few attempts to use robust evaluative methods to interrogate the impact of such services. This study sought to evaluate whether reduction in secondary care costs, resulting from the introduction of two CCN teams, were sufficient to offset the additional cost of commissioning. Methods Among the potential benefits of the CCN teams is a reduction in the burden placed on secondary care through the delivery of care at home, it is this potential reduction which is evaluated in this study via a two part analytical method. Firstly, an interrupted time-series analysis utilised Hospital Episode Statistics data to interrogate any change in total paediatric bed days as a result of the introduction of two teams. Secondly, a costing analysis compared the cost savings from any reduction in total bed days with the cost of commissioning the teams. This study used a retrospective longitudinal study design as part of the TraCCS trial, which was conducted between June 2012 and June 2015. Results A reduction in hospital activity after introduction of the two nursing teams was found, (9,634 and 8,969 fewer bed days), but this did not reach statistical significance. The resultant cost saving to the NHS was less than the cost of employing the teams. Conclusion The study represents an important first step in understanding the role of such teams as a means of providing a high quality of paediatric care in an era of limited resource. While the cost saving from released paediatric bed days was not sufficient to demonstrate cost effectiveness, the analysis does not incorporate wider measures of healthcare utilisation and non-monetary benefits resulting from the CCN teams.