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East Sussex
Older Peoples' Residential &
Nursing Care - Provider Forum
22nd May 2012
Kay Muir,
East Sussex PCTs /CCGs Programme Lead for EOLC
Sophie Clark,
Older Peoples Strategic Commissioning Manager,
East Sussex County Council
East Sussex
What we will cover today
• The big picture – nationally and locally
• The training and support available
• Overview of EOLC Care Home in reach
service piloted in 2011/12
• Findings ASC e-learning pilot 2011/12
• The benefits and rewards
• Next steps
• Questions
East Sussex
Where we are now
• National and local drivers for change
–
–
–
–
–
National strategies to support improved EOLC
Rising needs and expectations
Integration between health and social care
Regulatory requirements and quality standards
An identified need for training and support
• Workforce development plans
• Resources for workforce development
• A joint approach to workforce and end of life
care in East Sussex
East Sussex
The End Of Life Clinical Pathway
Coordination of Care for the patient
• Coordination of individual patient care
• Register-information shared across all sectors
Delivering high quality care
Starting the
conversation
•Open, honest
communication
• Identifying
triggers
for discussion
• Listening to cues
from patients
Assessment
and
care
planning
• Assessment
and regular
review of
patients’ needs
• Care planning
• Assessing
carers needs
• High quality care
provision in all settings
Last days of life
• Rapid response services
• Identification of
the dying phase
• Hospital, community, care
homes, hospices, community
hospitals, prison, secure
hospitals
and hostels
• Ambulance
Services
•All OOH services
• Spiritual care
Coordination of Care for carers
• Review of needs
and preferences
for place of death
• Support for both
patient and carer
• Recognition of
wishes regarding
resuscitation and
organ donation
Care after death
• Timely verification
and certification of
death
• Viewing of the
body/mortuary
facilities
• Return of
property
• Care and support
of carer and
Family
National EOLC Core Competencies
“Developing End of life Care Practice: A guide to workforce
development to support social care and health workers to apply the
common core principles and competencies for EOLC” 2012
A framework of competences, values & knowledge
• Communication skills
• Assessment and care planning
• Advance care planning
• Symptom management: maintaining comfort and wellbeing
• Overarching knowledge and values
http://www.endoflifecareforadults.nhs.uk/publications/corecompetn
cesguide
East Sussex
EOLC National Occupational Standards
A framework of National Occupational
Standards 2009 to support common core
competences and principles for health and
social care workers working with adults at
the end of life
Web:http://www.endoflifecareforadults.nhs.uk/
publications/corecompetencesframework
East Sussex
Where we want to be - routes to
success …
• More patients having a “good death” in
their preferred place of care
• Fewer complaints about end of life care
from relatives or friends
• An improved reputation for the provider
• Fewer unplanned hospital admissions
• A skilled workforce with improved morale
and retention
East Sussex
East Sussex End of Life Care Home Pilot
Quality -
high quality service to identify people at the
end of their life and support them to be cared
for and die in their preferred place of care
Innovation - Piloting initiative at a local level
Productivity - reduction in inappropriate admission to
hospital
Performance - evidence of people being cared for and dying
in their preferred place of care
- monitoring though activity and costs data e.g.
“Death in Usual Place of Care indicator”
East Sussex
EOLC Care Home Support Pilot Project
What the project involved
Two multi-disciplinary EOLC support teams, provided across East Sussex by St Michael’s and St Wilfrid's
Hospices, with the overall aim of supporting EOLC within care homes, to reduce avoidable EOLC hospital
admissions and to enable residents to be cared for in their preferred place of care.
Year 1 project summary
•
20 Care Home , 11 are residential and 9 nursing homes with a combined 714 residents. These Homes were
identified as having a high number of emergency admissions to hospital using urgent care data.
Progress to date
•
The EOLC Care Home support has been very well received in the community setting by the Care Homes
involved .
•
Baseline assessments were been completed and an action plan including training for each home was agreed
to meet the care home identified needs.
•
Training package for each of the care home commenced in September 2011 to Feb. 2012. The outcomes of
the training and comparison against baseline activity and behaviours are being completed,
Plans for 2012/2013
•
Project extended to inform health and social care commissioning in the future
•
Lot of learning about selection of care homes for 2nd year
•
Dissemination of year 1 outcomes and recommendations to inform commissioning intentions for 2013/14
•
Longer term aim for joint health and social care facilitator roles to support homes
East Sussex
St Michaels’s Hospice- Summary of the 10 Pilot Care Homes
Overall General information
•Total No of Care Homes 10 : 6 Residential home and 4 Nursing homes
•Total No. of residents: 347
•Types of residents supported include :
elderly, epilepsy, Parkinson's, stroke, hearing/speech/visual impairment, dementia,
learning disabilities, CVI, Cancer, MS, mental health and heart failure
EOLC Assessment Questionnaire Summary and update for EOLC tools
The education programme delivery is between September and December, 2011. The
initial EOLC Assessment Questionnaire / use of EOLC tools undertaken ( in May /June)
and repeated Spring 2012 to allow time for support following the educational input.
Summary of After Death Analysis (June to Sept 11)
1. Of the 25 collected 11 residents died in hospital, and 14 remained within the care
homes.
2. Evidence of PPC recording in 8/10 homes
3. DNACPR now starting to be addressed in 9/10 homes where appropriate
4. LCP being used in 3/10 homes
Issues identified during Stage 2:
• GP refused to initiate LCP as dying patient did not have cancer
• Lack of managerial support and attendance for EOLC training in some homes
• Managers are finding it difficult to release staff to attend training sessions
• Language barrier to training for some staff
• Most homes are receptive to training
• Staff are now actively approaching GPs for DNACPR/ JIC box
• Evaluations of session 1 of training very positive
• Session 1 attended by 74 staff, of which 8 were care managers/trainers
East Sussex
St Wilfrid’s Hospice - Summary of the 11 Pilot Care Homes
Overall General information
•Total No of Care Homes 11 : 5 Residential homes,5 Nursing homes and one dual
registered home
•Total No. of residents: 367 Types of residents supported include : elderly,
epilepsy, Parkinson’s, stroke, hearing/speech/visual impairment, dementia,
learning disabilities, cancer, multiple sclerosis, mental health and heart failure
EOLC Assessment Questionnaire Summary and update for EOLC tools
•The education programme delivery is between September and Jan 2012. The initial EOLC Assessment Questionnaire / use
of EOLC tools undertaken (in May /June) therefore not repeated until 1 month after completion of the training to
establish any changes to practice and any policies or procedures that are in place regarding end of life care.
Staff assessment
Staff have been asked to complete a competency questionnaire prior to commencing the training. This will be followed up
at the meeting highlighted above.
After Death Analysis
Further after death analyses will be completed at the planned focus group following completion of the education package
Supporting homes
• As there was a delay in commencing training, each home was offered the opportunity for any support from the project
leader and to try and form a relationship with the carers in the home. Four homes took up this opportunity:
• Home No 2. To discuss difficulties with advance care planning.
• Home No 3. To discuss care plans.
• Home No 6. To spend a day with the staff. Issues around updating care plans at end of life were discussed with the
manager.
• Home No 9. To spend a day in the home – an opportunity was taken to inform the staff of the project at break times.
• It is reinforced at all the training sessions that the hospice is happy to accept referrals for their residents where they
need support for end of life care, and that we will be happy to assist in the implementation of the LCP until they are
confident to do this.
East Sussex
Care Home Pilot Educational Programme
The Education Model being used to provide the educational input to the 10 Care Homes is designed around
3 workshops. Workshops will be for both HCA’s and RN’s together. Following the workshops, on going
support will be provided to help cascade and support implementation of the learning within each home. This
does vary slightly between Hospices although reflects similar content and competencies
Workshop 1 : Introduction to EOLC: Philosophy and Principles and Communication at EOL
(September 2011)
This workshop includes raising awareness of current initiatives in EOLC and concept of holistic care at EOL
The workshop will run within each care home ( some care homes are joining together for a workshop) so a total of 8
workshop will run. Homes can also send staff to other homes sessions to increase the number that can access the workshop.
This workshop covers all 6 Steps of the National EOLC programme 6 step model.
Workshop 2 : Holistic Assessment at EOLC and Symptom Control (October 2011)
This workshop includes common symptoms and their management, and team liaison / accessing resources in management
of symptoms
The workshop will run 4 times, twice in Bexhill and twice in Hastings at St Michael’s Hospice so each care home can
choose which venue it would like to sent staff to. This has been done to aid release of staff to attend.
This workshop covers Steps 2,3,4 and 5 of the National EOLC programme 6 step model
Workshop 3 : Advanced Care Planning and Care in the last Days of Life/After Death Care (
November / December 2011)
This workshop covers consideration of MCA, use of DNACPR, LCP and bereavement
The workshop will run 4 times, twice in Bexhill and twice in Hastings at St Michael’s Hospice so each care home can
choose which venue it would like to sent staff to. This has been done to aid release of staff to attend.
This workshop covers Steps 2,3,4,5 and 6 of the National EOLC programme 6 step model
12
Educational Model for Care Home Support Pilot
Advanced
Care
Planning
Implementation
Support
Evaluation
Session
1
EOLC &
Dementia
The above model
shows how the Care
Home programme and it’s
additional support fits within and can
be enhanced thought additional more
specialised sessions provided from the
Hospice ‘s wider educational programme
Session
2
Nursing Home Pilot EOLC
Education Programme
EOLC Clinical support
Syringe
Driver
Training
Liverpool
Care
Pathway 12
Spiritual
Care
Session
3
Additional learning /
e-learning
Introduction
to End of
Life Care
Grief and
Loss
Hospice Current Educational
Programme and Support
Sessions available to Care Homes
and Clinical Staff
East Sussex
QIPP EOLC Care Home support -Comparison of
Baseline ADAs and Last 5* ADAs uptake of EOLC
tools
Hospice
Uptake of Advanced
Care Planning
(ACP)
Recording of Preferred
Place of Care (PPC)
DNACPR completed
Liverpool Care
Pathway (LCP)
Baseline
Baseline
End of year
Baseline
Baseline
End of year
61%
27%
7%
26%
End of
year
End of
year
St
Michael's
percentage
34%
68%
30%
67%
St Wilfrids
percentage
68%
38%
76%
98%
27%
69%
8%
East Sussex
6%
Barriers and Resolutions
• Encourage care managers/DNs/RNs in nursing homes to initiate discussions with GPs,
with Hospice at Home providing back up
• Circulate letter to GP’s early on in project informing them that they will receive follow up call
from homes and Project Lead/Medical Director
Lack of commitment
care home
• Ensurefrom
Hospice
presence at GSF meetings for surgeries linked to the care homes
• Training sessions for GPs
Poor
engagement
with GP’s
•
Limited impact
of training on
change in
practice
 Syringe driver availability and more syringe driver awareness in educational package
 Empowering care managers to have confidence to assertively ask GPs for medication
 Liaison with project link for medicines management
 On-going support necessary to maintain skills
 Further work needed from ASC to address access to IT for e-Learning
 Use of alternative and Hospice e-Learning facilities
 Adapt training materials to easy read style to allow for communication via pictures rather
than too much text
 More objective project assessment tool or process for collecting information needed
Lack of
commitment
from care home
• Care Home commitment prior to engagement with project, including fines for non-required
attendance at booked training sessions.
• Deliver tailored training sessions in care homes wherever possible
Inappropriate
choice of care
home
•


Consult with GP’s and Hospice at Home
Choose homes asking for training or those with no or minor CQC concerns
Focus mainly on nursing homes as DNs have input to residential homes
East Sussex
Proactive Elderly Advance CarE
(PEACE) Tool
•
Pilot lead Dr Elena Mucci, Consultant Geriatrician, Conquest Hospital
•
pilot for 1 year and will finish in September- data available from October/Nov
2012
•
To date discharged 19 patients on PEACE in the first 3 months of the pilot.
Only received positive comments from relatives who support this process
•
Of 19 patients 6 died-all in their NH, the rest are alive and have not had any
admissions.
•
•
•
•
1. PEACE discussions on the ward: relatives, NH manager, GP, completion
of community DNAR by myself with agreement from GP.
2. PEACE completion by doctors, copy goes with the patient and copy given
to relatives
3. H@H visit within a week: review of patient and education.
East Sussex
Useful links for resources and support
•
Dying Matters website excellent for both professionals for resources and
information for residents / patients
http://www.dyingmatters.org/
•
National EOLC Programme – excellent professional support
http://www.endoflifecareforadults.nhs.uk/
•
Routes to Success resources
http://www.endoflifecareforadults.nhs.uk/tools/core-tools/rtsresourcepage
•
Gold Standards Framework (GSF) for Care Homes
http://www.goldstandardsframework.org.uk/
•
Liverpool Care Pathway
http://www.mcpcil.org.uk/liverpool-care-pathway/
•
Preferred Priorities for Care
http://www.endoflifecareforadults.nhs.uk/tools/coretools/preferredprioritiesforcare
East Sussex
End of Life Care
e-learning pilot
East Sussex
The Pilot
Who?
• 2 Home Care Providers
• Care Home In-Reach Team
What?
• To trial access to e-learning programmes for social care
providers,
• To monitor uptake
• To identify challenges and issues
• To assess and develop appropriate support tools
• Part of joint EOLC workforce development programme
East Sussex
EOLC training
• Free access to e-Learning resources and
the People’s Network
• Open to NMDS–SC registered employers
• Linked to QCF Levels 2 and 3 Diploma
• 150 sessions in four core competencies
• 12 open access modules
• Short sessions - around 20 minutes long
• Learning tailored to individual needs
East Sussex
East Sussex
East Sussex
Stakeholders
• Social care providers who:
– Deal with end of life care frequently
– Occasionally deal with end of life care
• Those approaching end of life, their family
and friends Managers
• Volunteers, carers and personal assistants
• Clerical and administrative staff
East Sussex
Benefits
•
•
•
•
•
Well trained and motivated staff
Better quality care and outcomes
Equal access and choice
Excellent personalised care
Improved communications with primary care
colleagues
• Compliance with CQC regulations – K4
• Delivering best practice and quality standards
• Competitive edge - become a provider of choice
East Sussex
Key Tasks
•
•
•
•
•
Benchmarking existing skills
Training needs analysis to tailor training
Marketing and promotion
Monitoring take up
Measuring impact
East Sussex
Some findings from pilot - staff
•
•
•
•
•
Lack of access to IT equipment
Difficulties with registration
On-line support not always effective
Most staff enjoyed the modules they did
One to one sessions worked better than in
a group
• Printed certificates popular
East Sussex
Some findings from pilot managers
• Generally positive response
• Training resource guide quite useful
• Need for support at front end- e.g.:
– Baseline assessment
– Training needs analysis
– Links with business planning
East Sussex
Next steps…
• Project manager recruited
• Identifying support needs
• Defining programme for roll out
East Sussex
Summary
• Improving EOLC has a high profile…
– National and local drivers for change
– Workforce development plans and resources
– A joint East Sussex EOLC project
• Lots of incentives to improve EOLC
• Training and support is available
• A wide range of benefits and rewards for
those who engage
East Sussex
Some questions…
• How can we best work together to take
forward EOLC workforce development?
• Are there any logistical issues that need to
be overcome?
• Would a more detailed session for a larger
number of providers be useful?
East Sussex
For more details please contact:
Kay Muir, Programme Lead , End of Life Care, East Sussex PCTs /CCGs
Based at:
ESDW PCT Headquarters
36-38 Friars Walk
Lewes, BN7 2PB
(Mon- Thurs.)
Email:
[email protected]
Office tel.:
01273 485335
Mobile:
07500 972 749
Sophie Clark, Older Peoples Strategic Commissioning Manager, ESCC Adult Social Care
Based at:
Adult Social Care
East Sussex County Council
County Hall
St Anne’s Crescent
Lewes
East Sussex
BN7 1UE
Email
[email protected]
www.eastsussex.gov.uk
Office tel: 01273 335392
Mobile: 078617471942
East Sussex