Marie Curie and Liverpool CCG: support at home at the end of life

In Liverpool, we’ve been commissioned as a partner in STARS (Supportive and End of Life Care Service). We work with healthcare professionals to ensure each patient gets the care they need in their final weeks of their life.

The challenge

Four out of five people say when the time comes they wish to die at home. Unfortunately, less than one in four people will.

For patients who are rapidly deteriorating and need to be cared for outside of hospital, the situation is bleak. Only 22% of Clinical Commisioning Groups (CCGs) meet the 48-hour guideline for delivering packages of care for those people*. Alarmingly 51% of CCGs fall within the 2-7 day window, often resulting in patients never making it out of hospital in time.

There were also 1.6 million emergency admissions for people in the last year of life in 2016, with many of those people never making it back home and costing the NHS around £2.5bn. While some were necessary, others could have easily been avoided with appropriate community-based End of Life Care.

The solution

Liverpool CCG   commissioned Marie Curie as a partner in STARS (Supportive and End of Life Care Service). We work with our fellow partners Crossroads Together   and Home Carers Liverpool Limited HCL   to support people in their own homes, as well as to help their families and carers.

Our healthcare professional colleagues refer patients who are at the end of life to STARS. A STARS registered nurse then works to make sure the right care is in place for the patient – this can include care overnight as well as during the day.

The team also makes sure families and carers have access to psychological support and advice.

What makes STARS work

Continuity of care – Delivering consistent patient journeys; supporting families emotionally and physically

• Dedicated team of Health Care Assistants (HCAs) allocated to each case
• City-wide coverage via Marie Curie and the sub-contracted domiciliary care agencies
• Standardisation of care provision via a single service

Quality of care – Building trust; up-skilling across the local stakeholder base

• Marie Curie Caring Services (MCCS) clinical expertise in End of Life Care
• Training provision for all HCAs by MCCS, including sub-contractors
• Ability for referrers to talk to experienced members of the STARS team, especially with challenging cases
• Advice and input into EOL and Palliative Care groups and meetings

"You can really see how we’ve been able to shift the variation in the quality of care that we’re able to deliver through the STARS programme.” Kerry Lloyd, LCCG

Communications excellence - Responding at speed; valuing people; providing reassurance

• Care assessed as close to point of discharge as possible
• Everyone understands each other’s part to avoid delays
• Issues flagged by partner agencies resolved swiftly via the Marie Curie hub
• Every member of the care team is treated as one of our own, including celebrating milestones together
• Family have more autonomy by having loved ones home, with a team they know and can talk to

"We’re a piece of the jigsaw that makes up superb end of life care.” Patricia Rowland, STARS manager

The outcome: more people are able to die at home

• To increase the number of people dying in their preferred place. 
  • 96% of patients who died did so in their preferred place1

• To meet rising demand for standard and fast-track EOLC. 
  • Average referral to response time: 24 hours1
  • Proportion of referrals categorised as complex 94.6%1
  • Packages reduced from initial package requested: 51%2

• To standardise EOLC and address care inequalities

• To reduce emergency admissions for people at end of life

1. STARS KPI Report, prepared by Liverpool CCG (12 months Feb 18 to Jan 19)

2. STARS internal audit

Get in touch

To discuss your local end of life care needs or ideas, email Charles Thompson: Charles.Thompson@mariecurie.org.uk.