The Palliative Care Hub was launched in April 2021 and became a 24-hour service in April 2022. It is staffed by clinical nurse specialists (CNS) and funded through the local Clinical Commissioning Group (CCG). It aims to:
improve access to advice, support and care for adults with life limiting illnesses
support people at home and prevent avoidable hospital admissions
work with partner organisations across the Integrated Care System (ICS).
It covers Cambridgeshire and Peterborough (the catchment areas of Arthur Rank and Sue Ryder Thorpe Hall hospices).
People contact the 24-hour phone line by calling NHS 111. This means anyone can easily access the service, regardless of whether they are already known to specialist palliative care teams.
Outcomes
In the first 38 weeks of the project the hub received 1,692 calls about 1,014 patient cases. Calls came from medical professionals, care homes, patients and their carers/relatives.
The patients were diagnosed with malignant and non-malignant conditions. 55% of patients were previously unknown to Arthur Rank and Thorpe Hall hospices.
The Palliative care hub made a further 2,153 calls to other services on behalf of patients. Nurses helped callers with a range of issues including:
symptom control (including pain)
medication
emotional support
palliative care
hospice referral
verification of death.
Data collected from calls suggests that the hub prevented 148 avoidable hospital admissions in the first 38 weeks.
Facilitators, challenges and advice
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Key facilitators
Partnership working and collaboration has been key to the success of the project. Partners include Sue Ryder Thorpe Hall hospice, the ambulance service, Herts Urgent Care (who run the NHS 111 service), GPs and primary care networks.
It was helpful that NHS 111 was already routing patients with mental health needs direct to a local mental health service, as this provided a model for the Palliative Care Hub to follow.
Challenges
Recruitment for clinical nurse specialists (CNS) to staff the Palliative care hub was challenging, partly because the service launched during the COVID-19 pandemic. For this reason, the service was not initially launched as a 24-hour service and operated only during times of peak need.
It can take a long time for people to get through to the Palliative care hub via the 111 service, especially during the pandemic. People were asked to persevere and reassured that they would eventually get through.
The catchment area for the Palliative care hub (Cambridge and Peterborough) is wider than the area served by Arthur Rank Hospice (Cambridge only). As the CNS team are based at Arthur Rank, it can be difficult for them to know which services are available in Peterborough. Sue Ryder Thorpe Hall Hospice staff have helped with this by sharing their local knowledge.
Tips and advice
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- Have a good understanding of all the services/groups and charity organisations in your area, so you can refer people to them. Create an extensive directory of all these services including opening times, contact details, and parking information so you have it all to hand for the service user.
- Make sure you understand what services can and cannot do. This will help when making key decisions about what support patients need.
- Find out how partners operate and how they can support you. For example, staff running the phone line need to know how to contact the 111 team if there are any technical issues.
Future development
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The service will be reviewed after 6 months of running 24 hours a day, to assess whether it is still meeting its aims.
Plans to further develop the Palliative care hub include:
using technology to make the service more accessible (for example talk to text, immediate translation and video calls)
widening the independent prescribing service.
Arthur Rank would like to improve data collection about the reach of the service, and further explore the data around prevented hospital admissions.
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