Hospital palliative care

Hospital palliative care support teams (HPCSTs) work with a range of other clinical teams to support the care pathway of someone admitted to an acute care setting. Referrals are made through the medical team, ward nursing staff or may be directly from the patient and family. Examples include: 

  • assessment of the patient in medical admissions units, often in conjunction with acute oncology teams, where early input can enable early discharge to community or hospice services especially for end-of-life care
  • symptom control for patients who may be at an early stage of their disease pathway, including those who may go on to be cured
  • support to patient and/or carers at diagnosis of a life-limiting condition
  • assessment of complex physical, psychological and social situations, especially when disease is progressive, but uncertainty around prognosis or when the focus of clinical management shifts from supportive care alongside proactive medical intervention to palliative and end-of-life care
  • support with intractable problems associated with patient, family and staff distress
  • support of the dying patient and family.

The HPCST is a consultant-led, multi-professional team including palliative care nurse specialists, allied health professionals, and representatives of the chaplaincy team.

  • Current minimum requirements are one WTE consultant and one WTE nurse specialist per 250 beds. This is far from being achieved across the UK.

The usual model is for teams to ‘work alongside’ in an advisory capacity although some may share in prescribing for pain and symptom management. It is an important principle that all healthcare professionals should have, and retain, responsibility for ensuring good palliative and end-of-life care for the patients they look after.

A minority of hospital-based teams are associated with palliative care inpatient units, ie with dedicated beds that are the responsibility of palliative care physicians. It is more usual however for the consultant to have a liaison role in a hospital, alongside the other specialists and with others across care settings (especially palliative care services) to facilitate coordinated care planning. Some may be single consultations; in most the team will review and provide ongoing support but the contact generally finishes with each acute care episode. Some patients may be reviewed in palliative care outpatient clinics or jointly with other clinicians in their clinics.

The HPSCT service should be provided on site 7 days each week. At weekends, palliative care nurse specialists are supported by palliative care physicians through on-call. The APM and RCP have produced recommendations for 7-day specialist palliative care services. There are insufficient WTE to provide 7-day medical services on each site; current staffing resources mean that in some areas, medical cover even with networks of sites may only be sufficient to provide telephone advice or limited availability for direct reviews within a large geographical area.

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