Patients must meet all five criteria below to be eligible for referral to Specialist Palliative Care (SPC). If there is any doubt about eligibility, the Referrer should contact the Service or Hospice to discuss further. It will be at the discretion of the Service as to whether patients who do not meet all of the criteria will be accepted.

1. The patient has active, progressive and advanced disease.

Patients eligible for Specialist Palliative Care are those with active, progressive, advanced disease for whom prognosis is limited and the focus of care is quality of life. An alternative term used is that of a life-limiting illness/condition. Prognostic uncertainty (such as exists when embarking on a trial of chemotherapy for an aggressive malignancy where the likelihood of response is low) should not necessarily be a barrier to referral; if there is a clinical need (criteria 2 below) the referral is likely to be accepted. Similarly patients may be eligible for referral to Hospital Palliative Care following a sudden or traumatic event in the absence of a pre-existing palliative condition (such as an intracranial haemorrhage or out of hospital cardiac arrest) if the condition is active, progressive and life-limiting.

2. The patient has a level of need that exceeds the resources of the primary palliative care provider.

The Resource and Capability Framework for Integrated Adult Palliative Care Services in New Zealand (Ministry of Health Jan 2013) states that palliative care services should "provide direct management and support of patients, their families and whānau, where more complex palliative care need exceeds the resources of the primary palliative care provider." The Framework emphasises that the level of input is needs-based rather than based on diagnosis or prognosis. Stated another way, referrals to SPC are appropriate where there is an extraordinary level of need and examples of this include:

• uncontrolled or complicated symptoms;
• specialised nursing requirements relating to mobility, functioning or self-care;
• emotional or behavioural difficulties related to the illness, such as uncontrolled anxiety or depression;
• concern or distress involving children, family or carers, physical and human environment (including home or hospital), finance, communication or learning disability;
• unresolved issues around self-worth, loss of meaning and hope, suicidal behaviours, requests for euthanasia and complex decisions over the type of care, including its withholding or withdrawal.

3. The patient agrees to the referral if competent to do so (or an advocate agrees on their behalf).

4. The patient has New Zealand residency or has reciprocal rights, and is resident within the DHB area.
(If the patient is not a New Zealand resident and is in hospital, discuss with the Hospital SPC team. If community support is needed, the referral must be discussed with the Hospice team and approval gained from the Hospice CEO prior to the referral being made to ensure funding is authorised).

5. The patient is registered with a local primary healthcare provider.
(Hospital inpatients without a GP must have this addressed prior to discharge if a Hospice or community palliative care referral is made).