RIPEL Service

The Rapid Intervention for Palliative and End of Life Care (RIPEL) project in Oxford was established to provide innovative, integrated palliative and end-of-life care services aimed at improving patient outcomes and reducing hospital stays for people living in Oxfordshire and South Northamptonshire. 

Launched in 2022 with support from the now-closed Macmillan End of Life Care Fund and developed through partnerships with key organisations, RIPEL delivered rapid, personalised support to patients who preferred to be cared for at home during their last year of life. 

Helping people to live and die well – reflections from the RIPEL team

Professor Bee Wee, Consultant in Palliative Medicine and Moses Tinuoye, Specialist Nurse in the RIPEL Palliative Care Hub.
Image: Professor Bee Wee, Consultant in Palliative Medicine and Moses Tinuoye, Specialist Nurse in the RIPEL Palliative Care Hub

Staff at the Rapid Intervention for Palliative and End of Life Care (RIPEL) project, the first service to be launched through the Macmillan End of Life Care Fund, say its achievements were rooted in the unique partnership between Social Finance, Macmillan Cancer Support, Oxford University Hospitals NHS Foundation Trust (OUH) and Sobell House Hospice Charity. 

“The benefit of using the Macmillan End of Life Care Fund was not only that it gave us the upfront money, but that it also bought the expertise and experience of Social Finance and Macmillan. They helped us define what we were trying to achieve… and to ask, how can we make this sustainable? How can we demonstrate that it’s value for money?” 
Professor Bee Wee, Consultant in Palliative Medicine, OUH 

Demonstrating Impact 

By May 2025, three years after launch, the services were delivering significantly better outcomes for patients at end of life, who were spending fewer days in hospital. The cost of delivering RIPEL’s services was also lower than the value of the bed days saved.

4,655

People who accessed personalised palliative care through RIPEL. 

33,000

Hospital bed days 'saved’* over three years.   *allocated to other patients. 

11 days

Reduction in the average number of hospital days for a RIPEL patient in their last year of life.
Figures are taken from July 2024 – February 2025.

Data analysis

The RIPEL Programme Manager reflects how the team gathered and analysed data to show not only that outcomes were improving, but also how the wider hospital system was being supported.

Kerri Packwood, Programme Manager, RIPEL.

Image: Kerri Packwood, Programme Manager, RIPEL

 

“It’s not just knowing that RIPEL patients are spending less time in hospital. It’s also knowing the equivalent value of the bed days we’re saving. We’ve focused on outcomes and on making sure the wider system understands the impact.”  

How the RIPEL services work

To illustrate how RIPEL’s four interlinked services came together to make a difference for patients and families, staff shared the story of one person’s journey through the system at end of life. Note: Significant details have been changed and/or omitted to protect privacy. 

1. An urgent referral came into the Palliative Care Hub from a consultant concerned about an outpatient with a life-limiting illness who had reached crisis point but wished to avoid hospital admission.

At the triage meeting, the team agreed that a RIPEL specialist nurse from the Hospice Outreach team should visit the patient the same day.
 
2. Sue Bird, the specialist nurse on duty, phoned the patient to make a preliminary assessment and quickly recognised that an occupational therapist should accompany her.

Sue Bird, Specialist Nurse, RIPEL.
Image: Sue Bird, Specialist Nurse, RIPEL

"From my assessment I could see that things were serious and changing rapidly. There was anxiety and distress, and clear risks around mobility and falls. Thanks to RIPEL, there’s always someone available to respond urgently for each part of the county."

 

3.  Occupational therapist Neale Conner travelled to the patient’s home, where she and Sue worked together to reassure the patient and put practical measures in place to support them at home for as long as possible. 

Neale Conner, Occupational Therapist, RIPEL.
Image: Neale Conner, Occupational Therapist, RIPEL
"We completed a joint assessment, reviewed symptoms and medications, considered practical challenges, and explored how the patient would manage when their partner was at work. 

We took measurements, ordered equipment, and arranged for carers to visit. Being able to refer quickly for crisis care helped ensure the patient could stay at home with their family."  


4. The Home Hospice Care team put the crisis care package in place, and Sue and the RIPEL team continued supporting the patient and family throughout the final stage of life.

Sue Bird on her way to visit a patient and their family.

Image: Sue Bird on her way to visit a patient and their family

"Without RIPEL, it would have taken longer to reach that family and longer to find care. The patient would have remained in crisis with a lot of unanswered questions. Instead, we could act quickly and effectively. 

So often families tell us, ‘I never thought it would be possible for my loved one to die at home." 

The difference RIPEL has made

Mary Wilding, Lead Specialist Nurse for Palliative Care, OUH.
Image: Mary Wilding

“One of the things that stays with me is seeing how proud our staff are – knowing they can do their job better than before. Instead of telling patients that hospital is their only option, we can now help them stay at home.” RIPEL Programme Manager, OUH

 Mary Wilding, RIPEL’s Lead Specialist Nurse, reflects on how the project changed the system of palliative care in Oxford. 

"If a patient phones into the Palliative Care Hub, they’re prioritised and spoken to that day. A plan is put in place. If they’re unstable, they’re seen. That simply didn’t happen before RIPEL. 

Before, if a patient wanted to speak to a particular nurse who wasn’t on duty, the call would wait. Now someone responds when they need it most. 

Most people at end of life don’t want to spend more time in hospital than necessary. But without the right equipment or support, staying at home isn’t possible. RIPEL changed that."