Agenda item

The Board at its meeting in November 2013 resolved to receive a report on the development of an End of Life Care Strategy noting that a working group of the CCG were currently undertaking an exercise to develop the same.

As the group continued to undertake work in its development at the time of the March meeting, Deborah Fielding, Chief Officer Clinical Commissioning Group, and Dr Helen Osborn, Lead GP, will present a report to this meeting.

Dr Helen Osborn as Lead GP on the End of Life Care Strategy provided an update on its development and the End of Life Care Programme which included details on the rationale behind the need for a strategy.  70% to 80% of patients in Wiltshire currently died within a hospital setting rather than their preferred choice of home and there was a desire to reduce the number in line with patients wishes. 

Following the development of the End of Life Care Strategy an End of Life Care Programme Board had been established to help with its development and delivery.  This Board had met twice this year and initial work streams identified included:

·         CHC fast track process review

·         Electronic Palliative Care Co-ordination system (EPaCCs)

·         Allowing a Natural Death (Treatment Escalation Plan and DNACPR2)

·         User experience, baseline and monitoring

·         Needs Assessment

·         Current service mapping and baseline

·         Care at Home

·         Education

As further work was continuing on the development of the work streams it was proposed that the Board may wish to receive a further update in November when further detail would be available.

Liz Brown, Chief Executive Dorothy House, was in attendance and was invited to speak on the item where confirmation was given that hospices had been involved in the review and development of the strategy presented today.

The Chairman of the Board expressed the importance of ensuring a robust strategy with a clear programme on how all partners were working together to meet the needs of the individual.

Attention was drawn to the End of Life Care pathway of six steps that underpinned the strategies, these were:

·         Discussions as the end of life approaches

·         Assessment, care planning and review

·         Coordination of care

·         Delivery of high quality services in different settings

·         Care in the last days of life

·         Care after death

In noting the positive steps planned to ensure the needs of the individual were met, the attending Chief Executive from Dorothy House also emphasised the need for sufficient shift of resources to deliver support within the community. 

To provide the Board with a clearer understanding of the process in action it was proposed that patient scenarios should be provided in future updates as well as a draft implementation plan.  Both of these actions would give the Board confidence that the Strategy met the needs of the individual and provided a clear system for the individual to follow.

In discussing required resources, reference was made to carer support in some outerlying areas of the County which had in the past proven difficult to resource. Reference was also made to the need for a 24/7 crisis team for patients and their carers noting that the ambulance service was relied upon in many instances at the time of crisis.  This emphasised the need for access to patient records out of hours to ensure the wishes of patients were followed.

The Companion Volunteer Scheme was referenced as a pilot scheme funded by the CCG to provide support which could be utilised in this area.  Specially trained volunteers were able to working alongside the hospice to provide additional support for families and patients and alleviate pressures on the system.

Acute hospitals were supportive of this approach with Salisbury Hospital offering any support required, noting the benefits to those at end of life.

The Board requested that the comments made should be taken into consideration and that a detailed implementation plan as well as a further update should be provided.

The Board agreed to receive an update on End of Life Care at its next meeting in September and that a further update, together with detailed draft Implementation Plan, would be presented in November.