Agenda item

[To consider the end of life strategy update report and offer comments,]

Clair Hobbs, Senior Matron – Adult Community Services Group (RWT), introduced the End of Life Strategy Update Report. She explained how the strategy is based on national guidance about how to care for people during their last days of life, and that Trust’s model is based on best practice from another trust. A new document launched on 24 April 2015 outlines the Trust’s priorities and is being implemented at some Trust sites, such as Compton Hospice. This document will be audited in the next few months to assess how the Trust can improve and build upon their progress in the area. The Trust has also created a best practice steering group.

The vision of the strategy is to meet the needs of a dying person holistically. By involving individual and relatives in a care plan, the Trust facilitates the needs and preferences of a dying patient. This can include accommodating spiritual and religious customs, spending time with loved ones, and making special arrangements for the patient’s pet to visit them in care. An internet page provides staff with information about these measures. Monthly training is also provided and over 500 employees have already completed the course. This has informed staff about the new care philosophy of tailored care. The Trust aims to implement a gold standards framework for end of life care to ensure people are able to choose where they die. It will do this by identifying patients at a palliative stage of care and proactively put measures in place to ensure they are able to choose how they are cared for.

Susan Seymour, Advanced Nurse Practitioner, presented the panel examples of resource boxes that are used to return patient possessions to a bereaved family. She explained how these resource boxes were a more personalised and sensitive gesture. She added that the hospital aims to accommodate the wishes of the family after bereavement, and that a discrete swan symbol informs staff that the patient is in end of life care. Departmental Swan Champions support the philosophy of this project and have been making arrangements for families to park at reduced rates when visiting relatives.

Cllr O’Neill queried how this service linked with patient complaints, noting that there could sometimes a desire to blame someone or something after bereavement. A patient liaison service processes such complaints currently, but an end of life steering group will monitor this in future. The group has designed a bereavement survey for relatives to evaluate quality of care and their experiences. The Trust is also voluntarily participating in the national end of life care audit. Cllr O’ Neill also queried where the national end of life audit report could be accessed. The Advanced Nurse Practitioner explained the Trust is currently submitting raw data for this year’s report, which won’t be available until January 2016. She added that previous years’ reports are available to access online.

Cllr O’Neill also commented on the financial implications of expanding the end of care team. Claire Skidmore, Chief Finance Officer at Wolverhampton Clinical Commission Group (WCCG), explained that the CCG commissions a Home In Reach Team and is aiming to extend the contract because they recognise the value of it. The Senior Matron confirmed this.

Cllr Collingswood commented on the sensitivity of the report and noted that there is an issue relating to people wanting to die at home, but being unable to. The Senior Matron explained that that the gold standards framework will see the Trust being more proactive in future when identifying patients. The framework will be implemented in the community with a view to liaising more closely with GPs and health professionals to identify patients in need of care.

Cllr Simkins enquired about the involvement of the Council’s Bereavement Services Team in supporting the strategy. He suggested that the Council’s input may help streamline the process for bereaved families, noting that administration is often a lesser concern for grieving families. The Senior Matron noted that this is not currently considered a problem as the swan resource pack provides clear information for families about what they should do after a relative has died. She did however welcome the input of the Council at the next steering group meeting.

Cllr Simkins also queried the procedure for discharges that enable patients to die in their own homes. The Advanced Care Practitioner explained that if people want to die in their homes they can be discharged within 24 hours; social services are not required to be involved if it is clear the person has a short amount of time left to live. She acknowledged there were greater challenges liaising with social services when it the condition of a patient was less clear. In such circumstances, staff can access information on the Trust’s intranet, which explains relevant procedures to discharge a patient.

Cllr Simkins made a final comment about whether people are directed towards charitable funding by the Trust. The Senior Matron commented that community matrons share information about how charities can help families, but that she would raise this issue again with the steering group.

Cllr Bagri commented on how there was a need to be spiritually and religiously sensitive to people’s need, citing the Sikh and Muslim faith as examples. The Senior Matron explained that personalised care profiles will allow patients to specify these kinds of requirements. She added that a multi-faith chaplaincy is involved in steering group and would support Cllr Bagri’s requests.

Ros Jervis, Service Director for Public Health praised the work of the report authors, but noted the immense challenge of identifying people in need of end of life care; she noted that this was a precursor to all the work the Trust has implemented. She added that it was important that a range of medical professionals (GPs, primary care physicians, consultants, inpatient teams, diagnostic service) should be able to feed into end of life team as this will support delivery of care. The Advanced Care Practitioner agreed and noted that the Trust’s aim is for the gold standards framework to grow into the model suggested.

Resolved:

1)    That a council bereavement officer attends the next end of life steering group meeting to discuss partnership working.

2)    That the Trust demonstrates a broader range of health bodies being involved in the gold standard framework used to identify patients in palliative care.