Background

The majority of palliative care in Fife is delivered by local healthcare teams. This care is most often co-ordinated by GPs and provided by district nurses. For those with complex palliative care needs, this is provided by Fife’s Specialist Palliative Care Service in a range of settings, including hospice, care homes, hospital and at home.

Prior to the start of the pandemic, it was acknowledged across Scotland that it was necessary to extend palliative care to greater numbers of those with life-limiting conditions.

Work to extend access to specialist palliative care in Fife was accelerated in its introduction by the pandemic and the need to keep vulnerable people safe. The demand for hospice care reduced significantly at the start of the pandemic, with far greater numbers wishing to be cared for at home. This led to Fife’s two inpatient hospices being under-utilised and necessitated Fife’s Specialist Palliative Care Service to adapt how it cared for patients.

Providing specialist outreach care

In order to continue to support patients and their families, the Specialist Palliative Care Service adapted how it operated so that it could continue to meet the needs of people in Fife, This meant moving to a single hospice to allow many specialist palliative care staff to provide outreach care in the community, where they were able to apply their specialist knowledge in providing multidisciplinary care for patients and families in their own homes.

This new way of working has enabled the service to provide hands-on specialist care to far greater numbers of people in Fife, while at the same time supporting their families and other loved ones. The ability to care for patients at home has meant that waiting times for a hospice bed have significantly reduced, with very many of those admitted currently waiting no time at all. This model remains in place and continues to evolve to best meet the needs of people in Fife.

The Proposed Future Model

The upcoming proposals will seek approval to continue the extended model, which has been embedded over the course of the last three years and has been shown to better meet the needs of the population.

The proposals have been developed by specialist palliative care clinicians and follow extensive engagement with patients, families and public groups prior, during and after the COVID-19 pandemic. 

Key to the proposed model of specialist palliative care delivery is to provide patients with greater choice around how their care is provided. Under the previous ways of working, the majority of those who required specialist palliative care had to be cared for in the hospice or in a hospital ward. While many people wished instead to receive this care at home alongside their loved ones, this was rarely possible as there was no community provision in place to support this.

The development of the specialist palliative care outreach team means that the vast majority of those who wish to be cared for at home, whether for part or the entirety of their illness, now have that option available to them.  

Similarly, those who would prefer to be cared for in a healthcare setting also have that choice, with continued access to inpatient palliative and end-of-life care beds in 5 community hospitals across Fife, including at Queen Margaret Hospital in Dunfermline, in addition to the centrally located Victoria Hospice in Kirkcaldy.

Making best of our resources to improve care for all

The proposed model of palliative care in Fife has been driven solely by the desire to provide patients and their families with the best possible care and support, wherever they are, seven days a week during the most difficult and emotional time for everyone involved.

The changes are not driven in any way by resource and the service’s budget has not been affected.

Approximately 4,000 people in Fife die each year, most of whom require palliative care. Under the previous ways or working, around 4% of deaths in Fife occurred in the hospice yet operating two hospices required around 80% of the specialist palliative care resource.

By shifting a greater balance of palliative care into Fife’s communities, this extended model of care is now better able to meet the needs of our local population, with the specialist service better prepared to respond to the increasing demand for palliative care.

Through adapting to the new model, this has allowed the service to achieve the following:- 

• A significant expansion in the numbers of patients receiving palliative care, rising from less than 20 under the previous model to more than 60 currently.
• Waiting time for hospice admission has reduced from 3.4 to 1.4 days, with those awaiting admission receiving support from the multi-disciplinary community out-reach team.
• Better support for those with non-cancer diagnoses, increasing from 9% to 30% of those cared for by the specialist service.
• Reduced admissions to acute hospital for patients in the last weeks of life.
• A reduction in emergency ambulance use for people in their last weeks of life.

In addition to providing hands-on care, the new model also enables specialist clinicians to better support local GPs and district nurses, who themselves co-ordinate and deliver the vast majority of palliative care across Fife.

This has been achieved through the establishment of a seven-day, single point of access helpline where local healthcare teams can seek expert advice from the duty senior nurse or consultant, who can also initiate a home visit whenever this is required. The Single Point of Access (SPOA) Professional to Professional Helpline is available 7 days per week and receives calls for between 150 and 200 new patients per month.

For more information on the proposed future model of specialist palliative care in Fife, a detailed briefing which was provided to elected representatives, which is available to view here.