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Economic evaluation to inform the redesign of a specialist palliative care nursing service

Margaret Cassidy, Community and Day Services Manager, Ayrshire Hospice

Margaret's case study was completed in 2019 and reflects 2019 prices

In 2018, the Ayrshire Hospice commissioned a clinical service review which surfaced requests for greater out-of-hours accessibility of services in the community. In concluding that a seven-day community specialist palliative care nurse service could go some way towards addressing this perceived unmet need, Margaret Cassidy, Community and Day Services Manager, undertook an economic assessment of her proposed service redesign.

In this economic assessment Margaret sets out the costs and benefits of providing a seven-day service through the redeployment of the establishment currently deployed over five days. The potential positive and negative outcomes of the proposed service re-design were systematically validated through stakeholder engagement and benchmarking with another hospice.

The additional costs of service provision over weekends and bank holidays are presented as a consequence analysis. The potential benefits, including opportunities for cost that may be avoided elsewhere in the system, are identified.

Case studies reported by the respite and response team are used to illustrate where community specialist palliative care nurse availability could ensure a more timely response to patients' and families' immediate care and support needs, as well as increase the continuity and consistency of care. They also highlight the potential for the service to reduce the burden of care on out-of-hours services and prevent avoidable hospital admissions.

A systematic audit of calls taken by the hospice in-patient unit charge nurse over weekends demonstrates the potential to "release capacity to care" here too. A summary of indicative costs that may be avoided is presented and set against the costs of service redesign.

You can contact Margaret by email via Margaret Wilkie, Patient Services Director,

Case study

One page summary