The pilot demonstrated the need for a CNS service 7 days a week, and the service is now embedded in practice. Seven-day working benefits patients and families while being valued by the professional team.

This article presents an evaluation of a rapid-response crisis-intervention service, hospice at home (H@H), for patients with advanced cancer. The project took place in Glasgow, UK, between July 1999 and May 2001. An integral part of the (H@H) project was the concurrent evaluation, which attempted to explore a range of service and user outcomes. The service was able to prevent admission to, or facilitate discharge from, institutional care on 62 occasions. The evaluation found significant improvements in some areas of pain and symptom management. High levels of satisfaction were recorded by all service users. A partial cost analysis revealed that the medical and nursing support costs for the (H@H) would have been substantially reduced if throughput had been higher. The (H@H) project team agreed that a valuable lesson learned from the project was the importance of involving all key players from the outset when determining the requirements of a new service initiative.

This article is the first in a series of two which report on the development and evaluation of a rapid response crisis intervention service for patients in the advanced stages of cancer. A number of recent studies have identified the need for rapid response teams who are able to provide palliative and specialist palliative care in the home setting (King et al, 2000; Mantz, 2000; Thomas, 2001). By providing an overview of the relevant literature and describing the experience of developing this scheme the authors' aim is to share good practice with interested professionals who may be contemplating setting up similar schemes. This article outlines the development of a 'hospice at home' scheme until its launch and identifies the strategies used to ensure the early success of the project.

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IntroductionIn response to the challenges faced by patients and carers out of hours, the service provided by the Community Clinical Nurse Specialist (CNS) team in an inner city hospice in Scotland was extended to cover 7 days per week. While this was recommended by NICE in 2004, there is little published information around the implementation and evaluation of this service development.Aim of the pilotTo examine the need for and benefits of an enhanced 7 day service by the Community CNS team.MethodThe team of 6.5 WTE staff piloted 7 day working for 6 months. Activity data was collected on planned and unplanned urgent contacts. Acceptability of the service to both staff and patients and families was sought.ResultsThere was an average of 5.3 urgent contacts per weekend (range 0–12). 36% of these contacts were unplanned, with the majority of these (68%) being made by a family member.Key benefits were seen to be: specialist symptom management 7 days per week, supporting patient choice in place of care, emotional support to patients and families and improved team working.DiscussionSuccessful management of change is dependent on a number of key factors. With these in place, resistance to change was overcome and staff were both enthusiastic and willing to embrace a new way of working. To support this service development an additional 0.5 WTE member of staff was recruited.Initially data was only gathered around the “unplanned urgent” contacts. The team recognised that they could also incorporate appropriate routine activity, negotiated with the patient and family.ConclusionThe pilot demonstrated need, was highly acceptable to staff, patients and families and its delivery was sustainable in our team. Seven day working is now established in the delivery of our Clinical Nurse Specialist service.