Western Cheshire had significant gaps in bereavement support. Local branches of CRUSE had closed and neighbouring branches were unable to help. The Hospice-provided was restricted to families known to specialist palliative care services. Those who experienced a sudden or unexpected death were therefore denied access to services. 

NICE guidelines outlined three necessary support components, and gaps were identified in each. Firstly, there were major gaps in the availability of generic information for the bereaved. Existing information was inconsistent and lacking in guidance. 

The aim was to deliver a bereavement service accessible to all, normalising grief, rather than  ‘medicalising’ it, while helping those needing further support. The team committed to developing a service for Western Cheshire, providing written information on the emotional aspects of bereavement and delivering counselling services consistently with regards to waiting times. 

They offered implementation of the CORE-OM system to provide risk assessment tools and measure therapy effectiveness.  Clients’ befriending needs were to be assessed within two weeks of referral. 

Macmillan Cancer Support funded the project for three years.  The expected outcome was evidence of need and a cost-effective model of delivery. Staff were appointed and a steering group formed. This included various stakeholders and met every four to eight weeks. 

A booklet was created, and the first edition amended following feedback. Future funding of the booklet was secured through advertising revenue. 

The CORE-OM system was purchased in order to measure client outcomes and benchmark against other service providers. All counsellors were trained in the use of forms and independent CORE-OM data analysis ensured data accuracy and quality. 

The service was introduced in phases to prevent overwhelming the existing service. Education sessions were offered to staff from primary and secondary care and care homes and presentations made to stakeholders. 

Waiting times were monitored and clients offered appointments at various times at a variety of venues, including their homes, if they were housebound.  Independent evaluation has shown an equivalent or better service than similar providers, such as NHS mental health teams. Service-user evaluation was overwhelmingly positive. 

Eleven per cent of those referred to the service accessed the befriending service, and the remainder, the counselling service. The bereavement support group is welcoming new members. 

Taking the time to visit partners and explain the project was found helpful in keeping all organisations on board. 

The need for accurate, robust and reliable data was clear from the start. Reports were presented at each steering group and data requirements and recording reviewed accordingly. Efficient administrative support was key, as was investing in the CORE-OM package. 

The focus of the work shifted from secondary care to ensuring hospital staff were familiar with the bereavement booklet. Attention was then given to primary care. The project really began to evolve once the team was able to present at GP locality meetings. Gaining the support of key GPs who endorsed the work was particularly beneficial.

Data shows that the service is used across the locality and that service users value it highly. The potential for disseminating the work through publication and presentation is being explored. 

The initiative has demonstrated that only a minority of people require access to specialist bereavement support.  Rather than setting a prescribed number of counselling sessions, allowing counsellors to offer sessions based on individual needs has helped reduce sessions needed.