Background Wirral Hospice St John’s (WHSJ) has been providing a Hospice at Home (H@H) service for 10 years, of 3 hours day slots for ‘carer respite sits’ as well as 11 hours overnight support.

In 2021–22 NHS winter pressures had a negative impact on access to end-of-life care at home. In view of the detrimental effect on patient care, local Commissioners approached WHSJ to support the system by providing personal care for end-of-life patients. Within budget 4 month pilot programme of reduced respite sits and six personal care visits per day 9–5, 7 days a week was commenced. Providing responsive care alongside Community Nurses to those in the last weeks and days of life. With an ICB award of c£100k enabling recruitment of three Band 2 HCAs working across both H@H services, this service continued throughout 2022. The key outcomes were Referral to Death interval 11 days, and 92% died at home. Due to positive outcomes, Commissioners agreed further funding for a permanent H@H personal-care service.

Current The new service delivers personal care to patients in the last four weeks of life. With referrals from the local hospital discharge and community nursing teams. The service anticipates a case load of 6–9 patients, with two teams delivering up to three calls with two carers daily, 8am-8pm. The staff team consists of: 12 WTE HCAs, 1.4 WTE Band 4 Coordinators, 1.4WTE Band 5 RNs. Ongoing recruitment enabled incremental service extensions.

Key outcomes (8 weeks’ post expansion):

• Referral to death interval 14.4 days.

• Deaths at home, 87.5%.

• Referral to care start ≤24hrs 86%.

• 4 patients in receipt of care for more than 28 days.

Key learning Community Nursing and Hospital discharge team prognostication was reliable. Families were well supported without the 4 calls a day usually requested from Continuing Health Care. Partnerships with Community Nursing, Hospital Discharge team, Commissioners and Continuing Health Care are essential.