Harrogate End of Life Planning and Support Service ? transforming end of life care for older people through proactive support

Background 

With funding from Macmillan Cancer Support, Harrogate and District NHS Foundation Trust partnered with Saint Michael’s Hospice and Airedale NHS Foundation Trust to create HELPSS. We aimed to identify more patients in their last year of life (LYOL), facilitate the creation of an advance care plan (ACP) and provide 24/7 telephone support to patients and carers in order to enable more people to die in their preferred place with dignity.

Introduction

Harrogate locality has a population of approximately 160,000. It has a higher than average proportion of older people which is predicted to increase. Approximately 1% of the population are in LYOL, many not identified or known to palliative and end of life care services, particularly those with frailty rather than a cancer diagnosis. Initial data showed a reliance on unscheduled and acute care, with patients spending an average of 20 days in hospital during the LYOL, which may not have reflected their preferences. 

Methods 

To identify patients in LYOL SNOMED-coded searches were developed for use in primary care, and the Supportive and Palliative Care Indicators Tool (SPICT) and ‘surprise question’ were promoted in primary and secondary care. A specialist ACP service was commissioned, alongside the 24 hour telephone service ‘Goldline.’ 

Results 

Over 21 months we saw an increase in identification of LYOL patients (Palliative Care Register 0.63% to 0.82% population), 1079 referrals to the ACP service, and 1780 calls to Goldline (61% out of hours), after which 95% patients remained at home, 40% with no onward referral. To date bed-day cost savings in LYOL have exceeded the cost of delivering HELPSS, demonstrating its cost-effectiveness.

Conclusions 

Through a combination of proactive identification, advance care planning and 24/7 telephone support, HELPSS has delivered sustained improvements in quality, safety and experience for patients in the LYOL, in a cost effective way.