gwent palliative care strategy an...
TRANSCRIPT
Volume 1, Issue 1 April 2017
GPCS Volume 1, Issue 1 Page 1
Welcome to... the Gwent Palliative Care Strategy Introduction This Introduction precedes the launch of a Newsletter every two months to keep you updated with
the work that is taking place within Gwent Palliative Care Strategy and within each of the eight
workstreams.
Introduction
Gwent Palliative Care Strategy was developed in partnership with Hospice of the Valleys, St. David’s
Hospice Care and Macmillan Cancer Services. My Role as MacMillan Palliative Care Service
Improvement Lead entails managing the Implementation of the Strategy across ABUHB, SDHC and HOV
in the period 2015 to 2018 and embedding it within the Palliative Care Patient Pathway and End Of Life
Processes.
The Strategy was officially launched on 07/10/2015 at Hospice of the Valleys and the event was well
attended by Secondary, Primary, Community Care and Social Services. Implementation of the strategy
involves and needs collaboration between Primary and Secondary Care, Third Sector Organisations and
Social Services in the implementation of the various Workstreams.
I am very keen for the Strategy to be successfully implemented across ABUHB and the partner
organisations within the 3 year period 2015 to 2018 and also keen to work in collaboration/partnership
with the other specialties, divisions and organisations to achieve that.
Therefore I would be very grateful if we can find ways of working together to achieve that.
Benefits of the Strategy
The main benefit of the Gwent Palliative Care Strategy is that all organisations providing palliative
care are working together to provide a seamless, equitable, co-ordinated approach to care delivery
across Gwent. This approach prevents duplication and silo working.
Other Benefits of the successful implementation of Gwent Palliative Care Strategy include:
Care Planning – ensure Advance Care Planning for those who are identified as approaching the end
of life (workstream 2)
Care Co-ordination – ensure improved communication and co-ordination of care across the whole
care pathway including all care settings, improved implementation and reporting tools, promoting
integrated priorities for last days of life. (all workstreams)
Care environments – enable more patients to be cared for at their chosen preferred place of care;
overcoming barriers and managing associated risks. (workstream 6)
Place of death – enable more patients to die at their chosen preferred place of death, overcoming
barriers and managing associated risks. (workstream 6)
Access – increase the proportion of patients with non malignant disease receiving palliative care,
ensure 24/7 access to specialist care and support when needed. (workstreams 1, 3, 4, 6)
Quality standards – ensure compliance with quality and clinical standards and performance targets.
(workstream 7)
Training – identify and address staff training needs to improve skills in planning for and delivering
palliative care and end of life care. (workstream 5)
Engagement in the Research and Development agenda. to ensure that services delivered are
evidence-based (workstream 8)
Gwent Palliative Care Strategy – An Introduction
Volume 1, Issue 1 April 2017
GPCS Volume 1, Issue 1 Page 2
THE EIGHT WORKSTREAMS
The 8 work streams of GPCS are mapped against the 6 delivery themes from the Welsh Government End
Of Life Delivery Plan up to March 2017 are as follows:
(the 3 Workstreams in Plum font are Priority Workstreams for 2015-16 & the 3 Workstreams in Green font
are Priority Workstreams for 2016 – 2017)
Workstream 1
Early identification of patients with a palliative care
need
Workstream 2
Advance care planning
Workstream Lead:
Dr Anish Kotecha, MacMillan GP Facilitator [email protected]
Workstream Lead:
Dr Aoife Gleeson, Palliative Care Consultant, ABUHB [email protected]
The Aim of Workstream (1) is the early identification
of patients with Palliative Care and/ or End of Life
needs in order for them to be offered timely
intervention.
The Aim of Workstream (2) is Facilitation of effective
advance care planning throughout the patients’ illness
with a focus on end of life
Workstream 3 Promoting well organised, co-ordinated care
Workstream 4
Supporting families and carers
Workstream Lead: Stephanie Thomas, CNS, SDHC [email protected]
Workstream Lead:
Clare Walters, Divisional Nurse – Community Division (BG
& Torfaen, ABUHB) [email protected]
The Aim of Workstream (3) is to promote well-
organised and co-ordinated care: Facilitating an
integrated, seamless service across boundaries and
settings
The Aim of Workstream (4) is to support the family and
carers of those who are receiving palliative care, who
are dying or who have recently died, throughout the
end of life care process and in to bereavement
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Workstream 5 Education & training
Workstream 6
Preferred place of care/preferred place of death
Workstream Lead:
Joanne Lane, Palliative Care Lead Nurse, ABUHB [email protected]
Workstream Lead: Tanya Strange, Divisional Nurse for Primary Care and
networks, ABUHB) [email protected]
The Aim of Workstream (5) is to ensure an
adequately trained workforce who are educated
to deliver excellence, who continuously improve
patient/service user experience and demonstrate
effective leadership
The Aim of Workstream (6) is to promote choice and
facilitate Preferred Place of Care (PPC) / Preferred
Place of Death (PPD)
Workstream 7 Performance & Quality
Workstream 8
Research & Development
Workstream Lead:
Fiona Baldwin, Divisional Planning, Performance
and Partnership Manager & Directorate
Manager for Palliative Care [email protected]
Workstream Lead:
Prof. Simon Noble, Palliative Care Consultant, ABUHB
The Aim of Workstream (7) is to demonstrate a high
quality service through measurable outcomes and
compliance with quality standards
The Aim of Workstream (8) is to engage in the research
agenda and to develop the skills and competencies to
generate as well as implement evidence in practice
If you are interested to know more about or participate in any of the above Workstreams please do
not hesitate to contact me on [email protected]
Please let me introduce myself, my name is Amal Shandall and I started a 3 year post as Macmillan
Palliative Care Service Improvement Lead at the end of June 2015 and my main role is to implement
Gwent Palliative Care Strategy across ABUHB and the partner organisations (Hospice of the Valleys and
St David’s Hospice Care) by the end of June 2018.
Amal Shandall April 2017
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Aneurin Bevan University Health Board, Hospice Of The Valleys, St David’s
Hospice Care
The Aneurin Bevan University Health Board (ABUHB) specialist palliative care service delivers specialist
palliative care to a population of 639,000 covering Caerphilly, Blaenau Gwent, Torfaen, Newport and
Monmouth across five community localities, three hospital sites, four day care centres and a specialist
inpatient Hospice The Hospital inpatient team also attend Cancer Site Specific Multi disciplinary team
meetings.
The Health Board Specialist Palliative Care Team is comprised of a team of Consultants and doctors in
palliative medicine, a Nursing Team which includes a Lead Nurse, Clinical Nurse Specialists and Health
Care Support Workers, a MacMillan Occupational Therapist and administrative staff. The Consultants in
Palliative Medicine cover Primary and Secondary Care, Community Services and St Anne’s Hospice.
The ABUHB Clinical Nurse Specialists (CNS’s) cover all Hospital Sites.
The Palliative Care Team work closely with the part time MacMillan GP Facilitators and the MacMillan
Palliative Care Service Improvement lead.
A full Multi Disciplinary Team (MDT) structure is in place; at hospital sites, all patients are discussed at
weekly MDT meetings. Community patients are reviewed fortnightly during consultant led case reviews.
All notes are recorded on CANISC.
The Specialist Palliative Care team review patients with malignant and non malignant palliative care
needs. Referrals are accepted on the basis of need, not diagnosis or prognosis. The team also provide a
specialist resource for those patients who have complex and often intractable symptoms, through
assessment, advice and evaluation and provide information to patients and their family about their
disease and support networks available to them.
The Specialist Palliative Care team provide specialist advice and support in end of life care
management and assist other ward-based teams to address the multi-faceted psychosocial issues with
patients and their families. Involvement in complex discharges of palliative patients forms part of the
role of the Specialist Palliative Care team to ensure continuity of care.
The Team’s aim is to provide a service that improves patient quality of life, facilitate patient choice and
treats patients and carers with dignity and respect.
This is achieved by provision of evidence based, individualised, symptom control, complex psychosocial
care, terminal care for all patients with advanced disease and liaison with specialist community
Palliative Care Services.
The team is committed to education, audit, research and supporting ward based health professionals in
their care of patients with palliative care needs.
The service received many awards and has had oral and poster presentations at National and
International conferences.
Working hours: Monday to Friday 9:00am to 5:00pm.
Weekend support is provided by a HPCT CNS covering all hospital sites contactable through hospital
switchboard 9:00am to 5:00pm.
To Contact the Service Monday to Friday
Royal Gwent Hospital and St Woolos Hospital 01633 234934
Ysbyty Ystrad Fawr 01443 802232 / 01873 732643
Nevill Hall Hospital 01873 732777
Out of Hours Advice Service
Available from on call Palliative Medicine accessed through hospital switchboard or Holme Towers
Marie Curie Centre, Cardiff, telephone no. 02920 426000.
Advice is available from Palliative Medicine Consultants 24 hours a day.
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GPCS Volume 1, Issue 1 Page 5
Hospice of the Valleys and St David’s Hospice Care provide nursing care in the community setting. This
structure can support joint working and communication but can also be logistically demanding and
result in triumvirate working. It requires commitment from all providers and dedicated leadership to
achieve true integration.
Hospice of the Valleys - Originally known as “Hospice of the Marches”, the organisation was started in
Hereford in 1985 by Dr Richard Lamerton and his wife, Patricia. Richard worked in Palliative care and
trained at St Christopher’s Hospice, London under the guidance of Dame Cicely Saunders, a world
renowned expert in palliative care.
Hospice of the Valleys was formalised as an incorporated company in March 1986 and registered with
the Charities Commission in July of the same year, the work of Hospice of the Marches became known
in nearby Blaenau Gwent when a local District Nurse Manager, Jayne Medlicott, heard Richard deliver
a lecture on his work at the Postgraduate Medical Centre, Nevill Hall Hospital in Abergavenny. Jayne
knew, from personal tragic experience, how valuable such a service would be to the people of the
borough and persuaded Richard to extend the service into Blaenau Gwent.
By 2000, the organisation employed several nurses, a social worker and a fundraiser and had changed
its name to “Hospice of the Valleys” reflecting its aim to care for the people of Blaenau Gwent in the
valleys of south east Wales.
Hospice of the Valleys is a registered charity and it is THE Blaenau Gwent Hospice, caring for over 500
patients every year, with a team of specialist palliative care professionals dedicated to providing
hospice care; taking care not only of people’s physical needs, but also providing for their psychological,
spiritual and social needs; helping them to live as actively as possible after diagnosis to the end of their
lives, however long that may be and the highest value is put on respect, choice and quality of life.
The Hospice employs 46 staff, including a range of multi-disciplinary specialist palliative care
professionals, supported by more than 170 volunteers. It is the preferred provider of specialist palliative
care in Blaenau Gwent for Aneurin Bevan University Health Board and provides services on a 24/7 basis.
Because of the high levels of illness in this deprived area, largely as a result of its industrial past, the
Hospice continues to grow and extend its services. In an updated report by the Joseph Rowntree
Foundation (Monitoring of Poverty and Social Exclusion in Wales 2013) the South Wales Valleys continues
to have the highest rate of unemployment in Wales.
Added together with the fact that Blaenau Gwent is one of the most deprived areas in the UK this
greatly impacts on our service, particularly the services of the social workers and welfare rights advisors
whose services continue to be in great demand.
Richard Lamerton’s original vision of high quality holistic Hospice care, providing for the physical, social,
psychological and spiritual needs of patients and their families has been consistent throughout and
remains central to the ethos of the organisation today, some 25 years later.
Working Hours: 9am–5pm Monday to Friday
Address: Hospice of the Valleys, Festival Drive, Ebbw Vale NP23 8XF
Phone: 01495 717277
e-mail: [email protected]
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St David’s Hospice - In 1979, Heulwen Egerton, a nurse tutor at Newport’s Royal Gwent Hospital set up
the ‘Gwent Hospice Project Group.’ The group was made up of like-minded individuals who were
concerned at the lack of palliative care available to the people of Gwent. From the first year of
operation, when St. David’s cared for six patients, St. David’s has grown to become the UK’s largest
provider of hospice at home care, caring for over 3,200 patients and families every year, at a cost over
£5.8 million.
In September 1979 the Domiciliary Care Pilot Scheme commenced and Miss Egerton was working in a
voluntary capacity. The introduction of a night nursing service in 1984 was followed by the extension of
Domiciliary Care Service to the whole of Gwent in 1986. Miss Egerton was also awarded an MBE for her
work later on in the same year. The Ystrad Mynach Day Hospice opened in 1995 and three years later
Day Hospice patients moved from Cambrian House to the Panteg Day Hospice. New premises were
secured for Panteg Day Hospice in 2000.
The year 2001 marked the opening of a 2-bedded Palliative Care Unit in a nursing home in Newport, the
opening of a Resource Centre in Chepstow, contracted nurses appointed to Hospice at Home service
and the launch of Tele-Medicine video conference project. The Family Support Team was established in
2002. In 2005 a 2-bedded Palliative Care Unit opened, based in a nursing home in Torfaen.
St David’s Hospice merged with a day hospice in Brecon, Usk House, in 2010. In 2011 St David’s
Hospice started providing Hospice at Home services to Mid & South Powys.
In 2012 a new state of the art Day Hospice Centre opened at Blackett Avenue, Newport and re-
opened at Ystrad Mynach Hospital, Caerphilly.
St David’s Hospice has a team of specialist nurses who work throughout the local community. The team
of specialist nurses offers advice and support to patients, families and carers from diagnosis onwards.
The team is also the first point of contact between families and St David’s. They may refer patients to
other St David’s services such as family support, day hospice, hospice at home or complementary
therapies. St David’s nurses also work very closely with patients’ GPs, Hospital Teams and District Nurses
to provide the highest levels of care for patients.
St David’s Hospice provide a Hospice at Home service to enable the patients to remain in their own
homes, and to die at home, if that is their choice.
There are four St David’s Day Hospice Centres offering a range of activities, treatments and respite for
patients and their families and carers: Ystrad Mynach, Panteg Hospital Pontypool, Usk House in Brecon
and Blackett Avenue, Newport
St David’s Hospice offer bereavement support to children via the Unicorn Service. Although
bereavement is a normal feature of growing up sometimes children and young people require
additional help and support to help them cope with the death of someone close to them.
Working Hours: 9am–4pm Monday to Friday
Address: St David’s Hospice Care, Blackett Avenue, Newport, NP20 6NH
Phone: 01633 851051
Email: [email protected]
Volume 1, Issue 1 April 2017
GPCS Volume 1, Issue 1 Page 7
Upcoming Events
Byw Nawr Annual Event – 11/05/2017
Annual Byw Nawr Event (Dying Matters in Wales)
Swalec Stadium Cardiff Thursday May 11th 2017
Living Well, Leaving a Legacy.
What can you do? What can we do together?
http://www.dyingmatters.org/blog/digwyddiad-blynyddol-byw-nawr-annual-byw-nawr-event
Partners’ events - please check the following links:
http://stdavidshospicecare.org/events/
Inflatable 5k – 23/04/2017
Location: Chepstow Racecourse, Chepstow, Monmouthshire, NP16 6BE
Event Type: Inflatable 5k Obstacle Run
For Tickets or more information, please contact:
Fundraising on 01633 851051
Download sponsorship form
To book your place call 01633 851048
http://hospiceofthevalleys.org.uk/support-us/events/
LAP THE LAKE – Sunday, April 23
Location: Parc Bryn Bach, Tredegar
Event type: Six mile race starts at 10:30am Fun run starts at 1pm
Click here to enter online or
Phone 01495 712936 for a form
Coming up in the next Edition of GPCS Newsletter ........
Interesting facts about EOL/ Palliative care
Information from the recently issued all-Wales End of Life Care Annual Report
What end of life care involves
Gwent Palliative Care Strategy updates
The story behind one of the Workstreams (told by the Workstream Lead) – each edition of the
newsletter will contain the story behind one of the Workstreams until all 8 workstreams are
covered
Contact details for:
Hospices in ABUHB area
Community Resource Teams and Local Authority teams in the 5 Boroughs
I hope that you find this newsletter useful and informative. As you are aware, I am very keen for the
Strategy to be successfully implemented across ABUHB and the partner organisations within the 3 year
period 2015 to 2018 and also keen to work in collaboration/partnership with the other specialties,
divisions and organisations to achieve that.
Therefore I would be very grateful if we can find ways of working together to achieve that.
“You matter because you are you. You matter to the last moment of your life. We’ll do all we can, not
only to help you die peacefully, but to LIVE until you die.” Dame Cicely Saunders Founder twentieth
century Hospice movement.