East Sussex Older Peoples' Residential & Nursing Care - Provider Forum 22 nd May 2012

1. EastSussex East Sussex Older Peoples' Residential & Nursing Care - Provider Forum22ndMay 2012 Kay Muir, East Sussex PCTs /CCGs Programme Lead for EOLC Sophie Clark, Older Peoples Strategic Commissioning Manager, East Sussex County Council

2. What we will cover today The big picture – nationally and locally The training and support available Overview of EOLC Care Home in reach service piloted in 2011/12 Findings ASC e-learning pilot 2011/12 The benefits and rewards Next steps Questions EastSussex

3. Where we are now National and local drivers for change National strategies to support improved EOLC Rising needs and expectations Integration between health and social care Regulatory requirements and quality standards An identified need for training and support Workforce development plans Resources for workforce development A joint approach to workforce and end of life care in East Sussex EastSussex

4. The End Of Life Clinical Pathway Coordination of Care for the patient • Coordination of individual patient care • Register-information shared across all sectors Delivering high quality care Assessment and care planning • • High quality care • provision in all settings • • Rapid response services • • Hospital, community, care • homes, hospices, community • hospitals, prison, secure hospitals • and hostels • • Ambulance • Services • All OOH services • • Spiritual care Last days of life Care after death Starting the conversation • Identification of the dying phase • Review of needs and preferences for place of death • Support for both patient and carer • Recognition of wishes regarding resuscitation and organ donation • Timely verification and certification of death • Viewing of the body/mortuary facilities • Return of property • Care and support of carer and Family • Assessment and regular review of patients’ needs • Care planning • Assessing carers needs • Open, honest • communication • • Identifying triggers • for discussion • • Listening to cues • from patients Coordination of Care for carers

5. EastSussex National EOLC Core Competencies “Developing End of life Care Practice: A guide to workforce development to support social care and health workers to apply the common core principles and competencies for EOLC” 2012 A framework of competences, values & knowledge • Communication skills • Assessment and care planning • Advance care planning • Symptom management: maintaining comfort and wellbeing • Overarching knowledge and values http://www.endoflifecareforadults.nhs.uk/publications/corecompetncesguide

6. EastSussex EOLC National Occupational Standards A framework of National Occupational Standards 2009 to support common core competences and principles for health and social care workers working with adults at the end oflife Web:http://www.endoflifecareforadults.nhs.uk/publications/corecompetencesframework

7. Where we want to be - routes to success … More patients having a “good death” in their preferred place of care Fewer complaints about end of life care from relatives or friends An improved reputation for the provider Fewer unplanned hospital admissions A skilled workforce with improved morale and retention EastSussex

8. EastSussex East Sussex End of Life Care Home Pilot Quality - high quality service to identify people at the end of their life and support them to be cared for and die in their preferred place of care Innovation - Piloting initiative at a local level Productivity - reduction in inappropriate admission to hospital Performance - evidence of people being cared for and dying in their preferred place of care - monitoring though activity and costs data e.g. “Death in Usual Place of Care indicator”

9. EastSussex EOLC Care Home Support Pilot Project • What the project involved • Two multi-disciplinary EOLC support teams, provided across East Sussex by St Michael’s and St Wilfrid's Hospices, with the overall aim of supporting EOLC within care homes, to reduce avoidable EOLC hospital admissions and to enable residents to be cared for in their preferred place of care. • Year 1 project summary • 20 Care Home , 11 are residential and 9 nursing homes with a combined 714 residents. These Homes were identified as having a high number of emergency admissions to hospital using urgent care data. • Progress to date • The EOLC Care Home support has been very well received in the community setting by the Care Homes involved . • Baseline assessments were been completed and an action plan including training for each home was agreed to meet the care home identified needs. • Training package for each of the care home commenced in September 2011 to Feb. 2012. The outcomes of the training and comparison against baseline activity and behaviours are being completed, • Plans for 2012/2013 • Project extended to inform health and social care commissioning in the future • Lot of learning about selection of care homes for 2nd year • Dissemination of year 1 outcomes and recommendations to inform commissioning intentions for 2013/14 • Longer term aim for joint health and social care facilitator roles to support homes

10. EastSussex St Michaels’s Hospice- Summary of the 10 Pilot Care Homes EOLC Assessment Questionnaire Summary and update for EOLC tools The education programme delivery is between September and December, 2011. The initial EOLC Assessment Questionnaire / use of EOLC tools undertaken ( in May /June) and repeated Spring 2012 to allow time for support following the educational input. • Summary of After Death Analysis (June to Sept 11) • Of the 25 collected 11 residents died in hospital, and 14 remained within the care homes. • Evidence of PPC recording in 8/10 homes • 3. DNACPR now starting to be addressed in 9/10 homes where appropriate • 4. LCP being used in 3/10 homes • Issues identified during Stage 2: • GP refused to initiate LCP as dying patient did not have cancer • Lack of managerial support and attendance for EOLC training in some homes • Managers are finding it difficult to release staff to attend training sessions • Language barrier to training for some staff • Most homes are receptive to training • Staff are now actively approaching GPs for DNACPR/ JIC box • Evaluations of session 1 of training very positive • Session 1 attended by 74 staff, of which 8 were care managers/trainers Overall General information • Total No of Care Homes 10 : 6 Residential home and 4 Nursing homes • Total No. of residents: 347 • Types of residents supported include : elderly, epilepsy, Parkinson's, stroke, hearing/speech/visual impairment, dementia, learning disabilities, CVI, Cancer, MS, mental health and heart failure

11. EastSussex St Wilfrid’s Hospice - Summary of the 11 Pilot Care Homes EOLC Assessment Questionnaire Summary and update for EOLC tools • The education programme delivery is between September and Jan 2012. The initial EOLC Assessment Questionnaire / use of EOLC tools undertaken (in May /June) therefore not repeated until 1 month after completion of the training to establish any changes to practice and any policies or procedures that are in place regarding end of life care. Staff assessment Staff have been asked to complete a competency questionnaire prior to commencing the training. This will be followed up at the meeting highlighted above. • After Death Analysis • Further after death analyses will be completed at the planned focus group following completion of the education package • Supporting homes • As there was a delay in commencing training, each home was offered the opportunity for any support from the project leader and to try and form a relationship with the carers in the home. Four homes took up this opportunity: • Home No 2. To discuss difficulties with advance care planning. • Home No 3. To discuss care plans. • Home No 6. To spend a day with the staff. Issues around updating care plans at end of life were discussed with the manager. • Home No 9. To spend a day in the home – an opportunity was taken to inform the staff of the project at break times. • It is reinforced at all the training sessions that the hospice is happy to accept referrals for their residents where they need support for end of life care, and that we will be happy to assist in the implementation of the LCP until they are confident to do this. Overall General information • Total No of Care Homes 11 : 5 Residential homes,5 Nursing homes and one dual registered home • Total No. of residents: 367 Types of residents supported include : elderly, epilepsy, Parkinson’s, stroke, hearing/speech/visual impairment, dementia, learning disabilities, cancer, multiple sclerosis, mental health and heart failure

12. Care Home Pilot Educational Programme The Education Model being used to provide the educational input to the 10 Care Homes is designed around 3 workshops. Workshops will be for both HCA’s and RN’s together. Following the workshops, on going support will be provided to help cascade and support implementation of the learning within each home. This does vary slightly between Hospices although reflects similar content and competencies Workshop 1 : Introduction to EOLC: Philosophy and Principles and Communication at EOL (September 2011)This workshop includes raising awareness of current initiatives in EOLC and concept of holistic care at EOL The workshop will run within each care home ( some care homes are joining together for a workshop) so a total of 8 workshop will run. Homes can also send staff to other homes sessions to increase the number that can access the workshop. This workshop covers all 6 Steps of the National EOLC programme 6 step model. Workshop 2 : Holistic Assessment at EOLC and Symptom Control (October 2011)This workshop includes common symptoms and their management, and team liaison / accessing resources in management of symptoms The workshop will run 4 times, twice in Bexhill and twice in Hastings at St Michael’s Hospice so each care home can choose which venue it would like to sent staff to. This has been done to aid release of staff to attend. This workshop covers Steps 2,3,4 and 5 of the National EOLC programme 6 step model Workshop 3 : Advanced Care Planning and Care in the last Days of Life/After Death Care ( November / December 2011)This workshop covers consideration of MCA, use of DNACPR, LCP and bereavement The workshop will run 4 times, twice in Bexhill and twice in Hastings at St Michael’s Hospice so each care home can choose which venue it would like to sent staff to. This has been done to aid release of staff to attend. This workshop covers Steps 2,3,4,5 and 6 of the National EOLC programme 6 step model 12

13. EastSussex Educational Model for Care Home Support Pilot Advanced Care Planning Spiritual Care Implementation Support Syringe Driver Training Introduction to End of Life Care Session1 Session2 Nursing Home Pilot EOLC Education Programme EOLC Clinical support Evaluation Liverpool Care Pathway 12 Session3 Grief and Loss EOLC & Dementia Additional learning / e-learning The above model shows how the Care Home programme and it’sadditional support fits within and can be enhanced thought additional more specialised sessions provided from the Hospice ‘s wider educational programme Hospice Current Educational Programme and Support Sessions available to Care Homes and Clinical Staff

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15. EastSussex Barriers and Resolutions • Lack of commitment from care home

16. EastSussex Proactive Elderly Advance CarE (PEACE) Tool • Pilot lead Dr Elena Mucci, Consultant Geriatrician, Conquest Hospital • pilot for 1 year and will finish in September- data available from October/Nov 2012 • To date discharged 19 patients on PEACE in the first 3 months of the pilot. Only received positive comments from relatives who support this process • Of 19 patients 6 died-all in their NH, the rest are alive and have not had any admissions. • 1. PEACE discussions on the ward: relatives, NH manager, GP, completion of community DNAR by myself with agreement from GP. • 2. PEACE completion by doctors, copy goes with the patient and copy given to relatives • 3. H@H visit within a week: review of patient and education.

17. EastSussex Useful links for resources and support • Dying Matters website excellent for both professionals for resources and information for residents / patients http://www.dyingmatters.org/ • National EOLC Programme – excellent professional support http://www.endoflifecareforadults.nhs.uk/ • Routes to Success resources http://www.endoflifecareforadults.nhs.uk/tools/core-tools/rtsresourcepage • Gold Standards Framework (GSF) for Care Homes http://www.goldstandardsframework.org.uk/ • Liverpool Care Pathway http://www.mcpcil.org.uk/liverpool-care-pathway/ • Preferred Priorities for Care http://www.endoflifecareforadults.nhs.uk/tools/core-tools/preferredprioritiesforcare

18. East Sussex End of Life Care e-learning pilot

19. The Pilot Who? 2 Home Care Providers Care Home In-Reach Team What? To trial access to e-learning programmes for social care providers, To monitor uptake To identify challenges and issues To assess and develop appropriate support tools Part of joint EOLC workforce development programme EastSussex

20. EOLC training Free access to e-Learning resources and the People’s Network Open to NMDS–SC registered employers Linked to QCF Levels 2 and 3 Diploma 150 sessions in four core competencies 12 open access modules Short sessions - around 20 minutes long Learning tailored to individual needs EastSussex

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23. EastSussex Stakeholders • Social care providers who: • Deal with end of life care frequently • Occasionally deal with end of life care • Those approaching end of life, their family and friends Managers • Volunteers, carers and personal assistants • Clerical and administrative staff

24. Benefits Well trained and motivated staff Better quality care and outcomes Equal access and choice Excellent personalised care Improved communications with primary care colleagues Compliance with CQC regulations – K4 Delivering best practice and quality standards Competitive edge - become a provider of choice EastSussex

25. EastSussex Key Tasks • Benchmarking existing skills • Training needs analysis to tailor training • Marketing and promotion • Monitoring take up • Measuring impact

26. EastSussex Some findings from pilot - staff • Lack of access to IT equipment • Difficulties with registration • On-line support not always effective • Most staff enjoyed the modules they did • One to one sessions worked better than in a group • Printed certificates popular

27. EastSussex Some findings from pilot - managers • Generally positive response • Training resource guide quite useful • Need for support at front end- e.g.: • Baseline assessment • Training needs analysis • Links with business planning

28. Next steps… Project manager recruited Identifying support needs Defining programme for roll out EastSussex

29. Summary Improving EOLC has a high profile… National and local drivers for change Workforce development plans and resources A joint East Sussex EOLC project Lots of incentives to improve EOLC Training and support is available A wide range of benefits and rewards for those who engage EastSussex

30. Some questions… How can we best work together to take forward EOLC workforce development? Are there any logistical issues that need to be overcome? Would a more detailed session for a larger number of providers be useful? EastSussex

31. EastSussex For more details please contact: Kay Muir, Programme Lead , End of Life Care, East Sussex PCTs /CCGs Based at: ESDW PCT Headquarters 36-38 Friars Walk Lewes, BN7 2PB (Mon- Thurs.) Email: kay.muir@nhs.net Office tel.: 01273 485335 Mobile: 07500 972 749 Sophie Clark, Older Peoples Strategic Commissioning Manager, ESCC Adult Social Care Based at: Adult Social Care East Sussex County Council County Hall St Anne’s Crescent Lewes East Sussex BN7 1UE Email sophie.clark@eastsussex.gov.uk www.eastsussex.gov.uk Office tel: 01273 335392 Mobile:078617471942