The service has two main aims:
1. The Urgent Service is for patients immediately at risk of admission to hospital (they are either in their own home or A&E). These patients will be seen within 6 hours of the referral and a health and social care package will be put in place to support them to stay at home fir 72 hours
2. The Community Matron service is for patients who have had admissions to hospital in the last 6 months and are at risk of further admissions. They will be seen by the team within 2 weeks and a management plan will be agreed with the patient, matrons will visit regularly depending on patients need but will also visit at the request of the patient family if the patient is acutely unwell.