Following advice from specialist voluntary organisations, such as St Mungo’s and Groundswell it was decided that a literature review using existing research would be the best approach in terms of understanding what we need to improve on in terms of community based specialist palliative care for people from a number of diferent groups and demographics including people who:
- are experiencing homelessness.
- have a learning disability
The purpose of the reviews were to identify the reasons why people do not have fair and equitable access to community based palliative care, which is explored under the following themes;
- Barriers to accessing community based specialist palliative care;
- What the challenges are for healthcare professionals;
- Care planning;
- Approaches to engagement
Each review outlines a number of recommendations to be considered as part of the Community- based Specialist Palliative Care Improvement Programme to drive positive health outcomes for the vulnerable groups.
If you would like to provide feedback on the literature reviews email email@example.com
Recommendations and how can this be taken forwards in the Community- based Specialist Palliative Care Improvement Programme.
Planning for end of life alongside discussions about health (parallel planning): when healthcare professionals speak to people about their health due to concerns, they should use this as an ‘entry point’ to begin thinking and talking about that person’s future options and wishes. In other words, this would involve talking about options which would help them live well now and their options when their condition deteriorates. This will help feed in the idea of palliative care services, in a way that feels supportive.
Better multi-agency working to support planning care and building collaborative relationships between organisations: we need to create a culture where palliative care is seen as everyone’s job in health and social care. Delivery of regular review meetings about individual patients, with representatives from multiple services including the person’s key worker would promote this as well as improve relationships between health, palliative care, drug and alcohol services, the voluntary and social sectors. We could also explore ‘twinning’ or joining up of local hospices to hostels as this has been successful in Manchester.
In reach to hostels/day centres and outreach- bring care to people: many people experiencing homelessness who are seriously ill remain in hostels, as such healthcare should reach into hostels and residents. In reach helps:
- Identify those with poor health and enable conversations about their health and end of life care, to support care planning.
- Develop ways to address unmet palliative needs through working in partnership and training hostel staff and frontline staff.
- Further explore the provision of virtual and remote support through Microsoft Teams to hostels.
- In addition to in reach, services should also reach out and identify patients not accessing services and deliver these to them. The role of peer advocacy approach could be further explored as this improves the likelihood of people experiencing homelessness attending appointments.
Better training and education for hospice/provider staff: support staff in hospices/providers and specialist palliative care settings to care for people, whose behaviour is often considered challenging. Training should focus on making care inclusive, tailored, more trauma informed e.g. recognising the impact of past and present trauma, include modules on problematic substance use (PSU), Pathway model/services, and the Homeless Palliative Care Toolkit.
Need for greater provision, access and choice: across the board (e.g. not just community specialist palliative care) there is a lack of choice for patients experiencing homelessness, particularly in terms of access to 24-hour support for dealing with serious illness.