From diagnosis to death: exploring the interface between neurology, rehabilitation and palliative care in managing people with long-term neurological conditions.

This article reports a parallel survey of consultants working in the fields of neurology, rehabilitation and palliative medicine, and explores the interface between the three specialties in providing services for people with long-term neurological conditions. There was general agreement with respect to the core contributions offered by each specialty. However, there were also important areas of overlap which highlight the need for collaborative working practice, and for clinicians to respect the expertise of others in related areas. The survey highlighted a general shortfall in service provision for both palliative care and rehabilitation services for people with long-term neurological conditions, particular in the community. There was also a marked lack of coordination between services. Perhaps not surprisingly, each specialty reported greater ease of access to services within their own field, which further emphasises the need to work closely together.

Survey of specialist palliative care and heart failure: September 2004.

AIMS: To describe English specialist palliative care (SPC) services' provision for, and attitude to, heart failure patients, and to identify developments of particular interest or expertise in this area. METHOD: Postal survey of all lead consultants of English SPC services, September 2004. RESULTS: Of 397 services, 233 replied (response rate 59%); 222 (95%) thought SPC had a role in severe/end stage heart failure, while three (1%) did not. A total of 197 services (85%) accepted heart failure patients, 26 (11%) did not. The most common reasons for not accepting heart failure patients were lack of resources or beds, implications for staff training or an organizational decision. The mean number of heart failure patients currently under a service was 2.2, but 15 had more than five (maximum 53). Fifteen services (6%) had specific referral criteria for heart failure patients, including recurrent hospital admissions without symptomatic improvement, inappropriateness of further hospital admission and severity of heart failure. Twelve services (5%) had or were developing treatment guidelines for heart failure: five were end of life pathways, three covered breathlessness management and three were symptom control guidelines. Some 137 services (59%) described local collaborative initiatives between SPC, heart failure services and primary care, such as mutual education, joint working and working groups. A number of models of joint working practices were described in detail. Twenty-seven (12%) knew of national initiatives. CONCLUSIONS: The current situation of SPC services in England for patients with heart failure varies widely. One in 10 SPC services in this audit did not accept heart failure patients. Few have developed services of significant size. Local collaborative initiatives are common. Specific referral criteria and symptom control guidelines have been developed. Their role in promoting good palliative care in patients with heart failure remains unclear. Better dissemination of practical knowledge gained by these initiatives could significantly improve the provision of SPC services to heart failure patients.