Case study:

11 May 2010

Integrated Palliative care service (St Luke’s Services) in South West Devon

Key points

Palliative care patients in South West Devon can now receive seamless services across all settings following the decision to bring all palliative care services under one management.

The new service consists of staff from the NHS acute trust, the three local PCTs and St Luke’s, the independent charitable hospice.

Its board of management is made up of a service director (employed by the charity) a medical director (employed by the hospital trust) a community services director (employed by a PCT), a hospice services director (employed by the charity) and a finance director, an HR director and an income generation director (all employed by the charity but interfacing with NHS colleagues where appropriate).

All NHS staff are now seconded to the service and service level agreements are being finalised for 2007/8. The team are also finalising shared guidelines, policies, protocols and working groups.

One major advantage of the new approach is that the charity’s non-in-patient services now work with the PCTs’ community services on one site.

The integrated service has also made it easier to recruit and support staff in the parts of the service that were previously isolated.

The board is now examining whether it can extend its operations, firstly to commission palliative care locally using both NHS and charitable funds, and secondly to oversee the local implementation of the end of life care strategy.

The integration of the service has been driven by the need to use available resources as effectively as possible and encouraging staff development.

Although some extra money was found for the service director and medical director posts, most has come from reallocating existing resources.

It was decided at an early stage to include the local lymphoedema and Marie Curie services in the new service.

This widened the group of people we needed to liaise with but has been valuable groundwork for the local end of life care strategy, which the integrated service is involved in developing.

A lot of time was spent debating and clarifying concerns before integration took place. Some of the keys to success were regular communications and ensuring that all staff and patients had good accommodation available.

It proved very difficult to find a legal structure that supported the innovation and in the end it was necessary to compromise.

For the first year, the service director controlled NHS budgets as well as the charity budget.

Thereafter the NHS bodies contracted with the service to deliver patient care.

The integrated service is now functioning as one organisation and some resources have already been redistributed.

Patient movements between the departments are now much smoother and staff find it easier to access appropriate care for their patients.

Integration is now a reality. The challenge for the future is to ensure there is sufficient funding to develop the areas that are currently under-resourced.