1. Hospice and Local EOLC update 2016
Dida Cornish

2. Hospice Community Support
Malignant or non-malignant
Don’t have to refer every-one
4 Hospice Community CNS Teams-Working with the primary health Care Team
- Psychological support
- Symptom Control advice
- Co-ordinate admission to hospice
- Visit weekly, monthly or telephone contact
- One off visits for advice about services
- Open appointment if not needing active involvement

3. Other Hospice Services
24 hour Advice Line for professionals in the community
- Calls taken by access team nurses 7/7 a week day time
- IPU nurses evening
- senior Doctor always available
Hospice Medical Team
- OPA or DV’s for most complex
Inpatient for symptom control/end of life (1-2 week)
- Can do paracentesis, treat hypercalcaemia, blood Tx
Day Hospice
- Symptom control/therapies/rehab – 12 week programme
- Fatigue and Breathlessness – don’t have to be known to us (FAB)
Hospice at Home
- Last days of life: shifts up to 24hr care and respite shifts

4. Other Hospice Services
For patients/carers/families known to hospice access to:
- Physio/OT
- Psychological support and spiritual care (multi faith)
- Complementary therapy
- Care support 1 to 1 and drop in
- Bereavement support
- Hospice Neighbours-volunteer befriending/odd jobs

5. Hospital / CCG Initiatives
Identify patients in their last 6-12 months is everyone’s business (Bristol CQUIN 2015)
Acute trusts will be identifying and communicating with GP’s about these patients on discharge
UHBristol: Poor prognosis letters, should identify if conversations have started in hospital
NBT: Tick box on discharge letter ‘suitable for GSF meeting’
Both trusts using locally adapted Prognostic indicator Guidance.

6. CCG/Regional Initiatives
Single Point of Access for end of life support
e.g. Bristol Care Co-ordination
- Access to Marie Currie and PCHS
- 8am – 6pm 7 days a week
Electronic Palliative Care Co-ordination System
- To replace end of life register on adastra
- Embedded in EMIS web/connecting care

7. NICE guidelines: last days of life
Recognising when a person may be in last days of life
Communication
Shared decision making
Individualised care plan
Maintaining hydration
- mouth care
-? Trial of CAH for thirst
Pharmacological interventions
Anticipatory prescribing

8. Resources
Care of Dying adults in last days of life