The St Helena Hospice SinglePoint Service

Summary

SinglePoint is a 24/7 advice and coordination service for all palliative and end of life patients, carers and professionals within North East Essex. As well as providing access to all hospice services it coordinates the local Marie Curie night nursing service and liaises with the specialist palliative care hospital team, community nursing, GP, ambulance and out of hours services. 

It includes ‘My Care Choices’, an electronic register of patients identified by GPs as being in the last year of life, making their care preferences accessible by all relevant agencies. It also provides a rapid response service to help prevent avoidable hospital admissions. The service is based on a single phone number given to all palliative and end of life patients and their carers.

Challenge

Palliative and end of life (EoL) care in North East Essex is provided by agencies and support, particularly out of hours, is unreliable. Mortality rates at Colchester Hospital were high and few patients died in their place of choice. Patients and carers said that having a single point of contact would improve their experience. 

St Helena Hospice already provided an advisory service for patients, so was ideally placed to propose plans for expanded service covering NE Essex. The proposal was presented to the local commissioning group as a partnership approach, funded jointly by commissioners and the Hospice. 

All calls would be answered by clinical staff able to organise immediate, appropriate, help. In its first six months the service dealt with 13,000 calls.

Objectives

The project had seven main objectives. First, to simplify access to palliative care advice, guidance and support, 24 hours a day, seven days a week. Secondly, to enable patients to continue to be cared for in their place of preference. The project also committed to reducing the number of avoidable admissions to hospital, and to improve the availability of specialist palliative support to healthcare professionals.

Further objectives included coordinating, on the patients’ behalf, the services provided by care agencies, and improving the quality of palliative and EoL care for all patients in NE Essex. The final objective was to ensure that the improvements are sustainable.

Solution

An outline proposal was submitted to the local Clinical Commissioning Group (CCG), who approved but agreed to fund certain elements only. A formal partnership was agreed, whereby a full service would be jointly funded by the Hospice and the CCG, the first such agreement nationally. 

Approval for the service, known as SinglePoint, was obtained in June 2013. A location was found within the Hospice, additional qualified staff recruited and trained and the IT infrastructure installed. 

The service went live in September 2013. Nursing staff from other Hospice teams were seconded to SinglePoint team for the first weeks to support the new staff. This led to shared learning and helped develop seamless care across all Hospice services.

Results

Statistics show a significant increase in patients achieving their PPC, and anecdotal evidence shows that the new service has deterred carers from calling the emergency services for help. As many as five emergency Hospice admissions are being avoided each week. 

Triaging of calls has allowed the team to arrange for home visits from appropriate care agencies. The electronic patient register, My Care Choices, has over 800 patients’ preferences recorded, giving the  ambulance service advance notice of patients’ wishes. 

Calls have now settled at 2,500 a month and patient surveys carried out show a very high level of satisfaction. A formal joint-funding agreement is in place with the CCG, securing the service for at least the next three years.

Learnings

The team learnt the importance of engaging potentially competing stakeholders at the earliest possible opportunity. This led to real co-operative planning and project development. The involvement of ‘users’ throughout the project ensured that the service is truly what patients and carers want, not just what professionals believe they need. 

Much planning and effort went into ensuring the service was excellent from the first day, as it was accepted that users may not have given it a second chance if their first experience was unsatisfactory. 

Collaboration across NE Essex multidisciplinary teams through joint working encouraged the cascading of palliative care knowledge and learning.

Evaluation

SinglePoint has become essential not only to the Hospice but the whole locality. The model has been shared with all other CCGs and hospices within the county. 

The Hospice chief executive has presented the model at a number of events, including the Help the Hospices national conference. The SinglePoint team plans to write up its experiences for future publication and presentation.

There is a belief that the SinglePoint model could be self-financing, using savings made by avoided hospital A&E attendances, emergency admissions and reduced excess bed days. Statistics proving this will be available after the first full year of operation. The service has been well received by GP surgeries. 
QiC Oncology Highly Commended
End of life care and bereavement
The St Helena Hospice SinglePoint Service
by St Helena Hospice

Contacts

Ken Aldred
Job title: Trustee – chair of patient and family care sub-committee
Place of work: St Helena Hospice
Email: kaldred@sthelenahospice.org.uk
Telephone: 01206 845 566