Home enteral feeding: II. A health service perspective

Developments in health care technology and rising patient expectations coup led with significant organizational changes have led to a dramatic increase in home enteral tube feeding. There are a variety of ways in which such a service can be provided within the existing national funding framework. How ever, it is not always possible to realize this potential at local level. T his paper describes current funding arrangements and some of the constraint s thereby generated in service delivery. The drivers for change are identif ied together with criteria for a patient-focused home enteral tube feeding service. An innovative approach to these challenges has been adopted by one health authority in response to patient needs, staff concerns and clinical governance requirements. The 'Avon Scheme' is the result of viring funding from primary to secondary care and concurrently, abandoning the National H ealth Service prescriptions route. This has led to economies generated by l arger scale purchasing. The savings thus realized have been reinvested in a comprehensive scheme resulting in an equitable approach to service provisi on, improved patient satisfaction and enhanced clinical care. (C) 2001 Harc ourt Publishers Ltd.