Currently, the provision of end of life care in care homes is of variable quality. There is not always good GP provision, and too often people who are at the end of life in care homes do not have access to specialist palliative nursing. As a result, symptom and pain management is not as good as it could be, and unplanned hospital attendances are common.

Approaches that aim to better integrate palliative care services in the community have been shown to improve the quality of life for older people (e.g OPTCare Elderly study). In addition, palliative care for people with multiple diseases has been shown to result in greater cost savings than for people with single diseases. However, as researchers, we do not currently know what the best way to provide palliative care in care homes is.

Aims of this project 

The aim of this project is to develop a new integrated service to improve care for patients in care homes in south London who are living with advanced and multiple diseases. This new integrated community palliative partnership (ICPP) will bring together specialist palliative care, including hospices, primary care, social care and specialised nursing support. 

We then plan to evaluate the service and generate the evidence necessary to inform health service planning and commissioning. The project will also evaluate the impact of the Covid-19 pandemic on care. Ultimately, we hope that the partnership service will reduce health and care inequities that are experienced by care home residents. 

Designing the new service around the views and experiences of patients, family and staff

The new integrated service will be designed around the views and experiences of older people with advanced illness living in care homes, as well as family and care home staff. We want to understand what is important to them, how they experience services and how services could be improved. We will conduct twelve interviews with care home residents with advanced illness and their family, and twelve with health or social care professionals. 

We will then conduct up to four workshops with a mix of health and social care professionals, including care home managers, GPs, community nurses, specialist palliative care nurses, hospice teams, and service commissioners, as well as family caregivers and patient representatives. We will use the workshops to explore how these teams can work together to improve care for residents and what is needed for a successful integrated service. We will also consider the cost implications of different service models. 

After this process, we will propose a new model of care that we can test in a future study.

Our collaborators 

We are collaborating with Quay Health Solutions GP Federation, Guy's and St Thomas' community specialist palliative care team, St Christopher's Hospice, community nursing teams, community geriatricians, and Southwark Clinical Commissioning Group. We are also working with four care homes in Southwark – Tower Bridge Care Home, Rose Court, Bluegrove and Queen's Oak.