Background

• Our Hospice at Home (H@H) service supports 31 GP practices (population 315,000 patients).

• Pre- COVID-19 pandemic service provision of seven-days 9am-5pm was reviewed.

• Enhanced model developed supporting people wishing to die at home. (DIUPR local CCG 45.9 vs 46.6 England 2017 ONS).

• DIUPR increased during the pandemic.

Aims

• Increase ease of access to care provision at home through increased service hours.

• Increase medical support to develop a specialist palliative care virtual beds model.

• Uphold hospice’s strategic aims and values of ‘widening access’ and ‘reaching more people’.

• Uphold ‘Ambitions for Palliative Care’ - ‘each person gets fair access to care’ (National Palliative and End of Life Care Partnership, 2015).

Methods

• Collaborative appointment (Hospice and NHS) of new community palliative consultant.

• Use of triage priority rating.

• Agreed a rapid service pathway for those unstable/dying.

• New service launched September 2020 with increased hours (8 am to 10 pm) and ability to review patients same day.

• Supported out of hours by on-call palliative consultants.

• Virtual beds model supported by daily ‘ward rounds’ and updated plan of care.

• Data collection – number of referrals, referral source, diagnosis, place of death.

Conclusion Service activity increased. 84% of patients died in their usual place of residence. Daily review of patient plans enabled continuity of care. Clear contact information required for patients and families as different service involvement can be confusing. Referral process between partner organisations needed re-discussion and review.

Future planning

• Priority ratings to be reviewed.

• Strengthen relationships with GP practices by attending Gold Standards Framework meetings.

• Increase use of data collection including user feedback to support the development of service to enable more patients to be reached in line with identified growing demand.