Background Research shows that the symptom burden of chronic respiratory disease and liver disease can be high (Santos, Reis-Pina. Respir Med. 2023;219:107411; Woodland, Hudson, Forbes, et al. Frontline Gastroenterol. 2019;11(3):218–227), however, there is a lack of specialist palliative care focused on these areas to support patients.

Aim To develop a specialist palliative care service for patients with chronic respiratory disease and liver disease.

Method New posts were created for one Respiratory Clinical Nurse Specialist (CNS) and one Liver Clinical Nurse Specialist in a hospice on the South Coast of England, to create a Chronic Disease Clinical Nurse Specialist team. Phases one and two (June 2023 – Jan 2024) included planning the service specification, setting referral criteria, formulating caseloads and developing links with hospital trust teams and larger specialist centres for both specialties. Participation in multidisciplinary meetings across acute and community services, increased liaison with charities and GP practices, and delivery of internal and external education sessions further supported the need for these posts. A Band 6 bank nurse assisted caseload management. Phase three (Feb – June 2024) - ongoing data collection and permanent employment of a Band 6 nurse to support increasing workload.

Results Data continues to be collected for ongoing analysis. A 10% increase in total non-cancer referrals to the hospice was recorded in the first six months. Significant findings indicate earlier referrals into palliative care for patients with chronic respiratory disease, resulted in improved symptom management and earlier opportunities for advance care planning discussions. Improved links with acute services have shown increased collaboration for patients with complex needs and facilitated admission avoidance in both specialties. Positive feedback from patients and carers evidence the benefit of the service locally.

Conclusion Feedback and statistics to date have shown a positive effect of these roles on patient care locally. Continued evaluation of the impact and effectiveness of these roles on patient and carer experience is required.