Introducing enhanced end-of-life beds to improve patient care

As part of our work to improve specialist palliative care services in north west London, we are proposing to introduce 46 new enhanced end-of-life beds within our adult community specialist palliative care bed services.

The 46 new beds will be a significant step forward in providing compassionate and specialised care for patients nearing the end-of-life and will double our existing bed capacity.

The new beds will be available to residents of all eight boroughs in north west London. They are designed to bridge a gap in our current healthcare provision that many residents who contributed to the development of the proposed new model of care identified, and will help ensure that patients receive the quality of palliative care they need.

The enhanced end-of-life beds will be integrated into existing community bed services, such as nursing homes or other community bedded units. These beds will be staffed 24/7 by nurses and healthcare assistants, who have received specialised training in palliative and end-of-life care. There will also be a weekly ward round of the patients admitted to the enhanced end-of-life beds by the community specialist palliative care team, and patients will have access to the community specialist palliative care multidisciplinary team throughout their admission.

This initiative addresses the needs of patients who do not meet the criteria or need for a hospice inpatient bed, but can't stay at home, don't wish to stay at home, and prefer not to be in a hospital for their care. This is especially true for those living alone without a local support system. They also offer the possibility of short-term respite care.

By offering this intermediate level of care, we can ensure that more patients have access to the specialised support they need in a comfortable and familiar community setting, reducing unnecessary hospital emergency department attendances.

Expert support around the clock

Each enhanced end-of-life bed will be supported by specially trained staff, including registered nurses and healthcare assistants with expertise in palliative care and end-of-life care. The staff will provide continuous care, ensuring that patients receive 24-hour support of their palliative care needs.

A key feature of this service is the weekly ward round of the patients admitted to the enhanced end-of-life beds by the community specialist palliative care team, with access to the community specialist palliative care multidisciplinary team throughout their admission.

Collaborative and comprehensive care

The patient will remain under the care of the registered GP, as if the case with all community bedded care, however the supervision of these beds will be by the adult community specialist palliative care team and their multidisciplinary team.

The community specialist palliative care team will regularly collaborate with the registered GP, other community supporting services and the patient, including those who matter most to them, to support personalised care.

This new service has the potential to address an unmet need for our residents in north west London. By providing these specialised care beds, we can offer more patients the opportunity to receive the palliative care they need in a supportive, dignified environment, closer to their loved ones.

Q: How will be people be able to gain access to the planned enhanced end-of-life care beds”?

A: The admission and discharge criteria for enhanced end-of-life care beds are set out in the new model of care:

• Patients should be registered with a local GP. Cases will be considered individually to ensure support is made available to those who need it, including for people experiencing homelessness
• Patients should have a life-limiting illness with a prognosis of a few months, possibly nearing the end-of-life stage
• They require enhanced palliative and 24-hour bed end-of-life care that their regular care team, like district nurses, GPs, hospice at home, social care package, or continuing health care, cannot provide
• Patients who can't or don't want to receive care at home due to medical needs, social circumstances, or lack of necessary equipment but don't meet the specific and complex specialist palliative care needs for hospice in-patient unit bed admission
• The anticipated length of stay is up to three months, but this may be less depending on the patient's needs
• Referrals for admission to these beds may come from the patient's GP, the adult community specialist palliative care team, hospice at home, nursing home, community district nursing, hospice in-patient unit, or hospital team
• Patients can be stepped up to these enhanced beds from a regular nursing or residential care home bed through referral by care home staff and the adult community specialist palliative care team
• Patients can also be stepped up to a hospice in-patient unit bed from these enhanced end-of-life care beds through referral from the community specialist palliative care team, GP, and community nursing
• The hospital or hospice in-patient unit can refer and discharge patients (step down) to these enhanced end-of-life care beds.

Find out more about enhanced end-of-life care beds.

Q: What is the proposed number of enhanced end-of-life care beds per borough?

A: There are currently eight enhanced end-of-life-care beds in Hillingdon. Based on this number and the population of each borough we are proposing the introduction of 46 additional end-of-life care beds meaning 54 in total.

Given the geography of north west London and availability of sites, some shared work across boroughs could be possible to give improved access for residents.