Nottinghamshire End of Life Care Newsletter

1. Nottinghamshire End of Life Care Newsletter Celebrating living and dying well • Review of the Liverpool Care Pathway (LCP) • In July 2013, the Independent Review of the Liverpool Care Pathway published its report ‘More Care, Less Pathway”. In response to its recommendations, the Leadership Alliance for the Care of Dying People was set up to lead and provide a focus for improving the care for this group of people and their families. Another recommendation was to set up public engagement events, one of which Steph & Elise attended in November 2013. • We were asked questions about the engagement document and the proposal to develop personal palliative care plans. There was a lot of debate about: • These plans being similar to advance care planning documents but there would also be a section on the last few days of life. But ACP already exist so is this a repetition of documents or should they have a completely new document that covers the whole of the period from diagnosis to death? • the cost implications for the development, launch, resources or education linked to a new document • ownership of the document (would it be patient held?) and the issue of accessibility of information/sharing of information. • the need for clear guidance to support staff who are not familiar with palliative care, rather than relying on the knowledge of the clinician alone • the “senior responsible clinician” is mentioned throughout the guidance (GP or consultant) and this left a question regarding the role of senior/specialist nurses. • the ability/willingness of some senior clinicians to recognise when someone was dying/was for palliative care, and how this could impact on the introduction/use of the new document. Dec 2013 • In summary, the review body stated that: • A personalised palliative care plan (whatever they finally call it) should be offered to patients. • Care should be aimed at achieving a set of outcomes. • The 10 outcomes would be supported by a set of principles. • There was a need for ownership/buy in from a senior level. • We think that it is important that you share your views considering how best the health and social sector can address the recommendations in the review about the accountability and responsibility of individual clinicians, out of hours decisions, nutrition and hydration and communication with the patient and their relatives or carers. Please complete the short survey via this link: https://www.engage.england.nhs.uk/consultation/care-dying-ppl-engage • You can find the report “More Care, Less Pathway” by clicking on: • https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/212450/Liverpool_Care_Pathway.pdf)

2. Celebrating living and dying well Notts GSF Cross Boundary Care Project As a result of our multidisciplinary approach to providing excellent end of life care cross health and social care, Nottinghamshire has been selected as 1 of 3 pilot sites for the Gold Standards Framework (GSF) Cross Boundary Project. Halima Wilson at Nottinghamshire County Council (care homes, homecare services and ASCHPP staff) is working collaboratively with Dr Julie Barker from the Newark and Sherwood CCG (GP practices) to ensure that end of life care is being delivered seamlessly and effectively across the community, care homes, hospitals and hospices. This will help avoid unnecessary hospital admissions and support the service user wishes and choices. The pilot is initially in the Newark and Sherwood CCG but it is hoped that it will be rolled out to the other 5 CCGs in Nottinghamshire. More Nottinghamshire Care Homes get GSF Accreditation! Congratulations to 3 more homes who recently attended the GSF conference in London to collect their GSF awards. Derbyshire House - Commend Highfields - Pass Wren Hall - Beacon Three more homes will go for accreditation in March 2014. We wish them luck. GSF Foundation Level for care homes The 38 care homes on this programme are making good progress in implementing good EOL practices in their organisations. The final half day of this course is on 11th February 1.00 to 4.30pm at Trent Vineyard. See you there! We are hoping to run another GSF Foundation level for care homes programme in 2014, so if you are interested in this course please contact me! Wren Hall getting their GSF award If you need any help with the Foundation course or in getting ready for full GSF accreditation please contact Halima Wilson on halima.wilson@nottscc.gov.uk We are designing an EOL training course for homecare providers which we hope to deliver in 2014

3. Celebrating living and dying well EOL Champions doing a “Champion Role” The EOL Champions are still very busy in their roles. Some of the Champions are helping colleagues in other care homes to attain GSF accreditation by allowing them to visit their homes and look at their portfolios. Managers have informed us that this has been of great help. Notts Dementia Update • Dementia Friends A number of people have completed the 1 day Dementia Friends Champions course. They will be delivering 1 hour Dementia Friends information sessions. Look at www.dementiafriends.org.uk for more information about this initiative • Well done to the 32 care homes who have been awarded the Dementia Quality Mark in Nottinghamshire. Hayley Spencer at Broadlands Care Home has told us about her experience please see: • http://www.nottinghamshire.gov.uk/living/business/supporting-social-care-businesses/npscwd/news-and-current-events/latestnews/?blogpost=2170 • One of the EOL Champions has recommended the Memory Bridge website http://memorybridge.org/as a really good resource for staff training and development. • The College of Occupational Therapists have launched an online toolkit to enable care homes to continue with activities. The resources are on: www.cot.co.uk/living-well-care-homes Dates for your diary Dignity in Action Day on is 1st February 2014. Get planning your actions – you can get ideas from http://www.dignityincare.org.uk Improving end of life care for people with a learning disability, +a multi-disciplinary workshop on Wed 5th February 2014 at Mansfield Towers. Improving EOL care for people with dementia is on 18th March 204 at the Richard Herrod Centre in Carlton Contact istraining@nottscc.gov.uk to book your place. Come and try out some activities that you can do in your care setting at our “Activities for Older People to promote healthy lives” - great activities to try out in your care home” Day on Friday 7th Feb 2014 at Mansfield Civic Centre. More details to follow soon. “’Dying Matters :You only die once’ -12th-18th May 2014. They have an event launch in London Jan 13th –offering practical support. www.dyingmatters.org.uk Congratulations to Elise Adam, EOL trainer who has passed  her MSc in Health & Social Care (Palliative and Eolc)

4. Celebrating living and dying well Support Care Clinic a success Lil Coleman is a Community Staff Nurse in the Integrated Team in the Hucknall and Eastwood area. She is the Palliative Link Nurse for the Hucknall team and is very proactive in this role. Lil realised there was gap in the service for palliative patients who were newly diagnosed or at early stages of their illness who sometimes did not want to wait in for the District Nurse to visit them at home or want neighbours seeing the nurses at their home and asking questions. Lil felt it was important to contact patients as early as possible to try and avoid crisis referrals at end stage, which often happens in the District Nurse Service, and started to think how this could be addressed. Lil and her team thought of ways to address this gap and it was decided to trial a Support Care Clinic in Hucknall for palliative patients who were not housebound but may need these services. Lil arranged a room for the clinic in Hucknall Health Centre and advised GPs of the new service and how to refer to the clinic. All new palliative referrals that came into the service were reviewed and the relevant ones contacted to see if they would like to attend the clinic. Lil runs her clinic on alternate Tuesday mornings and this has proved popular with patients who feel they need support but only on an adhoc basis. Patients can be seen as they feel the need, can bring a carer with them if they want to and bereavement support can be offered to carers at a later stage if necessary. This builds early relationships with both patient and the carer which appears to make it easier when end of life care is required at home. These patients have the same documentation as home visits so when they become more poorly and require home visits their notes are just transferred to the District Nurse team avoiding any duplication, have more history on the patients and carers from an early stage and also avoids difficult questions if they already know the teams. This trial was deemed successful and Lil has now been running this clinic for almost two years, with some excellent feedback from patients and carers. End of Life Care Update from Dr Julie Barker (Newark and Sherwood CCG) We are updating our EOL strategy to take into account our integrated care for long term conditions work. There is a more pro-active focus on self care and care planning including earlier advance care planning.   We have re-launched the Pathfinder central register held by CNCS with a dedicated Palliative Care telephone line and cards to give to patients similar to the 'Gold Card‘ used in other areas. We have now been given the go-ahead for the GSF XBC workshop on 12th Feb.  We are having an in-depth 'summit' with Mansfield and Ashfield CCG looking at the challenges highlighted by the Mid-Notts Mortality Report. Finally we have 2 GP Macmillan post as of September 2013  - Myself for 'Learning and Development' and Dr Thilan Bartholomeuz for pathway Redesign. Have your say Have you got any interesting news items that we can publish? Please send them to halima.wilson@nottscc.gov.uk