Introduction Patients with MND are usually referred to palliative care services late in their disease progression. Reasons for this appear to centre on patients being so distressed at the prospect of palliative care services involvement, that they delay referral for as long as possible. Having identifi ed this as a problem, the hospice embarked on a joint venture with the Motor Neurone Disease Association. The premise of such joint working was to develop an outreach project for local patients with early stage MND. A grant was successfully secured from the DH (project 64 grant). Aims The aims of the project were to introduce this cohort of patients/carers to palliative care services at a much earlier stage in their illness and to decrease levels of distress/anxiety associated with a referral. It was also to give the opportunity for patients/carers to meet others in a similar situation and to provide them with information about common problems. Methods Two programmes were devised, each of 10 sessions, with a different theme per session. Each programme was devised to support 10 new patients/carers, with sessions taking place in the day hospice (hence the title 'a foot in the door'). Results During the fi rst and fi nal sessions of each programme, patients/carers were asked to anonymously score a series of statements concerning their confi dence in (and experience in accessing) care, their concerns for the future and feelings about hospice services. Results show that a positive change in all domains occurred. Conclusion This outreach project had a positive impact on MND patients/carers. The project format can be replicated by other palliative care providers. A DVD further detailing the project is being made in order to help other palliative care providers develop similar work.

Introduction In 2006, we enhanced our specialist telephone triage service to keep pace with the increasing demands of providing accessible specialist palliative care to all with life limiting illness. Early statistical analysis revealed that the service was invaluable in coping with increased demand but were telephone triage patients receiving an effective service? In August 2010, a retrospective caseload analysis was undertaken to establish this point. Aims To determine the ability of the telephone triage service to reduce patient STAS (Support Team Assessment Schedule, Higginson 1993) scores or to refer on appropriately. To compare results with the community team's ability to reduce patient STAS scores. To highlight trends in types of care provided for patients managed by the telephone triage service. Methods The telephone triage service uses an adapted version of the Support Team Assessment Schedule tool to assess patients. 50 randomly chosen patients were recruited, with at least one problem scoring STAS 3 or above at triage fi rst contact telephone assessment. Analysis of STAS scores was undertaken at subsequent contacts, along with referral patterns and time lapses between contacts. Results At the second telephone triage contact, the number of problems scoring STAS 3 or above had reduced by 60%. A third telephone contact reduced the number scoring STAS 3 or above even further. Outcome scores for the community team were very similar. Conclusion The very nature of palliative care means that as initial STAS scores are reduced, new and often more complex problems develop. However, results clearly demonstrate that our telephone triage service is effective in palliating symptoms. Introducing telephone triage into our service has successfully reduced our waiting lists by providing a fl exible, responsive service appropriate to need. We are now able to confi dently evidence the effectiveness of this service in terms of providing high quality specialist palliative care.