Background ‘People who use alcohol and other drugs, and who are over the age of 40 are now more likely to die of a non-drug related cause than people who use substances under the age of 40’ (Witham, Galvani, Peacock. Health Soc Care Community. 2019;27:e637–e650). This population will therefore potentially need greater access to palliative and end of life care services, however, considerable gaps are evident. Providing palliative care for individuals who use alcohol and/or drugs poses a multi-faceted challenge. In addition to clinical and social needs, individuals may endure mental health problems, co-morbidities and homelessness, thus requiring a multi-disciplinary, flexible approach to care (Cook, Doran, Crosbie, et al. Palliat Med. 2022;36(2):292–304).

Aims The aims of this project are to replicate a tried and tested education and support model (Froggatt, Preston, Eastham, et al. BMJ Support Palliat Care. 2017;7:A7-A8), to engage with local drug and alcohol services, to upskill staff in relation to palliative and end of life care, and to embed proactive identification of the deteriorating person via monthly coding meetings, offering joint monitoring visits where indicated.

Methods Monthly coding meetings started in January 2024, with keyworkers from the active case management team highlighting service users with physical health deterioration, or those diagnosed with life limiting illness. A traffic light system adapted from the Gold Standards Framework identifies stage of disease, and this forum encourages discussions around advance care planning and signposting to other services.

Results To date four service users have been placed on the palliative care register and are discussed and monitored regularly. Staff from ‘We are with you’ are now able to access structured palliative and end of life care education via the hospice, and have an increased understanding of the role of the hospice following a planned visit.

Conclusion Whilst this work is still in progress, the early findings suggest this collaborative approach will lead to improved access to palliative care services for those individuals who have substance misuse issues.