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New nurse-led end of life service 'saves £350k in first year'

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A nurse-led service in south London that coordinates and delivers end-of-life care has led to fewer patients dying in hospital and saved an estimated £350,000 in the first year since it launched, according to an independent evaluation.

The Wandsworth End of Life Care Coordination Centre, which is based at Royal Trinity Hospice and run in partnership with Marie Curie and St George’s University Hospitals NHS Foundation Trust, has supported more than 400 patients in its first year of operation.

The centre sees a nurse-led team coordinate rapid packages of care and give advice to people over the phone. It also arranges for care to be delivered by the service’s community nurse from St George’s or its team of Marie Curie health and personal care assistants.

It is thought that the centre has made most of its savings through avoiding an estimated 77 admissions to local hospitals, which would have incurred costs of around £260,000.

”[Wandsworth End of Life Care Coordination Centre] is coming to occupy a pivotal position in Wandsworth’s end-of-life care system”

OPM Group evaluation of Wandsworth End of Life Care Coordination Centre

In addition, the centre is estimated to have increased the speed of discharges from local hospitals by an average of two days – saving around £67,000 – and also freed up clinicians’ time at other organisations by an average of two hours per referral due to the centre’s role in coordination, equal to a saving of £17,000.

In total, this adds up to an estimated £347,788 worth of savings in the first year with projected savings of more than £730,000 over the whole two-year pilot.

However, the service was set up with £60,000 and operational costs are estimated to be nearly £1.2million over two years.

The service had also led to an improvement in care for patients and families - due to them feeling supported at home, being reassured they would be looked after, and better quality of care arranged and provided - according to interviews with staff at the centre.

“Other services such as district nursing and community nursing are generally more stretched, under greater pressure, and have greater time constraints, whereas the centre does not face these challenges to the same extent which allows them to be more responsive and quicker organising and implementing care,” according to the evaluation.

The analysis by research consultancy organisation OPM Group concluded the centre, which is being piloted until March 2017, was “coming to occupy a pivotal position in Wandsworth’s end-of-life care system”.

The main benefits of the service, according to those interviewed as part of the research, were having a dedicated resource, that the centre was a singular point of access for end of life care in the area, its function as a central coordination point, and also its longer opening hours – from 7am to 10.30pm on weekdays and 9am to 5pm on weekends.

However the analysis did reveal some problems with the recruitment of nursing staff and the way the Marie Curie health and personal care assistants were integrated into the service.

“The biggest question mark around the model remains the use and role of the centre’s care delivery, currently provided by the Marie Curie health and personal care assistants”

OPM Group evaluation of Wandsworth End of Life Care Coordination Centre

Delays to recruitment of more senior nursing posts meant staff had less time for strategic work and there was a lack of role clarity, said the analysis, which also noted more nurses were needed for the service to meet demand.

With the care assistants, the evaluation identified ongoing operational challenges around issues such as planning their rotas, accounting for annual leave, payment for their travel costs and communication between the centre and Marie Curie.

In addition, clinical leadership of the assistants by the centre was described as “limited”, and problems with recruitment meant the team was understaffed and fewer patients could be supported.

“The biggest question mark around the model remains the use and role of the centre’s care delivery, currently provided by the Marie Curie HPCAs,” according to OPM Group’s report on the service.

“Although the care being delivered through the HPCAs is clearly regarded as high quality, the role of care delivery in the model has in practice not been clearly defined, and the current arrangement suffers from various operational challenges,” it added.

If the centre were to continue beyond the pilot, it should be decided whether it should stop providing care and just continue with its coordination role, said the report.

It also said the service would benefit from additional nursing capacity to meet levels of need and increase outcomes, support existing colleagues, and release senior time for strategic activities.

However, Marie Curie told Nursing Times initial issues had since been resolved.

“As with any innovative service, there are always challenges at the beginning, particularly when a partnership is integrating the operational processes of three different organisations,” said Nicola Surman-Wells, Marie Curie nursing services regional manager for London and the South East.

“Pilots by their nature allow us opportunity to determine what works well and what needs to be improved to achieve the most effective way of delivering care locally.

“Barriers to optimal operational service delivery in the care coordination centre have been collaboratively addressed by Marie Curie and Royal Trinity Hospice and are now resolved.”

  • 3 Comments

Readers' comments (3)

  • michael stone

    'In total, this adds up to an estimated £347,788 worth of savings in the first year with projected savings of more than £730,000 over the whole two-year pilot.

    However, the service was set up with £60,000 and operational costs are estimated to be nearly £1.2million over two years.'

    Would whoever wrote the NT piece, and the NT headline, please clarify: is there a NET cost, or a net saving, being claimed here ?

    Nurses are crucial in community EoL, but if this service has significant cost implications, I'm not at all sure it would be widely adopted. However 'necessary' it is.

    At least it seems that Wandsworth does have 'an end-of-life system' - which is progress.

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  • Did the evaluation take views from carers and patients or just the staff?? This is unclear in the report.

    If just the staff then it has very limited value.

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  • michael stone

    ANONYMOUS 15 SEPTEMBER, 2016 10:31 PM

    I agree with your point - can't say if it unclear in the report [which I have not read]. Many 'evaluations' seem to be based on staff reporting what patients and carers 'tell us' - not satisfactory, you need direct patient and carer reporting/evaluation.

    I wrote about something similar here in 'Both Parties to a Story need to Tell It':

    http://www.bmj.com/content/351/bmj.h4259/rr



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