Background February 2018, the CCG reported an overspend of the CHC (Continuing Health Care) budget, with delays in funding approval and sourcing care packages, resulting in patients dying without a care package or with inappropriate hospital admissions.

Following the success of the West Hertfordshire Palliative Care Referral Centre (PCRC), (Hospice UK 2017 innovation in care award - a single point of access; three hospices and NHS community trust) three hospices collaboratively submitted a business case, proposing that any cost savings of 5% and above would be reimbursed to the hospices. July 2018 the CCG commissioned (18-month pilot) delivering NHS CHC fast track pathway. The RPCS launched Sept 2018.

Aims of the RPCS Provide personalised care by trained end of life care carers.

• Based with the PCRC, so supporting the wider triage and coordination of Palliative/end of life care across West Herts;

• Receive hospital and community fast track referrals for community care packages

• Service provision from 8–8, 24/7 plus dedicated budget for overnight care, (sub–contracted with Marie Curie);

• More patients achieving their preferred place of care/death;

• No acute hospital discharge delays whilst waiting fast track care;

• Reduction of inappropriate hospital admission;

• Improved patient experience in last weeks of life;

• Opportunity to reach more people by the hospices.

Results to date (nine months)

• Deaths at home as a % of all deaths has risen;

• Preferred place of death risen from 79% to 90%;

• 99% of care delivered within 48 hours;

• Only 2% of patients have exceeded the CHC fast track criteria of 12 weeks;

• 100% of care has been sourced by the hospices;

• Rise in the initiation of care packages and referrals from the previous year’s data;

• Ability to change care provision at short notice ensuring patient–centred and cost effective;

• 95% of referrals met CHC criteria, demonstrating effective budget control.

Conclusions Based on the current figures and activity the pilot is delivering care for an increased number of patients for less care hours than previously seen in CHC.