Selby and York PCT extended its support services for palliative care patients as a result of feedback from professionals, patients and carers. All who provided feedback identified a need for a practical help and support service to complement the existing district nursing service for patients who wished to remain in their own homes the final weeks/days of their lives.
A pilot service began in April 2004, with the PCT providing an overnight service, providing basic nursing care and allowing the carer some respite. Following an evaluation, financial support from Macmillan subsequently enabled the service to expand to 24 hour availability and to become part of mainstream trust services.
We recruited 14 healthcare assistants as Macmillan carers with a particular awareness of and interest in palliative care. All have undergone comprehensive training including developing listening skills, dealing with difficult situations and support and coping strategies. The carers all undertook clinical placements within the community and local hospice environment to enhance their skills.
They also benefit from regular additional training sessions and attend monthly team meetings for updates on what is happening within the service and the trust and for their education, supported by the community Macmillan team.
We have found that this is a valuable forum for the exchange of ideas and for creating a team spirit and a supportive environment - this is necessary for what could be an extremely isolating role.
The primary aim of the service is to provide timely, high quality care, sensitive to the care needs of patients at home. The service is needs-led, and works within a set of eligibility criteria.
The interventions - essential nursing care and basic emotional and practical support - are usually short-term, although they can be adapted to individual circumstances. One of the core principles of the service is always to be responsive to need, while working within the available resources - to be cost-effective but quality-effective as well.
A key factor in the flexibility and responsiveness of the service has been the full-time coordinator, who is responsible for arranging care and coordinating care. This role has freed significant clinical time for district nurses who were previously responsible for arranging care. The coordinator is a Macmillan postholder, which has provided welcome opportunities for linking in with other, similar services.
The Macmillan HCAs also have the chance to work alongside the coordinator, to gain an insight into the administration of the service and the interface with patients and carers, as well as how to manage the communications with clinical and managerial staff.
In 2005 the service supported 126 carers and 105 patients. It also allowed 19 facilitated discharges from hospital and nine of the patients referred to the service lived alone or in residential care.
Feedback from families who have received this service and from other healthcare professionals has been positive and encouraging, emphasising the contribution that timely, sensitive and empathic support can make to the delivery of quality palliative care.
For further information contact Liz Allen, coordinator Macmillan carer support service, (Tel: 01904 724474) or Debra Johnson, Macmillan CNS (Tel: 01904 724476).