Background/ Context End of Life care support throughout Surrey had been fragmented and lacked an integrated approach. As a result three organisations came together to form the ‘Community and Hospice Home Nursing Service’.

The service supports a multi-disciplinary partnership approach to delivering nursing care at home. Central Surrey Health (CSH), and two Independent Hospices; Princess Alice Hospice (PAH) and St Catherine’s Hospice ( StCH) are now delivering a seamless seven day, 24 hour service.

Main Aim To provide care that avoids inappropriate hospital admissions and enables more people to be cared for and die in their place of choice.

Approach Used The service was designed following patient and carer feedback and necessitated hospices working together across traditional boundaries.

Key elements

• Co-ordination via a single point of access

• Additional clinical provision of night and day care by Staff Nurses and Senior Health Care Assistants.

• Partnership approach to care delivery.

Importantly the Hospices involved are extending their reach to support those who have not or may not need referral to specialist palliative care.

Outcomes Ninety eight percent of patients achieved their preferred place of care with 95% achieving their preferred place of death; 85% of those who were referred to avoid an admission to hospital achieved this; 28% of patients had a non- malignant diagnosis. The key performance indicator, aimed at increasing the number of referrals on CSH end of life care register by 5% was achieved with a 70.4% increase.

Application to hospice practice Commissioners were delighted with the multi-professional and integrated partnership approach to care delivery and the solution focussed proactivity. They champion the partnership as a model for the future. The community and Hospice home nursing service suggests that an integrated approach to care delivery can improve outcomes whilst being cost effective.