by Ian Mountford, Communications Executive, Energy Saving Trust The ihub Frailty and Falls Assessment and Intervention tool highlights a fuel poverty check as a key consideration when determining if someone is in a safe and… More
First of all I would like to say thank you to all the people who have got in touch with me in this new role as nursing national clinical lead for palliative care at Healthcare Improvement Scotland. Having conversations with like-minded colleagues is just great and, to me, the first step in working towards change and improvement. I am hoping that by engaging with as many teams as possible, I can learn about any particular issues and share best practice – please tell me about any good work going on, too! In providing palliative and end of life care we all have a common goal of getting it right for patients and those important to them at what can be a most difficult time, and we only get one chance to get it right.
In addition to working with six test sites in an advisory capacity, teams I have met to date include leads in NHS 24, Scottish Ambulance Service (SAS), Children’s Nurses, and Care Opinion, as well as teams within HIS and Scottish Government. All these conversations are about how we can ensure dignity at the end of life every time, such as through reducing the risk of inappropriate resuscitation attempts. Not surprisingly, it always comes back to the need for sensitive conversations earlier on in someone’s journey! It is essential that we support staff and teams to be able to have these conversations, which can be highly complex.
In July I attended a session at University College London Hospital recently on Talking DNACPR, and it was excellent. One thing I learned was the 5Ps model for sharing difficult information, based on work in St Christopher’s Hospice. Below is my adapted version:
P Purpose what is the purpose of this interaction?
P People who should be there? The patient/family? Should I take a colleague?
P Preparation what do I need to know?
P Process how will I construct the conversation – should I use a model, e.g. SPIKES?
P Product what is the outcome I expect? E.g. a completed Anticipatory Care Plan or DNACPR form?
I think this could be used as a simple approach when teaching staff.
Spotlight on the Four Principles
I mentioned the four principles from Caring for People in the Last Days and Hours of Life in my last blog post, and HIS have very kindly produced small cards that staff have can have in their pockets or use for teaching students, etc.
Please see below:
If you would like some, please contact: firstname.lastname@example.org.
Compliance with these principles will also ensure excellent delivery of the fundamentals of nursing as advocated in the Nursing and Midwifery Council Code.
Paul Baughan and Michelle Church, Improvement Advisor, with the Living Well in Communities poster at the conference
by Paul Baughan, GP and National Clinical Lead for Palliative and End of Life Care, Healthcare Improvement Scotland
For some people, the Scottish Partnership for Palliative Care conference is an annual pilgrimage, resembling a school reunion where people involved in palliative care can come together and catch up with one another (whilst secretly hoping that they have not aged as much as that colleague from the north or west of Scotland that they have not seen for a couple of years!). The informal sharing of experiences, pressures and local initiatives is every bit as important as the diverse programme.
My aims for the day
I attended this year’s conference with a specific question about how I could use the learning to support our six palliative care test sites. As joint clinical lead for palliative and end of life care with Healthcare Improvement Scotland, I am working with six health and social care partnerships (HSCPs) to support local improvement work around the early identification of those with palliative care needs and the co-ordination of their care.
We had the opportunity at the conference to display and discuss our poster, which outlines the approach and process which the test sites will undertake during their improvement work. There was great interest from the delegates regarding this work, which made me even more determined to use and apply learning from the day.
The morning sessions
Professor Havi Cavel opened the conference via video link. She was able to introduce quite complex philosophical questions around the management of breathlessness through a remote presentation from Bristol. My thoughts turned to considering how we might use similar technology during our work with Eileanan Siar / Western Isles.
Next Jeremy Keen from Highland Hospice explored how specialists in palliative care can build partnerships and share experience and expertise with non-specialist colleagues dispersed across the health and social care system. One aspect I found challenging was Jeremy’s assertion that measuring things in palliative care can become a distraction to the care that is being provided.
Each of our six HSCP test sites will be measuring and collecting data related to their individual areas of improvement, and it is essential that they examine and record information and data that is appropriate and relevant. We need to ensure that this measurement does not become a distraction. Jeremy continued to discuss the ECHO project that Highland Hospice is embarking on. This offers the opportunity for specialist advice and knowledge to be accessed more easily within the community, something which will be very relevant to the improvements in care co-ordination that our test sites will be developing.
Discussions on strategic commissioning
The biggest challenge of the morning fell to Diana Hekerem, as she was tasked with making the strategic commissioning of palliative care exciting. Having spoken with Diana before the conference, I knew this session would be anything but dull. The audience quickly realised that they would have to listen carefully as Diana had a series of questions lined up to test how well they were listening.
My ears pricked up when Diana asked the group which measure would they look at first when assessing success within palliative care. Perhaps the audience would heed Jeremy Keen’s caution about measuring things, and choose option 5 ‘something else’. Not so. A third of respondents suggested the Voices of the bereaved annual survey and another 30% thought the proportion of population with an anticipatory care plan (ACP) was important. The Living Well in Communities team have been developing a national approach to anticipatory care planning, and have recently launched an ACP toolkit, including an ACP app.
It was telling that only 2% thought that the number of people dying at home was the first thing that they would look at.
Diana’s next question asked the audience to consider where they would spend more money. 82% thought it should either go to increasing nursing and healthcare support in the community, or to increased social care support. This was hugely reassuring as many of the six HSCP test sites are looking at how we might support community nursing and social care workers better within their tests of change.
Diana conveyed the powerful message that we all should be involved in the commissioning of palliative care services. Through 2018 and 2019, our programme of work will learn a great deal from six diverse areas in Scotland. It made me realise that the outcomes from our project should and must be used to influence local, regional and national commissioning of services.
Highlights from the afternoon
Unfortunately, it was not possible to attend all the breakout sessions in the afternoon. Of particular relevance to our work were the results from the Renfrewshire community project. Susanne Gray, Katie Clark, and Joyce Dunlop shared learning from this work, which developed ways to integrate supportive and palliative care approaches into mainstream community service provision. Their project can clearly inform our test sites, and Perth and Kinross HSCP has already been in contact with the Renfrewshire team to invite them to speak with their South Perthshire test site.
I listened with interest to Dr Georg Bollig as he spoke about the concept of Last Aid, whereby local groups receive information and training around how to care for members of their community as they approach the end of life. This approach fits with the wider community engagement work which is happening across the country, using the assets and skills of local volunteers.
Robbie Steel and Jo Bowden held parallel workshops. Fife HSCP are likely to use the learning from the excellent proactive best supportive care TCAT project as they develop their improvement work, but expanding the focus from lung cancer to other conditions.
Issues in advocacy
The hardest slot at the conference must surely go to the last speaker. People are tired and thinking about travel plans, collecting kids, and what there is in the fridge for tea! Yet Prof Deborah Bowman pulled out a performance which would be worthy of a west end theatre. I stopped taking notes at this point and allowed her enthusiasm to wash over me. She discussed the relationship between advocacy, marginalisation and the ethical professional. Her description of the ‘restricted view theatre seat’ helped me realise that we all have a restricted view of palliative care, as we are only seeing it from our own perspective.
Engaging with social care
So now I have shared my perspective of the SPPC conference in the knowledge that every other delegate will have picked up different highlights and learning points. It was good to catch up with long-standing colleagues and friends, and this is a huge attraction of this particular meeting. Yet I also pondered an earlier poll which revealed that only 1% of conference delegates were from social care or the care home sector.
In our improvement work with the six HSCPs, we must do all that we can to engage with this important part of our workforce. They have an important voice which the wider palliative care community needs to listen to. And so next year, whilst I look forward to seeing the same familiar faces, I also hope to see many more unfamiliar faces. I’d like to move away from my restricted view seat, and listen and learn what palliative care is like from their perspective.
Our recent poster, displayed at the Scottish Partnership for Palliative Care annual conference, provides an update on where we are with our palliative and end of life care work.
Chief Officers and their representatives from the 31 Health & Social Care Partnerships were invited to take part in Intermediate Care & Reablement scoping, comprised of an online survey and conversation about Intermediate Care & Reablement within their partnership area.
As part of the outputs from the scoping, the following Atlas provides information on the provision of Intermediate Care & Reablement across Scotland. It anticipated that this will be a live document that can be updated to reflect developments over time.
Download the atlas here or click the image above.
We commissioned a series of films to introduce anticipatory care planning, how it can help to deliver person-centred care, and its benefits for people, families and their carers.
A homeless person’s story – Duncan is 41 and has been in children’s homes, hostels, psychiatric care or homeless for most of his life.
A child’s story – Jack has a life-limiting condition. His parents have been told it is unlikely he’ll get to school age.
A carer’s story – Fiona was caring for her husband with cancer until he died. Now she is caring for her father alone.
An individuals story – Jim is in his fifties and is in the late stages of kidney failure caused by diabetes. His condition is terminal.
An ACP nurse’s story – Evelyn was admitted to hospital for the fourth time and diagnosed with Menieres diease. She is focussed on her illness rather than her recovery.
Find out more about Anticipatory Care Planning at myacp.scot
Find out more about Anticipatory Care Planning at myacp.scot
by Laura Dobie, Knowledge and Information Skills Specialist
On Friday 12th May I headed to Inveraray for the Argyll and Bute Nursing Excellence Awards. This is the first year of the awards, which celebrate outstanding care by nurses and other healthcare professionals, and were organised to coincide with International Nurses’ Day. Staff were nominated by colleagues, and there was also a patients’ choice award. Nominations were based on caring behaviours, including attentive listening, honesty, patience, sensitivity and respect. Continue reading “Celebrating great care at the Argyll and Bute Nursing Excellence Awards”