Hospice/specialist palliative care inpatient units

Specialist multidisciplinary palliative inpatient care is required when management is proving difficult in other settings.

Hospices are, with a few exceptions, organisations within the independent sector. They are dependent upon charitable funding with variable NHS contributions (usually around 30%) towards the costs of care. Some are run by national charities such as Marie Curie, Macmillan or the Sue Ryder Foundation. There are hospices dedicated to the care of young people (18 and under) as well as those for adults. They are subject to the same healthcare regulation and standards as NHS providers. A range of services is offered by hospices. Most, but not all, units have beds that are designated for palliative care, supported by the multidisciplinary team.

Inpatient units may be situated in an acute trust, a community hospital or as part of a hospice. Most do not have resident medical cover out of hours and at weekends. This may restrict access to admissions out of hours.

Referrals are made by GPs, community nurse specialists or hospital teams and will be patients with known progressing, life-limiting conditions of whom the majority will have cancer but an increasing range of non-malignant diagnoses are accepted.

Admissions may be needed for a short period (2 weeks or less) for pain and symptom control, rehabilitation or end-of-life care when this is not possible at home and input from different professionals is needed. Typically around 40% of people will return home after their first hospice admission. An important feature of care is the combined multidisciplinary input, directed not only to the patient but for those close to them. Palliative care physicians contribute expertise in the assessment of complex situations, the clinical management plan, and liaison with the GP and other specialists to optimise coordination of care. In this setting the physician is the consultant responsible for the care of the patient; they will lead ward rounds and oversee the work of other doctors in the unit. On-call responsibilities vary and may be shared between a group of consultants who provide senior cover to several hospices and teams in a locality.

Inpatient units also provide a focus for education and training of both palliative care and other professionals; the application of the principles of the palliative care approach developed in hospices has considerably improved the end-of-life care in hospitals. They also provide opportunity for research, often through collaboration between several units to achieve sufficient recruitment.

For a population of 250,000 the recommended minimum is 20–25 beds with a ratio of one WTE nurse: two beds. 

The National Council for Palliative Care’s minimum dataset report (MDS) for 2014/15 shows that UK hospice units admission rates are increasing year on year. The proportion of patients admitted to hospices aged over 85 and with non-cancer diagnoses is increasing. About 35–40% of admissions are discharged from the hospice to home or care home after a mean length of stay of 14.1 days.

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