Establishing a Macmillan Supportive, Palliative and End of Life Care Service Prepared by Alison Kimber & Dawn Orr
NEAS is a major first point of contact for patients with a real perceived need for urgent and emergency care, taking millions of calls per year, through the numbers 999 and 111.
Context of Palliative & End of Life Care In England, approximately half a million people die each year. The number is expected to rise by 17% from 2012 to 2030. The percentage of deaths occurring in 85 years and over is expected to rise from 32% in 2003 to 44% in 2030. 25% of all hospital beds are occupied by someone who is dying with 40% of those people having no medical need to be there.
Context of Palliative & End of Life Care There are 15 million people in England with a long term condition (LTC). By 2025, this will rise to 18 million. An estimated 10-11% of people over 65 years, and 25-50% of those over 85 years, have frailty. Frailty is strongly linked to adverse outcomes, including increased mortality. Around half a million carers provide support to people dying at home of a terminal illness.
The Route to Success Ambulance services make a crucial contribution to enabling people to have their stated care preferences met and to achieve a good death dying with dignity, ideally in the setting of their choice. Clinician's have to make very difficult, time critical decisions with limited information of the person s history and condition.
The Policy Context The End of Life Care Strategy (DH 2008) Recognition of three key important roles for ambulance services: 1. Rapid transfer of the dying 2. Developing appropriate transport for the person/carer 3. Developing robust information systems to ensure the wishes of the person (i.e. DNACPRs) are communicated to ambulance services and staff.
SPEOLC NEAS Journey As NEAS host the regional IUC CAS it enabled us to realise our ambition to improve services delivered to this group of patients. Recognising that there was no internal expertise within NEAS regarding palliative care a partnership arrangement was formed with QE Gateshead. Macmillan Nurse Dawn Orr Seconded 1 day per week for 12 months.
Scoping the service Baseline audit & service review highlighted need for internal expertise & education and networking. Highlighted the need for the Trust to have a defined & sustainable strategy to continue this work following the end of the secondment. Utilised the route to success in end of life care achieving quality in ambulance services to devise strategy.
Education Baseline audit showed a lack of knowledge and confidence when supporting this group of patients. Designed and developed an education package to meet the specific needs of all staff incorporating three levels of training for patient facing and non patient facing staff. Added to annual statutory and mandatory training as a core element. Module added to the student paramedic university course at Sunderland and Teesside.
Strategy Designed and developed Trust policies and procedures to guide and support EOC and Operational Staff. Three year delivery plan based on the quality markers in the route to success. Macmillan engagement to support development of a dedicated SPEOLC team to sustain the service. Development of SPEOLC champions from across the whole trust.
Macmillan Bid Support from Karen Stenlund (Macmillan) to develop a quality partnership agreement to include three new dedicated roles to support the service. Significant investment by both Macmillan and NEAS Macmillan Nurse Facilitator Macmillan Engagement Officer Macmillan Administrative Support
Macmillan Nurse Facilitator Provide clinical expertise High level networking with strategic partners regionally and nationally Hosted by QE Ensure compliance with the strategy and work plan Lead and manage the service Maintain professional credibility whilst ensuring the service remains current and inline with national direction Review and develop educational materials and policies
Macmillan Engagement Officer Pivotal role within the team, who will be the go to person Daily support for NEAS Emergency Operation Centre and operational staff Point of contact for all external stakeholders i.e. primary care, acute trusts etc. Improving external relationships so that timely transfer of information takes place The day to day coordinator who will support the smooth running of the service.
Macmillan Administrative Officer General administrative duties Responsible for the inputting and maintaining of SPN, DNACPRs, EHCPs and advance decisions in a timely manner. Responsible for all secretarial duties to ensure up-to-date information is available Maintaining the SPEOLC section of the NEAS intranet site. Liaison with Comms. to continue to raise the profile of the service.
Networking Engagement with specialist colleagues to build connections & support improved ways of working and sharing of information. SPEOLC group membership, Link group at QE membership Referral links from the clinical hub clinicians Access and referral rights to specialist advice services for professionals Timely advice for paramedics via clinical hub and specialist advice via warm transfer
Review End of Life Transport Map service provision & utilisation to clarify if it is being utilised appropriately. - Timings and appropriateness - Which areas use it, who do not! Regular comms exercises & audits Development of a guide for the dispatch team so that there is clarity when booking the ambulance in and out of hours. Plan for an out of hours service
The Vision To work with you in the development of new services for specialist palliative and end of life care Our new service will offer: Dedicated point of contact for acute and community services Timely transfer of information from primary and acute care to NEAS Co-ordinating function between community and palliative care service Support with developing services to enhance care for specialist palliative and end of life patients For more information email Alison.kimber@neas.nhs.uk
The Future A leader in Service Provision A work plan with six work streams linked to route to success Sustainability with education, coaching and specialist links and support Specialist team working within the clinical hub to support operational staff Building connections with specialist teams & Macmillan Recognition as an excellent service with proven results and a high profile
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