Introduction Most people would prefer to die in their usual place of residence but 50% still die in hospital.1 Up to 40% of these people have no medical need to be there.2 The End of Life Care Strategy of 2008 recommends that locality registers are developed for those at the end of life, so that they receive priority care, and also that 24/7 services be developed to enable more people to remain in their own homes.3 Hospices are challenged to ensure access for patients and respond to inequalities, reaching more people and influencing other local health services.4 We responded to this challenge with a creative co-commissioned strategy.
Aims Our aim was to deliver change in the culture of end of life care across the region from a reactive, high hospital death rate situation, to one reflecting choice and quality in end of life care provision.
Methods We developed a locality register in conjunction with a 24/7 single point of access in September 2013. This has been supported with a primary care grant and education to local GP practices, encouraging their identification of patients likely to be in the last year of life. The triage service has grown to include a rapid response service. Hospice nurse specialists now head teams of registered nurses who offer key worker support to those identified by the register.
Results 38 of 42 local practices participated. More than 1600 (0.5% of the population) have their choices recorded. 43% of all deaths in those practices were pre-identified by the register and 86% of those were able to die in their preferred place. The chance of someone on the register dying in hospital is 18%.
Conclusion End of life care can be improved with a creative hospice co-commissioned approach.
National Bereavement Survey (Voices) 2011 www.dh.gov.uk/health/2012/07/voices
End of Life Care. The National Audit Office. 2008
End of Life Care Strategy. Department of Health 2008
Future ambitions for hospice care: our mission and our opportunity. Help the Hospices. 2013
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