Our experience has identified common barriers to good end of life care including:
Access to 24/7 care, particularly during out of hours
Coordination of care, and management and integration of community services
Hospital discharge processes
To address these barriers and align services, we have developed an end of life care integrated service model. The model, which you can see below, shows how relationships across health and social care in both acute and community settings can centre around the patient and family.
An integrated system reduces duplication of patient assessment, improves information-sharing between service providers, and fosters continuity in the delivery of care to patients and support for carers.
We can adapt the model to meet the requirements of different health economies. In Somerset, for example, it includes existing acute care, hospices, social services and out-of-hours care, supplemented by new services including a palliative care register and key worker role. Areas in London and the North East have also adapted integrated service models to suit their needs.