1. Dr Jane Gibbins Consultant in Palliative Medicine

2. What is important to patients Symptom control Time and support to prepare Priorities and preferences listened to & accorded with Well coordinated & integrated services Family support and reduction in burden on family Singer et al. JAMA 1999 Steinhauser et al. JAMA 2000 Heyland et al. CMAJ 2006 Hancock et al. JPSM 2007

3. Inpatient units 24/7 admissions High complexity Multi-disciplinary team - Holistic care with forward/parallel planning Daily consultant reviews - Early tailored plan Short length of stay - Average 7 days

4. Patient reported outcome measures St Christopher’s Index of Patient Priorities (SKIPP) - Validated tool - Main concern/symptom - Quality of life 150 consecutive admissions 79% symptoms controlled within 3/7

5. Outcome measures

6. Quality of life Mean change 2.6 to 4.65 p<0.001

7. Hospice stay Crisis management/urgent problem - Symptom control Important issues/concerns/goals - Time and support to prepare - Priorities and preferences listened to & accorded with

9. 24 hour advice line

10. Outreach services Patients seen at the right time and place –Home, Care Home or Community Hospital –Hospice Outpatient –Hospital Oncology Outpatients –Joint Pain & Palliative Care Service

11. Specialist services Lymphoedema Day unit -Blood transfusions -Bisphosphonates

12. Education Undergraduates One of the most extensive medical palliative care modules in the UK Postgraduates Nursing staff 5 GP trainees per year

13. Steering projects Cross setting collaborative education –Symptom control guidance –Acute trust, Community, Ambulance, Hospices –1200 HCP to date with QI methods

14. Knowledge scores

15. Research Research work –Outcomes at CHC –Intrathecal project at CHC –Junior doctors with Peninsula Deanery National involvement –Papers –Conferences –Editorial board

16. Challenges Generally Increasing demands on service/changing population, especially non cancer population Identification of patients into SPC services No substantive Palliative Care/EOL lead in CCG Cornwall Hospice Care Funding Facilities that could be used by more individuals; day unit SPC services being delivered by different organisations Different governance and expectations No format to enable shaping of service to address changing patient needs No formal SLA/funding streams

17. Caring for our community Inpatient stays Lymphoedema Day therapy unit Domiciliary visits Outpatient clinics Pain and Palliative care service Community SPCN team MDT and advice Support to Hospital team at RCHT 24 hour advice line Education/Research/Project wo rk

18. Aspiration Patient and family GP and primary care Specialist Palliative care support Specialist secondary care Urgent and OOH care Voluntary and community support

19. Questions/discussion