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Refer to Zest

Refer to Zest

If you are seeking supporting from our young adult service, Zest, you can refer on this page.

Zest supports young adults aged 14 and above with life-limiting & incurable illness. We currently cover Suffolk & North East Essex for referrals. Read more about our geographical area below.

Call Zest Team: 01473 707032 Make a Referral to Zest

Zest services on offer in your local area:

Transition nurse coordination support for young adults living with life-limiting or incurable illness.

Group support with Zest X-Change – a monthly evening social group for young adults 14 years upwards, a monthly parent support group and a monthly Saturday family drop in session.

Regular proactive 6 monthly clinical reviews with a doctor or nurse, and access to the hospice multi-disciplinary team. Discussions of each person at a multidisciplinary meeting on a regular basis.

Development of emergency care plans and other care plans to guide all health and social care professionals in the individualized management of the young adult.

Residential short break weekends for those aged 18 and above.

Zest Days – themed activities every Friday at St Elizabeth Hospice for those aged 18 and above.

Support from our OneCall advice phone line out of hours which includes consultant support – call the team on: 0800 567 0111

Transition nurse coordination support for young adults living with life-limiting or incurable illness.

Group support with Zest X-Change – a monthly evening social group for young adults 14 years upwards, a monthly parent support group and a monthly Saturday family drop in session.

Residential short break weekends for those aged 18 and above.

Zest Days – themed activities every Friday for those aged 18 and above.

Group support with Zest X-Change – a monthly evening social group for young adults 14 years upwards, a monthly parent support group and a monthly Saturday family drop in session.

We are working together with East Anglia’s Children’s Hospices (EACH) and other adult hospices in Norfolk to provide a monthly family drop-in that rotates around Norfolk.

Zest is currently hosting sessions at the Louise Hamilton Centre in Great Yarmouth.

The drop-in aims to support young adults transitioning from children’s services, as well as enabling a provision for young adults and their families. It will also provide an opportunity for people to help shape the future of support for families in Norfolk as we are keen to listen, learn and feed back to commissioners.

EACH are the coordinating partner on this provision, so head to their website to find out more here.

We are hoping to expand Zest services further into Great Yarmouth & Waveney in the near future.

Our Zest Care Standards

We will ensure all care is provided with dignity, respecting what is important to you
We will provide holistic care that includes the whole family
We strive to create a home from home environment
We will strive to make your priorities our priorities
We will give you our empathy and energy to enable the best care
We will provide care with a smile, and do all we can to enable you to feel happy at Zest
We will provide proactive care, attention to detail and think outside the box
We will offer you fun and social opportunities at Zest, whilst in the background providing high standards of care
We strive to enable you to have control over your care
We will encourage wise decisions but recognise when you able to make your own choices
We will ensure staff have the skills and confidence needed so you can trust us and feel safe at Zest
We will enable you to share ideas and together ensure we are innovative at Zest
We will always be open to learning from you and will always aim to improve your experience of Zest care

Make a Referral

Fill in this form to make a referral to St Elizabeth Hospice services in East & Mid-Suffolk or our Zest young adult service.

"*" indicates required fields

Step 1 of 8

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Select the service you would like to refer to:

Select one of the options below:*

St Elizabeth Hospice services in East & Mid-Suffolk

Zest for young adult hospice care

Are you referring yourself or referring someone else?*

I am referring myself to the service

I am referring on behalf of someone else

Patient information

If you are referring yourself, please enter your patient information below. If you are referring on behalf of someone, please ensure you have the below details to complete the referral.

NHS number:*

Name:*

First Last

Preferred pronouns:*

He/Him

She/Her

They/Them

Other

Please enter preferred pronouns:

Date of birth:*

Day

Month

Year

Address:*

Street Address Address Line 2 City County Postcode Country

Patient contact phone number:*

GP surgery:*

GP name:

If known

GP contact phone number:*

Reason for the referral

What are you hoping we can help with?*

Select the service(s) you are requesting:

Care at home or community setting, with an assessment & support within this location

Care at the Inpatient Unit in Ipswich

Care from the Community Care Unit team in Ipswich

Leave this blank if you are unsure. Our team will be able to direct you to the best support based on your answers in this section.

Please select any further reasons for your referral to St Elizabeth Hospice:*

Pain management

Symptom management

Emotional/psychological support

Social/financial

Spiritual

Carer’s needs

Palliative rehabilitation needs

Other

N/A

Select all that apply

Please select any further reasons for your referral to Zest:*

Support with transition from children’s care and/or children’s hospice care

Help with managing symptoms

Support with deterioration in patient’s condition and/or changing needs

Support planning for the future

To reduce social isolation and provide opportunities for peer support

Supportive care for the whole family

Access to Zest Short Breaks or Zest Days

Other

Select all that apply

If other, please specify reason(s)

Please give a brief history of diagnosis – including dates of diagnosis (if known) & key treatments:*

Please select any current problem(s):

Pain

Vomiting/nausea

Anorexia/loss of appetite

Breathlessness

Psychological/distress

Constipation

Diarrhoea

Anxiety

Depression

Mobility

Communication

Social

Confusion

Other

If other, please specify problem(s):

Please detail the location of where the patient is currently based:*

If in hospital, please detail the ward

If possible, please add a contact phone number for this location:

Consent to the referral

As a patient referring yourself, please confirm your consent to proceed with this referral*

I confirm my consent for this referral to hospice services

Are your family/next of kin aware of this referral?*

Yes, they are aware

No, they do not know of my referral

Please confirm your consent to the sharing of information with our hospice teams & other professionals to support your care*

Yes, I consent

No, I do not consent

By selecting ‘no’, please be aware that this may affect our team’s ability to contact your GP and medical record.

Is the patient aware and has agreed to this referral?*

Yes

Is this a referral in the patient's best interests due to lack of capacity?*

Yes

Are the family/next of kin aware of this referral?*

Yes

Is the patient aware of their diagnosis and/or prognosis?*

Yes

Has patient consented to sharing of information with our hospice teams & other professionals to support their care?*

Yes

By selecting ‘no’, please be aware that this may affect our team’s ability to contact the patient’s GP and medical record.

Carer/next of kin details

Full name of main carer/next of kin:*

First Last

Relationship to patient:*

Main carer/next of kin contact phone number:*

Main carer/next of kin address:*

Street Address Address Line 2 City County Postcode Country

Who should be the main contact for the patient's care?*

Patient

Carer/next of kin

Accessibility requirements

Is English a first language for the patient?

Yes

Is English a first language for the family?

Yes

Not applicable/unsure

If the patient or family requires an interpreter, please specify language:*

Does the patient have additional needs related to:

Vision

Hearing

Speech

Learning disability

Other

Select all that apply

Please specify any details below as applicable:

If there are any mobility issues, please state below:

If there are any equipment needs, please state below:

Do you have any lone-worker concerns?

Yes

Please state any concerns below:*

Are there any hazards in the home or risks to be aware of?

Are there any safeguarding concerns?

Yes

Please state any concerns below:*

Advance care planning

Does the patient have an advance care plan document?*

Yes

I don’t know

Which document does the patient have for their advance care plan?

ReSPECT form

CPR status

My Care Wishes

Advance decision to refuse treatment

Other statement of wishes – e.g. treatment escalation plan, preferred place of death or preferred place of care

Select all that apply

Please tell us any relevant details:

Is the patient on the Gold Standards Framework Register?

Yes

I don’t know

Please detail any other professionals involved in your/the patient's care

Leave blank if not known

Consultant(s):

District/Community Nurse:

Clinical Nurse Specialist:

Social Services:

Community Care Funder – local authority/contiu

This is the last stage, please confirm the referrer's details:

Full name of referrer:*

What is your relationship to the patient?

Patient’s relative

Patient’s friend

Patient’s carer

Healthcare professional

Please detail where you work and what department:

Referrer contact phone number:*

Referrer's email address:*

Enter Email Confirm Email

Date of referral:*

Day

Month

Year

Refer to Zest

Zest services on offer in your local area:

East & Mid-Suffolk

West Suffolk

Colchester & North East Essex

Great Yarmouth & Waveney

Our Zest Care Standards

Make a Referral

Select the service you would like to refer to:

Patient information

Reason for the referral

Consent to the referral

Carer/next of kin details

Accessibility requirements

Advance care planning

Please detail any other professionals involved in your/the patient's care

This is the last stage, please confirm the referrer's details:

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