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For healthcare professionals
Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. (World Health Organisation definition, 2002)
It is important that any electronic referrals are sent via our secure email address nesea.stwh-clinadmin@nhs.net and not via any stwh.co.uk email address.
Referral criteria
Referrals for specialist palliative care are accepted for patients who:
Have active, progressive, advanced disease of any diagnosis with a probable prognosis of less than 12 months
Have a complex level of need exceeding the skills and/or capacity of the current caring team
Are over 18 years of age
Some patients with advanced disease but a prognosis exceeding 12 months may have specialist palliative care needs earlier in their illness and may be accepted for care if criteria 2 and 3 are met. The care this group of patients receive may be termed supportive care. Such patients will be discharged when the issue leading to the referral has been addressed.
Complex level of specialist palliative care need means exceeding the skills, facilities etc. of an appropriately resourced primary health care team (including community matron or disease-specific nurse specialist), hospital ward or residential/nursing care home. Complex needs can be patient, carer or health care team centred and the help required may be intermittent or continuous depending on the level of need and rate of disease progression.
Areas of expertise
Specialist palliative care teams offer some or all of the following:
- Hospital specialist palliative care nurses, doctors & other professionals
- Hospice in-patient care
- Day hospice
- Palliative care community clinical nurse specialists (CNSs)
- Bereavement care
Teams are able to work with patients, carers and professionals to address problems in one or more of the following areas:
- Multiple, complex or refractory physical symptoms
- Complex end of life care
- Difficult social, psychological and spiritual issues
- Complex family and carer needs requiring specialist support
- Discharge planning when the situation is complex and no discharge co-ordination is available
- Bereavement support to families and carers of former patients
Echo
Echo (end of life care hub for Coastal West Sussex) is a telephone service which offers to support to patients, carers and health care professionals. Once registered, a patient can access support and advice 24 hours a day, 7 days a week.
FAQs
The appropriate time for a referral depends on many factors including the patient, the disease and the situation. These circumstances are so varied that it is hard to encompass them simply – but basically refer a patient when they meet the referral criteria above. A member of the Hospice clinical team is always willing to discuss a specific case on the telephone before a referral is made.
The Hospice’s specialist role is to support generalist palliative care provided by an appropriately resourced primary care team or hospital ward, and not to replace such care.
The catchment population is made up of the patients of general practitioners based in the Sussex coastal plain from Emsworth to Arundel, encompassing Chichester and Bognor, and Hampshire patients from the Emsworth GP practice. Occasionally patients who are not in the catchment population will be accepted for care at the Hospice if their acute care takes place at St Richard’s Hospital or their family live in the catchment population.
Patients from north of The Downs Patients with GPs in Midhurst, Petworth, Pulborough, Billingshurst and Loxwood may be offered admission or day care following consultation with, and agreement from, the Midhurst Macmillan Team.
The Hospice Community Team is able to support patients at home and is available 8.00am to 9.30pm every day. One health care assistant is available to support a single patient each night.
Although some admissions are received at weekends, we are not able to take them out of hours. Appropriate emergency out of hours admissions are rare as increasing amounts of community support are put in place as a patient’s condition deteriorates – with the aim of supporting the patient and family at home. Patients with new acute problems, such as new haematemesis, should go to hospital.
Echo (end of life care hub for Coastal West Sussex) is telephone service which offers to support to patients, carers and health care professionals. Once registered, a patient can access support and advice 24 hours a day, 7 days a week.
Telephone: 01903 254789
Email: sc-tr.echocws@nhs.net
Sussex Community NHS Trust webpage for Echo: www.sussexcommunity.nhs.uk/services/servicedetails.htm?directoryID=22986
St Wilfrid’s Hospice accepts referrals of patients with any diagnosis.
Patients eligible for admission to the Inpatient Ward are those with:
Multiple, complex or refractory physical symptoms requiring frequent medical review and/or intensive nursing care.
Complex end of life care needing admission to a specialist unit.
Difficult social, psychological and spiritual issues which may benefit from assessment and support in a specialist palliative care unit.
A requirement for convalescence, symptom control or complex discharge planning after a period of acute hospital care.
Many patients would choose to die at home, given adequate support – indeed enabling more people to die at home is the focus of the Department of Health’s End Of Life Care Strategy. This must always be taken into account when considering an admission request to St Wilfrid’s Hospice. The additional support required may be minimal and is available if the appropriate referrals are made.
When resources allow a pre-planned admission may be made to give a patient and/or family a break from care at home.
Patients are not accepted for in-patient hospice care on a long term basis. However some patients who have ongoing specialist palliative care needs may require an extended admission.
There may be occasions when it is more appropriate to admit a patient directly to a nursing home from home rather than admitting them to the Hospice first.
Requests for admission are prioritised according to need by our multi-disciplinary team.
If a person’s illness remains stable with no specialist palliative care needs they will be discharged from follow-up by all parts of the hospice team completely.
Around 10% of patients on the active case load are discharged in any year. Re-referral is welcomed if the patient subsequently develops specialist palliative care needs.
Patients will be considered for discharge if:
There has been resolution of multiple, complex or refractory physical symptoms.
The disease becomes stable and is no longer progressing quickly.
There is no longer a need for specialist, complex end of life care.
There are no longer needs for specialist palliative care follow-up and/or the patients on-going needs are more appropriately met by other health and social care agencies.
The patient’s difficult social, psychological or spiritual issues have been addressed.
The family and carer needs requiring specialist support have been addressed.
The patient requests discharge or is reluctant to allow effective support, e.g. restricting access for assessment.
A decision to discharge a patient will be made following multi-professional discussion to ensure that the issues above have been considered. The discharge will be organised in a planned way.