Background The COVID-19 pandemic placed heightened demand on statutory NHS services and to optimise timely patient care to our end-of-life patients, rapid changes to service delivery were required to work alongside our original Hospice at Home service (Etkind, Bone, Lovell, et al., 2020. J Pain Symptom Manage. 60: 31). There was a need for rapid flexibility and ongoing service development to drive forward this innovative practice/service change.

Aim To ensure our palliative patients received a timely, flexible and responsive service in their homes, whilst supporting hospital discharges, preventing admissions, and reducing calls to 111/999.

Method Flexible deployment of the existing clinical team was used to operationalise the Roaming Service, whilst continuing to deliver our commissioned Hospice at Home model. The Roaming Service to deliver care 7 nights a week 9.30pm to 6.30am. A RGN and HCA travelling between patients in a donated vehicle, providing responsive care across the county for any referred patients at end-of-life requiring interventions including symptom management, personal care, patient/carer support, and verification of death.

Results The Roaming Service proved an effective model for our patients at end of life and significantly reduced the impact on statutory services.

From 15/04/2020 to 11/05/2022:

• Over 1829 referrals have been received for the Roaming Service.

• The Roaming Service carried out 1951 patient visits.

• 3197 symptom management interventions were performed, preventing the need for NHS attendance.

• 5125 support calls were made or received in support of a patient.

Individual patient may receive one or more visit.

Conclusion Development of the Roaming Service played an essential role in ensuring quality end-of-life care was maintained, whilst responding rapidly and flexibly in response to COVID-19 (Etkind, Bone, Lovell, et al., 2020). Evaluations of the service reveal that 92% of patients supported by the service remained and died at home. User and staff evaluations have been exceptionally positive and the joint model of care our service now provides has proved successful.