In January 2018 Dorothy House Hospice Care commenced a service cost project to establish baseline figures and activity that would influence the future negotiations with the Non-Palliative Lymphoedema service. This exercise highlighted that the non-palliative service was not cost effective and was ineffective in being responsive to new referrals and follow-ups.

Due to ineffective diary management, lack of clinics and lack of time to engage with external referrers both the Non Palliative and Palliative Service were affected and response to referrals were poor.

Benefits of service review

• Opportunity to fully cost out a non–palliative service and ensure the service model is cost effective and ensure transparency with contracting and costings;

• Opportunity to redesign services to enable quality improvement to be part of continuous improvement of services;

• Opportunity to integrate Palliative and Non Palliative Services together to utilise fully the skills of the wider team;

• Provide a more responsive and consultative model of care to palliative patients.

Issues

• Conflict of historic model of care and changing processes within provider and commissioning service;

• Withdrawal of non–palliative contract meant reduction in team numbers and staff consultation proceeded;

• Historic expectations of hospice providing services based on thought and not need;

• Conflict about care provision to palliative vs non–palliative patients;

• Loss of experienced staff;

• Lack of non–palliative contract knowledge by external team members created uncertainty within core palliative services.

The future Through valuation and redesign/cost modelling of the non-palliative contract we have been able to fully cost out and design a service that is responsive, safe and provides quality care in a holistic manner. Through remodelling of the service we have been able to create additional time to support existing staff within the hospice to understand palliative lymphoedema and provide support and guidance to the patients etc. based on the lymphoedema service.