OUR COMMUNITY SERVICE
Farleigh Hospice Locality Care Teams provide expert specialist palliative care and support in the community for those living with a life limiting illness in the last year of life. This includes our Hospice@ Home service, providing personal care for people who are in the deteriorating or dying phase of their illness, likely to be the last 12 weeks of life.
OUR COVID 19 RESPONSE
Background: From March 2020 Farleigh Hospice mobilised all staff to work in Locality Care Teams based in the community, to provide personal care and specialist palliative care within people’s homes. To achieve this, we temporarily closed our Inpatient Unit and worked with our health and social care partners to care for these patients at home, where they were able to be with their families at the end of their lives. During this period, we cared for over 1,300 patients and their families, a 28% increase on this time last year.
Recovery phase: Our Inpatient Unit reopened in August 2020 and supported the Locality Care Team in caring for the patients who had the most complex needs.
Second wave: We have made the decision to take the same approach as we did in the first wave and pool all of our resources into providing community support, working closely with other partners and extending our offer to provide additional support overnight. This will mean a second temporary closure of our Inpatient Unit beds until spring 2021.
HOW HAS THE FARLEIGH COMMUNITY SERVICE EVOLVED DURING THE PANDEMIC?
- All Farleigh clinical staff worked together to care for the patients and families within their locality. They identified the needs of their patients within a shared caseload and pooled their expertise to meet these needs in the best possible way
- The Locality Care Teams include a range of staff - nurses, doctors, therapists, social workers, and assistants. Farleigh Hospice will, on occasion, be supported by approved agency staff
- The teams are supported by their own team ‘Navigators’ who answer calls to the team and direct the caller to the most appropriate person to assist them
- We are introducing a new level of ‘Clinical Navigation’ where a clinician will act as the key point of contact on any shift.
WHAT ARE THE AIMS OF THE CHANGED WAY OF WORKING?
- To continue to care for patients in their own homes
- To continue to support carers and families to be alongside their loved ones where possible
- Provide care within specific geographical localities to reduce potential spread of infection
- To work with our partners and share expertise and resources
- Reduce the need for admission to bedded units
- Underpin high quality care with education & training for all staff
- Reduce transfer of patients between settings
HOW DOES THIS WORK?
- All referrals for support are directed to the team where the patient’s GP is located – this is because we work closely with the Primary Care and District Nursing teams in each area
- This team then undertake an initial assessment by telephone and then follow up with a virtual or face-to-face consultation and agree a plan of care with the patient and their carer/family
HOW WILL THIS WORK IN THE SECOND WAVE?
- The team will continue to look specifically at the stage of the person’s illness i.e. if they are stable, unstable, deteriorating or dying, and will plan for care according to the needs of each individual patient
- This could include providing an enhanced Hospice@ Home service, with longer visits during day hours and, if needed, overnight care (shared with Marie Curie Nursing service), in what will now be known as our ‘Virtual Ward’ offer
WHAT IS A VIRTUAL WARD?
- This nurse-led ‘Virtual Ward’ is where specific patients will be admitted to an enhanced level of care and support with proactive daily case management by the Clinical Navigator on duty for that day
- The Clinical Navigator will monitor these patients and quickly identify where action is required e.g. review by a Farleigh Hospice specialist or additional care hours put in place
WHAT ARE THE BENEFITS FOR THE PATIENTS OF A VIRTUAL WARD?
- Avoidance of admission to a setting where visiting hours are restricted
- Being able to remain at home with an enhanced level of support
- Not having to tell their story over and over
- Having the same team of professionals involved in their care
- Retaining a level of independence where possible
- Being able to die in the place of their choice (if that place is home).
WHO WILL PROVIDE MEDICAL CARE AND ADVICE FOR VIRTUAL WARD PATIENTS?
- The patient’s GP will remain responsible for the care of their patient
- The Farleigh Hospice Medical Team will continue to provide specialist advice and support when requested through virtual and face-to-face consultations
- The Farleigh Hospice Medical Team will continue to provide an email advice service and out-of-hours on call service for medical staff via the MEHT switchboard
- The Farleigh Hospice Medical Team will continue to support the GP link meetings within each locality
WILL PATIENTS BE ASKED TO LEAVE THE VIRTUAL WARD?
- Caseload review meetings are held with each Locality Team – at this meeting the needs of all patients on the ‘Virtual Ward’ will be reviewed along with other complex patients
- If things have stabilised, a plan will be agreed with the patient and their family to reduce the level of input required and to discharge the patient from the ‘Virtual Ward’ to the usual Farleigh Hospice level of support
WILL TELEPHONE ADVICE BE AVAILABLE?
Farleigh Hospice will continue to provide a clinical advice line between 8am-8pm, 7 days a week via the advice line number, which is 01245 455478, with the medical on call service supporting overnight (as above).