Planning ahead for Hospice at Home

Seventy-five per cent of our care is delivered to patients in their own homes or in the community. This is a response to patient wishes: most people prefer to be cared for in their usual residence, which could be their own home or a care home.

Sadly, in society in general, this wish is often unfulfilled: around half of all deaths occur in hospital. At Rowcroft, our mission is to make every day the best possible for our patients and their families, and a vital part of this is to ensure our beneficiaries have choices and are in control of the decisions that affect their lives — and their deaths.

Specialist care at home

Our Hospice at Home service is key to addressing this. By providing high quality, specialist care to patients and families when and where it’s needed and most wanted, we can transform their experience.

The Hospice at Home service started in 2009, with two senior nurses working office hours, seven days a week, to provide clinical support to GPs and district nurses caring for patients at home in their last two weeks of life. In 2011, we expanded Hospice at Home to a 24/7 service with the aim of improving care, reducing hospital deaths by 207 patients a year, and saving on hospital spending.

One family described what Hospice at Home meant to them: “They were the light at the end of a long, dark tunnel. The help and reassurance they offered made it possible to carry on.”

Making an impact

The service has proved highly effective: in 2018 we enabled around 90% of patients referred to us to die in their own homes. The latest data for our region shows that 39% of patients die in hospital and that there has been a drop of almost 10% in local hospital deaths since 2011 — the year we launched our enhanced Hospice at Home service.

Although we can’t prove a definitive correlation between our Hospice at Home service and the reduction in local hospital deaths, we have evidence from referrers that Hospice at Home has prevented hospitalisation for many patients referred to the service. This has relieved pressure on our hospitals, enabled patients to make choices, and gifted precious time to families.

Understandably, the service is popular: across the 300 square miles that Rowcroft covers, all GP practices recommend the service. Patient and family feedback is overwhelmingly positive, summed up here by one family’s experience of how their loved one was treated: “He had all the respect and dignity due as an 89-year-old; nurses were well trained and caring to us all.”

Unfortunately, however, there are increasing pressures on health and social care services, due to an aging population and more people suffering from complex and chronic conditions. The demand is greater than we can currently meet. Nineteen times over the past year, we have had to either restrict referrals to people in the last 48 hours of life or refuse referrals completely.

A new service for tomorrow

As a healthcare service, we must adapt to meet the needs of our changing community in a way that is sustainable and looks to the future. To meet demand — and in line with our goal to expand our care to two-thirds of people with a lifelimiting illness in South Devon by 2030 — we’re exploring ways to enhance Hospice at Home in the near future.

We’ve committed to a three-stage process with our staff and service users to:

  1. Review the current service model and recommend a sustainable model of care for the future.
  2. Build enough capacity over the next three years to meet the predicted additional numbers of patients and their families.
  3. Engage staff and service users in helping to design and develop Hospice at Home.

In the coming months, we look forward to sharing our plans for providing a new, robust and comprehensive Hospice at Home service that will continue our outstanding record and meet the needs of the people of South Devon.



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