Right care in the last year of life: joining up services

Even as they approach the end of their lives, patients with lung disease face obstacles because they must deal with different parts of the health service who don’t seem to work together.

In particular, respiratory specialist services and more general services to help people towards the end of life are usually run separately.

We want to see a breathlessness support service that includes respiratory medicine, end of life care, physiotherapy, and occupational therapy for patients with advanced conditions and breathlessness. There should be joint clinics between specialist palliative services and respiratory teams.

Practice example: Joint palliative and respiratory clinic

New Cross Hospital in Wolverhampton has had a joint palliative and respiratory clinic since June 2015. Referrals are usually made by the chronic respiratory multi-disciplinary team or after discussion with the respiratory consultant or palliative care consultant.  The main objectives are to provide coordinated respiratory and palliative care, and to improve patient understanding about diagnosis and outcomes. These are achieved through joint discussion around the patient’s main symptoms and improving understanding of disease and future progression and treatment options.

The clinic has made it possible for patients with end stage respiratory disease to have coordinated and integrated access to palliative care and respiratory services. To date 66 patients have attended the clinic, of whom 30 have subsequently died. Only two of those who died passed away in hospital, which was not their stated choice. The others died at home or in a hospice. Significantly fewer patients reported being anxious or worried about illness and treatment after coming to the joint clinic.

No additional funding was required for the joint clinic as both consultants had clinic time within their job plans.

Practice example: Partnership working to better support patients 

North Manchester Macmillan Palliative Care Support Service is a partnership between the CCG, the hospital trust, Macmillan and a local hospice. Across a wide geographical area with limited palliative and end of life care services, it aims to enable patients to end their life in the place of their choice.

Key to this has been educating GPs and other frontline staff to be able to identify people approaching the end of life and refer them to the specialist service. The partnership provides training opportunities for health care professionals to do this.

There’s a 24/7 helpline for patients and carers so that they can access advice and support whenever they need it which offers a huge amount of reassurance A multi-disciplinary team meets daily to consider the needs of the patients being supported by the service and ensure they are being met.

The service has been successful in identifying patients nearing the end of life and providing them with tailored support. There has been a 90% increase in the number of patients on GP palliative care registers and a reduction in unplanned hospital admissions for patients using the service.

Measures of success

Patient-reported experience of whether they have received joined up, appropriate care to be measured in proposed new patient survey, with a baseline established within one year.

An increase in the number of health care professionals who have completed training in end of life care.

Data need: Data to be collected by Health Education England on the number of health care professionals who have accessed and completed training in palliative and end of life care, with a baseline to be established within one year.