end of life care strategy (adults) 2012/13 –...

End of Life Care Strategy (Adults) 2012/13 – 2015/16

End of Life Care Strategy (Adults)

2012/13 – 2015/16


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Version Control

Name Version Date Revision

Amy Williams, Acute Care

Commissioning Manager,

NHS HMR CCG

V0.1 19th October 2012

Dr Tony Dysart, GP and

Joint Clinical Lead for End

of Life Care, NHS HMR

CCG

V0.2 21st December 2012

Minor formatting

Insert in relation to NCB

(2.1.1 bullet point 3)

Karen Hurley, Director of

Operations and

Engagement, NHS HMR

CCG

V0.3 4th January 2012

Revision to reflect the

influence of national and

local policies as opposed

to PCT policy. (2.1.1

bullet point 9)

Addition: specific mention

of GP and General

practice staff (section 2.4)

CCC V0.4 4th January 2013

Charlotte Booth V0.5 8th January 2013

Minor Formatting

Chair’s foreward inclusion

pg 3

Springhill Hospice V0.6 10th January 2013

Local Pharmacy Committee V0.7 14th January 2013

Local Medical Committee V0.8 21st January 2013

Health Overview and

Scrutiny Committee V0.9 5th February 2013

Dr Raj Khiroya, GP and

Joint Clinical Lead for End

of Life Care, NHS HMR

CCG

V0.10

Locality Engagement

Groups V0.11

GP Member Practices V0.12

CCG Governing Body V0.13

Other Stakeholders V0.14


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Foreword

NHS Heywood Middleton and Rochdale Clinical Commissioning Group’s (NHS HMR CCG) End of

Life Care Strategy (Adults) 2012/13 – 2015/16 has been developed to support the emergent CCG

on its journey to become a fully constituted, well governed, authorised and successful Clinical

Commissioning Group.

Recent changes to the NHS offer us a unique opportunity to lead and shape safe, effective, clinically led services for the people of the borough of Rochdale and secure better quality of life and health for our population who experience some of the poorest health outcomes in the country. NHS HMR CCG wants the people of Rochdale borough to enjoy longer, healthier lives and as end of life approaches to experience high quality, in the right place at the right time. This can only come about by inclusive patient, public and stakeholder engagement in the work of our CCG, built on a foundation of transparency, openness and trust. Working together with local providers, patient groups and our Local Authority, we aim to build on the positive legacy left to us by our Primary Care Trust (PCT), and to continue to bring health benefits to the whole population. NHS HMR CCG and its predecessor organisation NHS HMR has a proven track record of delivering service transformation to improve patient outcomes, service quality and productivity whilst reducing unwarranted variation and tacking inequalities, whilst remaining within its financial allocation. This End of Life Care Strategy outlines how NHS HMR CCG plan to continue this success into the future. This End of Life Care Strategy is fully aligned with the NHS HMR CCG Organisational Development Plan, the NHS HMR CCG Communications and Engagement Strategy and the NHS HMR CCG Constitution. We hope you enjoy reading this End of Life Care Strategy (adults) 2012/13 and would be pleased to receive any comments you may wish to offer.


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Page

Chapter 1: Introduction 4

Chapter 2: Death and Dying in Heywood, Middleton and Rochdale 6

Chapter 3: The Challenges of End of Life Care 14

Chapter 4: The End of Life Care Pathway 16

Chapter 5: End of Life Care Work Streams 20

End of Life Care Plan on a Page 21

Table: End of Life Care Work Streams 23

Chapter 6: Delivery 30

Chapter 7: References 32

Appendix 1: End of Life Care Strategy – Stakeholder Engagement Plan 33

Contents


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Chapter 1: Introduction

NHS Heywood, Middleton and Rochdale Clinical Commissioning Group (NHS HMR CCG)

1.1 NHS HMR CCG believe that high quality End of Life Care involves an active, compassionate

approach that treats, comforts and supports any individual with a progressive life threatening

condition and who is in the last twelve months of life. End of Life Care should be underpinned by

evidence-based practice, including the Gold Standards Framework, Liverpool Care Pathway,

Preferred Place of Care and NICE quality outcomes for end of life care.

1.2 The aim of this strategy is to improve the quality of life for individuals and their carers and

families, through the prevention and relief of suffering; through early identification and treatment of

pain and other physical, psychosocial or spiritual problems.

1.3 This strategy has been developed alongside clinical leaders, local GPs and health care

professionals, social care colleagues and most importantly, patients, carers and families. In

addition, as part of the ratification process, this strategy was subject to public and stakeholder

consultation in order to ensure we get it right! (Communication and Engagement Plan appendix 1)

1.4 NHS Heywood, Middleton and Rochdale CCG have developed this local strategy in line with

the National End of Life Care Strategy (July 2008) outlining the intentions of the CCG in relation to

end of life care for the next three years (2012/13 -2015/16)

1.5 The strategic direction and resulting implementation of this strategy will strive for quality

through the utilisation of national guidance applied to the local setting.

NHS HMR CCG have 5 aims that they plan to achieve through the implementation of this strategy:

1.5.1 To commission high quality, world class services for End of Life Care

1.5.2 To support people with long term conditions to live well and die in their preferred

place of care.

‘The aim of this strategy is to bring about a step change in access to high quality care

for all people approaching the end of life. This should be irrespective of age, gender,

ethnicity, religious belief, disability, sexual orientation, diagnosis or socioeconomic

status. High quality care should be available wherever the person may be: at home,

in a care home, in hospital, in a hospice or elsewhere. Implementation of this strategy

should enhance choice, quality, equality and value for money.’

-National End of Life Care Strategy – Department of Health (June 2008)


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1.5.3 To support patients, their carers and families to plan for a good death.

1.5.4 To provide support and services at anytime of day or night for patients, their

carers and families.

1.5.5 To support the development of a skilled and confidence workforce.

1.6 What does ‘good’ look like?

NHS HMR CCG believes that good quality end of life care is:

• Patient, carer and family centred

• Doing the RIGHT thing – Right care, right place, right time, right people (including carers

and family), right conversations and the right plan

• Partnership working across all settings and teams which is collaborative and integrated

• Helping to support people to die in their preferred place of care

• Seamless provision of care

• Paying attention to how patients enter the pathway and are supported through the system

• Incentives must be aligned to quality and standards

• Getting it right – first time!

• Allowing for informed choice by patients, carers and families

N.B The use of the term End of Life Care within this strategy is intended to be

inclusive of both supportive and palliative care services for the patient, their



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Chapter 2: Death and Dying in Heywood, Middleton and Rochdale

2.1 Strategic Context

This strategy supports the NHS Heywood, Middleton and Rochdale CCG Integrated

Commissioning Plan 2012 -2015 and is underpinned by a number of regional, national and local

drivers, guidance and policies. This section of the strategy provides an overview of some of these

drivers, guidance and policies, however, this is not meant to be exhaustive and further guidance

will be taken into account as appropriate.

2.1.1 National Drivers

• The NHS Operating Framework and supporting technical guidance 2012/13 – pertinent

areas including dementia, care of the elderly, carers, enhancing quality of life for people

with long term conditions, cancer, care closer to home, QIPP, patient experience and

putting patients at the centre of decision making.

• The NHS Health Bill, 2012 – this will see the transition of PCT budgets to CCGs. 2012/13 is the year of transition from the current to the new system with CCGs working in shadow format. This strategy will aid the transition through providing a clinically led strategy for the development of end of life care services for the next three years.

• NHS National Commissioning Board Domain 2 (Long term Conditions) – Highlights the need to prioritise end of life care in the commissioning of services for people with long term conditions.

• Implementing Care Closer to Home - provides commissioners with the tools to redesign innovative services delivered outside of hospitals. Extensive consultation with patients and their carers/families has highlighted that patients would like to be treated closer to home in the community and that the majority of patients would prefer to die in their usual place of residence.

• Real Involvement: Working with People to improve health services - published to support Commissioners in ensuring that all service developments are influenced through patient involvement using a variety of methods as appropriate to the service. Commissioners are obliged to seek, gather and act on user’s views to ensure patient involvement is at the heart of any service redesign.

• Equality and Health Impact Assessments – national impact assessment requirements for the NHS

• National drivers and local policies in relation to procurement and market management.

• Competition and Co-operation Principles

• Everyone Counts: planning for patients 2013/14 2.1.2 Regional Drivers


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• QIPP - The QIPP programme is about creating an environment in which change and improvement can flourish; it is about leading differently and in a way that fosters a culture of innovation; and about providing staff with the tools, techniques and support that will enable them to take ownership of improving quality of care. This focus on innovation as the key driver for sustained quality improvements and unlocking productivity gains calls for a system wide focus on designing and implementing more efficient and productive services. These service do not compromise on the quality and safety of patient care but rather enhance the patient experience. A suite of documents is now available to support QIPP, including Demand and Threshold Management – programmes for reducing demand. A report of the North West regional QIPP workstream for demand and threshold management. QIPP underpins the HMRCCG Integrated Commissioning Plan.

• PCT Cluster Assurance Briefing Pack (July 2012) provides a detailed overview of the Gtr Manchester health economy including market analysis, performance review and reform workstreams.

• Healthier Together (formerly Safe and Sustainable) - a significant redesign programme looking at urgent care, primary care, surgical services, acute medicine, cancer, long term conditions, women & children and stroke services across Gtr Manchester. NHS HMR CCG will continue to ensure robust links with this programme.

2.1.3 Local Drivers

• NHS HMR CCG Commissioning Plan 2012-2017

• NHS HMR CCG Vision and Aims - HMRCCG’s vision is to support people in the Borough of Rochdale to live long and healthier lives; to commission a range of services that meet their needs and help them to enjoy a better quality of life – adding life to years and years to life.

• NHS HMR CCG Values - NHS HMR CCG encourages a set of behaviors in its workforce that embed the HMRCCG values into the way the organisation works. Figure one outlines these values.

Figure One – HMRCCG Values

• Joint Strategic Needs Assessment - Health and Wellbeing Boards have the statutory duty to prepare a Joint Strategic Needs Assessment (JSNA) and develop a Joint Health and Wellbeing


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Strategy (JHWS). JSNA is a process to identify the health and wellbeing needs of the local area, including current and future health and social care needs of the entire population across the whole life course, from pre-birth to death. Rochdale Borough’s JSNA process involved a programme of consultation with key stakeholders. There were a number of common themes and issues where stakeholders thought changes should be made to improve health. These are summarised in the table below. Themes highlighted in red are the top 5 priority areas identified by the Shadow Health and Wellbeing Board for inclusion in its 2012 Joint Health and Wellbeing Strategy. The 2012 JSNA is a new high level, overarching JSNA to establish a new set of priorities in the face of a challenging health and wellbeing commissioning climate. General points arising from our JSNA process regarding services include; there is a high level of emergency admissions to hospital in the Borough compared with other places. 1 in 20 of these admissions are thought to be for preventable medication issues (HMR 2011); Rochdale Borough has the 2nd highest rate of antibiotic prescribing in England; over half of the Local Authority’s Budget is spent on ‘critical services’ i.e. social care for adults and children (2011/12 - £108m); almost half of the local NHS Budget is spent on General Acute Care (2011/12 -£168m). In particular, there is high spend/poor outcomes for circulatory disease and respiratory disease; stakeholders say that we need to do all we can to strengthen prevention, reduce demand, strengthen primary care in deprived areas, ensure services are integrated, joined up and jointly commissioning where appropriate. Figure Two provides a broad overview of the Borough’s priorities at the beginning of 2012.

Figure Two - Summary of Existing Strategic Priorities for the Rochdale Borough

Rochdale

Borough

Pride of Place 2011-15

•Economy, work & skills

•Identity, promotion &

citizenship

•Health & Wellbeing

•Children & YP

•Environment

•Safety

HMR Strategic

Commissioning Plan

• CHD

• Stroke

• COPD

• Tobacco

• Alcohol

C&YP Plan 2011-14

• Narrowing the Gap

•Improving Readiness for School

•Enabling Young People to Make

Positive Lifestyle Choices

•Skills Improvement

•Workforce Development and

Integrated Practice

Safer Communities Plan 2011-14

•Perception and fear of crime

•Reducing crime & adult reoffending

•Reducing the harm caused by drugs &

alcohol misuse

•Preventing and tackling anti social

behaviour

•Preventing offending by children &

young people

•Community Cohesion

Community Strategy

•People

•Place

•Prosperity

families, deprivation,

alcohol, cohesion, boro’s

reputation

• Healthy Futures - one of the most complex service redesigns ever carried out in the north east sector of Greater Manchester and boasts a high level of clinical and patient involvement. Healthy Futures has seen the redesign of 4 hospital sites providing similar services to centralised specialist services on one of the four hospital sites.

• Our population experiences high levels of deprivation. Two fifths of the Boroughs residents experience relatively high levels of disadvantage, with 18% considered to be in the most vulnerable group and a further 22% at risk of becoming vulnerable (MOSAIC segmentation). Wealthy residents make up only 6% of the Borough.


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• Our population is growing. We currently have 205,200 people in the borough1 This is expected to rise by over 7000 to 212,300 over the next 20 years.

• Our population is ethnically diverse, with 17,200 people from a Pakistani origin. This is about 8.3% of the borough. In our most disadvantaged groups, around a quarter of people are of Asian origin. These groups are also generally younger than the general population.

• Our population is relatively young, with 21% of the population being under 16, compared with 19% across Greater Manchester and England (ONS mid-year estimates 2009). However, we also have a growing proportion of older people. In future we expect there to be a greater proportion of elderly residents compared to those of working age as people are living longer. The population aged 65 or over in Rochdale Borough is expected to increase by 34.6% between 2008 and 2025.

• We know that a large proportion of our early deaths are caused by heart disease, digestive disease (including liver cirrhosis) and lung disease (including lung cancer). These conditions are largely preventable through not smoking, drinking alcohol within recommended levels for health, maintaining a balanced diet, being physically active and maintaining a healthy body weight. Some people find it easier than others to have a healthy lifestyle and we need to understand and tackle those barriers. We can also identify and support people who are at risk from developing these conditions as they are more likely to smoke, have persistent cough, have high blood pressure, have high cholesterol, be overweight or obese, and live in the more deprived areas of the borough.

• The death rates of Cardio-Vascular Disease (CVD) over the past 17 years have fallen nationally and locally (by 54% since 1995). Despite this fall, Rochdale Borough’s 2010 CVD Profile (SEPHO 2010) tells us that early death rates from cardiovascular disease (in those < 75 years) are still significantly higher than the national rate. Men are more likely to experience Coronary Heart Disease than women (159.18 per 100,000 population of men in the borough compared to 78.38 for women in 2007-9). Emergency admission rates for both CHD and stroke are significantly higher than the national rate. Our deprived groups are still more likely to experience cardiovascular disease than the more affluent groups – another unfair health inequality in our population.

• More local people end up in hospital or die from stroke than in other places. NHS HMR CCG 2010 CVD Profile tells us that our stroke mortality is 22% higher than the England average. Emergency admission rates are significantly higher than the England average, and male stroke emergency admission rates are much higher than the rate for females.

• Lung cancer is the Borough’s most common cancer, contributing to the early deaths seen in our population, particularly now in women. Rates for all cancers in the Borough are higher than the England average for males (205.14 per 100,000). Rates are however, lower than the rest of the North West (217.93 per 100,000 population for males compared to 224.63 across the North West, and 153.74 for females compared with 162.28, based on 2007-9 data). Our more deprived groups are more likely to die from cancer. The difference in cancer death rates between the most affluent and most deprived people in the borough is 134.83 per 100,000 population for men and 48.19 per 100,000 for women

• Long Term Conditions are conditions that people live with day to day, and if not managed well can sometimes mean unnecessary repeat admissions to hospital, reduced quality of life and lower wellbeing. Figure Three shows our top Long Term Conditions for Rochdale (using data

1 ONS mid-year estimates 2010


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collected in primary care as part of the Quality Outcomes Framework), the most prevalent being obesity, hypertension and depression. Long Term Conditions are known to take up: - 50% of GP appointments - 70% of primary care budgets - 70% of inpatient bed days It is important that we do everything we can to prevent such conditions, to identify them early

and work with people to manage them well in the community.

Figure Three – Top Long Term Conditions

• Rochdale Borough’s Mental Health Needs Assessment 2009 suggested there are around 4,270 people in the Borough (2%) who are likely to be affected by severe mental health disorders requiring support from secondary mental health services. Of these, 800 are estimated to have a psychotic disorder. Levels of common mental disorders, including anxiety, depression and phobias, were estimated to affect 30, 178 people (14% of the population). A Learning Disabilities Needs Assessment (2009) tells us that the estimated number of adults aged 18-64 across Rochdale with learning disabilities at the profound (PMLD) and severe level of severity (SLD) is just over 600. Based on the number known to Rochdale services, virtually this entire group is likely to be receiving services. However, there are an estimated 3,500 people across the area with a learning disability at moderate level and above, with only 17% of these known to services.

• Local people can now expect to live longer! Between 1991 and 2009 in the borough: - Male life expectancy at birth increased from 71.4 years to 75.8 years (risen by 4.4 years) - Female life expectancy at birth increased from 77.5 years to 79.8 years (risen by 2.3 years) However, people in Rochdale Borough still live 2 years less than nationally, and within the

Borough a person in the most deprived group might expect to live 10 years less than someone

in the most affluent group. This is an unfair Health Inequality.

• People are living longer, meaning an increasingly elderly population in the future (expected to increase by 34.6% between 2008 and 2025). Population projection research for Rochdale Borough suggests that in future there will be a greater proportion of elderly residents compared to those of working age. Areas that have a high proportion of older people can be found in Littleborough, Bamford, Spotland & Falinge, and South Middleton. Women in Rochdale Borough can expect to experience 4.2 fewer disability-free years than the England average. Men can expect to have 4 fewer disability free-years than the England average. Hospital admissions for those aged 65 or over rose by 20% from 2007-10, although those for heart disease fell. More people are living with limiting long term illness (LLTI). The proportion of the population aged 65 or over with an LLTI is projected to increase from 58% to 63% between 2004 and 2021. There are also high numbers of admissions for falls (10% of A&E ‘injury


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attendances’). The projected increase in the numbers of those aged 65 or over will impact greatly on social care and related services such as dementia services. The total care need of the population is expected to increase around 49% from 2009 to 2029 (Borough Profile 2011).

• Financial Context – unexpected growth to NHS budgets during 2012/13 has led to investment monies being available for a range of end of life care schemes which are underpinned by the QIPP ethos.

2.1.4 Strategic Summary

National, regional and local drivers are outlined in section 1.7 identifying local objectives following implementation of this strategy as:

• Ensuring there are open conversations with patients, carers and families to ensure plans reflect their priorities and choices regarding their care.

• Ensuring end of life care is coordinated across professions and settings and reflect gold standard care.

• Ensuring patients, their carers and families are supported within the last days of life and their needs at this time are reflected.

• Ensuring families and carers are supported after the death of a loved one. 2.2 Joint Commissioning The Department of Health publication “Towards Establishment: Creating Responsive and

Accountable Clinical Commissioning Group”

(http://www.commissioningboardnhs.uk/files/2012/01/NHSCB-02-2012-6-Guidance-Towards-

establishment-Final.pdf) sets out a clear view on collaborative working. It states in order to

commission improvements in health and healthcare for local populations and to drive the

integration agenda around the needs of individuals, it will be important for CCGs to have robust

collaborative arrangements with other organisations.

2.2.1 There are a number of areas, including end of life care, where NHS HMR CCG has agreed to

develop robust collaborative arrangements with other CCGs in the NE Sector and Gtr Manchester

and the Rochdale Metropolitan Borough Council. These arrangements will enable HMR CCG to

work in a robust manner with other stakeholders including CCG’s to enable the commissioning of

key services across wider geographies and play a part in major service reconfiguration where

appropriate.

2.2.2 A NE Sector Commissioning Board has been created to strengthen commissioning

arrangements across the NE Sector of Greater Manchester. The membership of this Board

comprises the NE Sector CCG Chairs and Accountable Officers. This Board will ensure synergy of

commissioning across the geographic footprint. Areas for collaborative commissioning via the NE

Sector Commissioning Board will include cancer, long term conditions, elective and emergency

care. The NE Sector Commissioning Board will be the forum for the annual development of

commissioning intentions.

2.2.3 HMRCCG will also work collaboratively with the National Commissioning Board (NCB) from

1st April 2013. This relationship will involve HMRCCG supporting the NCB in its role as


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commissioner of primary care and specialised services, and work as a partner with the NCB to

integrate commissioning where appropriate.

2.3 Provider Landscape

General practitioners and NHS HMR CCG are the local leaders for health care provision within the

metropolitan borough of Heywood, Middleton and Rochdale and along with community partners

commission and provide end of life care to patients, carers and their families.

However, this strategy has the potential to have a significant impact on our providers.

2.3.1 Pennine Acute Hospitals Trust

The Pennine Acute Hospitals Trust services the communities of North Manchester, Bury, Rochdale

and Oldham, along with the surrounding towns and villages. This area is collectively known as the

North-East sector of Greater Manchester and has a population of around 800,000. It is a large

Trust with a total operating budget of £560m. Its main commissioners are NHS Bury, NHS

Heywood, Middleton and Rochdale, NHS Oldham and NHS Manchester.

The Trust provides Accident and Emergency; Diagnostics; Medicine; Surgery; Specialist Services

(HIV/AIDS) and Women and Children’s services and operates from five sites:

• Fairfield General Hospital, Bury

• North Manchester General Hospital

• Royal Oldham Hospital

• Rochdale Infirmary (The new Urgent Care Centre (UCC) at Rochdale Infirmary, which opened on 4th April 2011, replaced the A&E Department and Walk-in Centre).

• Birch Hill Hospital 2.3.2 Acute Sector Providers

The 2013/14 Commissioning Intention round has commenced. This process will inform our acute sector providers of our likely activity over the coming financial year. HMRCCG aims to decrease the levels of hospital based activity over the coming years. 2.3.3 Pennine Care NHS Foundation Trust

Pennine Care NHS Foundation Trust was established in July 2008. The trust provides community

health services, specialist mental health services and specialist drug and alcohol services to a

population of almost 1.2million people. Their complete ranges of services are provided to the

Boroughs of Bury, Rochdale and Oldham. Residents of Stockport and of Tameside & Glossop

receive mental health and drug and alcohol services.

2.3.4 Primary Care

The biggest impact will be for primary care, with the initial focus being on early identification, and

improved referral pathways to specialist services in the community and hospital and increased

support in order to ensure patients die in their preferred place of care. In order to provide additional

support NHS HMR CCG will be seeking to use innovative service models that utilise the third

sector, following market testing and analysis.


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2.3.5 Independent Sector Providers

NHS HMR CCG has a number of contracts and jointly funded initiatives with voluntary sector

providers. However we do not feel that we have tapped into the full potential of this sector. In

order to address this and develop meaningful social marketing programmes, we will develop

opportunities with the third sector to improve our engagement and understanding of particularly

hard to reach groups and how we commission appropriate services to meet their needs. The main

independent sector provider for patients at the end of life is Springhill Hospice.

2.3.6 Springhill Hospice

Springhill Hospice opened in 1989, and provides specialist palliative care for adults with life-limiting

illnesses. The Hospice is an independent charitable organisation which relies on both NHS funding

and fundraising in order to operate

Springhill Hospice offers a number of services to patients, carers and families, including, inpatient

unit, day hospice, hospice at home services, 24 hour advice line for patients and professionals and

support for families and carers after the loss of a loved one, including, bereavement support and

counseling.

2.4 Partners

NHS HMR CCG recognise the importance of partnership, multi-agency working in the delivery of

end of life care and endeavour to continue to work with the following local partners to deliver

seamless high quality care, every time.

• Local GPs and practice staff

• Rochdale Metropolitan Borough Council

• Pennine Acute Hospitals Trust

• Pennine Care Foundation Trust

• Springhill Hospice

2.4.1 End of Life Partnership - HMR

Within HMR a multi-agency end of life partnership has been developed to ensure a coordinated

approach to caring for patients at the end of their life. Whilst each agency has a role to play within

this partnership, it is noted that the aims to improve patient care; improve communication and

develop better services are valued by all.

Within this strategy NHS HMR CCG wish to make distinction between coordination of care of the

individual and strategic coordination. Strategic Coordination involves planning and monitoring of

service delivery across the population and is to be led by the CCG, working in partnership with

Rochdale Metropolitan Borough Council.


Chapter 3: The Challenges of End of Life Care

3.1 Introduction

In England each year, there are around 500,000 deaths, of which the vast majority (around 99%)

occur in adults over the age of 18 years, and most occur in people over 65 years old.

Within Heywood, Middleton Rochdale there are around 15002 expected deaths a year, most of

which (59%) occur in a hospital setting.

The majority of deaths occur following a period of chronic illness related to conditions such as

heart disease, liver disease, renal disease, diabetes, cancer, stroke, chronic respiratory disease,

neurological disease and dementia.

3.2 The Challenges of End of Life Care

As a Borough, the CCG face many challenges to meet the needs and preferences of patients as

they approach death.

A. Difficult Conversations

Very few adults, including older people, have discussed their own preferences for care at the end

of their life. In addition, relatively few health care professionals and care staff within the Borough

feel supported and confident enough to discuss these preferences with their patients. Often

patients have not discussed their own preferences with a close relative or friend and clinical and

care staff have not received training in how to have such discussions. In the absence of open

discussions it is difficult to understand a patient’s needs and preferences for care and to plan

accordingly.

B. Coordination of Care

Often at the end of life, a patient will need the care of multiple services and professionals. It is often

necessary for several organisations and agencies to be involved with the care of an individual

patient, with the patient often moving locations (home, hospital, care home, hospice etc.) Due to

this, there is significant risk that coordination of a patient’s care can be poor.

C. Access to services at whatever time of day (or night)

People who are at, or approaching the end of life need access to care and support 24 hours a day,

7 days a week. Often services in the community are unable to respond to these needs, resulting in

an increase in emergency attendances and admissions to hospital as opposed to patients being

cared for in their usual place of residence.

D. Training and Support for Staff

The training and support of all staff who care for patients at the end of life is paramount to the

success of the care pathway.

E. Support for Families/Carers and Bereavement Services

2 Based on the NHS Northwest 75% assumption (75% of all deaths are expected or predicatble)


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Families and carers are an integral part of the end of life care pathway and are fundamental to the

successful delivery of care. Support for family and carers throughout a person’s illness and into

bereavement is often inadequate. This can impact adversely on the health and wellbeing of carers

and make it difficult for them to provide care.

F. Complex Care

It must be recognised that patients at the end of life may have additional complex physical,

learning or mental disabilities which may not be identified, resulting in inadequate care.

3.3 As a result of the challenges identified above many people experience unnecessary physical,

psychological and spiritual suffering, which prevents many people from living out their final days in

a place of their choice and often has a negative impact on how family and friends cope during the

bereavement phase.


Chapter 4: The End of Life Care Pathway

4.1 The concept of a care pathway has been found to be useful for the planning, contracting and

monitoring of services, which is a concept that has also been applied to end of life care. However,

it is important to recognise, that whilst we aim to deliver one pathway Borough-wide through-out

Heywood, Middleton and Rochdale, individuals will differ in the way they approach the end of their

life, which means that the pathway should be flexible, and adaptable to the individual needs and

preferences of all patients.

4.2 The National Strategy document outlines the key elements of an end of life pathway (figure

four) as:

Step 1: - Discussions as the end of life approaches

Step 2: - Assessment, care planning and review

Step 3: - Coordination of care for individual patients

Step 4: - Delivery of high quality services in different settings

Step 5: - Care in the last days of life

Step 6: - Care after death

In addition, attention should be given to the following, at all stages of the pathway:

• Support for carers and families

• Information for patients and families

• Spiritual care for patients and families


Figure Four: Department of Health End of Life Care Pathway


4.3 Local End of Life Care Coordination Pathway

The End of Life Care Partnership, as outlined in section 3.3, have developed a localised End of

Life Care Pathway for implementation within Heywood, Middleton and Rochdale(Figure Five),

which has been adapted from both the National and the North West End of Life Care Pathways.

The Care Coordination pathway is separated into 5 key stages with key tasks, services and

responsibilities required to meet the needs of patients at the end of life highlighted at every stage.


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Figure Five: Heywood, Middleton & Rochdale End of Life Care Coordination Pathway

1 2 3 4 5

1 year

Advancing

disease

6 months

Increasing

disease Last days of

Life

Death

First Days

after Death Bereavement 1 year +

Stage 1

• Patient identified and

added to and GP register

• MDT discussion

• Care coordinator contact details given to the patient

and family

• Advance Care Planning discussion offered

• Undertake an holistic

assessment and provide

monthly face to face review

and support – agree review

date with patient/family using

clinical judgment

• Communication with relatives. Carers needs assessed and addressed

• Consider DN assessment and

equipment assessment

• Refer and liaise with appropriate Health and Social Care Professionals

Stage 2

• Initiate referrals to other professionals

• Complete health care assessment/fast track if

required

• DNA-CPR status

considered, documented

and communicated

• Provide minimum of 2

weekly face to face review

and support. Refer and liaise

with appropriate Health and

Social Care professionals

• Complete Palliative care

handover form and share

• Revisit ACP discussions

• Undertake CHC screening

Stage 3

• Multidisciplinary decision to commence care of the dying pathway

• Appropriate leaflets given to family

• Symptoms controlled as per local

LCP/local medication guidelines

• Discontinue non

essential medications when appropriate and request

anticipatory prescribing of end of

life care medication

• Minimum daily District Nurse visits in

24 hrs to be offered

• Refer and liaise with appropriate

Health and Social Care

professionals

• Re-visit ACP discussions

Stage 4

• Certification of death

• Care of the dying pathway

completed

• Bereavement leaflet offered

and what to do after a

death booklet

• Bereavement support

offered to relatives

• Notify all health and social

care professionals to

facilitate timely removal of

all equipment (RMBC ‘Tell Us Once’ policy)

Stage 5

• Follow up bereavement contact – at least 1 post

bereavement & funeral

attendance

• Signpost relatives to

bereavement counselling

services if necessary

• Sympathy card/condolences letter

sent if appropriate

• Ensure PARIS will

accept post bereavement visit


Chapter 5: End of Life Care Work Streams

5.1 This section will provide a brief description of the end of life care work streams. Each work stream will be required to gain formal sign off as per CCG governance arrangements at the

necessary project gateways in line with national drivers and local policies.

The end of life care strategy will deliver an efficient, productive and sustainable model of care for

end of life care services. It is imperative to ensure that a whole systems approach is used when

looking and redesigning the end of life care system to ensure that changes made do not have a

negative impact elsewhere in the health and social care system.

The implementation of these work streams will require significant engagement with key

stakeholders to ensure the delivery of an efficient, productive, high quality and sustainable model

of care for end of life care services.

5.2 Page 23 depicts the end of life care ‘plan on a page’. This plan on a page captures a high level

view of the contents of this strategy, all of which is underpinned by the ethos outlined in the

previous sections of this strategy.

NHS HMR CCG End of Life Care Strategy 2012/13 – 2015/16

22

END OF LIFE CARE PLAN ON A PAGE

Why is change needed?

• Increased number of deaths forecast in

the next 5-10 years

• Inconsistent standards of end of life care

in different settings

• Reduce the number of hospital bed days

for patients on the end of life care

pathway

• Implementing preferred place of care

(PPC) at the EOL – patient choice agenda

Objective

End of life care will be:

i. openly discussed with individuals and plans made that reflect their priorities and

choices regarding their care

ii. co-ordinated across professions and settings and reflect Gold Standard care

iii. support people in the last days of life and reflect their needs at this time

iv. support family and carers after the death of a loved one

How do we want the future to look and what are the transitional issues?

• All people in HMR towards the End of Life will have their needs, priorities and preferences

for End of Life Care, including care after death, identified and met throughout the last phase

of life and bereavement.

• Care will be consistent across settings through a coordinated collaborative approach to

delivering care that is delivered by skilled professionals who are appropriately trained and

supported.

• The ongoing support of families and carers is important to us and providing care and support

after a loved one’s death is also part of our vision.

What are we doing about it?

2012/15 £

Project Chart Y1 Y2 Y3 +* -*

Development of local end of life strategy

Hospice at home pilot √

7 day working for specialist palliative care team- √

Care home training and education facilitator √

To ensure that end of life care packages are co-ordinated and

available 24/7

Rapid discharge pilot √

Use of Advance Care plans across the Borough √

DNAR pilot delivered across Pennine Acute footprint √

Specialist training in care homes – 6 steps programme √

HMR general practice education programme √

Specialist palliative care education facilitator √

Community Palliative Care Consultant √

Increase in GPs registered to 1% campaign

Increase in GP practices achieving level 4 in GSF

Increase in number of care homes undertaking and achieving six

steps programme

√

Review of Marie Curie contract

Review of hospices services and contract

Implementation of electronic palliative care register √


23

Support services of carers and families, including bereavement

services

√

Joint Commissioning Innovation

• Work with the LA, Pennine Care, Pennine

Acute, Local Hospices, third sector and

voluntary organisations

• Hospice at home service will provide an

innovative platform for care and treatment

to be provided in the home.

What Key Performance Indicators will we use to monitor progress?

• Increase in the identification of patients in last 12 months of life (Implementation of 1%

campaign)

• Increase in the number of GPs registered to the 1% Campaign

Reduction in: -

• number of deaths in hospital

• number of hospital unplanned admissions for EOL patients

• total length of stay in last year of life

• Increase in number of deaths in usual place of residence

• Increase use of DNAR and advance care plans

• Improvement in patient satisfaction rates from baseline (yet to be established)

• All GP practices to achieve level 4 in GSF

• Increase in the number of care homes undertaking and achieving the 6 steps programme

Implications, Risks and Mitigating Actions

Risks Mitigating Actions

Limited engagement with the LA to date on the

EOLC agenda

Communication. Coordinate care across whole

pathway. Extensive engagement with care

homes, LA, hospice, health providers and other

stakeholders

Care packages are not currently co-ordinated

Joint Strategic Needs Assessment Mapping

JSNA Priority

Lifestyles Children and

Young People

Prevention and

Early

Intervention

Tackling

Inequalities

Wellbeing

√

√

√


24

Table: End of Life Care Work Streams

Work Stream Background Aims and Objectives Next Steps

Development of local end of life strategy

Due to the high profile nature of end of life care

at a national level, the appointment of two GP

end of life care clinical leads and significant drive

from partner organisations it was deemed

necessary to develop a local end of life care

strategy to provide direction and focus to the

development of end of life care services,

pathways and projects.

• To provide strategic direction for the

development of end of life care services

within the Borough of HMR

• To allow clinical leaders, GP member

practices, partners and providers an

opportunity to shape and develop the

strategic vision for end of life care in

HMR

Immediate next steps include the full

consultation in relation to this

strategy with all stakeholders

including:

• Patients, carers and their

families

• CCG Clinical Leads

• CCG Member Practices and

local GPs

• Local Medical Council

• Rochdale Metropolitan

Borough Council

• Pennine Care Foundation

Trust

• Pennine Acute Hospital

Trust

• Voluntary sector partners,

including, Springhill Hospice,

Carers Resource, Age UK,

Macmillan and Marie Curie


25


Hospice at home

In June 2012, NHS HMR CCG commissioned

Springhill Hospice to provide a hospice at home

service on a pilot basis. Hospice at home was

designed to deliver palliative care services 24

hours a day to patients at the end of life who

have indicated that they would like to spend their

last days in their own home.

The main aim of the Hospice at Home service is

to provide patients and families with the

appropriate level of additional care required to

ensure the patient has the support they need to

remain in their own home and to prevent any

unnecessary admissions to hospital.

The Hospice at Home team provide patient care

and family support according to the needs of the

individual.

Commissioners and Springhill

Hospice are currently in the process

of evaluating the hospice at home

service. Preliminary evaluations

have shown significant successes,

including, 100% of hospice at home

patients dying in their preferred

place of care. Following completion

of a positive evaluation, clinical

leaders and commissioners would

like to develop the next phase of

Hospice at Home to be ‘Hospice in

your Care Home’. This will focus on

patients residing within residential

homes within the Borough and

supporting staff within the care

homes with training, advance care

planning and specialist support.

7 day working for specialist palliative care team

Historically, within the Community the provision

for Specialist Palliative Care Nursing Services

has been Monday – Friday. NHS HMR CCG

have identified funding to expand the Specialist

Palliative Care Nursing Service to include 9am –

5pm Saturday and Sunday.

• Support patients’ preferred priorities for

care

• Promote seamless pathway of care in

HMR

• Improve the patient & carer experience

• Support generic teams to deliver

improved quality of palliative and end of

Pennine Care Foundation Trust are

currently conducting consultation

with current staff and recruiting to

the new roles required for this

expansion. Expected date for

implementation is 1.5.13


26


life care

• Demonstrate cost effectiveness of

service

• Support transforming community

services programme

• Modernise the existing service

• Develop the nursing workforce

• Contribute towards saving bed days

Use of Advance Care Plans across the Borough

The adoption and utilisation of advanced care

plans will increase the communication relating to

the wishes of the patient, carers and families,

which is essential for the delivery of this strategy.

There is no baseline evidence to show any

substantial use of advance care plans across the

Borough. Whilst NHS HMR CCG recognise that

advance care planning is delivered within the

health system, in particular, by community

nursing services and within some nursing and

residential homes it is essential to increase the

utilisation of advance care plans.

• To increase communication between

organisations and individual in the care

of end of life patients

• To increase the number of people dying

in their preferred place of care

• To reduce the number of deaths in

hospital

NHS HMR CCG Clinical Leaders

and Commissioners are currently

working with providers to develop

service proposals in order to meet

this need

uDNACPR pilot delivered across Pennine Acute

NHS HMR CCG form part of the project team

undertaking the implementation of a pilot unified

DNACPR policy across the Pennine Acute

• Reduce the number of unplanned

hospital attendances/admissions for

patients within the last year of life.

Continue to support the

implementation of this pilot across

the North East Sector.


27


footprint footprint, involving all partners and care settings.

The implementation of this uDNACPR will

override current national policies, which prevent

DNACPR documents from moving locations with

a patient, meaning a new document must be

completed for each patient in each setting.

• Increase the number of people dying in

their preferred place of care

• Improve the experience of patients, their


• Improve coordination of care between all

partners involved in the delivery of end of

life care.

HMR general practice education programme

The first GP education and engagement event

was held in November 2012, which established

good engagement with GP members. This event

will be followed in February 2013 and will be

used to form an ongoing GP education

programme for GPs and practice staff.

• Increase the skills and knowledge of

General Practice in the care of End of

Life Care patients

• To improve the quality of care for End of

Life patients and build upon existing

good practice.

• To allow GPs to shape the future of end

of life care within HMR

Next event to be held February

2013.

Community Palliative care Consultant post

Historically HMR have been unsuccessful in the

recruitment of a community palliative care

Consultant. Funding is allocated from the

Greater Manchester Cancer and End of Life

Network, which has, as yet, not be utilised due to

HMR being unable to recruit.

• Support patients’ preferred priorities for care

• Promote seamless pathway of care in HMR

• Improve the patient & carer experience

• Providing care within patient’s homes and at Borough-wide community clinics.

Finalise service specification and

begin to implement with preferred

provider, following appropriate

procurement and tender guidance.


28


• Support generic teams to deliver improved quality of palliative and end of life care

• Demonstrate cost effectiveness of service

• Modernise existing services

• Contribute towards saving bed days

• Reduce number of deaths in hospital

• Reduce admissions/attendances for patients at the end of life

• Support hospice services

• Advice, support and educational resource for all clinical staff involved in the care of patients at the end of life.

Greater Manchester EOL QIPP

NHS HMR are required to meet the obligations

of NHS Greater Manchester in the delivery of the

EOL QIPP Programme. (Quality, Innovation,

Productivity and Prevention)

• Reduce hospital deaths by 10%

• Increase GPs registered to the 1% campaign

• Ensure all GP practices achieve and maintain level 4 in the Gold Standards Framework

• Deliver the 6 steps campaign into 6 care homes through-out the Borough

At present, NHS HMR are on target

to deliver the obligations outlined

within the GM EOL QIPP.

Work will continue to meet these

obligations and exceed where

possible.


29


Marie Curie Contract review

Marie Curie currently deliver a nursing and night

sitting service within the Borough. Whilst this

contract value and service size is relatively low

NHS HMR CCG often exceed activity levels

within the contract.

• Establish whether the service is currently meeting need

• Review in line with north east sector colleagues

NHS HMR are currently reviewing

Marie Curie contract in line with

NES colleagues. Following this

review a decision will be required by

the Specialist, Scheduled and

Cancer commissioning group and

Clinical commissioning committee in

relation to next steps.

Electronic Palliative Care Coordination Systems

All CCGs are required to develop an electronic

palliative care coordination system to allow

communication from all organisations, including

GPs, out of hours, NWAS, providers, local

authority and hospices about end of life care

patients.

• Allow for communication between all services involved in the care of end of life patients.

• Increased identification of patients within the last 12 months of life

• Increase patients dying in the preferred place of care

• Reduce hospital admissions/attendances

A project team are in place to

deliver this project across the NES.

Key next steps include the clinical

validation of the data set and

completion of current state of all

organisations involved.

Work is currently being undertaken

to develop a local enhanced service

to support this implementation.

6 Steps Programme

6 steps is an education and support programme

for staff involved in the care of patients at the

end of their life. In HMR, this is currently being

rolled out within 6 care homes.

• Increase knowledge and skills of care home staff in order to allow them to care for patients more effectively at the end of life

• Increase patients dying in the preferred place of care

• Reduce hospital admissions/attendances

Commissioners are currently

reviewing data in relation to deaths

in hospital in order to identify the

next care homes for roll out of this

programme. This will link to the

ongoing consultant outreach

programme and other initiatives

currently active within HMR care


30


homes.

Bereavement Services

Historically GPs have struggled to access

bereavement services for carers and families

who have lost loved ones and require additional

therapeutic and psychological support. NHS

HMR CCG have agreed funding to deliver

additional psychological and therapeutic

bereavement and counselling services by

Springhill Hospice Borough wide at community

locations.

Within this expansion Springhill Hospice aim to provide the following formal and informal emotional and psychological support for all bereaved people within the Borough of Heywood, Middleton and Rochdale including:

• Remembrance Service – run by a spiritual Care Coordinator a remembrance service for next of kin, along with other relatives.

• Lights of Love – a Christmas service where lights are lit on the Christmas tree in memory of loved ones. Music and carol singing make it an uplifting and emotional event.

• Bereavement support group – Twelve weeks after a death the Psychological and Supportive Care Lead offers support by way of a monthly support group.

• Bereavement counselling – Relatives and carers can self refer at any time to ‘talk’.

• Funeral planning and conducting – Our spiritual care co-ordinator is available to help individuals and families think about and plan funeral ceremonies and to conduct them if requested.

• Bereavement support groups and Well being workshops – Bereavement support group and ‘well being’ workshops to educate and assist people

Funding has been agreed in

December 2012, with the service

specification currently being

developed.


31


in looking after themselves and each other in times of grief.


32

Chapter 6: Delivery

6.1 As a newly emerging clinical commissioning organisation, NHS HMR CCG need to

develop our capabilities to ensure we commission services that are of the best value. We

also need to develop our external stakeholders to secure the very best clinical support and

quality to meet the needs of our population and offer a choice of services delivered at the

right time and in the right place.

Some of these capabilities the CCG already have as an organisation and will develop

internally; whilst others are more challenging and can best be incorporated by developing

relationships with partners including other CCGs and the Gtr Manchester Clinical Support

Unit (CSU). As commissioners, we will look to actively manage the market where service

provision is consistently poor or where we need new and different approaches to delivering

care.

6.2 Greater Manchester Commissioning Support Unit (CSU)

As part of the new and emerging NHS landscape NHS HMR CCG will also purchase a

range of services from the developing Gtr Manchester CSU. Gtr Manchester CSU will have

a wide remit in delivering both the initiatives outlined in this plan and key performance

indicators used to monitor the delivery of this plan.

The organisation will need to develop skills internally and externally with partners to support

effective procurement, market testing and analysis for new and innovative service models.

These skills will need to sit alongside the development of expertise to deliver efficient and

effective commissioning of services. This will ensure that resources are allocated for the best

outcomes and review investments that are not in line with the outcomes required for the

delivery of this Commissioning Plan.

6.3 How we will know we have achieved success

This strategy will be held by the Scheduled, Specialist and Cancer Commissioning Group

which is a clinically led commissioning group that reports on a monthly basis to the NHS

HMR Clinical Commissioning Committee. This group links with the NES Elective Care

Development Board and the NES Cancer and End of Life Group.

Finally, we have outlined how we think success might look, feel and sound for people living

in the Borough of Rochdale as a consequence of the successful delivery of the End of Life

Care Strategy 2012/13-2015/16.

6.3.1 There will be an increase in the identification of patients in the last 12 months of life (implementation of the 1% campaign) 6.3.2 There will be an increase in the number of GPs registered to the 1% campaign 6.3.3 There will be a reduction in the number of deaths in hospital 6.3.4 There will be a reduction in the number of unplanned hospital admissions for EOL patients 6.3.5 There will be a reduction in the total length of stay for patients in the last year of life 6.3.6 There will be an increase in the number of deaths in a person’s usual place of residence 6.3.7 There will be an increase in use of DNACPR and Advanced Care Plans


33

6.3.8 There will be an improvement in patient satisfaction rates for end of life care services 6.3.9 All HMR GP practices will achieve level 4 in the Gold Standards Framework 6.3.10 There will be an increase in the number of care homes undertaking and achieving the 6 steps programme

This section has outlined the way in which the organisation will deliver the vision of the

commissioning plan for the next three years. We will continually review the plan and adjust it

as we evaluate our impact and as new information and evidence base becomes available.


34

Chapter 7: References

Department of Health: End of life Care Strategy (2008) Promoting High Quality care for all

adults at the end of

lifehttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuid

ance/DH_086277

Department of Health (2008 World Class Commissioning Vision, Department of Health

http://www.dh.gov.uk/en/Managingyourorganisation/Commissioning/Worldclasscommissioning/ind

ex.htm

Department of Health (2008) High Quality Care for All: NHS Next Stage Review final report,

Department of Health

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D

H_085825)

Department of Health (2007) Implementing Care Closer to Home, Department of Health


H_074428

Department of Health (2010) The operating framework for the NHS in England 2010-11,

Department of Health


H_110107

Department of Health (2010) The NHS quality, innovation, productivity and prevention (2009) http://www.institute.nhs.uk/nhs_alert/guest_editorials/July_2009_Guest_Editorial.html

Healthy Futures (n.d.) Healthy Futures available at

http://www.healthyfutures.nhs.uk/Consultation.php

Joint Service Needs Assessment (n.d.) http://www.statsandmaps.org.uk/jsna

NHS HMR (2010) NHS Heywood, Middleton and Rochdale Strategic Commissioning Plan,

available at www.hmr.nhs.uk

North West Public Health Observatory (2010) Life Expectancy available at

http://www.nwph.net/nwpho/default.aspx

North West Public Health Observatory (2009) Health Profile 2009 – Rochdale available at

http://www.apho.org.uk/resource/view.aspx?RID=50215&REGION=50151

North West SHA (2008) Healthier Horizons for the North West: A vision for health and

healthcare in the North West, North West SHA available at

http://www.northwest.nhs.uk/whatwedo/healthierhorizons/


35

Appendix 1: End of Life Care Strategy – Stakeholder Engagement Plan

Phil Burton, Patient and Public Involvement Officer, NHS HMR CCG

In order to provide direction for the commissioning and delivery of End of Life Care for adults

within the Borough of Heywood, Middleton and Rochdale, it has been deemed essential to

develop an End of Life Care Strategy.

The draft strategy incorporates key performance targets and priorities, whilst reflecting

existing service provision and subsequent gaps in service. Key strategic priorities include:

• Reducing number of deaths in hospital of patients identified as EOL

• Increase in deaths in preferred place of care

• Increase in patients of end of life registers

• Professionals utilising the Gold Standard Framework

• Increase the number of GPs ‘signing up’ to the 1% campaign

• Increase palliative care nursing services to 7 day a week service

• Increase care home uptake of 6 steps care home education programme

• Provide 24 hour access to services with single point of access for end of life patients, careers and their families.

• Provide access to community palliative care consultant cover

• Improve and expand on existing third sector services, including hospice services

• Provide access to education and engagement for GPs and practice staff on end of life care

• Implement a unified Do Not Attempt to Resuscitate policy for adults across the Borough, alongside partners and NES CCGs

• Increase Advance Care Planning across the Borough

• Implement Electronic Palliative Care registers across the borough

• Development of services for carers, families and the bereaved

Category Approach

Target

Audience

GPs, Care Homes, patients, Public, Carers, RMBC Adult Care,

Rochdale Hospice, RMBC Health Overview and Scrutiny Committee,

Health and Wellbeing Board

Customer Amy Williams – Commissioning Manager

Why do this

work

Minimising the stress and distress around the end of life and

providing the type and level of care that patients and families require

is critical. To achieve this, those most closely involved with the end of

life of a patient must be involved in any strategic decisions and

service design. This exercise will give the target audience group the

opportunity to affect those decisions.


36

Deadline for

completion

Engagement must finish by 24th December 2012 and report complete

by 4th January 2013.

How Focus group meetings and one to one interviews.

One to one interviews – these will be targeted at health professionals

and families and carers of those in end of life care

Focus groups – targeted at family and carers of those in end of life

care

Stand at GP event on 27th November

Where Various locations in the borough

Resources

needed

Venues, materials,

Discussion

points

• How do you feel about your current care pathway?

• What are your preferences for your future care?

• Where would you like to receive your care?

• Do you think every patient approaching end of life should have a “preferred priorities for care” plan and what should it contain?

• How should the patient be involved in the decisions about their care?

• How should family, close friends and carers of people approaching the end of life be involved in the patients care?

• Should clinicians decide what is the best approach to care and then inform the patient about it?

• Should there be a register of patients who are approaching the end of life? If yes what information should the register contain?

• How can care for those approaching the end of life be coordinated between providers?

• Discussion about proposed quality markers

• Having seen the draft strategy for HMR CCG do you think it: o Covers the right areas o Could be improved in any way, if so how?

• Would you like to be involved in further development around end of life acre?

Key point To examine what stakeholders think about the draft End of Life Care

Strategy.

To discover how patients and their families feel they should be

involved in End of Life Care.

end of life care strategy (adults) 2012/13 –...

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