Background Specialist palliative care services (SPCS) often develop within organisations providing care in community, hospital and hospice. Even in their own geographical area, patients may meet at least three separate specialist teams – all working slightly differently, with individual telephone numbers and sets of guidelines – in addition to tertiary centre specialist teams.
Aim To provide a single, seamless, SPCS for patients, families and their associated health professionals.
Method A recent community services tendering process had threatened to destroy at a stroke, a successful, longstanding plan to keep community and hospital SPCS integrated through five local health service reorganisations/TUPE transfers. Negotiation, opportunity and creativity allowed the final pieces of the jigsaw to slot into place. Palliative care nurse specialists (PCNS), admin staff and consultants (NHS contract retained) transferred under TUPE arrangements, enabling the formation of a single integrated SPCS working across all settings.
Results A single telephone numbered, Hospice Central Access Hub, takes all clinical calls from patients registered with the integrated SPCS, their families and health professionals – manned 7/7, from 9–5. A full service operates during the week, and a doctor, PCNS, Transform facilitator and admin support share weekend work across all settings. At night clinical calls are directed to the inpatient unit who access the doctor on call if required.
Conclusion Wholly integrated services means patients have ONE – number to ring, team to speak to, joined up service, set of guidelines and bereavement service. The team receive the SAME – development training, uniform, support, and access to assistance. ONE single multidisciplinary team meeting discusses all new referrals to the whole service, documented on ONE single electronic patient record with mobile access for clinical staff with no duplication. There is much to do and many ideas for further development, but with a new improved road to travel.