End of Life Care

February 2011 Issue 10

Everyone’s business in

Gloucestershire

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To improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice.

Welcome to the tenth issue of Gloucestershire’s newsletter End of Life Care.

The purpose of this newsletter is to raise the profile of end of life care by informing you about local and national end of life care issues and developments, promoting the message that end of life care is everyone’s business.

Through the sharing of best practice, together we can achieve high quality care for patients and their carers.

In this issue:

National and Regional Updates 02zz

Local Service Updates 04zz

Education Training 08zz

EoLC Tools/Care Planning 10zz

Involving and Supporting Carers 13zz

Co-ordination of Care 14zz

Measurement and Research 15zz

Rapid access to care/Supporting and involving carers 16zz

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National & Regional News

NHS South West

National QIPP (Quality, Innovation,Prevention and Productivity) workshopThis involves:

12 work streams zz

Planned projects all linked to the EoLC zzstrategy (DH July 2008)

Expected benefits zz

In the South West

10 areas identified – (all link to the zzstrategy) re shifting the way things are done e.g. hospital stay and looking at long term conditions

Working groups set up with the lead zzbeing CE from each PCT

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Project plan includeszz

Best practice zz

Submission of a coherent set of key zzinitiatives

There are golden rules – mainly around getting people out of the acute setting and back into the community

The Strategic Framework for the South West can be viewed on www.nhssouthwest.nhs.uk in ‘Publications’.

Gloucestershire will be represented at quarterly South West meetings to ensure progress is reported and updated appropriately, and that best practice is shared across the region to the benefit of patients and carers.

Using intelligence to improve end of life care

The National End of Life Care Intelligence Network (NEoLCIN) aims to improve the collection and analysis of information related to the quality, volume and costs of care provided by the NHS, social services and the third sector, to adults approaching the end of life. This intelligence will help drive improvements in the quality and productivity of services. The Network is supported by the National End of Life Care Programme.

There are four sections:

Profiles: zz

Data and statistics on end of life care, by Local Authority area in England and broken down by age, gender, place of death and cause of death.

Resources: zz

Including data and analytical tools, information on research, links to other

useful sources of information and publications from the Network and other organisations.

Data Sources:zz

A guide to key health, social care and related data sources in the field.

EoL Information:zz

Where to go for advice and information, for patients, carers and relatives.

For a more comprehensive update on national end of life care news go to www.endoflifecareforadults.nhs.uk/eolc/files/NHS-EoLC_News_Update_15_Aug2009.pdf

To improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice.

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End of Life Care in Gloucestershire

End of Life Care Facilitators

Karen English (on maternity leave)Karen works on Mondays, Tuesdays and Wednesdays.

Contact details: Email: karen.english@glos.nhs.ukMobile: 07990 802047

Gina KingGina works on Mondays, Wednesdays and Thursdays

Contact details: Email: georgina.king@glos.nhs.ukMobile: 07990 803221

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The EOLC Steering Group operates on a quarterly basis and is commissioning led. Membership aims to be representative of a wide variety of key stakeholders to provide the following:

Equal engagement and collaborative partnership workingzz

Continued commitment to develop and deliver an EOL strategy for Gloucestershirezz

Leadership and sponsorshipzz

Robust systems for evaluation and reporting zz

Coordination and direction for effective cross-boundary workingzz

Establish and support sub-groups to ensure all associated work streams are fully zzimplemented and sustainable

Membership includes leading representatives from a wide range of sectors at both commissioning and provider level: primary care, secondary care, social services, specialist palliative care, hospices and other charitable organisations, mental health and learning disabilities, clinical networks, ambulance, Out of Hours, service users, Higher Education Institutions, private and independent partners.

The importance of involvement from organisations and departments with specific disease areas is recognised and representatives will be invited to attend for specific agenda items. Circulation of minutes will be widespread.

End of Life Care in Gloucestershire

To improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice.

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Updates for Gloucestershire

Local Service updates

²gether NHS Foundation TrustThe ²gether Trust End of Life Care steering group continues to meet on a two monthly basis with representatives across the Trust including a service user. Our priorities have been agreed with the help and support of the EoLC facilitators. To date we have:

Worked collaboratively and taken active involvement to progress zzthe Advance Care Planning document- we have plans in place to actively promote and support our services to deliver this now that it has been launched.

We have continued to work with NHS Gloucestershire to agree a zzcommon assessment approach to pain particularly in Dementia

Taken a lead in establishing End of Life Care Champion Link Workers to provide zzmore specialist and focused support across our services

Providing EoLC training including the Liverpool Care Pathway training on an ongoing zzbasis.

Plans to undertake case study reviews this year measuring the standards outlined in zzthe GSF and also the implementation of the MCA in relation to EoLC decisions

We plan to work with NHS Glos and complete whatever work is needed, as part of zz2gether’s Care Management systems, to identify when someone is terminally unwell and requiring EoLC or palliative support.

The steering group is also planning to work with NHS Gloucestershire to identify zzappropriate information resources are available about death and dying to give to individual in contact with our service

Tim Coupland Business Development & Governance Manager, ²gether NHS Foundation Trust

Sue RyderI recently joined Sue Ryder in Leckhampton in a new post as Practice Educator. I have worked for many years as a Clinical Nurse Specialist in Palliative Care within the Acute Trust and prior to this post have spent 5 years teaching in higher education at the

University of Gloucestershire.

This new post has enabled me to be more focused in practice in developing the education in palliative care and end of life care both internally and externally across the county. I am looking forward to working collaboratively with other organisations to deliver palliative

care and end of life education to patients, families, carers and professionals.

We are currently developing a new education programme for the coming year. If anyone has any requests please contact Kathy Keogh on

01242 230199 or email Kath.keogh@suerydercare.org

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Updates for Gloucestershire en

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Specialist Palliative Care TeamOut of Hours Telephone Advice LineThe service is provided by Clinical Nurse Specialists and Consultants in Palliative Medicine. The Clinical Nurse Specialist is the first on call with a Consultant as second on call.

The service operates from the hours of 5.00 pm until 9.00 am daily. At weekends the service is provided continuously on a 24 hour basis ending on a Monday morning at 9.00 am. The service then reverts to 5.00 pm to 9.00 am Monday to Friday. The service also covers a 24 hour period at bank holidays.

The specialist palliative care telephone service provides specialist symptom management advice to healthcare professionals out of hours. The advice line is accessed by healthcare professionals working throughout the county of Gloucestershire. The service contributes towards ensuring that patients remain in their preferred place of care and helps to prevent unnecessary hospital admissions.

The service has been operational since January 2009. During the first year 410 calls were received. The majority of calls during this period were for pain and symptom control advice. Twenty seven hospital admissions were prevented.

The pager number for the on call service is 07659 119458.

Community Specialist Palliative Care Nursing TeamHello, my name is Helen Roberts and I have taken over from Debra Clark as the Clinical Nurse Manager for the Community Palliative Care Clinical Nurse Specialists (Macmillan). Debra has left to work with NCAT facilitating the roll-out of information prescriptions. I previously worked in the Cheltenham Hospital Specialist Palliative Care Team as a Clinical Nurse Specialist and team leader.

Later this year the Community Palliative Care Specialist Nurses will be moving to be locality based at Sue Ryder Hospice, Cotswold Care Hospice and Gloucestershire Royal Hospital, vacating the Wheatstone building at Barnwood. We will continue to provide the same service, which is continually being improved, with patient triage, home visits, clinic appointments, Monday to Friday office hours telephone advice and the out of hours telephone advice for professionals. There will be a single point of access for referrals, advice and enquiries which will be communicated once final arrangements have been made.

Helen Roberts Clinical Nurse Manager for the Community Palliative Care Team.

01452-371022.

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Updates for Gloucestershire

The Living Well Handbook was launched in September 2010. A boost was provided to the launch by news that the Living Well Handbook was the successful regional finalist for success in the partnership working category at the Health and Social Care (South West) Awards. Helen Vaughan was accompanied

by Mr and Mrs Hennell to the award ceremony in Yeovill where they received a framed certificate and glass trophy. Mr and Mrs Hennell are a person with dementia and carer, respectively, who have been very instrumental in the design of the handbook.

As the handbook has been issued, feedback has been shaping the content. One carer simply wrote “I no longer feel alone”. When the content is reviewed, the progress in increasing the number of memory cafes in the county will be included as peer support is recognised as invaluable in tackling social isolation. The SHA have offered funding to translate the Living Well Handbook into Gujarati, Bengali, Chinese, Urdu, Polish and Czech, on the understanding that the handbook can be accessed by other areas in the South West. Currently the following documents are added to the handbook;

The Alzheimer’s Society This is Me zzleaflet to help plan the information that

might be helpful to hospital staff on admission

The DisDAT tool which helps to assess zzthe person with dementia’s response to distress; including pain. The tool draws information about the behaviour and expressions of the person when they are content, and when they are in distress. Carers appear to find the tool easy to use and it has the potential to provide information for health and social care professional who are able to assess the present situation, but lack awareness of the individual’s contented appearance.

NHS Gloucestershire Planning for Your zzFuture Care; Advanced Care Planning.

The sources offering the Living Well Handbook are increasing;

Managing Memory 2getherzz

Dementia Advisors in Berkeley Vale, zzGloucester and North Cotswolds

Carers Gloucestershirezz

Caring with Confidencezz

Community Hospitals; Tewkesbury, zzBerkeley, Stroud, Cirencester, The Dilke

Memory Assessment Nurseszz

Regent Street Surgery in Stonehousezz

Health and social care professionals can access information or a free supply of the handbook by contacting:

Helen Vaughan helen.vaughan@glos.nhs.uk

Recent Developments in Dementia for Gloucestershire

Living Well Handbook

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Living Well Handbook

NHS Gloucestershire

Gloucestershire Hospital NHS Foundation Trust

2gether NHS Foundation Trust

Gloucestershire Care Services

To improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice.

Updates for Gloucestershire

Respiratory

Many thanks to all of you who attended the World COPD Day at Oxstalls University campus last November. We had even more attendees than last year from all areas of health care with very positive feedback on all parts of the day. We hope to see you all again next year

The Community Respiratory Team (CRT) are pleased to be involved with End of Life developments particularly the Advance Care Planning tool that is to be launched in January. Initially we intend to use this tool in 2 key areas of our service which will help us all to come to terms with how to integrate this into usual care of our patients. Firstly every patient who attends Pulmonary Rehabilitation (PR) will hear one of the educational sessions that will cover “Planning for the Future”. This session will introduce patients and their carers to the tool which will be available for them to take away on the day. The team can then offer further opportunities for them to return at other sessions on the programme to discuss any concerns they may have on using the tool. Currently the PR service is only offered in the Forest Of Dean and St Paul’s in Cheltenham to approximately 80 patients per year but is due to expand in 2011 to offer 240 places all around the county

We also intend to offer the ACP tool to all patients who receive Telehealth home monitoring. This is a service offered to patients who regularly seek emergency care due to their respiratory disease and offers them home monitoring of key respiratory symptoms. Patients enter data using an interactive monitor and the information is sent daily via secure networks to a web based site where the CRT Telehealth Nurse can view the results and act quickly should the trends in their vital signs suggest an exacerbation is brewing. We feel that both these groups of patients are well placed to receive the support and advice from the specialist team on using this tool and will facilitate our learning and understand the typical questions that are likely to be asked.

Please look out for a session on February 28th from 6.30 – 8.30 at EJC with the Gloucestershire Respiratory Forum where Gina King has kindly offered to come to speak to the group on using the ACP tool in the context of a respiratory patient.

This event is open to anyone; please call Kathy Cambell on 08454 221663 or email kathy.cambell@glos.nhs.uk Kathy Cambell, Respiratory Specialist Practitioner, Community

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Mentoring Workshops on End of Life CareWho are they for?Adult Care Social Workers and Field-work Support Assessors (FS3)What is on offer?

The opportunity to update your skills zzin approaching difficult conversations towards the end of lifeTo enhance your understanding of zzwider End of Life Care initiativesTo value and share your experience zzwith others in a supportive setting.

Who will be facilitating?Felicity Hearn and Eve Jackman, who are Specialist Palliative Care Social Workers at local hospices.Where and when? 6 workshops on the following dates only

Tues 15th March 9am-1pmCheltenham: Sandford Park HouseFri 18th March 9am-1pmCirencester: Chesterton Holt Adult Opportunity Centre

Tues 22nd March 9am-1pm FULLGloucester: Quayside House FULLFri 25th March 9am-1pmTewkesbury: Borough Council OfficesTues 29th March 9am-1pmStonehouse: Sherbourne Sheltered Housing Complex

Fri 1st April 9am-1pmForest: venue to be confirmed

How do I book my place?Please email your name, job title and full contact details, specifying which date you prefer, to: felicity.hearn@suery-der.orgCLOSING DATE 28th February 2011Attendance is free of charge as this project has been funded by the National End of Life Care Programme. Coffee and biscuits provided.Project Lead: Felicity Hearn tel 01242 246298 felicity.hearn@sueryder.org

Free EoLC training for 18months

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Education and Training

This calendar is now up and running so do make sure you bookmark this page as a favourite!

www.nhsglos.nhs.uk/content/services/eolc/documents/Calendar.docRemember its only as good as information that is sent to me so please provide me with any EoLC education events you know about.

Sue.goold@glos.nhs.uk

Calendar of events

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Workshops related to all recent EoLC training resources that have been commissioned will now be available for 18months. These workshops are pitched at a foundation level and could be suitable for a whole wide range of health and social care staff. Be sure to read the Calendar of events for details.

What workshops are available?Raising an Awareness of End of Life Carezz

Communication with Confidencezz

Assessment at the End of Life which raises awareness of Advance Care Planning and zzthe Liverpool Care Pathway.

Symptom control which will include an optional one hour update on the use of a zzsyringe driver.

Supporting the Bereaved.zz

Recent Workshops on Raising Awareness and Communicating with Confidence 32 staff have attended 2 workshops.zz

100% said they would recommend the sessions to their colleagues.zz

Attendees have included Domiciliary care staff, field work assessors, all grades zzof nurses, Occupational Therapist, Social Worker, trainers, Care home staff and a Practice Nurse.

“I like the fact that the course was informal and we were ALL able to interact”“I am now more confident in communicating thanks to the role play and have a better understanding about what End of Life Care really is”Free EoLC education resources are now available on the Internet.

Have a look…. www.nhsglos.nhs.uk/content/services/eol/eolc-education.html

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Care Home Education Resources

You will see on the above website that the Care Home Resource packs that were facilitated by Maggie Martin are also now available for your use. You will find managers notes, a workbook and a power point presentation under each subject heading.

Assessment at the End of Life in a Care Homezz

Communicationzz

Advance care Planningzz

Symptom controlzz

Training the trainers

Many organisations have shown an interest on developing their staff using the above Educational resources. Two Train the trainers sessions have been planned in January and February. See Calendar of events for details.

Dying Matters – free resources!Dying Matters is a broad based and inclusive national coalition of just under 12,000 members, which aims to change public knowledge, attitudes and behaviors towards death, dying and bereavement. Visit their website to find out more about their Mission www.dyingmatters.orgFree Leaflets, posters, resource packs, power point presentations and books5 minute film! A Party for Kath” is a 5-minute film produced by the Dying Matters Coalition, demonstrating the benefits of greater openness around death and dying. Centering on the story of a son, a mother, and an extraordinary party, the film is a unique and poignant representation of the last Awareness Week’s message www.dyingmatters.org/site/party-for-kath

Publications from The National Council for Palliative care

The Missing Piece: Meeting People’s Spiritual Needs in End of Life Care This discussion document explores what people’s spiritual needs might look like at the end of life and steps that should be taken by staff working

in health and social care across settings to meet these needs.

Author: Simon Chapman, Publisher: NCPC Price £10, ISBN 978-1-898915-84-9

Difficult Conversations – Communicating with people with Chronic Obstructive Pulmonary Disorder about the End of Life. Whilst many people live well with Chronic Obstructive Pulmonary Disorder (COPD) for many years,

it is the cause of death for approximately 25,000 people a year. It can therefore be extremely difficult to know how and when to start conversations about end of life issues, for fear of taking away a sense of hope.

We asked around sixty people affected by COPD (patients, carers and former carers)

how, when and with whom they would like to have conversations about end of life care. The guidance is based entirely on these discussions. It presents a unique perspective, containing practical hints on what to say and more importantly, what not to say. This guidance was produced with support from the British Lung Foundation and the Department of Health. Jo Black (A5, 20 pages), Price £5 ISBN 1-898915-79-9

Ultimately Personal: Shaping Services Around People in End of Life Care

This publication considers what personalised services at the end of life look like beyond budgets. It

suggests some of the ways greater choice and control might be delivered on the ground, within the context of the proposed reforms to the NHS as detailed in the White Paper. The publication is intended to stimulate wider debate about the concept of personalisation in end of life care.

Authors: Simon Chapman, Publisher: NCPC, Published: September 2010 (A4, 32 pages) ISBN: 978-1-898915-84-9

EoLC tools/Care Planningen

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NHS Gloucestershire has developed its own Advance Care Planning (ACP) booklet “Planning for Your Future Care” which encompasses all aspects of Advance Care Planning with support from our health, social and voluntary care partners. The county-wide ACP booklet will be launched the week commencing the 24th January.

The main emphasis of the Advance Care Planning (ACP) booklet is that it is held and owned by the individual to support discussions about their end of life decisions and to record what they would like to happen or not want to happen. Whilst the ACP booklet is associated with end of life care anyone can have one even without a prognosis, long term condition or diagnosis – we should all thinking about planning for our future care. ACP enables people to be supported as they would wish, even when they are unable to express their views for themselves. ACP includes planning for a time when we may lack capacity to make decisions using an Advance Decision or Lasting Power of Attorney.

The booklet is designed to guide the individual through the process rather than being led by the professional involved. The aim is that the patient or carer completes the booklet themselves but

must be regularly reviewed to ensure that preferences or decisions are kept up to date as circumstances can change. Not all the sections needed to be completed or all at one time. Individuals can use it which ever way they feel is right for them. The professional/clinician/paid carer can then use the information to proactively plan care and inform the patient and family of the availability of services and resources to support their preferred place of care and wishes. This will be supported by a Care Plan.

Content of the ACP Tool The booklet has been divided into 5 sections. Each section also contains signposting for individuals to gain further information and guidance:

Statement of your wishes and care zzpreferences

Advance Decision makingzz

Putting your affairs in order zz

Making a willzz

Funeral Planningzz

Advance Care Planning Document – NHS Gloucestershire

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Statement of your wishes and Care preferences (Advance Statement)This section:

Is based on the National Preferred Priorities zzfor Care Tool and has four opened questions that enables discussions about wishes and preferences

Provides examples of information which should/zzcould be recorded

Includes prompt questions to help provide zzideas about what might be recorded

Advance Decision makingThis section:

Provides a definition of an Advance Decision:zz

Is a legal documentzz

Is about refusingzz not requesting certain treatments

Only comes into place if capacity is lost, must zzbe ‘relevant & applicable’

Requires a signature zz

Individualzz

Witness zz

Links to further information on advance decision making are included.

Putting your affairs in orderDescribes the two types of Lasting Power of zzAttorneys (Property & Affairs and Personal Welfare).

Lists information which should be stored in a zzsafe place with the name of a trusted nominee who can access this.

Page 15 - is focused on End of Life Care zzwishes

Links to further information on Lasting Powers of Attorney are included.

Making a willThis section:

Explains the benefits of making a will and zzguidance on what to include

Funeral PlanningThis section:

Provides an example form for recording funeral zzplanning preferences.

Who can use the ACP Tool Anyone - even individuals without a diagnosis, a long term condition or a poor prognosis can use the ACP Tool. If appropriate, Professionals can support patients and their carers in completing the ACP Tool in parts, or in total, but is not a Clinical Record.

When to use the ACP tool The ACP Tool should be introduced as early as possible when appropriate to the individual. Identifying cues in conversations or “triggers” can be an opportunity to introduce the idea of ACP e.g. early stages of Dementia. The booklet can be left for the individual and their family to discuss or be introduced as a concept for a later conversation. Every person should be given the opportunity to make an informed choice to whether they would like to discuss planning for their future care (ACP).

If you would like to understand more about advance care planning go to www.endoflifecareforadults.nhs.uk/publications/differencesacpadrt - This explains the differences between general care planning and decisions made in advance and other related information.

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Protecting the Most Vulnerable People in GloucestershirePutting the Mental Capacity Act into Practice Conference

The Multi-Agency Gloucestershire Local Implementation Network (LIN) held a conference for 150 delegates on 30 November 2010. Despite snowfall on the day the Conference was well attended by a

wide range of delegates representing Gloucestershire’s health & social care community, both statutory & non-statutory.

The aim of the conference was to inform professionals working in the county about how to use the Mental Capacity Act to protect the most vulnerable people in our society – particularly relevant as one of the findings from ‘Meeting the Challenge’ road shows being that the public wanted to ensure such residents are safe.

The Conference was opened by David Martin, Interim Group Director CACD & followed by a series of national, regional & local presentations including a key note address from Paul Gantley, National Implementation Programme Manager for

the MCA at the DoH, and a selection of informative workshops.

The conference was over-subscribed suggesting there is a thirst for knowledge & understanding about how to put the Mental Capacity Act into practice, and it formed a key part of the consultation process on the multi-agency MCA Policy & Procedure which is currently out for consultation until 17 December 2010. For details about the LIN and how to respond to the policy consultation please see www.gloucestershire.gov.uk/index.cfm?articleid=16497Preliminary evaluation suggests the Conference met all its objectives & was rated ‘excellent’ by the majority of delegates.The conference objectives and presentations for the day can be found at www.gloucestershire.gov.uk/LINconferenceFor more information about the LIN please go to www.gloucestershire.gov.uk/LIN For more details contact Gina King EoLC Facilitator via email georgina.king@glos.nhs.uk

Society’s wall of silence around dying and death prompts call for national debateA Dying Matters survey revealed that three out of four (75%) people in England do not set aside time with friends and family around this time of year to remember loved ones who have died.The survey also found that over three fifths (62%) of the English public think the English are more reserved about talking about dying, death and bereavement than our counterparts in other countries around the world who have traditions of commemorating their dead. This “reserve” is having a direct impact on our experience of end of life and on the services available.

We are now only 3 months away from Awareness Week 2011The theme for Dying Matters awareness Week 2011 is ‘Why Dying Matters to me’.We are now only 3 months away from Awareness Week 2011 (May 16th – 22nd), so why not start thinking about how you can engage your local community and help your neighbours find out why talking about and planning for the end of life is important for them and their loved ones?Why not find out who else in your community is interested and organise a joint event?

Celebrating the Day of the Dead in Mexican styleOn Monday 1st November, Dying Matters held an afternoon of presentations, short films, discussions and a celebration with music and food, to celebrate the Day of the Dead in Mexican style.We heard from a wide range of inspirational speakers, including people initiating local Dying Matters community development projects, working hard to promote open discussion around end of life issues within their local area; a school art project around the Day of the Dead and remembering loved ones; and a fascinating insight into dying and death in Aztec culture from Dr Elizabeth Baquedano from the University of London. The day concluded with tacos, day of the dead bread and

margaritas accompanied by a traditional Mariachi musician. Highlights of the event were continuously streamed on our Facebook site.

Is British reserve 'spoiling' death?Is our fear of dying - and of talking about it - costing us the death we want?In the UK, talking about death is still a taboo to many. If a relative or friend is dying, British people often acknowledge it - then politely avoid mentioning it.But experts say that by putting our heads in the sand we are denying ourselves, where possible, the time to prepare for our deaths and say our goodbyes.Professor Mayur Lakhani, GP and chair of the Dying Matters Coalition and The National Council for Palliative Care, said that those who know they are dying should be encouraged to plan the death and funeral they want. To find out more visit: www.dyingmatters.org

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Raising Awareness

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Coordination of Care

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Social Care Framework Project: Mentoring Workshops for Social Workers and Fieldwork Support Assessors March - April 2011

In July 2010, the National End of Life Care (EoLC) Programme published a framework for social care at the end of life, entitled Supporting people to live and die well which is downloadable at: www.endoflifecareforadults.nhs.uk/publications/supporting-people-to-live-and-die-well-a-framework

In my role as a specialist practitioner, I was invited to be a member of the framework’s Advisory Group, which brought together professionals and leaders from across the spectrum of social care. Subsequent to the framework’s publication, I was successful in bidding to project lead one of 8 test sites around the country, with the brief to demonstrate the principles of the framework in practice in our local area and evaluate the results.

This project aims to deliver 6 facilitated Mentoring Workshops for Adult Social Care social workers and fieldwork support assessors (FS3) from both hospital and community settings. These half day workshops will be held in Locality - based venues around the county throughout March 2011 (see dates below). The facilitators will be myself and Eve Jackman, who is another experienced palliative care social worker, currently working at Great Oaks Hospice in the Forest of Dean. The workshops will be part educative in current EoLC initiatives, including Advance Care Planning, but specifically aimed at building the skills and confidence of staff to approach difficult conversations at the outset of end of life care. Our workshop style will be highly interactive and reflective. We will also signpost staff to the wider EoLC initiatives coordinated by Gina King, EoLC Facilitator who leads on the EoLC Strategy across Gloucestershire.

Workshop dates and venues

Please note you are welcome to apply to any of the 6 workshops. Attendance is free of charge and coffee and biscuits are provided

Tues 15th March 9am-1pm

Cheltenham: Sandford Park House

Fri 18th March 9am-1pmCirencester: Chesterton Holt Adult Opportunity CentreTues 22nd March 9am-1pm

Gloucester: Quayside House

Fri 25th March 9am-1pm

Tewkesbury: Borough Council Offices

Tues 29th March 9am-1pmStonehouse: Sherbourne Sheltered Housing ComplexFri 1st April 9am-1pm

Forest: venue to be confirmed

To apply, please email your name, role, and full contact details, specifying your choice of date, to:

felicity.hearn@sueryder.org

Closing date 28th February 2011

Felicity Hearn, Head of Family Support

Sue Ryder - Leckhampton Court Hospice Tel: 01242 246298

The Gold Standards Framework “After Death Analysis”

The Gold Standards Framework “After Death Analysis” (ADA) is a web-based audit and improvement tool based on the Gold Standards Framework (GSF) and is in complete alignment with the Department of Health draft quality markers. End of life care is a very difficult area to measure and an even more difficult area in which to assess progress. However, measurement and audit against accepted standards is a very powerful tool to improve the quality of care provided by an organisation such as a general practice or care home.

ADA is a highly regarded and simple to use online audit which looks at actual care given to patients from the perspective of the practice or care home. Softer quality indicators such as ‘caring shown’ or ‘confidence’ are equally important but are not part of ADA. ADA does not at this time include direct patient feedback. Future developments include use of audit measures before death so that individual patient care improvements can result. Some indicators are about documentation. Many GPs say ‘I carry that information in my head’ but this makes team co-ordination of care difficult, makes it impossible for others to continue care and understandings can be mistaken or change.

ADA measures the effectiveness of practice systems by looking at specific Key Topics:

1. Patient Choice: - Numbers having advance care plannning discussions - Numbers dying where they chose or their

usual place of care - Reasons they might die elsewhere

2. Hopitalisation: - Hospital bed days and crisis admissions

3. Pre-planning of care: - Anticipatory prescribing - Out of hours forms sent

4. Local Services - Use of gaps in service provision - Bereavement Care offered

5. Systematic - Benefits advice offered

ADA is recommended in the National End of Life Care Strategy (July 2008) as a use-ful measurement tool and is endorsed for use in primary care by the Royal College of General Practitioners. Developed six years ago as part of the GSF Programmes in collaboration with the University of Birming-ham, ADA has been refined and improved following in-depth evaluation. It can now be used in a wide range of settings to assess and improve care provided for patients nearing the end of life.

PCTs increasingly need to identify those factors which influence key clinical out-comes. ADA PCT reports give an area level overview to help direct funding to the best places so that commissioning meets local strategic targets. It measures key fac-tors such as:

unscheduled hospital admissions zz

place of death and zz

Patients dying in their preferred place.zz

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Involving and supporting Carers

And finally - something to think about………………

Definition of a carer…

A carer spends a significant proportion of their life providing unpaid support to family or potentially friends. This could be caring for a relative, partner or friend who is ill, frail, disabled or has mental health or substance misuse problems’.

Carers at the Heart of the 21st Century DH, 2008

Carers get into the role often without zzchoice or age considerations ranging from 5 to 95. Many carers often cite working 24/7 zz

Many carers find themselves in poor zzhealth being potential patients in waiting

Some carers often go without any respite zzor holiday for many yearsNon-working’ carers often have anxieties zzabout their deteriorating financial situation Some carers may not even automatically zzreceive the full basic state pension Almost all carers start without any formal zztraining Carers find themselves having to zz‘muddle through’ without adequate information or support before becoming experts in many aspects of the role 50% of carers providing regular & zzsubstantial care have been treated for stress related illness & 50% have sustained an injury

end

of

life

care

16

“Call for contributions – Case Studies, Letters, Question and Answers, New Posts”? If you would like to submit an article for the next issue of the newsletter, please contact Gina King mobile: 07990 803221 or georgina.king@glos.nhs.uk and Karen English mobile: 07990 802047 or karen.english@glos.nhs.uk

February 11 Issue 10

Unscheduled Care Single Point of Clinical Access (SPCA)An EoL Pathway will form part of the SPCA referral criteria. As part of the referral, the following four questions and areas of need will be asked to prioritise their care (High, Medium, low):

Where would the patient/carers like the last days of life to be spent? (Identifies zzpatients wishes) Is the referred patient on a Liverpool Care Pathway? (identifies last days of life) zz

Is the patient rapidly deteriorating/ CHC3 ? (Identifies last weeks of life) zz

Has the patient got a DS1500? (Identifies last months of life) zz

The patient will then be assessed into one of three areas of need – Symptom Control, Crisis management (e.g. equipment, carer’s crisis) and terminal care (dying)

Rapid access to care