Hampshire County Council

Health Overview and Scrutiny Committee Item 7

29 May 2007

Health Review Programme: Update on the Care at End of Life Review

Report of the Chief Executive

Contact: Martin Combs [email protected] 01962 847479

1. Background

1.1. This report provides the HOSC with:

An update on progress in key areas identified at the last meeting. These include progress with:

· Arrangements for accessing appropriate pharmacy support

· Reviewing needs for specialist palliative care across all care settings

· Ensuring clear protocols are in place to avoid inappropriate interventions or admissions

1.2. The recommendations in this report support the corporate strategy aim of maximising health and wellbeing through the scrutiny of health services in the County Council area.

2. Responses

2.1. Hampshire Primary Care Trust

Details of the Recommendations and detailed responses from Hampshire PCT are attached at Appendix One.

2.2. Hampshire County Council

· In order to promote consistency in service provision, and support front line staff, Hampshire County Council shall publish a County wide policy setting out the support to be provided to informal carers. This shall include arrangements for supporting patients and carers with social care needs where NHS continuing care is being provided.

Recommendation for which a response from Adult Services is requested for this meeting:

Adult Services will be providing an oral update on progress at this meeting.

2. Care at End of Life Research Project

3.1. The University of Southampton has commissioned the Office of National Statistics (ONS) to randomly select potential survey participants for the VOICES research. This aspect of the work is nearing completion.

3.2. The ONS, has, however, insisted that further ratification from the University Ethics Committee will be required. This substantial work is being progressed by the university research project manager.

3.3. The first meeting of the Advisory Group for the project, originally scheduled for 9 May, was cancelled due to illness of Professor Addington-Hall. The Professor is now recovered and the meeting is being re-arranged.

3.4. An article has been prepared for raising public awareness of the research to be included in the Summer edition of Hampshire Now.

3. Recommendations

That Members determine if they are satisfied with progress with regard to:

Hampshire PCT

· Arrangements for accessing appropriate pharmacy support

· Reviewing needs for specialist palliative care across all care settings

· Ensuring clear protocols are in place to avoid inappropriate interventions or admissions

Adult Services

· How informal carer assessments are requested

· A County-wide policy setting out support provided for carers

Appendix One: Hampshire PCT

Hampshire County Council Health Overview and Scrutiny Committee May 2007

Update on the Care at the End of Life Implementation Plan

1. Introduction

The PCT Care at the End of Life Implementation Plan was approved by the Health Overview and Scrutiny Committee 12 April 2007. This update refers to the 3 recommendations the PCT was committed to responding on in May 2007.

2 Recommendations

4.2.15 Arrangements for accessing appropriate pharmacy support (including controlled drugs) both in and out of hours shall be reviewed to identify and implement good practice to ensure that the needs of patients in their homes or other community settings are responded to in a timely and appropriate manner.

Diana Dunford, Head of Medicines Management for the North Area of Hampshire PCT, has been identified as the Pharmaceutical representative on the Project Steering Group. Diana will link with some work already being undertaken by the Central South Coast Cancer Care Network Palliative Care Group to identify gaps in service provision. From this recommendations will be made to ensure a comprehensive provision

4.2.16 Hampshire PCT shall review the needs for specialist palliative care across all care settings to ensure that an appropriate level of service is commissioned and resourced to support people living in their own homes or the community and reduce avoidable admission to hospital. Best practice in hospice services and other partnership working across Hampshire shall inform this work.

The Project Steering Group will map current service provision, identify gaps, and consider best practice from other areas. Recommendations to ensure an appropriate level of service will then be made.

Preventing avoidable hospital admissions is a key target for Adult Services during 2007/2008 and the service will be closely monitored to ensure the target is achieved. The new Community Matron posts across the PCT will build upon the good practice developed as a result of the Integrated Cancer Care Programme and together with the wider community nursing teams be key in delivering this target for the PCT. In addition the community nursing teams will increase support to Nursing Homes to ensure that inappropriate hospital admissions at the end of life are avoided for this most vulnerable group of older people. To assist this process, Gill Nother, Nurse Manager for all HCC in house enhanced beds will be a member of the project steering group.

4.2.17 Hampshire PCT, working with the South Central Ambulance Trust, Adult Services, hospice services, Care Homes and OOH services as appropriate shall ensure clear protocols are in place to respond to patients requiring transfer who may be in the final stage of their illness. This shall include specific protocols to ensure that there is clarity about the resuscitation status of the patients and to avoid inappropriate interventions or admission to hospital. Mechanisms to communicate these protocols to GPs and other front line staff shall be identified.

This is a significant piece of work to ensure a process whereby there is clarity over the current resuscitation wishes of patients so they do not have an inappropriate hospital admission or interventions. The Project Steering Group will discuss fully and a cross organisation policy similar to the Adult and Child Protection policies may be the way forward. A contact in the Ambulance Service has been identified and the Group will also seek the advice of the PCT's clinical governance lead.

3 Project Steering Group

PCT Care Services, PCT Commissioners and HCC Adult Services have met since the last HOSC meeting. Draft Terms of Reference for the Project Steering Group have been agreed (attached). The first meeting of the Project Steering Group will be held 26 June 2007.

4. Actions requested

The Health Overview and Scrutiny Committee is asked to note the contents of this report.

Elizabeth Emms

10 May 2007

Care at the End of Life Review Implementation Plan Project Steering Group

Terms of Reference

1. Purpose

To work across health and social care in consultation with service users, carers, and the voluntary sector to lead the implementation of the recommendations of the Hampshire County Council Health Overview and Scrutiny Committee Review of Care at the End of Life.

In response to the awaited Department of Health End of Life Care Strategy, to develop a strategy for the future development of Care at the End of Life and support its implementation.

2. Objectives

· To identify actions required to successfully implementation of the recommendations of the Hampshire County Council Health Overview and Scrutiny Committee Review of Care at the End of Life

· To develop a Project Plan to implementation of the recommendations of the Hampshire County Council Health Overview and Scrutiny Committee Review of Care at the End of Life

· To lead the implementation of the Project Plan

· To support and coordinate the work of the Project Steering Group sub groups

· To ensure a communication strategy between the Project Steering Group, the sub groups, and key stakeholders

· To ensure effective consultation with service users and carers

· To develop a strategy in response to the awaited Department of Health End of Life Care Strategy for the future development of Care at the End of Life with all stakeholders and support its implementation

3. Membership

The Project Plan Steering group will have representation from:

· Acute Trusts

· Hampshire County Council Adult Services (HCCAS)

Carers Lead

Commissioning

Nurse Manager

· Hampshire Primary Care Trust (HPCT) e.g.:

Commissioning

Continuing Care Team

Finance

Primary Care

Medicines Management

Provider services - North, SE and SW

Public Health

· Joint Equipment Store

· Voluntary Sector

· Strategic Health Authority

4. Operation of the Group

· The Group will be chaired by the Area Director of Care Services with the Adult Services lead

· An agenda for each meeting shall be prepared by the Project Lead and distributed at least a week prior to the meeting

· Notes of the meeting shall be prepared by the Project Lead and distributed within two weeks of the meeting being held

· The group shall meet monthly for no longer than two hours

5. Reporting:

The Group will report to:

Hampshire Primary Care Trust Professional Executive Committee/Care Services Board

Hampshire County Council Health Overview and Scrutiny Committee

Hampshire County Council Directors Management Team

Local Implementation Teams or planning forums

7 May 07