Launched in 2004, the Lincolnshire project was the Delivering Choice Programme's first pilot site.

The project introduced pioneering end of life care initiatives, including a community nursing rapid response service, palliative care coordination centre and discharge liaison service.

Following its successful completion in March 2008, services were handed over to local partner organisations and are now part of the local delivery plan.

An independent evaluation by The King's Fund found that deaths at home for patients using services introduced by the project in Boston were 42 per cent compared with non-users at 19 per cent. The report also concluded that the project has not increased the overall cost of care for patients in the last eight weeks of life.

Understanding the local needs

A high proportion of the population in Lincolnshire lives in rural areas with limited access to responsive palliative care services.

The project found that this lack of access to services was particularly evident in the community and during out of hours periods, resulting in inappropriate admissions and readmissions to hospital.

The project's scoping phase also identified the following areas for improvement:

  • Coordination between providers of community care
  • Timely discharge from hospital
  • Training and education in palliative care for professionals
  • Support for patients and their carers

Designing and piloting new services

The Lincolnshire project was the first to pilot a number of Marie Curie's innovative services that are now part of the charity's main service offerings.

Rapid Response Team

A community-based nursing service serving the remote areas of Boston, South Holland and its surrounding areas, the Rapid Response Team makes emergency and planned visits to patients in their homes during the twilight and out-of-hours period.

The service was vital in preventing the escalation of symptoms that could otherwise lead to emergency admission to hospital. It also provided reassurance to patients and carers over the phone. In its first two years of operation, the Rapid Response Team had seen nearly 1,400 patients and prevented more than 1,000 unnecessary admissions to hospital.

Palliative Care Coordination Centre

The arranging of care packages for patients at home was found to be time-consuming, complex and inefficient. To address this issue, the Lincolnshire project set up a coordination centre dedicated to booking health and social care for palliative patients who are being cared for at home. The service coordinates care on behalf of professionals in the community and hospital across the county.

In its first two years of operation, the centre's coordinators received around 62,000 requests to arrange care for patients in the community. Most requests were made by District Nurses, who reported that the service saved them up to four hours a day, leaving them more time to provide care to their patients.

Discharge Community Link Nurses

Two discharge nurses based at Lincoln County Hospital and Boston Pilgrim Hospital were appointed to facilitate the timely discharge of end of life patients to their preferred place of care. They coordinate packages of home care, communicate patient needs to community healthcare teams and, if necessary, accompany patients home and help them get settled.

In their first two years in post, the two Discharge Community Link Nurses discharged 715 patients out of hospital to another place of care. For patients whose preferred place of care was home, the service helped 72 per cent of them to do so.

Education and training

To ensure professionals have access to appropriate palliative care education and training, a Skills and Training Coordinator was appointed to develop and deliver a training plan in conjunction with the Lincolnshire Education and Training Forum.

The training programme combined existing courses with new initiatives, and involved the use of community-based video conferencing facilities to allow easier access to training for care professionals across the county. Another outcome of this workstream was the development of a directory of courses available across Lincolnshire.

Support for carers

To provide practical and emotional support for carers who play a vital role in a patient's choice to die at home, the project worked closely with Lincolnshire St Barnabas Hospice to enable the hospice's carer support services to be more widely available across the county. These support services focus on increasing carers' confidence and skill in practical caring, as well as reducing their feelings of isolation by giving them a chance to meet others in similar situations.

Project evaluation

According to independent evaluations by The King's Fund and Lancaster University, the Lincolnshire project provides better patient outcomes at no extra cost.

The King's Fund evaluation found that deaths at home for patients accessing the project's services were 42 per cent compared with non-users at 19 per cent. Importantly, the evaluation revealed no difference in overall cost of care, because the increased community care provided by the programme's new services was offset by reductions in acute admissions, number of GP contacts, 999 ambulance journeys and out-of-hours visits.

The Lancaster University evaluation reported that 71 and 63 per cent of patients in Lincoln and Boston respectively who used the Discharge Community Liaison Service achieved their wish to be cared for at home. The evaluation also found that the Rapid Response Service played a key role in keeping patients at home until they died. As many as 73 per cent of cancer patients who accessed the service in Boston and South Holland were able to die at home.

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