Problem identified Heart failure (HF) affects millions of people worldwide in almost epidemic proportions with higher morbidity and mortality than many cancers presenting a major burden on individuals, families and healthcare resources. The unpredictable nature makes HF difficult to manage, to identify when referral to supportive and palliative care (PC) is appropriate, and when end of life is nearing. The national agenda is beginning to acknowledge the importance of addressing these issues. Healthcare professionals need to adapt their care, practice and services to reflect this. Work is required to address the common misconception that Hospices are only for people dying from cancer.

Solution A major grant from Help the Hospices and The Burdett Trust enabled an inner-city hospice to employ a Heart Failure Nurse Specialist to address the above issues. The work aims to:

• ▶ Improve awareness of benefits and appropriateness of supportive and PC within the HF community (patients and professionals)

• ▶ Establish a new model of care to suit clients needs and illness trajectory

• ▶ Establish joint working and shared learning opportunities between PC and HF professionals

• ▶ Development of a HF Wellbeing Clinic (HFWBC) opening access to the Hospice, introducing support and services earlier in patients' pathway.

Findings The project already has significant findings:

• ▶ Patients with suspected HF are referred to the hospice with advanced symptoms prior to formal diagnosis or treatment optimisation as per NICE guidelines

• ▶ HF patients have embraced the HFWBC and other hospice services

• ▶ Communication and collaboration is improving between PC and HF professionals.

Future plans The project plans to:

• ▶ Re-audit referral patterns, numbers and patient outcomes for HF patients

• ▶ Conduct training needs analysis to formally highlight gaps in knowledge

• ▶ Develop a trigger tool and referral pathway into PC services

• ▶ Review of alternative models of care.