Palliative care is partnership work

Palliative care is an important part of what we do and recognising that the solution in one part of geography may need to be different from another, reflecting the differences in service provision. Continuous improvement has been at the heart of our organisation since its inception. We work closely with our partners across the healthcare landscape to ensure our patients receive the best possible care at all times while reviewing patient needs and demand.

Throughout the early months of the pandemic, as we audited and assessed our performance and patient outcomes for contacts with NHS 111, we became aware of the additional impact of COVID-19 on one of our most vulnerable patient groups and their special requirements.

In previous years, patients receiving palliative care, i.e. care that improves the quality of life for patients who are facing challenges associated with life-threatening illnesses, would have had to undergo a complete NHS Pathways assessment upon contacting NHS 111. This is a telephone triage system to enable health and care decisions, supporting the remote assessment of callers to urgent and emergency services. When patients, or their carers or guardians, contact NHS 111, they are taken through a series of questions generated by an algorithm depending on their presenting concern. This process is not best suited for patients receiving palliative care, especially as these assessments can be repetitive and lengthy if frequent contacts with NHS 111 are required. Aligning our services with the aim of palliative care, we believe it is more appropriate to reduce unnecessary steps for these patient groups and making sure they receive timely access to appropriate care.

A patient receiving palliative care can be of any age. Often, they contact NHS 111 themselves, however, on occasion, a family member or someone providing care may ring to seek advice. We wanted to develop a process that would align with the true purpose of palliative care, to improve quality of life of those patients and their families. This understanding led us to develop a telephone-based process specifically for patients receiving palliative care within our service areas of Hertfordshire and West Essex as well as Cambridgeshire and Peterborough.

We aimed to instil a new pathway for patients receiving palliative care with specialised colleagues including general practitioners (GPs), senior nurses and paramedics who understand the importance of enhanced personalised palliative care. This programme would also allow us to create a network where patients feel more supported.

In order to achieve these goals, the team at HUC worked with care providers who specialised in palliative care as well as partners like East of England Ambulance Service NHS Trust and Arthur Rank Hospice Charity. Within a short time, working groups were stood up across an already well-connected and integrated regional care system and plans made for how we could work together to help these patient groups. These strong partnerships across the regions we serve have allowed HUC to streamline the assessment process for a vulnerable patient population, improving their experience and their outcomes as well as preventing unnecessary and lengthy assessments.

Our two palliative care pathways have slight differences. In Hertfordshire and West Essex, the patient or a person close to them making the contact, after speaking with a Service Advisor is routed to a clinician who can assist them with the appropriate treatment. In Cambridgeshire and Peterborough, we partnered with a local charity, Arthur Rank Hospice, which has served the community for almost 40 years to create direct access to palliative care nurses. The Palliative Care Hub team we work with focuses on keeping patients at home or in their preferred place of care. They can refer into hospice or other healthcare services and signpost callers to organisations or other groups that may help.

Both projects are stand-alone collaborative efforts with healthcare partners across those regions, launched throughout early 2021. This means that in Hertfordshire and West Essex as well as Cambridgeshire and Peterborough, we are able to connect patients with other services rather than them or people close to them trying to find the right care at a challenging time.

“Often family members don’t know where to start,” said Jo Franklin, Clinical Nurse Specialist – Palliative Care Hub. She continued, “Many need additional advice and support to look after someone who is deteriorating or dying.” For this reason, in Cambridgeshire and Peterborough, the nurses who speak with patients can coordinate with hospice nurses, district nurses, paramedics and local specialist palliative care teams to ensure that patients and their families receive answers to their questions and subsequently alleviate their concerns about care.

In Hertfordshire and West Essex, we utilised technology provided by East and North Hertfordshire CCG, Herts Valleys CCG and West Essex CCG to create a shared platform that compiles patient information, which is then filtered through to our systems when a patient receiving palliative care contacts us. When this contact is made, a process begins that provides the NHS 111 call handler answering the call with an enhanced patient profile containing crucial details needed to adequately support the patient.

By working with partners and specialised and senior healthcare professionals, we can better support patients receiving palliative care across the regions we serve, leading to better outcomes whilst giving the patients themselves, as well as the people close to them, peace of mind that appropriate support and advice is only a phone call away.