Introduction

The National Council for Palliative Care’s minimum dataset report (MDS) for 2014/15 indicates that the number of patients being referred and seen with non-cancer diagnoses has doubled in 7 years. Community palliative care teams enable 81% of patients under their care to die at home in comparison with the national average for this year of 48%. Length of care is reducing year on year and was 85 days on average in 2014/15.


Back to Overview of palliative medicine services

31/12/2018

Recommendations for services

Per population of 250,000 the minimum requirement is for five whole-time equivalent (WTE) community specialist palliative care nurses.

Joint working between hospital and community is essential for good community services for patients and medical posts should be integrated across settings.

Seven day and 24-hour generic and expert palliative care services are critical to enable patients to remain in the community by meeting out-of-hours palliative care crises and avoiding carer breakdown. They should be provided as routine in all areas. The distress of uncontrolled pain and other symptoms cannot be left until normal working hours. The APM and RCP have produced recommendations for 7-day specialist palliative care services.

Shared records and access to comprehensive and robust data is essential in order to be able to deliver outcomes that matter to the person and to measure the extent to which they are being achieved.

Education and training for colleagues in the community is a key role for consultants in palliative medicine and community nurse specialists. All localities and professions should have a framework for education and training in end-of-life care.


Back to Overview of palliative medicine services

31/12/2018

Rapid access to social care

Most patients prefer to have their care at home. Palliative care for patients at home is led by GPs and community nurses. Expert input, when required, is provided by community specialist palliative care teams made up of clinical nurse specialists with clinical leadership provided by consultants in palliative medicine. These expert teams are usually advisory rather than providing hands-on care although this will vary between localities. In many cases there will be shared care with GP colleagues. Access to palliative care is through referral by the GP, a hospital team or sometimes at the request of the patient and family. In the last days of life at home, this may be supplemented by hands-on care from carers provided by social services or Marie Curie (or equivalent) nurses. Some localities offer hospice at home services. These vary in what they deliver and can range from a rapid response service to provision of hands-on care in the home over a sustained period. 

Palliative care is well used to delivering and influencing services in acute hospitals and community settings. Professionals are skilled in the delivery of integrated care and are able to bridge the gap between care settings which strengthens the continuity of care so important to patients and families. This integration helps to support quicker and more effective discharge from hospitals and reduce unplanned admissions. From within an acute setting, palliative care teams will facilitate earlier discharges from hospital to home. 

Palliative care input provides expertise in difficult clinical situations encountered by the patient, family or attending professionals, such that hospital admission may be avoided. In some localities this is augmented by hospice at home services. 

Consultant-led comprehensive community-based palliative care services, which through close integration with the GP and district nursing teams, achieve a proactive rather than reactive model of support to the patient and family where problems are anticipated, reduce the risk of crises and unplanned hospital admission. This may include MDT working where the palliative care nurse joins primary care team discussions of patients on palliative and end-of-life care registers; referrals triggered by discharge from a local acute trust rather than awaiting for urgent referrals; support for intravenous infusions and drainage of effusions at home. Examples such as the Macmillan Midhurst model (opens PDF, 2.3MB) have offered innovative 7-day services that support people effectively at home.


Back to Overview of palliative medicine services

31/12/2018