Previous team composed of static level of Clinical Nurse Specialists (CNSs), increasing caseloads, limited prioritisation, silo working, resistance to change/new opportunities, and static budget. This led to high demand and high pressures with a rigid workforce. The need for change was identified to make the service fit for the present and incorporate future-proofing.

OACC was identified and developed as a means to achieve a skill mix team: right person, right place, right time, to improve caseload management. The existing team were put at risk of redundancy and given the opportunity to apply for a position with the new structure.

March 2018 – the majority of the existing team decided to take redundancy reducing the Hospice Community Team (HCT) to a few remaining team members along with some agency and bank staff during the recruitment phase. HCT were not fully staffed until October/November 2018 with geographical ‘zones’ and ‘urgent response’ teams introduced in December 2018.

Three OACC tools (IPOS, AKPS, Phase of Illness) are being used with Views On Care due to be introduced shortly.

OACC impacts:

• Re–design of the hospice referral form;

• Using OACC as part of admissions and discharges from IPU and clinical assessment process;

• Development of Clinical Drop–In Day;

• New MDT process focussed around ‘unstable’ and inactivating;

• Prioritisation of assessments in zones between Registered Nurses and Clinical Nurse Specialists/Advance Nurse Practitioners;

• Utilisation of Paramedic role in ‘urgent response’ team to assess unstable/crisis situations;

• HCA role to manage more ‘stable’ patients and support carers at end of life;

• Good communication essential between roles, zones and urgent response teams.