- Overview
- Available Locations
- How do I register for this service?
- Meet the team
- Useful resources and links
Type
Adult Services - Specialist Palliative CareOur teams provide specialist support and advice to patients who have been diagnosed with a life-limiting illness. The patient is considered to be within the last 12 months of life. There are a number of different services that sit under this pathway. They work together to provide specialist physical, psychological and spiritual care to patients and carers.
Our countywide services offer a united approach to providing end of life care. We ensure a seamless and supported journey for patients, service users and their carers/families.
We care for patients and service users in their homes through our community teams or in our hospice inpatient units. This is dependant on individual care required. We help with symptom control to improve comfort and enhance quality of life. We also help with discharge planning in complex situations involving other hospitals, hospices and primary care teams.
Who is this service for? Adult patients considered being within the last 12 months of life and having specialist palliative care needs and their families.
Available Locations
- Cransley Hospice
- Cynthia Spencer Hospice
- Hospice at Home
- Palliative Care Clinical Nurse Specialist Service - Cynthia Spencer Hospice
- Palliative Care Clinical Nurse Specialist Service - Danetre Hospital
- Palliative Care Clinical Nurse Specialist Service - St Mary's Hospital
- Palliative Care Lymphoedema
- Palliative Therapy Team - Cransley Hospice
- Palliative Therapy Team - Cynthia Spencer Hospice
- SPC Consultant Outpatients - Cransley Hospice
- SPC Consultant Outpatients - Cynthia Spencer Hospice
How do I register for this service?
Community teams
Referral Criteria
Our services are for:
- Patients who have a progressive, life limiting diagnosis
- There is complex symptom control or complex functional or psychological issues important to the patient, that cannot be readily managed by the team responsible for care
- The patient agrees to referral to the Community team, if competent to choose.
Referrals that would not be considered
- Patients with chronic stable disease, or disability with a life expectancy of several years
- Patients with chronic pain problems not associated with progressive terminal disease
- Competent patients who decline referral or who are unaware of referral
- Patients whose needs are principally psychological, and need specialist psychiatric referral, whether or not they have declined such help.
Proactive Indicator Guidance: The following is intended as a guide for professionals looking after patients who may be referred to the Community Specialist Palliative Care Team (adapted from the Gold standards framework 2016, 6th Edition). The team are happy to advise in uncertain situations.
General indicators that referral may be appropriate
At least one of:
- Progressive functional deterioration in performance scale (Karnofsky Performance Scale -Appendix 1)
- Dependence in three or more activities of daily living
- Multiple co-morbidities
- Symptoms that cannot be alleviated by treating underlying disease
- Signs of malnutrition due to illness – cachexia; albumin <25g/l
- Deterioration in Phase of Illness e.g. UNSTABLE/DETERIORATING (See appendix 2)
Disease specific indicators
Cancer
- Incurable metastatic disease or inoperable disease
- Complex symptomatic or psychological problems
Cardiac Disease
At least one of:
- Advanced heart failure (New York Heart Association Grade 3 or 4 see appendix 3)
- 3 or more admissions to hospital within the last 12 months with symptoms of heart failure
- Physical or psychological symptoms despite optimal tolerated therapy
- Symptomatic arrhythmias resistant to treatment
Pulmonary Disease
At least one of:
- Shortness of breath at rest (MRC Grade 4, see appendix 4)
- Documented progressive disease
- Symptomatic right heart failure
- Cachexia
Renal Disease
Not able or willing to undergo dialysis or transplant and at least one of:
- Stage 4 or 5 Chronic kidney disease
- Patient wishes to stop dialysis
- Signs of renal failure (severe nausea, pruritus, restlessness, altered consciousness)
- Intractable fluid overload
- Rapid deterioration anticipated by renal team
Liver disease
At least one of:
- Hepatocellular carcinoma
- Liver transplant contra indicated
- Advanced cirrhosis with complications including:
- Refractory ascites
- Encephalopathy
- Other adverse factors including malnutrition, severe comorbidities, Hepatorenal
- Bacterial infection current bleeds, raised INR, hyponatraemia, unless they are
- Ascites despite maximum diuretics; spontaneous peritonitis
- Jaundice
- Recurrent visceral bleeding if further intervention inappropriate
Appendix 1 - AKPS
General category |
% |
Specific criteria |
|
100 |
Normal general status - no complaints - no evidence of disease |
90 |
Able to carry on normal activity - minor symptoms of disease |
|
80 |
Normal activity with effort; some signs or symptoms of disease |
|
|
70 |
Able to care for self; unable to carry on normal activity or do work |
60 |
Requires occasional assistance from others; frequent medical care |
|
50 |
Requires considerable assistance from others; frequent medical care |
|
|
40 |
Disabled; requires special care and assistance. |
30 |
Severely disabled; hospital admission is indicated although death not imminent. |
|
20 |
Very sick; hospital admission necessary; active supportive treatment necessary |
|
|
10 |
Moribund |
0 |
Dead |
Appendix 2 - Phase of illness
Stable |
|
Unstable |
|
Deteriorating |
|
Terminal |
|
Appendix 3 - NY heart
Class |
Patient Symptoms |
I (mild) |
No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath). |
II (mild) |
Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath). |
III (moderate) |
Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea. |
IV (severe) |
Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases. |
Appendix 4 - MRC dyspnoea
Grade |
Degree of breathlessness related to activities |
1 |
Not troubled by breathlessness except on strenuous exercise |
2 |
Short of breath when hurrying on the level or walking up a slight hill |
3 |
Walks slower than most people on the level, stops after a mile or so, or stops after 15 minutes walking at own pace |
4 |
Stops for breath after walking about 100 yds or after a few minutes on level ground |
5 |
Too breathless to leave the house, or breathless when undressing |
How to make a referral
This service accepts professional referrals only.
Routine referrals
Please complete the electronic referral form :
Urgent referrals or advice
If the patient is felt to be in last four weeks of life and requires Hospice at Home support, please telephone your referral to 03007 770002 option 1 (Monday-Sunday, 8am to 11.30pm).
For urgent clinical advice call 0300 777 0002 (option 1). The Community Specialist Palliative Care Team are available Monday-Friday, 9am-5pm. The Community Nursing team are available to triage urgent calls from Monday-Sunday, 8am to 11.30pm
If SPC advice is required outside of these hours, or you wish to discuss possible hospice admission then please refer to ‘Hospice Admissions’ section below.
Hospice admissions
If you are considering a hospice admission please call 03000 274200. This will be answered Monday-Friday, 9am-5pm.
Please DO NOT use this number to seek a medical opinion as those answering this phone may not be medical colleagues.
For a medical opinion, please call Cransley Hospice on 01536 452013 or Cynthia Spencer Hospice on 03000 271290.
Outside of these hours, please call Berrywood Hospital Switchboard on 01604 682682 and ask to speak to the first on call doctor for Specialist Palliative Care.
Meet the team
For many patients in the late stage of their illness, palliative care needs can often be straightforward, and their needs met by their GP and community (district) nursing team.
If there is complex symptom control or psychosocial issues present or predictable, then advice from or involvement with Community Specialist Palliative Care Team should be considered.
Who we are
A team of expert healthcare professionals, who specialise in the area of palliative care. We offer specialist support and advice, including emotional support to patients, their families and carers living with cancer and other life threatening illnesses. We also offer advice and support to other healthcare professionals involved in the patients care.
The Community Specialist Palliative Care Team is made up of the following healthcare professionals:
- Specialist Palliative Care doctors
- Palliative Care Clinical Nurse Specialists and Senior Nurses
- Specialist Physiotherapists
- Specialist Occupational Therapists
- Hospice at Home Support - for patients thought to be in their last 4 weeks of life
What we do
We offer advice, support and care to patients with advanced, progressive and life-limiting illnesses, cancer and non-cancer, their carer’s and families and staff across the Northamptonshire community.
The advice and support includes:
- assessment of palliative care needs
- symptom management
- psychological, social and spiritual support
- end of life and terminal care
- information about other community services
Hospice at Home Support includes:
Registered Nurses and Care Assistants who are experience in end of life care. They can provide nursing care; symptom control and emotional support to facilitate care at home in conjunction with existing community services.
The aims of this support are:
- To assist with end of life care where the preferred place of care is in the home (including care homes or other long-term care facilities)
- To support rapid discharge from hospice
- Crisis intervention to avoid inappropriate admission in the last days of life
Who is it for?
The service is for:
- Patient who have a progressive, life limiting diagnosis
- There is complex symptom control or complex functional or psychological issues important to the patient, that cannot be readily managed by the team responsible for care
- The patient agrees to referral to the Community SPC team, if competent to choose.
The service is not for:
- Patients with chronic stable disease, or disability with a life expectancy of several years
- Patients with chronic pain problems not associated with progressive terminal disease
- Competent patients who decline referral or who are unaware of referral
- Patients whose needs are principally psychological, and need specialist psychiatric referral, whether or not they have declined such help.
Useful resources and links
Links
Cynthia Spencer Hospice tour video
National Association for Hospice at Home
National Council for Palliative Care
Resources
Advance Care Planning (ACP) Booklet[pdf] 2MB
Advance Care Planning Easy Read A5 Leaflet (ACP)[pdf] 600KB
Cynthia Spencer Hospice - smoking shelter information[pdf] 251KB
Cynthia Spencer Hospice - smoking shelter information[pdf] 251KB
EASY READ - Advance Care Planning Booklet (ACP)[pdf] 3MB
Flyer to Launch Easy Read ACP Booklet[pdf] 592KB
Hospice at Home Northamptonshire [pdf] 738kb
Lymphoedema Service - leaflet[pdf] 665KB
Need to access one of these services? - leaflet[pdf] 281KB
Palliative and End of Life Care Education Prospectus 2020[pdf] 12MB
What to expect when someone is dying leaflet[pdf] 3MB
Wellbeing@CynthiaSpencer
This service is available to anyone over the age of 18 currently facing a life limiting illness, this can include advanced cancer, neurological conditions such as Motor Neurone Disease and Parkinson's, advanced respiratory and cardiovascular disease and dementia.
Find out more here www.cynthiaspencer.org.uk/wellbeing
Wellbeing at Cynthia Spencer - booklet[pdf] 2MB