This is achieved by close collaborative working between us and those working in the Acute Trust Hospitals , Community (including Care Homes) and Hospice settings. There is no arrangement in place for service in Private Hospitals

The Team
There are 7 whole-time equivalent Clinical Nurse Specialists (CNS) employed by St Catherines Hospice and based at the Hospice.

CNS's work in geographical areas, with specified GP practices and District Nurse teams., The areas covered are Preston , Longridge, Chorley and South Ribble .

The number of patients referred to the service from the 1 st January 2006 to 31 December 2006 was 742, of these 625 were being referred for the first time.

Team Functions

1. Communication and collaboration with other professionals involved in the patient's care in the Hospice, community or secondary care setting and also including nursing or residential care homes
2. Empower and enable generalist colleagues to provide palliative care
3. Identify both formal and informal educational opportunities
4. Plan and deliver education according to the team education strategy
5. Support and mentor students and newly qualified nurses
6. Support the development of other health care professionals
7. To have in place standards (Operational Procedures) and a programme of auditing those standards
8. Define and promote Specialist Palliative Care Services to encourage appropriate use of resources

Criteria for Referral

• The patient has a GP within the Central Lancashire PCT boundaries
• The patient has agreed to, or requested referral to the CNS service
• The patient has progressive malignant disease
• The patient has been referred to the District Nurse

The District Nursing Service is available to patients 24 hours a day seven days a week. The CNS liaises closely with the Primary Health Care Team (PHCT) and is complementary to PHCT services.

• The patients GP has been informed of the referral to the CNS by the referrer.

The Referral Process
Referral is by completion of the Hospice referral form, which should be completed as fully as possible, including the reason for referral. The referral must be signed with clear indication of the designation/department of the referrer, (this enables feedback to the referrer following first assessment visit to the patient, or access to the referrer for additional information if required).

Referrals are accepted from;

General Practitioners (GP's)
District Nurses (DN)
Hospice Doctors
Hospice Nurses
Hospital Doctors
Hospital Nurses
Site Specific Clinical Nurse Specialists

1. The referrer has a responsibility to inform the patient of the role of the CNS in community palliative care in order to facilitate informed choice. The patient must be agreeable to the referral and the sharing of information.
2. The patient has an identified need for 'Specialist Palliative Care' intervention
3. Patient's GP and DN are made aware of the referral by the referrer
4. The referral is completed as fully and accurately as possible and sent to the Medical Secretary at St Catherine's Hospice, this enables the patients details to be entered onto the Hospice database and case notes to be made up, or retrieved from archive if a re-referral.
5. Referral passed to the Community CNS Team
   • Medical/Team Secretary informs the GP and DN of receipt of the referral
   • Community CNS manager reviews the referral and allocates to CNS
   • Community CNS liaises with relevant professionals, e.g. Site Specific CNS, GP or DN etc
   • Community CNS requests hospital annotations in order to be as informed as possible prior to contacting the patient
   • CNS contacts patient or carer and arranges a mutually convenient time to conduct the initial assessment visit
   • Following the assessment, the CNS writes to the patient's GP outlining the identified issues and copies the letter to the DN, the Referrer, the Oncologist/Consultant 

Criteria for discharge from the service

1. The patient carer or family member no longer have complex needs requiring CNS intervention
2. The patient moves out of the Central Lancashire locality
3. The patient, carer or family member's needs are beyond the skills of the Community CNS and has been referred to another agency, e.g. Psychology
4. The patient carer or family members needs are being met by another service
5. The patient has died and the carer, family member has declined bereavement support or this is being provided by another service.

Process of Discharge

• The patient / carer is assessed as no longer requiring Community CNS intervention
• Following negotiation with the patient / carer / family,and GP and DN the patient is discharged
• Relevant professionals including GP, DN, Oncologist etc. are informed by letter of the discharge

Bereavement Care

• Initial CNS telephone contact with bereaved carer, relative
• Further CNS visit/s
• Referral to Hospice Bereavement Support Team
• Referral to Bereavement Support Counsellor (Vine House)