Locality care teams for community hospice care

Project overview

Even before the Covid outbreak, Farleigh Hospice wanted to develop a more joined-up service for patients, their carers and families in the community. When lockdown began and the decision was made to close the in-patient unit (IPU), it became even more important to make sure as much care as possible could be delivered safely in people’s homes.

All clinical staff were redeployed into three Locality Care Teams, covering the North, South and Central areas of Farleigh’s catchment. Each Locality Care Team was multi-disciplinary, and had a shared caseload. 

Outcomes

Having a shared caseload between a team meant there was more continuity at a time when staffing capacity was fluctuating due to Covid plus all of the skills of the multi-disciplinary team could be used to maximum benefit for patients and carers.

Providing an extended hospice service at home meant that families were able to spend more time with their loved ones at the end of their lives, instead of having to negotiate the pandemic restrictions on visiting in-patient units (IPUs), hospitals or care homes. Staff reported having more time with patients, as they no longer had to travel around a large geographical area. This meant they were more able to build a rapport with patients and their families, and tailor care to individual needs. 

Even though the IPU at Farleigh has now reopened, the Locality Care Teams remain in place and are providing a full multi-disciplinary range of care. Some staff who originally worked in the IPU requested to stay in the Locality Care Team because they have found it so rewarding. During lockdown, non-clinical staff were given the opportunity to retrain in a care role and some have also opted to stay in this role moving forwards.

There has been an overall shift in the hospice towards asking “can we provide the care this person needs at home?” rather than assuming a patient needs to be admitted to the IPU.

Key facilitators

Good relationships with partners has been key to the success of the Locality Care Teams. During lockdown, there was more emphasis on collaborative working and this has been built on over time. For example, the North Locality Care Team has regular meetings with the District Nurse team and recently provided cover for the district nurses when there were gales which meant some nurses were unable to visit patients.

Having a multi-disciplinary team has enabled staff members to learn from each other, for example by coaching colleagues about how to respond to domestic abuse concerns in a family.

Challenges

In an independent evaluation of the Locality Care Team model, staff said they felt they needed more support and supervision, and more equitable pay between team members. The hospice was able to put new measures in place to address these issues, including more supervision and updating employment terms and conditions.

The Locality Care Teams are large teams of around 40 people each. The hospice is considering how best to sustainably manage and support this number of people within one team such as support via ‘cluster groups’.

There are variances between localities and each team operates slightly differently. The hospice would like to develop a framework for Locality Care Team working, which will ensure a consistent approach for staff and patients but still have room for flexibility to meet local needs.