In 2008 the Department of Health (DH) identified increasing evidence that lack of co-ordinated community support was resulting in avoidable admissions and prolonged hospital stays. They went on to describe how hospice at home services could have a significant impact in enabling patients to die in their own home. The existing night hospice at home service provided practical support to patients and carers between 10 pm and 8 am. Building on the 7 C’s of the Gold Standards Framework (2005) the team promoted contingency planning and service co-ordination ensuring that they were already an integral and valued part of the community based services.

However, with an expected increase in the number of deaths from cancer and non-cancer deaths (Kings Fund 2011) and a local emphasis on preventing unnecessary admissions (Health and Well-being Board, 2012) a wide ranging review of the hospice at home service was undertaken in 2012. Service users and health care colleagues emphasised the importance of:

1. A 24/7 service

2. Rapid response

3. Not being reliant on external funding

4. Supporting carers via ‘on the job training and support’

5. Being accessible

6. Highly skilled, consistent and compassionate staff

The review also identified several unmet needs which could be addressed by an expanded hospice a home team, these included:

• Crisis intervention, for example whilst acute symptoms were addressed, carer stress or ill health

• Rapid response and extended packages of care for changing needs

• Pre-admission to the hospice in-patient unit

• Supported discharge from the hospice in-patient unit

• Rapid discharge from the acute sector

Our service outcomes include:

• Provision of a hospice at home service tailored to meet local needs

• Increased integration of hospice services.

• Cost effective use of hospice resources

• Increasingly achieving preferred place of care/death