Introduction Initially the ‘Severn Hospice at Home Day Care Service’ was created to provide specialist support and care to patients who were experiencing a crisis in their illness where additional nursing care could prevent hospital/hospice admission. The service needed a review to see if what it provided was what was needed by our local community.

Method Band 3 Healthcare Assistants were deployed to supplement other community teams supporting the assessment of that patient for a defined period of 72 hours. Evaluation of the service identified that most of these patients were in the last few weeks of life, requiring continual nursing care support. Subsequently the Hospice approached Complex Care (Continuing Health Care funding service) to become the palliative care provider of choice for Fast Track clients in the last 6 weeks of life.

Results End of life care is provided to all patients over the age of 18 regardless of diagnosis. The service provides one point of contact for all referrers seven days a week. Service quality standards already identified:

• Links to access to specialist advice – Outreach team, GP

• Prescribing and monitoring of medications

• Decrease in complaints received by complex care

• Fast track status reviewed early if not appropriate

• Coordination of care – having oversight of care at the end of life

• Having links to the hospice – work more effectively together

• Flexibility – challenge the standard ‘x2 carers/x4 a day request’ – refocus on patient–centred care

Typical 4-month stats (April - July 2019): Referrals – 296 and Care Hours - 6,331.75

Conclusion The primary objective of the service is to provide Individualised packages of care, increased/reduced according to need for patients in the last 6 weeks of life and those closest to them. Through this provision of home care, we are demonstrating that we can improve the assessment and management of symptoms.