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Evaluate the improved value that NHS 111 can provide to palliative care patients and their families by utilising specialist palliative care nurses within urgent and emergency care
  1. Alison Bradley,
  2. Michela Littlewood-Prince,
  3. Usha Kaushal,
  4. Kathryn Mitchell,
  5. Claire Leyland,
  6. Judith Wanstall and
  7. Nicholas Cooper
  1. NHS 111, Yorkshire Ambulance Service, UK


Introduction NHS111 Yorkshire and Humber, using the 4C’s framework to review Concerns, Complaints, Compliments and Comments became aware of issues regarding ‘delays’ to care for palliative care patients. We conducted a systematic review of palliative care services to identify areas for improvement.

Aims To improve the value that NHS111 could provide to palliative care patients by understanding pathways for palliative care, testing the use of specialist palliative resources, developing ideas for technology developments, enhancing access to medicines through the use of pharmacists and to understand how NHS111 can work to enhance out-of-hours palliative care services in the region.

Methods Intelligence was gathered to identify the current position to support palliative patients. Interventions were designed to provide new and improved ways of working. Palliative Nurses were employed for 5-weeks during out-of-hours and training provided to the wider healthcare team.

Results Analysis of the results allowed further improvements to the provision of 24-hour care and out-of-hours provision. Higher levels of demand were experienced during weekend hours and at the start of a Bank Holiday periods. Palliative Care Nurses were also able to provide high levels of self-care’ advice without requiring onward referral.

Conclusions We directly identified empirical evidence and delivered a range of benefits which support the ‘Dying without Dignity’ report and provided recommendations to directly address the issues of poor symptom control, inadequate out of hour’s service and poor care planning.

Furthermore Training and Development for NHS 111 staff in palliative care matters was further enhanced with the development of a palliative care e-learning package.


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  2. NHS The Five Year Forward View; 2014

  3. NHS EnglandNHS 111 Learning & Development Programme – Phase 2; 2014

  4. Dying without dignity. Investigations by the Parliamentary and Health Service Ombudsman into complaints about end of life care. [online] Ombudsman service; 2015. Available at: [Accessed 7 Jun. 2016]

  5. Willett K. Pharmacy and the urgent and emergency care review, 2014

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