Case study:

23 July 2007

Model of care covering palliative patients’ health and social care needs in Lancashire

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Key points

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Lancashire County Council has linked with East Lancashire PCT to provide a seamless service to all patients with malignant or non-malignant disease who wish to die at home.

The service, which has been operating since September 2005, aims to provide the care and treatment needed to ensure those who want to can remain at home.

Since it began 70% of those referred have died at home and only 13% in hospital.

Hospice@Home care service is designed to meet the health and social care needs of palliative care patients.

As their needs change the level of care progresses from social to a combination of social and nursing, leading to enhanced palliative nursing care.

Referrals are accepted where death is expected in the next six months.

At the discretion of the referring agent DS1500 can be used as a marker for referral (Gold Standards Framework) to predict the increased needs of the patient.

A service level agreement (SLA) with social services funds the social element of the service, with additional contributions from PCT and the hospice.

Care is available 24 hours a day with the core service operating between 8am – 8pm.

Additional care, including night support, is arranged on an individual basis, with additional funding sought where applicable from Continuing Health Care funding.

The service is staffed by a nurse manager, nurse co-ordinator, administrator, six full time equivalent healthcare assistants and ad-hoc registered general nurses.

There have been occasional problems because funding has to come from different budgets.

For instance, late referrals necessitating end of life care do not meet the criteria for the social care aspect of the service.

It is also difficult to obtain the funding for non-malignant disease patients. And finding appropriate staff for patients wanting night sits sometimes proves problematic.

PCT commissioners and the H@H nurse manager have now agreed to fast track the continuing healthcare funding system to cover some of these problems.

The service, which was piloted from October 2005 to March 2006, has received excellent evaluations from both carers and professionals.

It has also led to better relations between staff in the different organisations and improved patient care in the community.

It also seems to be achieving its principal aim of allowing people to choose where they die.

From October 2005 to May 2007 132 patients were referred, of which 70% died at home, 13% in hospital, 14% hospice in-patients/residential care while 3% died before care was implemented.

There are now plans to enlarge the catchment area covered by the service.

It is also hoped to develop a service level agreement with the PCT to cover continuing healthcare funding.

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