Living & Dying Well

This paper provides an update (as at 1st November 2011) on the implementation of the Scottish Government’s action plan on palliative and end of life care Living and Dying Well. It gives information about work at national level, but does not cover all the work going on at local level across Scotland.

Testing of Audit Measures

NHS Board DNACPR leads will be progressing a two-phase testing process of a proposed DNACPR audit measure at local level.

Challenges in Implementation

The Scottish Association of Medical Directors recently discussed the challenges of implementing the DNACPR policy and agreed to undertake some supportive actions.

Education

Recent education initiatives supported by NES include the development of a new DNACPR module for Foundation Years 1 and 2 as part of the Doctors online training system (DOTS).

A reporting template for NHS Boards was issued at the beginning of August. The reporting template covers all the key areas of NHS Board action in both Living and Dying Well and Living and Dying Well: Building on Progress. Broadly speaking the template sought information about plans, processes and structures, whilst the national measures of quality (see below) will focus on outcomes. All NHS Boards have now reported and SPPC are undertaking tabulation and analysis on behalf of the Living and Dying Well National Advisory Group. The purpose of the reporting is:-

• To ascertain progress in improving palliative and end of life care
• To facilitate shared learning
• To identify areas of common concern and hence inform consideration of additional future support/action

The National Advisory Group will consider the reports at its meeting in November.

Advance and anticipatory care planning (ACP)

The report on the ACP Facilitator training evaluation presents an overview of the findings of the three phases of the study and assesses the degree to which the ACP facilitators training programme and resource pack have prepared the facilitators with the knowledge, skills and tools to deliver training in ACP to address local and regional needs. The full report is available from http://www.nes.scot.nhs.uk/education-and-training/by-discipline/nursing-and-midwifery/resources/publications/evaluation-of-the-advanceanticipatory-care-planning-(acp)-facilitators-training-programme.aspx

In line with recommendation 10 of the report NES is in the process of commissioning an update of the ACP facilitators training pack.

Communication and Human Relationships work stream (in collaboration with Long Term Conditions)

2010-11 projects: A collated summary of the final reports from the projects including information on the evaluation of the impact of the NES supported projects during 2009 – 11 is under development.

The report on the scoping exercise undertaken by Create Consultancy to identify how healthcare professionals develop their communication skills, attitudes and behaviours has been completed.

A new web based resource to be entitled Communicating, Connecting, Caring is currently under construction with an anticipated completion date of October 2011. The site will offer healthcare workers, managers, supervisors and educator’s information and resources to support the development of communication and relationship skills and behaviours.

During 2011/12 funding was made available to support the wider implementation of the CARE measure and a Practice Based Small Group Learning Module (Sensitive conversations at the end of life: Learning from each other using PBSGL methodology). These projects are now underway and are due to report in March 2012.

In collaboration with the Living and Dying Well Short Life Working Group 5 and Consultant Medical Staff a new publication titled An Evolving Process: Snapshots of palliative and end of life care in acute care settings in hospitals is now available on the NES website. The publication aims to help doctors and healthcare teams in hospitals to overcome some of the challenges they face by presenting examples - ‘snapshots’ of good current practice across Scotland, as described by physicians working in different hospital settings. It is available at

http://www.nes.scot.nhs.uk/publications-and-resources/publications-search.aspx?title=evolving+process

A Project Group chaired by David Oxenham has been tasked with identifying measures which, at NHS Board and national level, provide evidence of change within the health and social care system which is indicative of improved outcomes for patients with palliative and end of life care needs and their families. The Group has met 4 times and has now submitted candidate measures for consideration by the Living and Dying Well National Advisory Group. The measures will be subject to wide consultation before adoption.

Co-Chairs for the steering group have been identified and nominations sought from all NHS Boards for participation in the review and development process. The Group is aiming for a first meeting in December. If you are interested in being involved then please contact the Palliative Care Executive Lead in your health board area since they are co-ordinating nominations.

The new alliance will launch publically on 22^nd November 2011. The Alliance’s website will go live shortly and its link made available to SPPC members and stakeholders.

The requisite content has been developed and a “go live” date is still awaited from NHS Inform. A meeting between LDW project group and NHS Inform is scheduled for the morning of 4thNovember.

Further revisions have been made to the draft Health Care Strategy for Palliative Care for Children and Young People (produced by SCYPPCEx) and a meeting is planned with John Froggat.

CYPADM - A national meeting HB reps is scheduled for November 23^rd the aim of which is to

1. Feedback of Audit carried out on usage of CYPADM forms
2. Feedback from individual health board paediatric palliative champions and paediatric nursing leads.
3. Sharing of problems, solutions and best practice.

Scottish Government has convened a short life working group to progress this issue. The group comprises hospice, NHS Board, SPPC and Scottish Government representatives.

Palliative care in practice - Online Resource www.palliativecareinpractice.nes.scot.nhs.uk

This new site was launched in June 2011. Use of the site is being monitored and between July 18 – Sept 19, 2011 there were 522 visitors to the site. The site content is currently under review and will incorporate any relevant user feedback and additional resources currently hosted on the Palliative Care Education MKN.

Dissemination

As part of the project exit strategy NES is in the process of developing a new publicity leaflet which will highlight some of the key educational resources developed by the Palliative Care Project. This will be circulated to the NES palliative care project reference group and other key contacts for onward dissemination.

During July - September a number of meetings and events have been accessed to further disseminate information on the project outputs including;

• Meeting with Leading Better Care facilitators and contact with Releasing Time to Care programme leads
• NHS Education for Scotland Community Nursing Events
• NHS Lanarkshire Palliative Care Managed Clinical Network
• NHS Scotland Event
• Macmillan Cancer Care Masterclass
• NHS Lothian Education Facilitators
• Living and Dying Well Care Home Steering Group
• Reshaping Care For Older People events (Aberdeen and Glasgow
• Macmillan Cancer Care Centenary Conference
• Scottish Partnership Annual Conference