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PALLIATIVE CARE SERVICES

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PALLIATIVE CARE SERVICES

THE NORTHERN IRELAND PERSPECTIVE


Palliative Care

The active total care of patients whose disease is not responsive to curative treatments. Control of pain and other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of treatment is quality of life

WHO 1990


  • Principles of Palliative Care

  • Affirms life and regards dying as a normal process

  • Neither hastens nor postpones death

  • Provides relief from pain and other distressing symptoms

  • Integrates the psychological and spiritual aspects of care

  • Offers a support system to help patients live as actively as

  • possible until death

  • Offers a support system to help the family cope during

  • the patients illness and in their own bereavement.

  • WHO 1990


Palliative Care

“Many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with anti-cancer treatments”

WHO 1990


LEVELS OF PALLIATIVE CARE

  • General Palliative Care ( Generic Teams,Primary Care Teams )

  • Specialist Palliative Care Teams ( provided by multi-professional Teams who have undergone specialist training and whose main area of practice is Palliative Care.


  • PALLIATIVE CARE

  • “Provision of palliative care services to all who need them regardless of diagnosis”

  • Standing Medical Advisory Committee 1992

  • NHS Executive E L (96) 85


National Services Frameworks

Cancer

Coronary Heart Disease (including Heart Failure)

Older People

Should have access to Palliative Care appropriate to their needs


Calman – Hine (NHS Cancer Plan) Report 1995

Campbell Report 1996

HSS Boards Cancer Strategy Reports

Palliative Care Sub-Groups

Regional Advisory Committee on Cancer (RACC)

Regional Review of Palliative Care Partnerships in Caring /Standards

DHSSPS group implementation ofPartnerships in Caring

DHSSPS/NCHSPCS standards & guidelines group

DEVELOPMENT OF SERVICES


N. Ireland Specialist Palliative Care Services (1.5m) (Red dot indicates Hospices)


Specialist Palliative Care Services (Yellow dot indicates hospital palliative care teams)


Specialist Palliative Care Services (Shaded areas show community palliative care teams )


Best Practice Guidelines

  • Control of pain in patients with cancer

    SIGN Guidelines 2000

  • Changing Gear: Guidelines for managing the last days of life

    National Hospice Council 1997

  • Integrated Care Pathway for the Dying

    Ellershaw 1997


10 (+2)Consultants

4 Trainee Doctors

46 Specialist Nurses

61(80) Hospice Beds

1 Cancer Centre / 4 Unit PCT

11 Community Teams

6 Day Hospice Facilities

4 Bereavement Services

1Paediatric palliative care team (Regional)

Paediatric Hospice Service

PROVIDERS

N Ireland Hospice Care

Marie Curie Cancer Care

Macmillan (Cancer) Relief

The Foyle Hospice

Southern Area Hospice Services

Partnerships in Caring


Undergrad. medical

Undergrad. nursing

Postgrad. medical

Postgrad. nursing

Postgrad. multi-professional

Specialist Medical Training

Queens Belfast (QUB)

University Ulster(UU)&QUB

Hospital& Community

UU &QUB

Hospital& Community UU/Hospice/MCCC

4year specialist programme (RCP/JCHMT & APM)

Education


Training for consultants in Palliative Medicine

  • Entry criteria MRCP,MRCGP,FFA,FFR

  • Numbered training posts (SpR)

  • Training curriculum APM, JCHMT

  • 4 year rotation

  • Palliative Medicine,GIM,Oncology Research ,HIV/AIDs ,Elective modules

  • Assessment & Appraisal

  • Accreditation ,(STA)


Research

  • U U & NI Hospice Care (Dyspnoea)

  • UU & Cancer Unit (Altnagelvin HSS Trust)(Syringe driver use)

  • Marie Curie Belfast /RCSI Dublin (QoL)

  • UU (Masters &PhD in nursing research in palliative care)

  • Cancer Center/UU (Distress in cancer patients)

  • Cancer Center/Consortium (Fatigue Study)

  • Multi-center trials (Ketamine, Cannabis)

  • Resources

  • Ethical issues & high attrition rates


N.I links with National Groups

  • Association for Palliative Medicine of Great Britain and Ireland

  • Irish Association of Palliative Care

  • National Council for Hospice and Specialist Palliative Care Services

  • N. Ireland Ethics Forum

  • Royal College of Nursing Palliative Care Forum


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