1. ‘Going for Gold’ Evidence of Dignity in Care Nikki Sawkins GSF National Nurse Lead

2. Plan of session Background to GSFCH training programme Key Topic – Dignity Accreditation and the 20 standards Examples in practice - Dignity Shared experiences in practice

3. This is about life before death “Our aim is that every person should be able to live well and die well in the place and in the manner of their choosing”

4. The Gold Standards Framework A framework to deliver a ‘gold standard of care’ for all people approaching the end of their lives A system - focussed organisational approach to optimising the care delivered by generalists.

5. Background to the GSFCH Training Programme Overview of Gold Standards Framework in Care Homes Based on GSF Primary Care- now used by most GP practices in UK at least at basic level 1. ‘Next stage primary care’ – embed further, training programme, new resources GSF in Care Homes programme developed 5 years ago in 2004, rooted and grown from experience of care homes staff Now used by nearly 1000 homes Training run by GSF Centre in annual phases –commissioned/ open Integrating experience, adaptations and learning from accredited homes using showcased examples Accreditation Going for Gold - since 2008 - twice a year - 100 homes/ year Solid ‘gold club’ of accredited homes – supported and endorsed A national momentum of best practice in end of life care in care homes

6. GSF Care Homes Programme “ The biggest palliative care initiative in care homes so far” Aims 1.To improve quality of end of life care for all residents 2.To improve collaboration with primary care and specialists 3.To reduce hospitalisation in the last stages of life, enabling more residents to die with dignity in the care home

7. 3 stage process Preparation, training and consolidation + accreditation Stage I PreparationStage II TrainingStage III Consolidation + Sustainability 3-6 monthsworkshops in 9 months9 – 12 months  Awareness Raising Meeting Local Coordinator s Meetings Workshop 1 Workshop 2 Workshop 3 Workshop 4 GSFCH Accreditation      ADA After ADA Before Final Appraisal Ongoing ADA Enrolmen t of Care Homes

8. What are we aiming for? A gold standard of care for residents A gold standard of care for their families Job satisfaction, confidence, rewards and enjoyment for us as staff Benefits to the owners, the GP/ primary care teams, the PCT, the NHS and the wider community Best care for us if/ when we need it……

9. Key themes in GSF Pre-planning of care Making the system work, so you can focus on real care You’re doing well- but you can do even better- enabling and encouraging all Communicating well Aspiring to the best

10. Pre-planning of care Documenting and coding Planning meetings - thinking what if…? Meeting needs - use of Needs Support Matrix, Advance Care Planning discussions with resident + family, Planning ahead with GPs e.g. anticipatory prescribing, handover forms OOH Use of LCP/ICP/min protocol

11. Making the system work, so you can focus on real care Once set up - runs smoothly Preventing crises Working smarter Enjoy better work Spend more time with people

12. You’re doing well- but you can do even better- Enabling and encouraging all Build on good practice Improve confidence of staff Everyone is involved - all staff aware and working together to ensure high standard Adapt and use tools, protocols, policies etc so that they become part of your home Embedding the work- so it remains if a key person leaves

13. Communicating well Staff pre-empt issues Better working with GPs Better working with others eg hospice Honest discussions with residents and families Team spirit Documentation clear

14. Aspiring to the best Are you the best you could be ? Can we guarantee best care every time- gold care? What would it take to get there?

15. 20 Key standards - Accreditation checklist 1.Leadership + support 2.Team-working 3.Documentation 4.Planning meetings 5.GP Collaboration 6.Advance Care Planning 7.Symptom control 8.Reduce hospitalisation 9.DNAR +Vo D policies 10.Out of hours continuity 11.Anticipatory prescribing 12.Reflective practice+ audit 13.Education + training 14.Relatives 15.Care in final days 16.Bereavement 17.Dignity 18.Dementia 19.Spiritual care 20.Sustainability

16. Key Topic – workshop 1 - Dignity ‘What do you see nurse when you look at me?’ DVD Discussion and debate Re-look at Dignity related issues as a team – guidance in Good Practice Guide How do you engage all staff? Cultural issues? Key elements highlighted – Dignity Conserving Care, RCN ‘Dignity – at the heart of everything we do’ Workshop 2 – Speed dating – sharing of experience and information, challenges and solutions

17. ABCD of Dignity conserving care (in Good Practice Guide) ABCD of Dignity Conserving Care By Harvey Chochinov (in Good Practice Guide) A- Attitude B- Behaviour C- Compassion D- Dialogue

18. Bringing it all together….. …..how can we do the right thing at the right time for the right person every time ? …can we all talk the same language?

19. Key components of GSF & EOLC Education communication Co-ordination Team approach Ongoing Implementing an advanced care plan Identification Assessment of need assessment

20. Portfolio of evidence How using GSF helps improve the dignity of residents Dignity in good end of life care e.g. respect, autonomy, choice, humanity of each person Breakdown in dignity when things go wrong crisis – admission, deaths in A&E, poor symptom control, not respecting pt wishes Improved dignity – ethos of good individualised care, enhances choice, control, self determination, pt choice at centre Family discussions and information Enhancing the skills of staff, improved confidence, improved communication

21. Standard 17 Ensuring the dignity of residents is part of policies and practices of home, particularly related to care in the dying phase, including compassionate holistic care Evidence Evidence of policy statements and practice on ensuring dignity Attention to detail in practice and policies, tools and resources and individual care plans provided by all staff

22. What are the drivers for GSFCH? Professional pride Staff job satisfaction, Staff retention and recruitment Good reputation Work smarter so more time for people Fewer sent to hospital More Money !! Attracts more residents Owner/ Policy/ external pressure

23. Don’t forget - its fun too!

24. For more information on GSF National GSF centre – Walsall Judy Simkins - GSF Administrator judy.simkins@walsall.nhs.uk Tel: 01922 604666 Nikki Sawkins – GSFCH Lead Nurse nikki.sawkins@nhs.net Mobile - 07825197625 Email: info@goldstandardsframework.co.uk New Website Launch: 15 th July www.goldstandardsframework.nhs.uk NHS End of Life Care Programme www.endoflifecare.nhs.uk