Service area 1: Care at home
Q: How will the new model improve care at home?
We’re improving care at home by expanding services across all boroughs. Here’s what will change:
The new model will provide a 7-day specialist palliative care service, operating 8am-8pm, across all boroughs, expanding from the current 5-day service in some areas, such as Harrow. We’re increasing support for care homes, in the form of training and support, to ensure residents get the right care and advice when needed.
Hospice at Home services will now provide 24-hour care in collaboration with your existing community care team. This includes overnight support and personalised care designed to help you stay in your home. This service will also be expanded to areas like Hammersmith & Fulham, Ealing, and Hounslow, which previously didn’t have full coverage.
A 24/7 specialist telephone advice line will be available for anyone, whether you’re already known to palliative care services or new to them. This ensures that help is just a phone call away, anytime you need it. This is a change from current 24/7 specialist palliative care advice line services, which in the main only support known patients and have variation in the level of advice and support offered.
Q: Can you tell us more about the hospice at home service?
The Hospice at Home service helps people receive care in the comfort of their own homes. It’s focused on providing high-quality, compassionate care, especially for people in the final stages of life who wish to stay at home. The service includes:
- Personal care (e.g., bathing, dressing) and help with daily activities
- Medication management and comfort care
- Overnight support, allowing carers and family members to rest
- Access to a full care team, including healthcare assistants, nurses, and palliative care consultants.
Hospice at Home is designed to ensure that patients feel comfortable and supported, working closely with your usual care team, such as GPs and district nurses.
Service area 2: Community specialist in-patient beds
Q: How will the new model improve access to inpatient beds?
Currently, there are 57 hospice inpatient beds available across north west London for patients with the most complex palliative care needs. These beds provide highly specialised care for people with complex needs in the final stages of life. Under the new model of care:
- We will keep these 57 hospice inpatient beds open, so access to specialist hospice care will remain the same
- In addition, we are introducing 46 new enhanced end-of-life care beds, which will be available across all boroughs, totalling 54 end-of-life care beds across north west London. These beds are designed for patients who need more support than can be provided at home but do not require the full level of care provided by a hospice
- This means that overall access to specialist palliative care beds will significantly increase, ensuring more people get the right care in the right setting.
These changes mean that more people will have access to the right level of care, whether at home, in a hospice, or in a dedicated care facility.
Q: Can everyone have a hospice bed if they need one?
Hospice beds are for people with the most complex care needs at the end-of-life, and not everyone will need this level of care. But we understand that not everyone can or wants to stay at home. That’s why we are adding 46 new end-of-life care beds, which offer extra support for people who don’t need hospice care but can’t stay at home.
Our goal is to make sure that everyone gets the care that best suits their needs—whether that’s at home, in an enhanced end-of-life care bed, or in a hospice. This new model of care offers more options for more people, ensuring that the right level of support is available at every stage.
Service area 3: Hospice out-patient services, hospice day care services and well-being services (including psychological and bereavement support services for patients and families)
Q: How will the new model improve outpatient care and well-being services?
While all boroughs already have access to hospice outpatient services and day care, we’ve found that some areas, like Ealing, Hounslow, and Harrow, have fewer services available. The new model of care changes this by:
- Making sure every borough has doctor and nurse-led clinics, so residents can access the care they need closer to home
- Expanding lymphoedema services (for patients with non-cancer-related swelling) in areas that currently lack this care
- Improving access to psychological and bereavement services for patients and their families, with options for face-to-face or virtual support, and group or one-on-one sessions.
Our goal is to ensure that everyone receives the same high-quality care, regardless of where they live.
We aim to make sure hospice out-patient multidisciplinary team (MDT) clinics (including but not limited to medical and nursing clinics, rehabilitation via therapists, and dedicated lymphoedema services) deliver the same core level of service. This refers particularly to the boroughs of Ealing and Hounslow where doctor and nurse led clinics are currently not available via Meadow House Hospice, as well as Harrow where there is currently a gap in provision of lymphoedema services for non-cancer patients. We propose to expand lymphoedema service provision for these non-cancer patients in Harrow.
We aim to make sure well-being services including hospice day care, family and carer practical support and education, complimentary therapies, and dedicated psychological and bereavement support services deliver a core level of service.
Particularly for psychological and bereavement support services for patients, their families, carers and those important to them which includes: a more streamlined pathway to access these services; increased personalisation of care for example offering one-to-one and group sessions, face-to-face and virtual support; and increased cultural and spiritual sensitivity to delivery of this care and support. While all boroughs currently have access to some psychological and bereavement services, this varies in level of support
Why are we consulting on these two options?
The financial and non-financial appraisal of the shortlisted options for delivering the model of care, identified the two highest scoring options as being:
- Option A: Full delivery of the proposed model of care with the suspended Pembridge Inpatient beds remaining closed
- Option B: Full delivery of the proposed model of care with the suspended Pembridge Inpatient beds reopening.
Of these two options, Option A scored highest and is therefore identified as the preferred option. In more detail:
Option A (Preferred):
- Fully implement the proposed model, including 46 new enhanced end-of-life care beds, while maintaining the existing hospice beds without reopening the Pembridge Hospice inpatient beds.
- This option would be easier and quicker to implement and benefit more north west London residents as a whole.
Option B:
- Fully implement the proposed model, including 46 new enhanced end-of-life care beds and reopen Pembridge Hospice inpatient beds.
- This would require a reduction in hospice beds elsewhere and have a longer implementation timeline due to the need to recruit specialist palliative care consultants and 35 additional staff.
We are pleased that in both of these options, we are proposing to almost double the number of beds available to local residents and fill the gaps in service provision that have meant that some residents in some boroughs have a less good service. We believe this is the fair and right thing to do.
Whilst one of the two options (Option A) scored higher in the financial and non-financial appraisal to provide us with a preferred option, no decision has been made and we are seeking your views on both options to inform the final decision. This will be made after the consultation has closed and the feedback independently reviewed.
Q. Why is option A the preferred option?
When we started looking at all the potential implementation options we originally identified 54. Following a robust assessment process this was narrowed down to two options that scored the highest against the agreed criteria.
Option A is the preferred option as we will be able to make the improvements and implement the new model of care quicker and will provide improved equity of access to the north west London population as a whole. The in-patient specialist hospice beds would remain as they are in option A, versus option B where the Pembridge Palliative Care Inpatient Unit beds would reopen. There are two aspects to this:
- Our analysis shows that the current 57 inpatient hospice beds that we have open are sufficient for the immediate and future needs. We would therefore need to reduce the number of beds in the other hospices in north west London, and would result in a loss of income for charitable hospices. Whilst re-opening Pembridge Palliative Care Inpatient Unit beds would improve access to residents in the immediate surrounding area, on balance it would reduce access to a broader range of the north west London population. Our travel analysis also shows that residents in the immediate area around the Pembridge Palliative Care Unit will still have better access to inpatient hospice beds that pockets of the north west London population elsewhere.
- In order to reopen the Pembridge Palliative Care Inpatient Unit beds, we need to recruit specialist palliative care consultant cover and 35 additional specialist staff. In current circumstances, where there is a national shortage of these really specialist staff and we have failed to recruit in the past, we believe it will be more difficult to implement option B and it is difficult to put a timescale to this.
Q. Why is the Pembridge Palliative Care Inpatient unit not open?
The Pembridge Palliative Care Services in-patient unit has been suspended for use since the end of 2018 as a result of the inability to recruit and retain specialist palliative care consultant cover required to safely run the unit.
All other Pembridge Palliative Care Services (ie. 24/7 specialist telephone advice line, community specialist palliative care nursing day hospice services and outpatient services and other services) are unaffected and continue to operate.
NHS North West London has not made a decision to permanently close the Pembridge inpatient unit site and, together with the Central London Healthcare Trust (CLCH) who provide the service, have remained open to recruiting the specialist palliative care consultant to support the safe reopening of the in-patient unit.
We have heard from local residents there is still a strong desire for the Pembridge in-patient unit to be reopened and that options from the public for how we could reopen the unit could be more widely considered than they have been to date.
We had two meetings in late 2023 with patient representatives, CLCH and Imperial College Healthcare NHS Trust (ICHT) to discuss options for re-opening the in-patient unit. It was agreed that ICHT and CLCH would meet to discuss whether and how the two services could work together in a more integrated manner to support re-opening the inpatient unit in future with a more robust and resilient staffing model and whether joint recruitment to posts at Pembridge may be possible.
These discussions have now taken place. However, it proved very difficult to find a suitable solution and the impact of trying to do this would be significant on both providers and would risk destabilising Imperial’s workforce significantly. NHS North West London is satisfied that the relevant conversations between ICHT and CLCH have taken place and no alternative solution has been deemed feasible, and that therefore the discussions have come to a close.