Background Access to a 24/7 service supports people at the end-of-life, enabling them to be cared for and to die at home. Prior to this project all overnight/out-of-hours (OoHs) calls were dealt with by the hospice staff giving telephone advice, often referring to the 111 service. Delays in the delivery of care and lack of specialist face-to-face support often resulted in unnecessary/unwanted admissions to hospital.
Aims To question the need for an out-of-hours visiting service and to develop the future planning of services to support people at the end-of-life to die at home.
Method Three-year funding was secured, and the service was introduced in 2019. The service provides a clinical nurse specialist and healthcare assistant out-of-hours to deal with calls from known and unknown patients in our communities. The service offers telephone advice, face-to-face consultations and accepts new referrals for people often in crisis. The service works in collaboration with London Ambulance Service (LAS), out-of-hours general practitioners and district nurses.
Results Joint working with LAS developed an appropriate care pathway for all end-of-life patients in the three boroughs. Most calls into the service are for symptom management and emotional support, however, new patient referrals have increased with the team often seeing people in crisis. The activity of the service has increased significantly from year 1 to year 3 with 50% of calls from patients and 50% from professionals.
Conclusion The benefits of the service are evident in the data reports and the patient experience feedback, it has enhanced the community service by ensuring a seamless service for people at the end-of-life and supporting next of kin and professionals 24/7. The service has prevented admissions to hospital reducing the pressure on the acute sector. The data provides evidence for the need of 24/7 visiting and we are currently exploring funding options to continue the service.
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