The MidCentral DHB / Arohanui Hospice Palliative Care Model

1. The MidCentral DHB / Arohanui Hospice Palliative Care Model Barry Keane Director of Clinical Services Arohanui Hospice August 2007

2. Palliative Care Is care for people of all ages with life limiting illness which aim’s to: • Optimize an individuals quality of life until death: to do this, a person’s physical as well as psychosocial, spiritual and cultural needs are assessed and addressed. • Support the individual’s family, whanau, and other caregivers where needed, through the illness and after death. NZSpecialist Palliative care Service Specifications (draft) 2007

3. To be able to deliver effective care wherever patient is, which may not necessarily be in bed of their choice. Barbara Monroe 2006

4. Where have we come from? • Reactionary movement • Cottage Hospice • Charity base • Culture of “specialness” Arohanui Hospice was no different

5. What are the modern challenges? •  referral rates • Non-cancer issue • Needs of specific populations • The funding model • Consumer expectations

6. Community Care Project

7. Specialist Palliative Care provided by an interdisciplinary team with specialist training - Generalist Palliative Care integral to all clinical practice but carried out with specialist support NZCTWP – PC 2006

8. Why integrate? • Focus’ on patient needs • Flexibility • Spreads knowledge /empowers • Maximizes use of existing resources • Enhances equity of access • Cost effective

9. Role of Specialist Palliative Care 1. Manage complex need 2. Support generalist partners See new specialist palliative care service specifications

10. Hospital Palliative Care Team

11. Community Team The Palliative Care Co-ordinator role

12. Education Programme • Care Assistants Programme • Subcut Syringe Drivers Competence • Primary Care Nurses Workshops • General Practice Team Education • Maori Health Provider Staff • Grief and Loss Workshops • Pastoral Care Workshops • Post Graduate nursing paper • Liverpool Care Pathway Education

13. Relationship Management

15. Integrated Palliative Care Model Specialist Palliative Care Primary/Secondary Care nInterdisciplinary Team nIn Patient Services nDay Stay nCare Co-ordination nBereavement Support nQuality Team nEducation RResearch nPalliative Care Partnership nMOU with District Nursing nEducation Programme nLiverpool Pathway nHospital Palliative Care Team nInterface Forums nGeneral Practice Teams nDistrict Nursing nMaori Health Providers nAged Residential Care nCommunity hospitals NAcute Hospital Services

16. Director Palliative Care Clinical Quality • Education/ Research Unit • Education • Research • Liverpool Care Pway Administration Services Finance Facilities Management Human Resources Quality Assurance Fund Raising Arohanui Hospice Trust Board HPCT 1 Med Specialist 2 CNS Chief Executive Director Clinical Services In-Patient Nursing Community Nursing Allied Health Day Stay Family Support Pastoral Care Bereavement Support Volunteers Medical Staff

17. Outcomes we are looking for 1. Specialist palliative care defined 2. Generalist palliative care defined 3. Systems to support relationships 4. Palliative care need quantified 5. Capacity to meet both referred and unreferred need 6. An appropriate funding model 7. Sustainability