Macmillan Palliative Social Work

Macmillan Palliative Social Work Delivering Choice and Control in NNUH End of Life discharge. Lorraine Munro & Grainne Murray Macmillan Specialist Palliative Social Work 09/05/17 lorraine.munro@norfolk.gov.uk

Who are we? 2 man team providing Specialist Palliative Social Work to patients (and families); recognised in NNUH as approaching end of life. We are one Social Work post (on jobshare); plus one full time assistant. Funded by Macmillan charitable funding; to September 2017 Rare birds Endangered species

Specialist Palliative Social Work, employed via MacMillan charitable funding, to: Provide patients over the age of18, & their families and their carers, with the specialist social support advocated as required by policy and research findings in EoL care; Aiming that patients are reconnected with diverse networks; empowered to be discharged from the Norfolk & Norwich NHS Trust Hospital, to their Preferred Place of Care in a timely and effective manner. Work alongside the Palliative Nursing Team at NNUH to support the psycho-social (in addition to clinical) aspects of a good death. Assist the delivery of national Ambitions for local end of life care

Ambitions for Palliative and End of Life Care

Statistics & where do we fit in? NNUH serves a population of over 750,000 people. NNUH experiences over 200 deaths per month in acute hospital care. Very few of those who die in NNUH will see a social worker as NNUH refers to Social Services primarily for discharge assistance. Only 20% of those end of life in NNUH patients, are seen by the specialist palliative nursing team, as their symptom management may be viewed as non complex by the wards. BUT the palliative nursing team additionally works with stabilising symptom management for those who seek to leave the hospital for end of life care. Approximately 140 referrals per month, referred for palliative symptom management, to the palliative nursing team. 30 to 40 of those seen by the palliative nursing team are additionally referred, per month, to Macmillan Specialist Palliative Social Worker, for discharge support; because of discharge blockages in networks support; or funding difficulties. Numbers of Macmillan Specialist Social Work referrals growing.

In Acute Hospital Discharge. speed is of the essence In a busy acute hospital, once symptoms are stabilised, discharge is sought. ALL of those requiring discharge, are monitored and reported as potential delayed transfers of care. BUT, following clinical discussions, patients and families can find it hard to make speedy decisions on discharge options AND Funding applications for discharge care require time to achieve. Discharge within 72 hrs, once no longer requiring acute care, is aimed for by the acute hospital BUT flexibility, and many changes to plans may be required, following the initial discharge choice

Interesting facts 400 per day for NNUH bed blocking Remaining in NNUH can be more then 60 miles from family and friends 70% want to die at home: need trusted resources to do so

Many ways to leave a hospital: NNUH transferring care to :- Nursing Homes Family Carers and spiritual services District nurses & OTs Residential Homes Own home & friends & neighbours GPs & Community Palliative Teams Homecare & nursing agencies Marie Curie, Red Cross Carers Supports Priscilla Bacon Lodge

Palliative discharge requires: Clinical and social Identification of end of life progression. Forecasting of needs which will arise following acute discharge. Discussion with patients and families on how needs might be met. Support to express preferences and resolve network/ family disagreements. Achieving funding to meet needs Market capacity to meet needs Information shared across multiple providers The flexibility to move between provisions, as needs change

Many Ways to leave a Hospital : Finding the Funding Routes NHS CHC Fast Track to NHS nursing, or EoL care at home Social Care & NHS Funded Nursing Contribution ( 150 wk) : to nursing home care Social Care Homecare & Family & Primary Health inreach to home Patient Self Funding 100% self funded care at home or in nursing care NCHC NHS Funded Palliative Beds ( Community Hospitals or Nursing Homes) NCH&C Priscilla Bacon Lodge

Let me tell you a story.. Rosie Good advance care planning. No Yellow Folder but LPA welfare and LPA Finances set up and wishes known. Preferred Options 1 and 2 not available Options 3 required self funding. Family struggling to accept Five weeks to achieve discharge Passed away, in care home, the day following discharge.

Let me tell you a story Frank Good advanced care planning. ( No Yellow Folder but had pre discussed with family) Four adult children: proposing rota of live in family care but also needs homecare and district nursing. Rural area. 7 days to find 4 x daily double up homecare. Discharged with anticipatory meds and syringe driver Homecare funded by NCC Social Services for two weeks Received hospital at home service from NHS in last 3 days of life.

Let me tell you a story.. Peter Good advanced care planning. ( No Yellow Folder but had pre discussed with family) Expert wife /carer. Cared for husband for more than 20 years ( long term deteriorating condition) Deteriorating in NNUH, and wanted home. Wife felt now dying. No agreement as end of life by clinical teams. 3 weeks of funding applications to both NHS and Social Care. (Needs changing daily) Agreed as NHS funded Fast Track in week 4: NHS providing live in care to support wife to take home to die.

Supporting choice and control? Yes, but to improve.. Need simplified & speedy access to (currently diverse) funding streams. Ability to apply money for personal solutions, flexibly as needs change. Joined up information across acute, primary health and social care. Development of market capacity for end of life care? Long term funding for social work in end of life care?