SOMERSET healthcare workers caring for patients nearing end-of-life have been trialling a new way to help people spend their remaining time at home, without waiting for funding.

The project, called Care First Fund Later and shortened to CareFFul, allows patients to be quickly discharged home with a package of care, regardless of whether other funding streams are being applied for.

The sometimes-lengthy process of applying for other funds, and then securing a package of care, often delays patients from being able to go home.

CareFFuL prioritised patients’ wishes by enabling them to be discharged from hospital within 24 hours, making the whole process easier, by-passing lengthy funding applications, and prioritising care, using Somerset NHS Foundation Trust’s rapid response teams.

Previously, it took over six days on average for patients receiving end-of-life care to receive a funding decision before plans could be made for them to go home.

The CareFFuL project was a finalist in the Health Service Journal's Patient Safety Awards.

Miss Jo Morrison, a consultant gynaecological oncologist at Somerset NHS Foundation Trust, explains: "Colleagues involved in the discharge of patients from hospital were concerned that it was taking too long for ‘fast-track’ funding decisions to be made for patients who were really close to the end of their life.

"This meant that one in three people were dying in hospital, often not in line with their wishes, which caused huge distress to families, and this just didn’t feel right. Our colleagues also became despondent and felt like the bureaucracy and red tape came first, and patients came second.

"During the COVID-19 pandemic, the application process for funding was stood down to allow prompt discharge and we wanted to see whether we could replicate this in some way."

Fiona Robinson, a clinical transformation advisor at Somerset NHS Foundation Trust, describes the project. "Our initial trial focused on 13 patients, which identified that the delays in them leaving hospital were related to equipment issues, communication, and funding approvals,” she says. “Then, in the expanded phase, we looked at a further 104 patients.

“Colleagues in our rapid response service took patients home for a couple of days, and completed the continuing healthcare fast-track funding paperwork at the same time, rather than when they were waiting to leave hospital.

“The outcome of this work was incredible, as although 1 in 10 patients still died in hospital, mainly because they were too close to the end of their life for our project to help, it was still a massive improvement on the previous 1 in 3 dying in hospital. We were able to help most people to get home within one day.

“The project also meant we freed up an extra 550 hospital inpatient beds, that would have otherwise been occupied by a patient who wanted to be at home, but was awaiting a funding decision or placement."

Ally Witney, clinical lead for Somerset NHS Foundation Trust’s end-of-life care coordination team, adds: “Feedback from the families of patients we supported was overwhelmingly positive, as they expressed a profound gratitude for the opportunity to care for loved ones at home, and for the peace, dignity, and precious time together that this brought them.

“One family member told us: ‘we are so grateful...we were with her in the calm of her flat and could just enjoy sitting with her, as a family, enjoying conversation around her. It was very healing and has left us with only positive memories of her passing.’

“Overall, it’s a great project about making the right thing, the easy thing, but we aren’t able to extend it widely, even though it’s happening in other areas of the country.

“The future of the project will very much depend on our health and social care community coming together to look at how we can find sustainable funding to make this happen for the benefit of our patients – I really hope we can.”

Lynette Emsley, associate director of continuing healthcare services at NHS Somerset Integrated Care Board, says: “Being able to discharge people to their home as soon as possible is an example of best practice in person-centred care for people at end of life.

“The CareFFul project showcases how the system can work collaboratively in the best interests of patients and their families, to provide optimal care, coming together creatively to break down traditional service boundaries, to do the right thing for the person.”