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)