Background Recognising an ageing population and increased need for palliative and end of life care, hospice services need to respond and expand in order to deliver quality care and choice. How is this achieved in financially challenging times, where fundraising alone cannot meet the financial costs?

Aim An initial case presented to the local CCG enabled recruitment of 2 WTE clinical nurse specialists, for a pilot service offering clinical support and education to 10 care homes, 7 days a week. The pilot was evaluated against identified primary outcomes, risks and challenges over a 12 month period. The knowledge gained evidencing quality and economic value, informed service developments.

Approach used Qualitative evidence to demonstrate KPIs included end of life tools, a reduction in inappropriate hospital admissions, increase in patients with non-cancer diagnosis accessing palliative care, and increase in number of staff accessing education.

Quantitative evidence of success included patient, family and professional feedback, and “patient stories” demonstrating individual patient and family benefits, examples of effective collaborative working and positive changes to systems to benefit others.

A comprehensive business case included these measures and supported by the CCG, informed a proposal for an integrated home palliative care service, enabling provision of high quality care, with demonstrated cost savings.

Outcomes In addition to the original 2 WTE CNSs funded in the pilot, additional funding provided to employ a further 1.6 WTE CNSs and 0.6 WTE administrator for the Care Homes Support Team. An additional outcome was funding to create a new Hospice @ Home team.

Conclusions With ongoing evaluation and demonstration of effectiveness it is hoped these services will become fully and recurrently commissioned through the CCG.

Application to hospice practice Applies to all hospices, especially those hoping to expand their community services and support to other professionals delivering generalist palliative care.