Continuous Professional Development slides delivered in March 2015

1. 1
End of Life Care
Blaine Robin PhD
March 2015

2. Definition of EOL care
2
Audit Commission(2008)
End of life care is care that helps all those with advanced, progressive,
incurable illness to live a well as possible until they die.
It enables the supportive and palliative care needs of both
patient and family to be identified and met throughout the last phase
of life and into bereavement. It includes management of pain and other
symptoms and provision of psychological, social,
spiritual and practical support.
http://www.nao.org.uk/wp
content/uploads/2008/11/07081043_Doctorssurvey.pdf
(date accessed: 1st
March 2015)

3. 3
Guiding narratives that feed
the vision for good practice
 “Advice around the clock service”.
 “Choice regarding place of care”.
 “A good death should be the benchmark of all
those who we care for”.
 Gold Standards Framework, Liverpool Care
Pathway and Preferred Priorities of Care.
 Implications of the Francis Report

4. Key Documents
 NHS Cancer Plan (2000) £50 million investment each year over three years, to tackle
inequalities in access to specialist palliative care
 £6 million investment over three years to provide education and training in the principles
and practice of palliative care for district and community nursing Joint investment of £3
million between the Department of Health and Macmillan Cancer Relief to appoint a lead
clinician for cancer within each PCT. Additional New Opportunities Fund funding for
community palliative care projects from 2001 to 2005.
 Building on the Best: Choice, Responsiveness and Equity in the new NHS(2003).
Pledges action to ensure that all adult patients nearing the end of life, regardless of
diagnosis, have access to high quality palliative care so they can choose to die at home if
they wish. Department of Health End of Life Care Initiative to take this forward, with £12
million over three years towards implementing the Gold Standards Framework and the
Liverpool Care Pathway for the Dying and developing the Preferred Place of Care document.
 The new general medical services(GP) contract(2003). The general management of
patients who are terminally ill forms an essential service to be provided by all GP practices.
Practices may transfer the provision of out-of-hours care to PCTs.
 NICE guidance on supportive and palliative care (2004) Key recommendations for the
provision of palliative care for people with cancer, including access to 24-hour medical and
nursing services for patients at home.

5. Our Business - Assessment
 Responsible for assessment of need, care planning and initial
review
 New referrals come from the Contact Centre - Initial screening &
re contact
 If suitable, allocated for FACE assessments, OT assessments
(including moving and handling), carer’s assessment
 Eligibility criteria for services, develop support plan in conjunction
with service-user, informal carer, other stakeholders
 Support plan is implemented, monitored and reviewed after 4-6
weeks
 Transferred to support plan review tray for ongoing review (our
statutory obligation
5

6. Our Business - Reviews
 Responsible for review and ongoing care management &
now moving and handling of cases
 Includes: regular monitoring, reviewing, re-assessment of
cases that are open to the team
 Community teams receive cases from the Hospital care
management teams and DART teams for reviews and
thereafter annual reviews
 Duty workers deal with cases that need intervention prior
to next review date i.e. where not currently allocated
 Transferred back to reviewing system after 6 month or
annual review has been completed
6

7. 7
High Quality
Services
• Supportive care combines: Art, Ethics and Science
Case study: A Review of the Provision of End of Life Care
Services in Herefordshire Primary Care Trust 2008.
http://www.nao.org.uk/wp-
content/uploads/2008/11/07081043_Herefordshire.pdf
(date accessed 1st March 2015).

8. 8
Lutons vision?
 Strengths – Organisational
Development Planning
 Relationships with opinion formers
(e.g. GP consortia and HOSC’s)
 Beacon of practice - excellence
 Beacon of hope – community
 Innovative practice : “Finding Space”

9. 9
Engagement?
 Effects of change requires bringing
people along the journey
Team, colleagues
Senior management team
Stakeholders and partners
Councillors, Directors, Board,
Trustees, Donors
National Professional networks -
Palliative and Cancer

10. 10
How would you achieve
such a vision?
 Rich community engagement
experience
 Supervision and performance
management, including CPD
 Balance - Strategic and Operational
obligations
 Promoting a working climate of
warmth, empathy and ambition

11. 11
Our Journey 2015 - 2016
 SWOT analysis
 Strengths – relationships, resilience
reputation
 Weakness - Economic climate
 Opportunities – achieved through
good communication , tendering
process
 Threats – Competing resources

12. 12
Our Journey 2015 - 2016
 PEST analysis
 Political – Local and Coalition government
expectations, Parliamentary working parties
 Economic – National deficit, limited
disposable income, investment capability
 Social – Changes in demographic profile
 Technological – Medication developments,
tools to aid staff in the work environment

13. 13
Business Case & Business
Planning
 Positioning ourselves - More coordinated
outreach
 Personalisation Agenda
 Abolition of Primary Care Trusts in 2012
 GP consortia – commissioning bids
 Social Enterprise funding
 Framework agreements with other core
providers (e.g. Housing, Millbrook
Healthcare, NHS, Home care providers).
 Telecare and Telemedicine
 CHC funding (fastrack applications)

14. 14
Thank You
Questions