Agenda item

1.1.        The Committee considered a report on the progress of East Sussex Healthcare NHS Trust (ESHT) End of Life Care (EOLC) project.

1.2.        Catherine Ashton, Director of Strategy, and Hazel Tonge, Deputy Director of Nursing, both from ESHT, answered questions from HOSC Members.

New EOLC team structure

1.3.        Hazel Tonge explained that the new EOLC team structure – including the Senior Nurse who will coordinate and oversee the EOLC service across both hospital sites – came together in May and is currently focussed on making sure the right governance arrangements are in place to ensure both the Conquest Hospital and Eastbourne District General Hospital (EDGH) team work to the same standards. There is currently not enough available data to demonstrate success of the new arrangement, but in two months’ time there should be. The two teams have, however, said that they are now functioning as one team, have access to the same specialist support, and are supporting each other.

1.4.        Hazel Tonge explained that EOLC Practice Development Facilitators have trained 1,065 acute ward staff on the new Individualised Care Plan. A patient’s individualised care plan includes symptom controls and their preferred plan for death, and also includes where to refer them within the healthcare system.

Culture and leadership

1.5.        Hazel Tonge explained that staff have told her that there is a very different culture in the organisation than there was two years ago. Staff now feel secure enough to seek support and raise concerns – for example, through weekly nurse meeting groups – or access counselling should they require it. The NHS Staff Survey results reflect this observation.

Extending the service to 24/7

1.6.        Hazel Tonge said that she has written a draft options paper for the ESHT Board to consider setting out the advantages and disadvantages of maintaining a 5 day service or moving to a 7 day one.  The Trust Board will consider it during July and decide on the necessary financial support.

Identifying patients in the last year of their life

1.7.        Hazel Tonge said that ESHT’s priority currently is to identify those patients in the last days of their life. The EOLC teams are working with non-palliative teams, such as cardiology and gastroenterology, but the process is not yet complete. There is an awareness and engagement workstream in place to raise clinicians’ awareness of palliative care, but raising awareness is a nationwide challenge – which is why so much national guidance is written on the subject.

1.8.        Jessica Britton said that the ESBT Alliance is developing an EOLC Strategy. This involves ESHT working with CCGs to develop a system where staff from primary, community and acute care can share information about patients who are in the last year of their life, with their consent. The EOLC Strategy will also develop awareness raising programmes and training courses to assist clinicians to identify those patients in the last year of their life. Further details of the strategy are likely to be available by next year.

1.9.        Catherine Ashton said that ensuring patients’ EOLC needs are tracked is a key part of the ESBT Alliance’s EOLC Strategy. The purpose is to avoid having to provide reactive hospital care, and to ensure that when a patient visits hospital they have a GP’s care plan in place that has been worked through with them and is easily accessible to hospital staff.

1.10.      Hazel Tonge added that a case manager is assigned to patients who are identified as requiring long term health or social care. The case manager supports them to maintain wellness by making sure the appropriate health and social care workers are informed about the patient’s needs and this should include palliative care needs.

Involvement of chaplaincies and hospices

1.11.      Part of the EOLC service’s five year strategy involves bringing together all sectors – CCGs, carers, chaplaincy service, voluntary sector, and hospices – to support people with palliative care. ESHT now has formal arrangements in place with both hospices in East Sussex, for example, as part of the EOLC service’s new “one team” approach, the Consultant in Specialist Palliative Care is providing two morning or afternoon sessions per week to develop care standards and training at the hospices.

1.12.      Hazel Tonge agreed that the chaplaincy service is important for providing spiritual support to patients – including to those who are not religious. There are both paid and voluntary chaplains operating in ESHT. The chaplains need to know which patients in the Trust are identified as being EOLC patients and are provided with a list of patients that they can visit and see whether they want spiritual support.  They also provide support beyond EOLC for carers and relatives of deceased patients.

Ensuring consistency of EOLC care

1.13.      Catherine Ashton explained that it is difficult issue to ensure a named member of staff provides EOLC due to the difficulty in predicting when palliative care is required. There is, however, a recognition that the Palliative Care teams need to ensure that the handover information about patients within the teams needs to be really thorough. This will result in a team of people who know the palliative care needs of a group of patients and so will all know who it is they are seeing and what their needs are. 

Living wills

1.14.      Hazel Tonge explained that ESHT has an advance care planning system in place that includes discussing living wills with patients. This has received positive feedback from families.

1.15.      Hazel Tonge added that it depends how the patient presents on admission whether or not they will be asked if they have an advance care plan. Usually patients will present at a hospital with an acute condition and treating that is the clinicians’ priority. However, some patients, or their families, will proactively identify that they have an advance care plan in place, and in those situations the clinician may ask about a living will.

1.16.      Hazel Tonge advised HOSC that there is a public event in July that will ask people for feedback about advance care planning and living wills.  Jessica Britton added that the CCGs have not done specific engagement work on living wills, but will work with colleagues from provider organisations to raise the profile of them in the future. Living wills are gaining a high profile nationally, with more national guidance including reference to them.

Referral flow chart

1.17.      Hazel Tonge confirmed that the referral flow chart for ward staff should be shared with patients, but she could not guarantee all patients see it, as it is not something that she audited.

EOLC plans in the C4Y area

1.18.      Ashley Scarff said that Sussex Community NHS Foundation Trust (SCFT) is the provider of community services in the HWLH area and it has in place a well regarded EOLC pathway.

1.19.      He said that developing the ability for organisations to share care records is particularly important to improving EOLC as it will allow organisations to access to patient information in a sensible and reasonable manner.

1.20.      He added that a system-wide piece of work to improve support for families and carers beyond the death of their loved one is also very important, been raised at broader engagement events held by HWLH CCG.  He said that there is a risk that a carer may suppress their own health and social care needs to look after a dying loved one, so it is important that health and social care systems are in place to support them after the death of the patient.

1.21.      The Committee RESOLVED to:

1) note the report;

2) request a future update at the March 2018 meeting;

3) request confirmation by email about how widely referral flow charts are shared with patients; and

4) request that the audit against NICE QS 144: Care of dying adults in the last days of life is provided by email.