Background Woodlands Hospice previously operated a traditional specialist palliative day hospice service, four days weekly, with limited therapy out-patients and domiciliary care. Patient satisfaction was high. However the model of care provided support for a limited number of patients and did not meet needs of all, specifically younger patients, those not wanting to stay all day and those requiring specific and targeted interventions.

Aim To improve access to individually tailored, evidence based specialist palliative care for community based hospice patients.

Method Stakeholder consultation: patients, hospice staff, trustees, volunteers, healthcare professionals Literature review

Visits to other hospices

Outcome Reconfigured service improved patient choice and access. Face-to-face contacts increased (2012–2013 = 4032; 2014–2015 = 5059).

1. Building Project (Hospice UK funded): purposely designed rooms enable 1:1 appointments, group therapies and a rehabilitation room for group exercise

2. New Hospice Programme:

• Twice weekly day therapy- for complex unstable or deteriorating patients with needs that cannot be met in other services

• Individual out-patient and domiciliary appointments with any member of the multi-professional team

• Multi-professional group program- enables more patients to access care and peer support:

• Exercise

• Breathlessness management

• Fatigue/anxiety/sleep management

• Creative arts and legacy work

• Self-management programme (nurse facilitated, topic based education and peer support)

• Patient led peer support

• Bereavement support

Introduction of validated outcome measures to evaluate care

Conclusion Access to comprehensive individualised specialist palliative care for community based patients has been improved. Patients move seamlessly between 1:1 appointments, groups and day therapy according to need. Structured evaluation of care continues to influence service improvements.