HNY Policy and Pathway Repository - Humber

The Hull and East Riding Specialist Palliative Care service provides palliative and end of life care to patients with a life limiting condition who experience unmet complex needs. The operational hours of the service are outlined in the table below;

The Hull and East Riding Specialist Palliative Care Clinical service is delivered by the following staff members;

• Band 7 Macmillan Clinical Nurse Specialists
• Band 6 Community Macmillan Palliative Care Nurses
• Band 5 Palliative Care Staff Nurse (Hull only)
• Macmillan Specialist Physiotherapist (Hull only)
• Macmillan Specialist Occupational Therapist (Hull only)
• Therapies Assistant Practitioner (Hull only)
• GP with a Specialist Interest in Palliative Care
• Consultants in Palliative Medicine
• Macmillan Clinical Palliative Care Pharmacists (Hull only)

Additionally, 24 hour access to general palliative nursing care is provided by the Community Nursing Service via Care Co-ordination Hub – 01482 247111

• Patients requiring a syringe pump (already prescribed) / administration of anticipatory Medications  / Verification of Expected Death (for patients known to the Community Nursing Service) refer immediately to:
  • CHCP Community Nursing Service – Via 01482 247111

• Patients requiring a general palliative nursing care assessment who have no complex, unmet symptoms refer to;
  • CHCP Community Nursing Service – Via 01482 247111

• Patients with social crisis refer directly to;
  •  Hull or East Riding Social Services.

Exclude Red Flag Symptoms

• Patients with suspected oncological emergencies refer directly to A&E or Cancer Assessment Unit (CMU) with the following ‘Red flag symptoms’;
  • Suspected spinal cord compression
  • Superior Vena Cava (SVC) syndrome

• Patients with suspected reversable causes refer immediately to the relevant clinical specialist with the following ‘Red flag symptoms’
  • Anaemia
  • Infection
  • Sepsis
  • DVT
  • Hypercalcemia
  • Stroke
  • Fractures

Many patients palliative care needs can be managed by their GP and the Community Nursing Team, with referral onto Specialist Palliative Care services only if complex needs develop.  An initial palliative assessment by the Community Nursing Team can be beneficial as they can refer onto the Specialist Palliative Care team as needed.

A patients need may be described as complex when they cannot be met by the primary care giver, i.e. the GP or the Community Nursing Service, or those who have symptoms that have not responded to first line interventions.

Patients with capacity should give consent for a referral to be made to the Specialist Palliative Care Team.

The Specialist Palliative Care team will triage all new referrals as a team to assess the appropriateness of the referrals.

If a referral is not accepted by the specialist team, the team will signpost the referrer to make a more appropriate onward referral.

If accepted, the referral is allocated to a member of the team who will make initial contact with the patient/carer/relative (within 5 working days) and gather initial information. They will plan an initial assessment, which includes a full holistic assessment including symptom management, psychosocial needs and advanced care planning. A plan of care will be devised with the patient to address their individual needs. Onward referrals will be made if necessary and the team will liaise with the other healthcare professionals involved in that patients care as appropriate. All new patients are discussed at the Multidisciplinary Team Meeting on a weekly basis. 

DO NOT REFER

• Patients under 18 years old
  • Refer to Children’s Community Nursing – 01482 344075
• Community Nursing only interventions – ie Syringe pump / VOD / administration of anticipatory Medications
  • Refer directly to Community Nursing Service – 01482 247111
• Patients without a palliative diagnosis (an advanced progressive, life limiting illness
• Patients with capacity, who are not aware that they have a palliative diagnosis. (patients with capacity should be aware of referral)
• Palliative patients with controlled symptoms / no complex palliative needs.
  • Refer directly to Community Nursing – 01482 247111
• Patients who have chronic problems that are not associated to their palliative diagnosis, for example, chronic arthritic pain.
• Emotional/psychological/financial support only.
  • Please find onward referral information:   

Welfare Benefits support

Referral Criteria

• Consents to referral to the Specialist Palliative Care Team
• Is aware of their diagnosis
• Must be over 18 years of age 
• Must be registered with a Hull or East Riding GP (or be resident within the city of Hull or East Riding and not registered with any GP)
• Must have a medical diagnosis of a progressive, incurable, life limiting illness who has existing unmet complex problems with pain or other uncontrolled symptoms that have not responded to first-line interventions   Please refer to “Guide to Symptom Management in Palliative Care” – produced by Yorkshire and Humber Palliative and End of Life Care Groups for guidance regarding first-line interventions
  • (free pdf to download - A-Guide-to-Symptom-Management-in-Palliative-Care-v8-Approved-by-HNY-IPMOC-February-2024.pdf (humberandnorthyorkshire.org.uk).  
• Has an unmet complex social, psychological or spiritual need over and above those that the key worker can provide 

Referrals

Referrals are accepted into the service from the following:

• Self referrals
• Other Healthcare Professionals
• Family / Relative / Carers
• GP
• Hospice
• Acute

Referrals can be made via;

• Specialist Palliative Care Single Point of Contact (SPOC) – 01482 247111
• Via electronic referral form to a secure email address – CHCP.palliativecarereferrals@nhs.net

Information to include

• Patient details and next of kin details.
• Referrer & their contact details – clinician picking up the referral may need to make contact to obtain additional information
• Professionals involved.
• Diagnosis. Prognosis if known. Patient awareness.
• Details of current symptoms and complex needs that cannot be managed by the key worker.  
• Reason for referral – What is required from the service.
• Relevant psychosocial elements.
• Up to date medications and treatment plans including any previous treatment.

Additional Resources

Referral form on ARDENS

Advice : if you would like to discuss a patient with a palliative diagnosis, please make contact with our single point of contact via 01482 247111 and advise you would like to discuss the case with a Specialist colleague rather than request a face to face assessment of the patient.