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

2. 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”

3. 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

4. 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

5. “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”

6. 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 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

7. % Cancer vs non-cancer for 2017/18 = 80%/20%
400% increase in Hospice at Home provision in Gloucester City
Deaths in usual place of residence (2016) 
England – 45.8%
SW          %
Glos       %
2017/18, of 382 people who died cared for by our 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
% 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, /19

8. Advance Care Planning What is Advance Care Planning?
What is an Advanced Care Plan (ACP)?
What is ReSPECT?

9. 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

10. 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

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

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