Future plan for Fife’s palliative care to offer care at home and hospice

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Plans for the future of Fife’s palliative care services are set to be unveiled after the contentious move to a single specialist hospice at Victoria Hospital in Kirkcaldy.

That sparked a backlash in west Fife with a campaign launched to restore a ward at Queen Margaret Hospital, with one MSP accusing health bosses of “closure by stealth.”

The changes come after the pandemic had a significant impact on the way palliative care services were delivered in Fife. Work on how to shape the service had started before lockdown, and now the future direction will be presented to Fife Health and Social Care Partnership’s Integration Joint Board and NHS Fife Board at their respective meetings later this month.

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Dr Jo Bowden, a consultant in palliative medicine, said: “As clinicians, we want to be able to provide patients with personalised care, in a place of their choosing, whether that is at home or in a hospital.”

Consultation on the future of the service started before lockdownConsultation on the future of the service started before lockdown
Consultation on the future of the service started before lockdown

Currently the majority of palliative care is delivered by local healthcare teams, co-ordinated by GPs and provided by district nurses. For those with complex palliative care needs, this is provided by Fife’s specialist palliative care service in a range of settings, including hospice, care homes, hospital and at home.

Dr Bowden said: “At the start of the pandemic, our service had to adapt and provide a much greater balance of specialist palliative care to help keep vulnerable patients safe and away from our hospital sites. These changes have proven to be hugely beneficial, both for patients and their carers, and enable us to care for far greater numbers of people than we could have previously.

“As clinicians, we want to be able to provide patients with personalised care, in a place of their choosing, whether that is at home or in a hospital. In the past, we couldn’t offer that choice, with many people unable to be cared for at home with their loved ones around them.”

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The proposals will seek approval to continue the extended model, which has been embedded over the course of the last three years .

Under the pre-COVID model of care, the specialist palliative care team could look after a maximum of 19 patients at any given time, across two hospices units - the purpose-built specialist Victoria Hospice and a hospice ward at Queen Margaret. The move to a single hospice during the pandemic allowed many specialist palliative care staff to provide outreach care in the community, where they were able to apply their specialist knowledge in providing multi-disciplinary care for patients and families in their own homes.

The creation of outreach team meant the service could care for as many as 60 patients at any time, and the ability to care for patients at home has meant waiting times for a hospice bed have significantly reduced. Access to inpatient palliative and end of life care beds is still available at five community hospitals.

Lynne Garvey, Fife Health and Social Care’s head of community care services,said: “We want to ensure that patients across the whole of Fife, their families and loved ones, can get access to the very best care and support possible, particularly in the final months and weeks of their life.

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“It’s vitally important that we provide patients with greater choice around all aspects of their care, and we are now in a position to do this by expanding the way we deliver specialist palliative care across Fife, giving patients and families greater choice. The proposals will also help us better meet the needs of our population by widening and ensuring equity of access, while enabling far greater numbers of patients in Fife to receive specialist palliative care.”

In March, Claire Baker, MSP for Mid Scotland and Fife, launched a petition calling on NHS Fife to save the hospice at Queen Margaret Hospital. She accused NHS Fife of of “closure by stealth” - and criticised how it handled the announcement of the move.