Background St Richard’s Hospice have instigated a ‘Gateway Service’ for patient and family referrals to the hospice. This new service is designed to enable all patients to choose the level of care and support from the most appropriate specialist palliative care professional at the most appropriate time.

Aims Gateway aims to support national agendas by providing a better use of resources both physical and financial and by promoting patient choice to provide a greater experience of care for all involved. Active discharge planning is encouraged with a ‘step down’ facility of telephone support.

Methods Gateway makes the first telephone contact and undertakes an expert assessment of need, ensuring patients and families are fully involved in their care through informed decision making in order to live well and die well. Gateway can provide an urgent home assessment to support appropriate admission to the inpatient unit if needed. Gateway provides specialist advice for patients and families to manage their condition promoting resilience and empowerment.

Results Patients and families receive true holistic assessment of need to identify and pre-empt potential problems with compassionate care through competent professionals who are committed to excellent communication. This service has proved to be cost effective and efficient whilst being highly effective. Economic evaluation provides evidence of significant reallocation of costs up to £423 000 per year across the hospice, enabling appropriate resources to be deployed to those most in need.

Conclusion Through leading change to effect a new culture of practice, current feedback identifies better allocation of resources at a cost saving, whilst enhancing excellent individualised care provision to patients and families referred for hospice support.