EoLc in Gloucestershire Hot Topics 2018 EoLc in Gloucestershire Hannah Williams- Senior Commissioning Manager End of Life Care, Gloucestershire CCG

Once upon a time in 2015…………. Relative feedback “We received compassionate care in all settings but it didn’t feel like the systems joined up”

CQC “Lack of strategic direction and vision” 2 NHS Trusts assessed as Requires Improvement in EOLC Our reflections Lack of baseline/needs assessment Inequity of access and provision of care Confusing documentation Low level of patient and public involvement

Developed system wide strategy Feedback Assessed Need Developed system wide strategy Service re-design Established STP EOLC Clinical Programme Group Workstream identification – co-productive approach Evaluation and Review QI Methodology

“The Gloucestershire End of Life Clinical Programme aims to deliver county-wide provision run by kind, compassionate and competent staff, that supports people to have the best possible death”

Shining a light on 2018……… On the ground Training and Resources CQC Countywide documentation travels with the patient Medicines optimisation Just in Case Boxes Integrated personalised commissioning within day hospices Care home support team support EOLC across all care homes Training and Resources All trusts have EOLC within mandatory training Countywide education framework with education programme partnership led by hospices EOLC masterclasses G-Care electronic resources Cultural App https://www.glos- care.nhs.uk/CulturalAwareness/communities.html White rose café/Schwartz rounds Dying matters week/hot-topics week CQC Both trusts have a ‘good’ rating for EoLC System wide approach noted as Outstanding practice in 2018 CQC report Feedback System wide M&M meetings including wider reviews of patient journey Comm hosp inpatient feedback Acute hospital feedback Bespoke ‘HealthWatch’ feedback survey NACEL Beyond Gloucestershire Commissioning representative on NHSE EOLC Board Escalation of nationally relevant concerns Local specialists involved in research/education/national advisor roles

% Cancer vs non-cancer for 2017/18 = 80%/20% 400% increase in Hospice at Home (H@H) provision in Gloucester City Deaths in usual place of residence (2016)  England – 45.8% SW          - 51.8% Glos       - 53.7% 2017/18, of 382 people who died cared for by our H@H providers – 93% achieved death in preferred place 42% of deaths of people with a learning disability in Gloucestershire occur in acute hospitals compared to 66% nationally H@H % Cancer vs non-cancer for 2017/18 = 80%/20% 2018/19 year to date = 75%/25% “Knead to Know” Three pop-up events engaging with 273 people SCR with AIs created by GPs is now 23,800. Up from 20,000 in 2017 Dying Matters Bus – stopping at all regions of the county SPC HCP line – 17/18 prevented 75 unplanned admissions Financial savings through optimising meds Projected £50,000 2018/19

Advance Care Planning What is Advance Care Planning? What is an Advanced Care Plan (ACP)? What is ReSPECT? https://www.respectprocess.org.uk/_pdfs/ReSPECT-Specimen-Form.pdf

What is ReSPECT ReSPECT – an alternative process for discussing, making and recording recommendations about future emergency care and treatment, including CPR ReSPECT – developed by many stakeholders, including patients, doctors, nurses and ambulance clinicians, to try to achieve a process that will be adopted nationally ReSPECT focuses on treatments to be considered as well as those that are not wanted or would not work ReSPECT encourages people to plan ahead for their care and treatment in a future emergency in which they are unable to make decisions

Who is it for? Anyone, with increasing relevance for those: with particular healthcare needs nearing the end of their lives or at risk of cardiac arrest who want to record their preferences for any reason A ReSPECT form is best completed when a person is relatively well, so that their preferences and agreed clinical recommendations are known if a crisis occurs ReSPECT can be used for people of any age When used for a child or young person there must be appropriate parental involvement ReSPECT can complement other documents such as advance care plans but does not replace them If a person has a completed ReSPECT form there should be no need for a separate CPR decision form

ReSPECT - Recognition Policies Clinical leaders All specialties aware Other areas Buy in Reassurance

ReSPECT - Implementation Champions in each area Teaching and awareness Ward by ward Feedback – adapting ReSPECT along side UP form Feb 2019

https://www.youtube.com/watch?v=bYy4q8R9kro