Case study:

02 February 2009

Palliative Care Ambulance in Leeds

Key points

The Marie Curie Delivering Choice Programme in Leeds has been running a dedicated ambulance service for the past 18 months to ensure that terminally ill patients are discharged rapidly to their preferred place of care.

The Palliative Care Ambulance operates across the city and is available every day of the year, from 9am to 7pm. As a result patients can be discharged from hospital or hospice at short notice, and without unnecessary delays, so they can spend their final days or weeks in the place of their choice.

The ambulance is also available to transport patients to and from urgent appointments, as well as for admissions to a hospice. By linking up other services in the community, such as the local hospices, the ambulance service has improved coordination between hospital staff and those in the community.

Between May 2007 and October 2008 the ambulance service made a total of 1,762 journeys. Of these 558 journeys involved transferring discharged patients from hospital to their own homes and admissions to a hospice.

The decision to introduce a dedicated ambulance service for palliative care patients came after a review revealed that patients classified as non-urgent had to wait, sometimes for days, for an ambulance to take them home because existing services were not prioritising their needs. As a result some might end up dying in hospital.

In addition the existing ambulance services did not have a crew specially trained to manage the physical and emotional needs of patients approaching the end of life.

The new service is operated by the Yorkshire Ambulance Service NHS Trust in partnership with the Marie Curie Delivering Choice Programme. The ambulance crew has undergone specialised training in caring for palliative care patients.

A new booking system allows professionals to call a direct line linked to the Yorkshire Ambulance Service to refer patients to the service. A collection time is then agreed. Bookings can only be made within 24 hours of the time requested to ensure the service is available mainly for urgent transport requests following a discharge.

The primary function of the service is to transfer patients speedily to their preferred place of care. But it does also transport patients to urgent palliative care appointments and at times this service is more frequently used.

The problem is this can delay discharge of patients wishing to go to their preferred place of care. To address this, the team has set aside two slots every day which are only available for patients waiting to leave the hospital or hospice to go to their preferred place of care.

Although the service has generally been well received, many hospital wards are still failing to make full use of it. The programme team regularly visit the wards to tell healthcare professionals about the service and how they can access it.

The team is also trying to encourage healthcare professionals to discharge more of their patients at the weekend when use of the service can be very low. This will prevent delays in discharge and free up the use of the service during the week.

Patients and professionals have been extremely positive about the new service. Patients have commented on its high quality, the caring and professional crew and the service’s timeliness in getting them to their preferred place of care.

The service, which is being independently evaluated by the King’s Fund and Lancaster University, is funded until the end of the pilot in May 2009 by the Marie Curie programme but the team are already in discussion with Leeds PCT about its continued funding after this date. The possibility of increasing the number of dedicated ambulances and extending the service to patients who are admitted to Leeds hospitals but live outside the area are also under consideration.