Out of hours support for a rural community

Project overview

St David’s Hospice Care serves a large geographical area in South East Wales. This includes Newport, Caerphilly, Torfaen, Monmouthshire and Mid- and South- Powys. Powys is a rural, agricultural county. The county does not have a district hospital or an out-of-hours district nursing service. Nursing home and care service provision are also very limited.

Feedback from hospice patients showed that there was a huge need for support in the area, but the hospice didn’t have the capacity to meet demand. Patients and carers particularly wanted help during evenings and weekends.

St David’s decided to expand its Hospice at Home services in Powys, to better meet the needs of patients and carers in the community.

Outcomes

St David’s Hospice Care has now employed two part-time nurses to work in the Hospice at Home service, solely supporting patients in Powys over night.

This enables the hospice to provide more care in the area for people with complex palliative needs. The nurses support patients to remain at home for as long as they wish, by:

• managing and controlling symptoms
• managing pain
• comforting and reassuring patients and their families
• providing respite while carers catch up on sleep.
   

Key facilitators

St David’s Hospice Care was grateful to receive a grant from St James’s Place Charitable Foundation via Hospice UK's grants programme in 2022/2023. This funded the two nurse’s positions.

Employing two part-time nurses (instead of one full-time) means the service in Powys can run consistently. The two nurses are able to work flexibly and cover for each other as needed.

People in rural communities often have a close relationship with their District Nurses. St David’s works with the local District Nursing teams and other primary care providers, to raise awareness of the Hospice at Home service and encourage referrals.

Challenges

It was challenging to recruit the two nurses to work in Powys. The people in this role need to be highly skilled and have a resilient nature. Criteria includes:

• being comfortable working without the support of other nurses on a ward
• being flexible (in rural communities you sometimes need to be a ‘jack of all trades’) 
• being able to drive long distances to get to a patient
• having previous experience of both palliative care and community nursing.

Travel and navigation can be difficult in remote areas! The team have found that What 3 Words is helpful.

St David’s Hospice Care would like to expand their work in Powys, to provide Hospice at Home care during the day. They are currently funding the night service from charitable funds, but are seeking sustainable funding.