Background People experiencing homelessness encounter barriers in accessing healthcare services, experience poor health outcomes and early mortality. In Leeds we have developed a city-wide service aimed to widen access to palliative and end of life care for this disadvantaged group. The service works with stakeholders across the city to ensure early identification of need. This allows for early referral into the service, resulting in co-ordinated care for the complex patient group that is in line with ‘Care Committed to Me’ (Hospice UK; 2018) and ‘A Different Ending’ (Care Quality Commission; 2016) developing nurturing relationships, removing barriers and promoting equality of care.

Aim To enable people experiencing homelessness to access person-centred, non-judgemental specialist palliative care.

Method The service is led by a Nurse Consultant with support from a Clinical Nurse Specialist and a Peer Navigator with lived experience of homelessness. Alongside the core team is the hospice-wide multidisciplinary team and stakeholders from across the city. The service prides itself on timely non-judgemental, compassionate, person-centred palliative care. Undertaking comprehensive holistic assessment of patients’ needs allows the team to manage complex symptoms taking into account safety and risks. Working as a co-ordinator of care, the service supports patients to attend appointments/treatment, advocating for patients who are not always heard.

Results In 2023 the referral rate into the service grew significantly, increasing by 200% on the previous year. Twelve patients died whilst under the care of the service and only one patient died in hospital which is a 40% reduction on the previous year. 83% of patients achieved their preferred place of death. All patients were given the opportunity to participate in advance care planning discussions.

Conclusion Collaborative working and ‘thinking outside the box’ is paramount when developing palliative care services for people experiencing homelessness.