St Luke’s Hospice has developed a model of care which is shaping the sector. The St Luke’s Palliative Helpline (PALL24) is available to patients, carers and healthcare professionals who need advice and support regarding end-of-life care.
PALL24 provides advice and a co-ordination service 24 hours a day, seven days a week. Direct care can also be delivered through their rapid response team. St Luke’s has been working closely with the London Ambulance Service.
In the first of a series of features celebrating this year’s winners, Dr Charles Daniels, Medical Director at St Luke’s Hospice, sheds light on why the hospice was recognised in this category.
Strengthening ties with local services
Our 24-hour helpline and referral service, PALL24, is run by a dedicated team of expert nurses who can give advice, provide a rapid response in times of crisis and effectively co-ordinate care, from arranging prescriptions to getting vital equipment delivered – anything people need to avoid going to the hospital and to stay comfortably in their home.
Previously named Single Point of Access (SPA), the helpline was set up in 2015 based on clinical experience where many Harrow and Brent patients, their relatives and healthcare professionals, felt a need to be able to access 24-hour advice from palliative care/hospice colleagues. In response, we initially set up a nursing service to answer telephone calls 24 hours a day and then supplemented this with further expert advice from consultants in palliative medicine as needed.
This service aimed to provide a co-ordinated, 24/7 telephone service, offering specialist advice and assistance to patients in the last year of life and those individuals caring for them. The project was and still is available to health and social care professionals, including paramedics from the London Ambulance Service (LAS), to discuss patients who are either: (i) already known to the service, or (ii) appropriate for referral. As a direct consequence of the project, communication between the hospice and the LAS has strengthened, facilitating clinical collaboration and improved patient outcomes. One of our driving factors following the introduction of the service was to assess the frequency, nature and outcomes of the calls made to the helpline from local paramedics.
Targeting and responding to demand
The project was multi-disciplinary-led and involved the collaboration of GPs, district nurses and more. One of the professional groups that was often identified as being called to the support of palliative patients in the community was London Ambulance staff. In response, we worked together and co-designed a training programme for our local ambulance colleagues and arranged shadowing placements for them to improve their working knowledge. Both of these created a close working relationship and, over the years, we have seen increasing use of our service by ambulance colleagues.
The initial surge of COVID-19 infections saw an even greater need to provide this service. During the first two months of the first national lockdown, the PALL24 team enabled 95% of people to remain at home and not be transferred to hospital, helping to alleviate pressure on local NHS services. Throughout the years, the service has been associated with low rates of subsequent patient transfer to the hospital making it a sustainable and much-needed service to help reduce pressure on the NHS.
Multi-faceted service delivery
PALL24 provides advice and a co-ordination service through a single telephone number 24 hours a day, seven days a week, available for patients, carers or healthcare professionals in the London Borough of Harrow. Direct care can also be delivered through our rapid response team. All calls are answered by registered nurses who are experienced in palliative care, and the nurses can make referrals, signpost them and advise on queries. The service is very integrated, and we collaborate with community palliative nurses, GPs and the LAS. In addition to this, referrals are received for the service. Once the referral has been received, one of our registered nurses will contact the patient to explain the service over the phone. Nurses also do home visits in response to a crisis and relieve symptom control. Our nurses are also able to do verification of death. The team can order equipment for emergencies, as well as set up packages of care to enable patients to die in the comfort of their home.
In contrast to an acute hospital setting, community services can appear siloed. With different teams carrying out their assessment, patients can be confused as to who to contact when there is a new care need. Understandably, families worry whether they will be able to successfully care for their loved ones as death approaches. PALL24 has tried to bridge these concerns and to reassure the family that there is someone they can call no matter the time or day.
One of the main challenges that we have faced is that the service is only funded for one of the London boroughs that we cover. As the hospice covers two London boroughs, we receive calls from people outside of the funded catchment area, adding pressure on the team to manage the caseload.
During our initial contact with patients, carers or healthcare professionals, we seek to understand any potential difficulties trying to co-ordinate care or to understand which patients in the community have rapidly changing needs. This helps us to plan ahead of time and review any obstacles regularly with other community teams. At Luke’s, we are fortunate to have a palliative care consultant available 24-hours, so there is a healthy support system to meet any challenges that we might face.
Looking towards the future
We believe in empowering people and that people can receive personalised care in line with their wishes. We are hoping to build on the helpline’s current success by contributing to more people achieving their preference for end-of-life care at home. Currently, across the UK, 44% of people who would prefer to die at home do so. This is a rise from 38% a few years ago, so things are getting better.
We have received excellent feedback from service users and their families who have written in to say how thankful they were to receive a high level of quality and timely care and support to enable their loved ones to remain at home. This has been especially valuable during the pandemic, where acute settings could not always accommodate visitors or family until the end of life. We hope to achieve even better outcomes for the project. We will continue to strengthen interdisciplinary relationships between healthcare professionals in the hopes that vital information needed for delivering care is shared simultaneously.
Ultimately, enabling more joined-up work, giving patients and their families in the community confidence that their care and changing needs can be seamless, responsive, timely and person-centred, resulting in a ‘good death.’