1. Delivering Improved Outcomes: Palliative and end of life care in care homes 30 September 2010 Marcia Ramsay Director of Adult Services Regulation

2. The Care Commission is the national regulator of registered care services in Scotland was set up under the ‘Regulation of Care (Scotland) Act 2001’ started operating in April 2002 is a Non Departmental Public Body with a Board, whose 12 members include people who use care services and carers

3. SCSWIS and HIS As of April 2011 Social Care and Social Work Improvement Scotland (SCSWIS) will commence Health Improvement Scotland (HIS) will undertake the existing regulatory functions around registered independent healthcare services ie independent hospices and hospitals

4. Palliative and end of life care… the story so far… National practice statements for general palliative care in care homes for adults, “Making good care better” (May 2006) Scottish Government - National Care Standards

5. Moving on… Inspection focus area (2007/08) Better care every step of the way (2008) Audit Scotland 2008 review of provision of palliative care delivery in Scotland Living and dying well action plan (2008)

6. Inspection focus area: Palliative Care Do you provide palliative care for service users who have cancer or a life limiting illness? Do you have a copy of making good care better? Are staff aware in the care home of the term and understand the palliative care approach? How do you record staff training in palliative care?

7. IFA: Palliative Care Do you have a policy for accessing advice, information and support from members of the primary health care team and the specialist palliative care team if this is required? Do your staff have access to communication skills training to help them meet the more sensitive personal issues of service users? How do you make sure that staff take the responsibility for reporting to the service users GP any symptoms?

8. In 2008 we found that: 290 (32%) care homes in Scotland were involved with palliative care link nurse meetings to access education and training Over 363 (40%) care homes had accessed the Macmillan Facilitated Learning Training Pack to learn about palliative care

9. Brief findings - highlights 291 (32%) of all care homes in Scotland work with a Practice Education Facilitator 483 (53%) care homes for older people said that they worked with specialists in palliative care in their local areas E learning was not widely used at this time only 87 (9.5%) out of 909 care homes used this method of accessing education 319 (35%) care homes access their education by accessing courses provided by hospices

10. The Care Commission recommends that… Follow up is done on progress of the last inspection focus area There should be on-going scrutiny and regulation of the quality of palliative care being provided not only in care homes but in care at home services Methodology will continue to develop but we expect that a focus on services caring for people living with life limiting long term conditions will continue

11. The way ahead… We will continue to influence improvement in palliative and end of life care by making sure care homes develop policies relevant or related to palliative and end of life care e.g. DNACPR Continue to collect and analyse data from the annual return information so that we can identify both improvements and issues Reshaping care and shifting the balance agenda

12. Some key points for others who can assist care services… A need for consistent DNACPR and associated documents (such as example developed by NHS Lothian) across all care settings Continue to improve upon joined up working between care services and other e.g. GPs etc

13. Thanks for listening