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Background Access to out-of-hours specialist palliative care advice and support is inconsistent across many regions, resulting in avoidable emergency admissions and suboptimal end-of-life experiences. In response, a triumvirate of regional hospices in Staffordshire and Stoke-on-Trent implemented a 24/7 Specialist Palliative Care Advice Line to provide a single point of access for patients, carers, and healthcare professionals.Aims This service, operational since December 2023, aims to improve patient outcomes, reduce health system pressures, and align with national policy guidance mandating 24/7 palliative care access.Methods In addition to our core daytime services, a single number and overnight component (9pm–9am) was funded by hospices during the pilot phase, with a proposal for Integrated Care Board (ICB) commissioning based on demonstrated impact.Results Over a 167-day evaluation period, 1,121 out-of-hours calls were received; 64% required specialist clinical advice, and nearly half originated from patients or carers. Expert review of a random sample showed 72% of activity received therapeutic benefit and 54% prevented emergency service use.Projected impact includes diversion of 846 urgent and emergency care episodes, avoidance of 239 unplanned admissions, and potential indicative annual savings exceeding £936,000. The model supports improved symptom management, preferred place of death, and continuity of care. It is underpinned by consultant oversight, a standardised operating framework, and interoperable call routing infrastructure.Conclusion This hospice-led model offers a scalable, cost-effective solution to meet the ICB’s statutory obligations and system-wide objectives to reduce preventable hospital admissions at end of life and improve the experience of patients and their families. The triumvirate successfully gained ICB investment to sustain and expand the service. With increasing demand and a growing cohort of palliative patients, this approach highlights how strategic third-sector partnerships can fill critical service gaps and deliver high-quality, person-centred care around the clock through collaborative working.