Background Our Family Support Service (FSS) is a small team covering community and inpatient unit (IPU) provision (approximately 500 community patients, and 10 IPU beds). As reflected nationally, a shortage of experienced palliative care nurses (The Parliamentary Office of Science and Technology. Palliative and end of life care. POST NOTE number 675; 2022), combined with an increasing number of complex distressed patients and family carers (Oechsle. Med Sci. 2019;7(3):43; Hughes, Noyes, Eckley, et al. BMC Palliat Care. 2019;18:8), led to IPU staff managing amplified levels of psychological distress. This caused a marked increase in referrals to the FSS, many of which were labelled as ‘crisis’, requiring urgent input. Simultaneously, the waiting list for the FSS in the community became unsustainable, resulting in a delayed response.

Aim To re-model our service to support the acute needs of the IPU, while balancing service provision to a higher volume of community patients.

Method We devised a new ‘IPU Acute FSS’ to work as follows:

• IPU staff discuss FSS input requirement during their morning handover meetings, to identify patients, carers, and staff requiring support.

• A member of the FSS works within the IPU for four hours, over two sessions per week offering specialist psychological, financial, and practical support to patients, carers and staff.

• Counselling interventions are clearly defined as single session therapeutic input to manage expectations.

• The IPU FSS is managed as a team, and not individually, as before.

Results The overall referrals to the FSS over the 3 months of the trial are shown below.

This reduction in referrals was explained by IPU staff reporting that the predictable presence of the FSS staff in the IPU had helped them to feel supported in managing complex situations, with increased confidence in assessing appropriate psychological distress.

Conclusion The FSS is now more integrated with IPU and able to offer a more equitable service to community patients and carers.