End of Life - Directory of Services

The Palliative Care Urgent Response Service (PCURS) ceases on the 31st of August 2023 due to funding. Services are already funded to deliver the service and care that the PCURS provides.

 DHU Healthcare, with the support of the ICB, will continue the PCURS for patients and families who need urgent intervention at weekends and bank holidays,

 From 2^nd September 2023 there will be two vehicles, one covering North Derbyshire based at Chesterfield, and another covering South Derbyshire based at Derby. The service will operate from 08:00-18:00. Referral into the service is via the 111 Healthcare Professional (HCP) line i.e., 111*5 or 08444 122 235.

For patients known to a Community Palliative Care Team (CPCT) nurse they will give advice to health care professionals and document the advice on systemone. 

There is a nurse doing CPCT triage who is available via a CPCT secretary on 01332 787582 Monday to Friday 9am-4pm.

On weekends and  bank holidays for a health professional to speak direct to a CPCT nurse. Contact  the patient directed advice line: 01332 786040.

Out of hours we have an advice line for patients which is answered by a band 7 CPCT nurse at the weekend 9am-5pm Between 5pm and 9am it is held by a band 5 staff nurse on the Nightingale Macmillan Unit RDBH.

Please see the below leaflets for Patients and Professionals

Dementia Palliative Care Team - Patient Trifold Leaflet

Dementia Palliative Care Team - Professional Leaflet (Feb 21)

The purpose of a Virtual Ward is to provide safe care in the patient’s own home(including care homes) for palliative patients. The aim is to avoid admission into acute hospitals where appropriate or support faster discharges back home. This will be facilitated using face-to-face visits and the use of digital technology.

Currently this is a pilot service for patients who are North Derbyshire/North Dales/N.E Derbyshire and High Peak The service is being led and delivered by Ashgate Hospice .

See further information for details on the profile of the service and how to refer:

Virtual Ward - Ashgate Hospice

Virtual Ward DoS Profile Proforma

The Enhanced Beds Service is part of the Department of Palliative Care at Royal Derby Hospital and can offer community-based 24-hour care within dedicated palliative care beds in Nursing Homes. The Nursing Homes have a proven track record in palliative and end of life care and are supported by the Enhanced Beds Nurses. The beds are spread across Southern Derbyshire in order to provide patients and families with options for care that are closer to home.

What is the aim of the service?

• To offer an increased level of care and avoid crises.
• To avoid unnecessary, distressing hospital admissions for palliative care patients.
• To offer support to carers.
• To offer an environment in which care needs and future preferences can be reviewed.
• To support discharge from hospital where needed.
• To be an appropriate setting for care in the last days of life.

What will the service provide?

• 24hr care in a Palliative Care Bed in one of a number of Nursing Homes around Southern Derbyshire.
• The opportunity to review symptom control, social support and future care preferences.
• A realistic alternative to hospital admission for people nearing the end of their lives.
• Care will be provided for up to two weeks, (but sometimes potentially longer) with support in place for discharge planning.
• The support of Enhanced Beds Nurses, who have regular meetings with a Consultant in Palliative Care to review patients’ symptoms and needs.

Where are these beds?

There are numerous beds available in South Derbyshire and are paid for by the ICB on an ad-hoc basis, we only pay for the bed days that we use. We currently use The Meadows NH in Alfreton, The Firs NH in Codnor, Ashfields NH in Heanor, Aspen Court NH, Shelton Lock NH, and Littleover NH in Derby City, Abbeydale and Stanley House in Darley Abbey, and Jason Hylton Court NH in Swadlincote.

Which of my patients are appropriate?

 Adults aged 18 or over, registered with a Derbyshire GP with life shortening illness and appropriate for your palliative care register, who have a need for 24-hour care for a period of time. This may be for care in the last days of life, a period of monitoring or to prevent a crisis.

How do I refer?

• Call the Enhanced Beds Team on 01332 258031 to discuss any possible referral.
• Referrals will be taken Monday to Thursday 0900 until 1600 and Friday 0900 until 1200.
• Once received, referrals will be responded to within four office hours or as appropriate.
• Please see guidance notes overleaf for further details of referral process.

Guidance Notes for Referrers to the Enhanced Beds

Who can refer?

Referrals will be accepted from any health or social care professional providing direct care to the patient.  Referrals will be accepted between 0900 and 1600 Monday to Thursday and 0900 until 1200 Fridays.  This is to ensure that all care arrangements are in place prior to the weekend in order to support the safety of the patient.

How will the person be assessed?

A nurse from the Enhanced Beds team will visit the patient in their current place of stay.  A holistic assessment will be completed, including the needs of the carer as appropriate, and the benefits of the service will be explained in detail.  A joint decision between the nurse and the patient will be made as to whether the service can meet their immediate and ongoing care needs.  If appropriate, patients will be offered a bed in the most convenient bed available.

Who organises admission, transport etc?

The Enhanced Beds team will organise admission in liaison with the referrer and the patient and their family.  The team will also liaise with the patient’s own GP to ensure that medication (including anticipatory meds if appropriate) and advance care planning (DNACPR, ResPECT, RightCare plan) are in place and up to date. If the patient is to be registered as a temporary patient with a local GP, a patient summary is required from the GP Surgery.   Transport will be arranged by the team if required. For patients being discharged from hospital, the Enhanced Beds team will talk with the Ward Staff about what is needed for a successful transfer. A negative Covid-19 screen is required prior to admission to an Enhanced Bed following transfer from hospital.

Who will care for the patient while they are in the Nursing Home?

The Nursing Home staff will provide 24hr nursing care to the patient.  This will be under the guidance of the Enhanced Beds team from Monday to Friday.  Additional specialist palliative care support and advice is provided by the Community Palliative Care Team and Consultants in Palliative Medicine if needed.  At weekends and Bank Holidays additional advice and guidance can be sought via the Nightingale Macmillan Unit out of hours palliative care advice line (01332 786040).  If a patient’s own GP is unable to provide ongoing medical cover, the team will register the patient temporarily with the GP who supports the care home.

What happens at the end of two weeks?

From the point of admission, where appropriate, discharge planning will begin.  The team will liaise with the referrer and other health and social care professionals to ensure the patient is discharged safely home or to another care setting once stable and needs are met. If appropriate and required, the team may complete a Fast Track referral in order to arrange increased care at home, or for the patient to stay in the nursing home, if that is their choice. Patients reaching the last days of life will not be moved unless desired by the patient and family.

What happens if a patient is not appropriate, or there is not a bed available?

If there is not a bed available, the referrer will be advised prior to assessment.  The patient will be put on a waiting list for an available bed.  If a patient does not want to be admitted to the service or is not appropriate for admission, the assessing nurse will liaise with the referrer to arrange alternative support where possible. 

What if I have other queries and/or concerns?

Please call the Enhanced Beds team on 01332 258031 to discuss any details further.