Improving End of Life Care in Leeds

1. Improving End of Life Care in Leeds 15th June 2009 Angela Gregson Practice and Professional Development Lead Palliative and Continuing Care

2. Background • March 2006 - Marie Curie Delivering Choice Programme • October 2006 – merger of previous 5 PCTs to become 1 – Leeds PCT • 2006 - Review of Continuing Care Provision citywide

3. Service Delivery Framework Development Why? Required to address gaps/inconsistencies across the city Recommendation from review of Continuing Care Need to put DNs back at the centre of care delivery – key worker role. Review of DN service – “Moving Forward”

4. Service Delivery Framework Development How? Engage key stakeholders March/May 2007 - two workshops held – cross city/discipline representation Draft framework developed – presented to critical friends July 2007 – education planned Nov/Dec 2007 – mandatory training delivered January 2008 – SDF launched

5. Complex and Palliative Continuing Care Service(CAPCCS) One of the outcomes of the workshops held to discuss Palliative Care and service delivery Steering group formalised Structure of new citywide service determined Sept 07 Merger of District Nurse Relief and Support Team(NW) and ELIPSC(East) Oct 07 Recruitment Process Nov 07 CAPCCs to begin operationally Jan 2008

6. CAPCCSReferral Criteria ELIGIBILITY CRITERIA CAPCCS will accept individuals based on the following eligibility criteria: Aged over 18 years Registered with a Leeds GP Meet continuing care criteria for fast track status Have an individual business case written and agreed for on-going complex continuing care need under the care of the District nursing service

7. Partnership workingPalliative Care - Case History 1 Tuesday - Very ill patient in hospital wishes to come home to die Ward contacted CAPCCS and care planning meeting arranged Wednesday – Meeting with ward staff, Social Worker, District Nurse, CAPCCS Senior Nurse, patient and daughter. Marie Curie Ambulance booked, Meet & Greet booked, DN/CAPCCS visits arranged Thursday – Patient discharged home and spent 2 ‘precious’ days with her family before she died peacefully.

8. CAPCCSComplex Care - Case History 2 Patient with complex continuing care needs in hospital for 2 years Wishes to be looked after at home Working Group set up & Business case prepared Framework developed & robust Governance arrangements Team of carers appointed Patient now home with family

9. CAPCCSBenefits / Acheivements Enhance District Nursing Service to ensure service sustainability Facilitate patient choice Prevention of Hospital admissions for complex and palliative care patients Facilitate timely patient discharge Patient with complex needs looked after at home Create a supportive environment for patients and care providers Ensure quality, safety, compassion and efficiency at all times

10. Improving access to Palliative Care within BME communities NHS Leeds BME Network Network was established in March 2004 Made up with BME staff working at all levels within the PCT and the Acute Trust

11. BME Network Vision BME Network Awareness of cultural diversity Empowering staff Sensitive to patients needs Patient focused care

12. Improving access to Palliative Care within BME communities Identified within Phase 1 of MCDC programme as an issue in Leeds Established as one of the workstreams of the programme Link worker appointed October 2007 Reference groups established in LS 11 and LS7 Workshops and events Mainstreamed into Patient and Public involvement

13. The future Further embedding of Service Delivery Framework Development of CAPCCS Verification of expected death DNAR/FAST Track sign off by RNs Increased uptake from within BME communities of palliative care services

14. Outcomes Equity across patient population of Leeds in terms of palliative care delivery Patients able to die in their Preferred Place of Care

15. Discussion Any questions?

16. Thank you for listening! Contact: Angela Gregson angela.gregson@nhs.net 07985 749446