There is growing national recognition that people with Advanced Liver Disease (ALD) have limited access to palliative care despite a high symptom and psychological burden.

St Luke's Hospice and Basildon and Thurrock NHS Trust (BTUH) have designed a collaborative shared care pathway to ensure early and timely access to a range of support services and interventions in order to provide optimal wellbeing; the management of distressing symptoms and emotional support for patients and their families living with ALD.

The services now offered to ALD patients and their families in South West Essex are seamless and robust and are based on a 'One Stop Shop' ethos. The project serves patients at all stages of their disease and this includes patients identified transplantation.

The setting for the project involves Hospice outpatient services and occasional inpatient Hospice care.

Objectives

• to enhance and embed links and referral pathways between the Liver team at BTUH and hospice

• to increase access to the provision of Hospice based holistic, supportive care for ALD patients

• to streamline the process and improve access to timely paracentesis therefore improving patient experience and reducing hospital admissions and length of stay

Outcome measurement

• improved patient experience (POS scores; service user satisfaction surveys; stakeholder feedback)

• improved access to services (as above)

• reduced morbidity

• reduction in Acute hospital admissions and length of stays (collation of activity data)

• timely intervention for paracentesis (service user and stakeholder feedback; activity data analysis)

• improved emotional wellbeing (POS scores; wellbeing tool analysis)

• improved carer support (CSNAT analysis)

Outcome measurementHospice based paracentesis data is showing significant cost savings but importantly significant improvements in quality of life outcomes.

Local CCGs are engaged in this project and there is national interest as the collaborative design of the model could enable timely replication nationally.