Somerset

Launched in 2008, the Somerset Delivering Choice project covered a population of around 700,000 people.

Health and social care organisations in Somerset and North Somerset worked together as part of the project to review existing service provision, redesign patient pathways and implement new end of life care services in their local areas.

New initiatives introduced include:

  • end of life care coordination teams
  • an out-of-hours advice and response line
  • discharge nurses
  • support workers providing heath
  • social and personal care
  • an information website.

An independent evaluation by the University of Bristol   has found that patients using services introduced by the Somerset Delivering Choice project are less likely to be admitted, or to die, in hospital at the end of their lives. The evaluation also looked at the experiences of families, carers and health professionals using these services, and they consistently reported excellent quality, coordinated care.

Understanding the local needs

Somerset and North Somerset have a particularly large number of residents over the age of 65. The over-65 population ranged between 22 per cent and 33 per cent in some areas.

The project's review of local services identified key areas of improvement including:

  • information sharing between professionals and services care coordination
  • the provision of high quality care whenever it is needed
  • support and information for patients, their families and carers
  • access to palliative care services for patients with non-cancer diagnoses
  • a consistent and overarching pathway for end of life care.

As there are a large number of care homes in Somerset and North Somerset providing care for residents who are at the end of life, the project also found scope for improving access to palliative care tools and training for care home staff.

Designing and piloting new services

A number of new initiatives were introduced in Somerset and North Somerset as part of the Delivering Choice project and they include:

  • A coordination centre and a single point of access for care coordination which arrange packages of home care for terminally ill patients on behalf of healthcare professionals
  • An advice and response line for out-of-hours advice and referrals to the appropriate community care teams for patients and carers
  • Discharge in-reach nurses to coordinate the timely discharge of end of life patients from hospital to the community
  • Facilitators to improve community care staff's understanding and use of end of life tools such as the Gold Standards Framework
  • 'Just in Case' anticipatory medication boxes in patients' homes to enable community care professionals to administer medication promptly should a patient's condition change
  • Support workers who provide health, social and personal care to patients in their homes
  • A website offering practical information on local services and support for patients and carers. Visit the website  
  • Education and training opportunities for domiciliary care workers, ambulance staff and GPs

For more information on the project's new initiatives in Somerset and North Somerset, download the overview documents below.

The Somerset Delivering Choice project also developed a new end of life care pathway and framework.

  • The pathway consists of a nine-step guideline for professionals, outlining what they can do to support their patients at each stage of their illness, from the patient being placed on the end of life register and discussion about their preferred place of care to the delivery of coordinated, responsive care and bereavement support for their families
  • The framework can be used by professionals across all care settings to help them prioritise their patients' care needs based on the framework's traffic light categories and useful prompts.

Project evaluation

The independent evaluation of the Somerset Delivering Choice project by the University of Bristol was published in October 2012. Key findings from the evaluation include:

  • Families, carers and professionals consistently reported excellent quality, coordinated care. Family and carers in particular found all services with direct patient contact very beneficial, reporting that the services released them from their full time caring role and reduced their anxieties.
  • In North Somerset, those receiving a Delivering Choice intervention were 67 per cent less likely to die in hospital compared to those who did not receive care from Delivering Choice. The evaluation also found that emergency admissions to hospital in the last month of life were 51 per cent lower and A&E attendances were 59 per cent lower for Delivering Choice service users in North Somerset, compared to people not in contact with the services.
  • In Somerset, those receiving a Delivering Choice intervention were 80 per cent less likely to die in hospital compared to those who did not receive care from Delivering Choice. The evaluation also found that emergency admissions to hospital in the last month of life were 39 per cent lower and A&E attendances were 34 per cent lower for Delivering Choice service users in Somerset, compared to people not in contact with the services.

Get in touch

Although the Somerset Delivering Choice project ended in August 2011, the excellent work on end of life care continues across Somerset and North Somerset. For information on end of life care improvements in Somerset, please get in touch with us.
Phone: 0207 599 7221
Email: servicedevelopment@mariecurie.org.uk

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