Patsy Gibson End of Life Care Facilitator Neil Hooley Home Manager, Burrswood Nursing Home

1. Developing Engagement & Partnership WorkingCommunity Services BuryEnd of Life Care in Nursing Homes Pilot Project Patsy Gibson End of Life Care Facilitator Neil Hooley Home Manager, Burrswood Nursing Home Lynn Hopwood Specialist Palliative Care Nurse Tinna Quinn Programme Manager – Clinical Services 29th June 2011

2. Background - PRIDE (Personal, Respect, Inclusion, Dignity and Experience) work undertaken within Bury The Project - looked at the workforce skills and capabilities required to deliver quality services for residents at the end of their life focusing on the whole workforce in the selected nursing homes Engagement – Stakeholder event, nursing home selection process, regular group and individual meetings with staff and home managers Governance – Project metrics developed, Operational Steering and Nursing Home Working Group established. Communication plan & clear reporting lines defined Competencies – identified using the Skills for Health Competency Tool Kit – Health Functional Map. Skills gap analysis, training needs analysis conducted & staff surveyed via competence & confidence questionnaires Training – Comprehensive training plan developed and delivered Evaluation – Metrics revisited and contrasted with baseline data, Confidence and Competency questionnaires repeated and compared Conclusions & Lessons Learned – were identified and included in the End of Project report

3. Community Services Bury were keen to engage with a range of care home providers. • Following the stakeholder event 6 Nursing Homes were interviewed and 4 were selected: • Burrswood a large 120 bedded nursing and residential home part of the BUPA organisation • Cameron House a smaller 40 bedded nursing home part of the Four Seasons Group • Nazareth House an independent 56 bedded nursing home (who subsequently withdrew) • Rose Court a medium sized 90 bedded nursing and residential home part of the Southern Cross Organisation • Engagement with all levels of staff was achieved initially via promotional events and via the training sessions held at the individual nursing homes • The inclusion of all staff groups in completing self evaluation questionnaires regarding competence and confidence levels ensured engagement across the disciplines • Group and individual meetings were held with staff and the home managers at each of the nursing homes

4. A training programme was developed to meet the needs identified from the skills gap, training needs analysis & self assessment questionnaires • Process mapping with the staff from each of the nursing homes highlighted key areas for development • The knowledge, skills and experience of the Specialist Palliative Care team were utilised to develop the training programme • The proposed training programme was then mapped against the competencies identified and agreed from the Skills for Health - Health Functional Map • The training programme consisted of 7 workshop sessions which were replicated and repeated at each nursing home over a number of sessions; • Introduction to Palliative Care • Communication skills • Symptom Control (Pain) • Symptom Control (other symptoms) • Oncological Emergencies and Oral Care • Recognising Dying and Syringe Driver Awareness • Death and Bereavement

5. The national target for end of life care is to achieve a 10% reduction in inappropriate hospital deaths The approximate cost of a hospital admission at the end of life equates to approximately £3,370 per admission Previous work within Community Services Bury using the Gold Standard Framework (GSF) training programme has demonstrated a potential saving of approximately £40K to £80K saving per nursing home over a 3 month period Extrapolating from the demonstrated GSF savings, an assumption could be made that there is a potential to also achieve significant cost savings from this pilot project. Recent repeated project metrics evidenced that more patients are dying in their preferred place of care in their nursing home thereby reducing inappropriate hospital admissions Evaluation of the competency and confidence questionnaires repeated one month after training demonstrated increased levels of competencies and confidence of nursing home staff it is envisaged this will translate into improved quality of palliative care for residents

6. Quotes from nursing home staff regarding the training they received “I benefitted by having more confidence in supporting relatives, colleagues, family members and other residents” “The training helped me because I am now confident to help those who are going through the process” “The training put me more at ease with the whole situation” “I found the training very interesting & have learnt a great deal as it was simplified I didn’t feel that it was daunting, I would recommend the training” I have benefited by an “improved knowledge and insight into end of life care”