Health and social care staff in Greenwich are operating an integrated approach to end of life care that has led to a dramatic rise in the number of people dying at home as they wished, and a big reduction in hospital admissions.
The scheme, called the Greenwich Care Partnership, is led by Greenwich & Bexley Community Hospice in partnership with Marie Curie Cancer Care and Oxleas NHS Foundation Trust. The service aims to reduce inappropriate hospital admissions and enable more patients to be cared for, and to die, in their place of choice.
The service operates alongside, and supports, existing core services such as GPs and district nurses to provide high quality care for patients with end of life care needs in the borough of Greenwich. It includes a palliative care coordination centre, based in the hospice, ensuring seamless coordinated care for patients and their carers, as well as a 24/7 single contact number giving them direct access to services and support.
Perhaps the key to its success, says GP Ram Aggarwal, Cancer and End of Life Care Lead for Greenwich CCG, is having a single point of contact that both professionals and members of the public can ring 24 hours a day.
Once an individual has made contact they will be assigned a key worker who will help coordinate their care throughout their journey. In addition, the team can arrange for a nurse from the rapid response service to make a planned visit or a healthcare assistant trained in end of life care to remain with the individual through the night if that is considered necessary. Personal care assistants can also provide care at home during the day.
If someone is hospitalised they will be seen by the palliative care discharge coordinator who will do a needs assessment, assign them a key worker and ensure they are discharged as soon as possible if that is their wish.
The results of the pilot, which ended last March, show just how successful this approach has been. In 13 months, 541 patients were cared for under the scheme of whom 337 died. Of these 81% died in their usual place of residence or in the hospice as they had requested. This contrasts with 63% of deaths occurring in hospital prior to the pilot. Hospital admissions and lengths of stay have also declined.
The pilot has been so successful Greenwich CCG is recommissioning it. Another indicator of success is that Greenwich now boasts the lowest rates in the country of hospital admissions for people with chronic conditions.
The service is available to people with a variety of life-limiting conditions such as cancer, dementia, motor neurone disease, heart failure and chronic obstructive pulmonary disease, in the last year of life. There are also plans to give care home residents a similar level of end of life care support.
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