Background Most people would prefer to die at home (Office for National Statistics. National survey of bereaved people (VOICES). 2016), yet less than 50% do (Nuffield Trust. End-of-life-care. 2023). Oxfordshire is an outlier for persons with three or more non-elective admissions during the last 90 days of life at 8.82% (English average 7.4%), (Office for Health Improvement and Disparities. Atlas of variation (Palliative and end of life care), 2018).
Aims To facilitate personalised care including fulfilling end of life choices, whilst reducing days spent in hospital. Analysis of individual elements will indicate cost:benefit ratios to aid conversations around sustainability.
Methods RIPEL consists of four elements: A Home Hospice (HH), Hospital Rapid Response (HRR), Palliative Care Crisis Team (PCCT) and an Enhanced Palliative Care Hub. HH, initiated in April 2022, provides care at home with oversight from the Palliative Care MDT. HRR, launched October 2022, facilitates rapid support and provisions for patients in hospital who are dying, and who have expressed a preference to be at home at the end of their life, to get them home. PCCT focuses on palliative care support to a patient’s own home. Alongside expanding our Palliative Care Hub, this facilitates an integrated response to help patients remain in their place of choice. 29 quantitative and qualitative KPIs are assessed across the four elements each month.
Results In year 1, RIPEL accepted 645 referrals, enabling each person on average 15 more days at home instead of hospital in their last year of life. This totals to 6755 days, translating to a net benefit of £587,327. We will provide an update at 18 months.
Conclusion The first two live arms of RIPEL have exceeded expectations. Key to success is co-ordination between elements. Patients are reviewed together daily as a virtual ward facilitating continuity of care and MDT oversight. Complexities are acted on promptly. The final two elements will launch soon, looking to build on the successes so far, allowing many more people to be cared for in their own homes, where this is their choice.
This project receives funding and support from Social Finance, through Macmillan Cancer Support, and from Sobell House Hospice Charity.
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