Case study:

29 November 2010

Introducing a new hospice community care model (CCM)

---

Key points

---

St Catherine’s Hospice in Crawley introduced a new community care model (CCM) in 2009 with the aim of becoming more responsive to patients and carers and enhancing patient choice at the end of life.

As a result of the changes, which involved introducing a 24-hour, 7-day-a-week service, over 75% of those patients who indicated their preferred place of death died where they wished.

In addition the changes have prevented unnecessary admissions and facilitated rapid discharge. This has been particularly noticeable in care homes with over 90% of the patients who wished to die in care homes able to do so.

The main drivers behind the new approach were government policy stating that all adults should be entitled to quality palliative care, in the setting of their choice, to enable them to die where they chose and NICE recommendations that palliative care services should be available 24 hours, 7 days a week.

As a result, the strategic decision was made to change from a Monday to Friday advisory and support nurse specialist model of community care to a 7-day a week advisory, support and hands-on care service delivered by a multi-professional team.

This new CCM was offered as part of a range of hospice services, including specialist inpatient care. The multidisciplinary care is delivered in partnership with existing statutory care providers in NHS Surrey (East) and the north east locality of NHS West Sussex.

The new service began in early 2009 and in its first year 1,207 new patients were referred and 1,510 patients and families received support from the team. Interventions included 9,087 home visits and 17,404 telephone contacts by the multi-professional team.

The changes have meant that increasing numbers of patients are dying where they have indicated in their PPC. Of the 126 patients whose preferred place of death was a care home, there was only one inappropriate admission to hospital at the end of life.

However, a significant number of patients continue to die in hospital. Although initial analysis suggested admissions were appropriate because of sudden changes in the patient’s condition, further work needs to be done to establish whether more of these admissions could have been prevented. Work is also under way to identify opportunities to reduce admissions and discharge patients more rapidly if acute care is no longer appropriate.

There have also been delays in the provision of continuing health funded (CHF) packages of care for some patients wishing to be cared for at home. Currently the CCM will provide care at home while CHF care packages are mobilised and will support patients and carers through this transition.

Over the time that the new scheme has been operating better channels of communication between CHF, other statutory providers and the hospice have been established to facilitate rapid exchange of key patient information between the services. This work is ongoing.

---

Back to top