Background: Unscheduled care is used increasingly during the last year of life by people known to have significant palliative care needs. Aim: To document the frequency and patterns of use of unscheduled healthcare by people in their last year of life and understand the experiences and perspectives of patients, families and professionals about accessing unscheduled care out-of-hours. Design: A mixed methods, multi-stage study integrating a retrospective cohort analysis of unscheduled healthcare service use in the last year of life for all people dying in Scotland in 2016 with qualitative data from three regions involving service users, bereaved carers and general practitioners. Setting: Three contrasting Scottish Health Board regions and national datasets for the whole of Scotland. Results: People who died in Scotland in 2016 ( n = 56,407) had 472,360 unscheduled contacts with one of five services: telephone advice, primary care, ambulance service, emergency department and emergency hospital admission. These formed 206,841 individual continuous unscheduled care pathways: 65% starting out-of-hours. When accessing healthcare out-of-hours, patients and carers prioritised safety and a timely response. Their choice of which service to contact was informed by perceptions and previous experiences of potential delays and whether the outcome might be hospital admission. Professionals found it difficult to practice palliative care in a crisis unless the patient had previously been identified. Conclusion: Strengthening unscheduled care in the community, together with patient and public information about how to access these services could prevent hospital admissions of low benefit and enhance community support for people living with advanced illness.

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recognised by medical staff. 27/40 (67.5%) patients were BPS positive. Of these only 1 (3.7%) was referred to HSPCT. Conclusions This work demonstrates a significant symptom burden in patients with DCLD. This does not appear to be recognised by the medial team, meaning referral rates to HSPCT are low. Routine use of the IPOS in conjunction with BPS may aid identification and referral of patients to HSPCT, and help address this.

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we will increase our reach to unique children by offering Outreach as a core service. Methods Reinstating outreach, a team of qualified nurses, in July 2021, re-engaging with families who had little or no contact with Acorns through the pandemic through reassurance that we kept children safe through effective use of immunisation, testing and PPE. Results Capturing the changes in development and care needs of those who had not engaged with us in 18 months, other than by having regular virtual contact from the family team, we were able to reassure families that re-attending the hospice would be safe for children and give families the much needed break from the intensity of caring. Some families chose not to come in-house, but appreciated the outreach model.Model to be rolled out to families newly referred to Acorns to build relationships with Clinical Services.