An update from Sandra Campbell

Sandra Campbell
Sandra Campbell, National Clinical Lead for Palliative and End of Life Care (Nursing)

My experiences

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: hcis.livingwell@nhs.net.

Compliance with these principles will also ensure excellent delivery of the fundamentals of nursing as advocated in the Nursing and Midwifery Council Code.

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My Perspective on the SPPC Annual Conference

Paul and MichellePaul 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

Diana slideThe 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.

DianaDiana’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.

Introducing Sandra Campbell

Sandra Campbell
Sandra Campbell, National Clinical Lead for Palliative and End of Life Care (Nursing)

I am absolutely delighted to have taken on the role of National Clinical Lead for Palliative and End of Life Care for Nursing.

Having been in post for a few weeks I’m now beginning to link in with key individuals in each of the Health Boards to truly represent nursing across Scotland, ensuring the nursing voice is fully heard on behalf of patients and those important to them.

My passion is communication and I believe fully in the human connection that we as nurses have with our patients.

Compassion is about the human experience of noticing, feeling and responding.

Delivering compassionate care has to be fundamental for all staff, and supporting nurses to be able to do this is one of my main goals.

Strategic Framework for Action

The Scottish Government is committed to working in partnership to support a range of improvements in the delivery of palliative and end of life care in Scotland. Continue reading “Introducing Sandra Campbell”

Introducing Michelle Church

Michelle Church
Michelle Church, Improvement Advisor for Palliative Care

Around 54,000 people die each year in Scotland, most following an illness. Four times as many are affected by the loss of a loved one.

How do we best support these people to live well, help manage conditions and give quality and meaning to their life as their health declines?

This is the question I ask myself, as the Improvement Advisor for Palliative Care within Living Well in Communities, and as a daughter who looked after her Mom during the last few months of her life.

I loved my Mom so very dearly, and I started grieving while still caring for her. It was a time I found incredibly difficult.

Mom wanted to stay home but the say of doctors and the power of the system dominated the decision-making around her care. It seemed to me you were either in the system (hospital) or out (on our own).

Her palliative journey was one of pain and crisis. As her main carer, I gradually became exhausted and, whilst we tried to treasure her final months, her last few days were chaotic and full of interventions rather than the peace and respect she so very much deserved.

Many things have changed since then. Continue reading “Introducing Michelle Church”

Scottish Partnership for Palliative Care Annual Conference: Realistic Palliative Care

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The Scottish Partnership for Palliative Care Annual Conference took place on 22nd September, at the Royal College of Surgeons in Edinburgh. In attendance, a range of people from palliative & end-of-life care and the health and social care sector (including of course Living Well in Communities).

This is a summary (and recording thanks to University of Glasgow’s End of Life team) of what went on during the day.



This year’s theme of Realistic Palliative Care was inspired by the CMO’s annual report: Realistic Medicine. The six point approach below is just as applicable to palliative care and quality of death.

infographic



Making the Case for Palliative Care in Times of Austerity
Professor Charles Normand, Professor of Health Policy and Management, University of Dublin

What do people want? Less hassle. It is bad enough to be dying.

  • Evaluation of palliative care is difficult and important, so better tools for assessing value and cost need to evolve. It’s impossible to have simple measures for complex activities with complex objectives.
  • Early interventions can reduce costs and improve care, particularly for those with complex needs.
  • Improving access when needed and reducing stress on informal carers are common themes stated in palliative care preferences.
  • Those requiring care often have different goals and priorities than their families and carers.

Continue reading “Scottish Partnership for Palliative Care Annual Conference: Realistic Palliative Care”