This project considered how counselling is offered, accessed, received and perceived on the In-Patient Unit (IPU) at Hospice in the Weald. Questions were formed about adapting and modifying the existing service to better meet the needs of our service users.

Unstructured interviews were held with professional MDT groups, inviting them to discuss perceptions of psychosocial care and how patients’ needs are met on the IPU. Sessions were audio recorded, transcribed and analysed.

A new model of care was proposed. Counsellors rotated through IPU for 6 weeks. At the end of the rotations, each counsellor was interviewed, as was the larger MDT (in one collective group). Interviews were recorded and salient learning points identified. After each rotation, questionnaires were given to IPU staff to identify the benefits, things to change and give feedback.

We learned that traditional methods of referral, assessment and practice of counselling are inappropriate to the specialist setting of in-patient care. Questions about ownership of psychosocial care, referral processes, multidisciplinary aspects of collaborative working, audit/review and IPU admissions for psychological care were asked and partially answered in the study. Interviewing staff after the change in practice revealed much more satisfaction with the counselling service and many advantages arising from the change in practice. Improved MDT working and speed of access to counselling were cited most frequently.

The wider implications include considering how we modify our practice to better meet the needs of our service users. Working differently may lead to investigations about what we call this approach to the provision of psychological support to in-patients and their relatives. For some it’s still counselling, for others it’s an exciting challenge to expand both their practice and capacity to offer support to those facing the end of a life; particularly those who otherwise reject talking therapy.