Agenda item

7.1

The Chief Operating Officer, NHS Sheffield, submitted a report providing an update on progress towards achieving an increase in the preferred place of death for Sheffield residents.

7.2

Kate Gleave, Senior Commissioning Manager, End of Life Care, NHS Sheffield, stated that the report had been prepared following a request by the Committee at its meeting held on 21^st November 2011, and contained details of the progress made since that date.  Ms Gleave added that, as part of the progress of work undertaken, an outline business case, based on the new End of Life Care (EOLC) Home Care Model, had been produced and would be submitted to NHS Sheffield for approval in December 2012, and to the City Council’s Cabinet in March 2013.  It was envisaged that the new model would be in place by October 2013.

7.3

Ms Gleave also referred to the actions taken to address the prioritised problems and details of the comparisons between the current arrangements and the new model for End of Life Home Care, which were attached Appendices 1 and 2, respectively, to the report.

7.4

Members of the Committee and representatives of the LINk raised questions and the following responses were provided:-

·               Using a set of prognostic indicators, health workers were able to identify when the majority of patients were in, or entering their last year of life and would be expected to discuss this directly with the patient and/or their carer or family at this point.  In cases where patients were likely to lose their mental capacity prior to their last year of life, such as suffering from dementia, such discussions should take place earlier, in order to ensure that they could fully understand the position.  NHS Sheffield was encouraging clinicians to commence such discussions as early as possible, as well as giving them the required confidence to raise such delicate issues with patients and/or their carers and families and to detect when patients/carers did not want to discuss this.

·               For some patients, there may come a point when their condition was so severe that it made it impossible for them to be cared for at home.

·               The level of support and care could increase as a patient’s condition worsens, but such care and support would vary for different patients.  Even if a patient’s condition was viewed to be stable, they or their carer could suffer some form of crisis, which would require the care they required to be increased in order to meet their needs on an as and when basis.  For this reason, it had been identified that there was a need for a more flexible model.

·               It was accepted that informing patients about end of life care was a very delicate and emotional issue and in the light of this, NHS Sheffield had invested in communications training to all health and social care staff in the City. This would include the necessary training to ensure that health care staff have fully explained the position to the patient and that the patient has fully understood the position that they were in.  It was also accepted that a large proportion of people did not wish to know, or accept the fact that they were nearing the end of their lives and informing them of this fact was seen by many as a reason to give up any hope.

·               There were measures in place to deal with those cases where patients or their families had expressed a wish to spend the remaining time of their lives in the comfort of a hospice or by receiving care at home, rather than undertaking constant visits to hospital, which could cause unnecessary upset and inconvenience for both patient and family.  The planned implementation of the Assessment, Management, Best Practice, Engagement, Recovery Uncertain (AMBER) care bundle at STHFT would further support identification of such patients.

·               The Electronic Palliative Care Communication System (EPCCS) was designed to improve communication between hospitals and GPs about patients in their last year of life.  In the long-term, it was hoped that this system would be used to communicate information to members of the wider team involved in a patient’s care, such as their care home and Accident and Emergency staff.  The timing of this development is dependent on technical issues and resolving how best to obtain patient consent.

·               There had been considerable debate on the issue of confidentiality, particularly with regard to patients’ details being included on lists of those people in their last year of life.  Currently, the EPCCS only communicated information which should be on a normal clinic or discharge letter between secondary and primary care, that is what patients would expect to be shared routinely.  The sharing of this information with a wider group of clinicians involved in the patient’s care would require patient consent and NHS Sheffield was currently exploring how this could be done appropriately. It was considering developing a patient communications leaflet which fully explained the position relating to patient confidentiality.

·               Whilst research had concluded that 63% of people in Yorkshire wanted to die at home, between 2008 and 2010, 57% of deaths in Sheffield had occurred in hospital, which was significantly higher than the England average of 54.5%.  It was hoped that, by implementing a joint health and social care model, the number of deaths in hospitals could be reduced in the future. The service providers of this model would work closely with the Integrated Care Teams, which comprised a broader range of health and social care professionals.

·               There were a number of national campaigns to get more people to talk about death and dying.  One group involved in this was the Dying Matters Coalition, who organised an Awareness Week in May every year.  In addition, NHS Sheffield had developed a  media campaign, and had already advertised on local radio, with plans for further advertisements and announcements in the local media.  It was also writing to various charities, requesting them to display information on their media communications on this issue. 

·               Whilst the new care model was aimed at people aged 18 or over, a need to introduce similar measures in terms of people under 18 had been identified.  STHFT was in the process of developing a Limitation of Treatment Agreement (LOTA), in consultation with patients’ families.  There were also transition arrangements in place when such patients reached the age of 18. 

·               Although the number of people over the age of 80 in the City was likely to rise in future years, this would not necessarily have a direct effect the numbers of people entering the final year of their lives.  There was a need, however, to ensure that plans were in place now to ensure that the correct approach was taken in respect of such people and to ensure that the health and social care system was working effectively so that the needs of the increasing numbers of people over 80 in the City could be met.

·               In terms of the recent issues and concerns raised in the national press regarding the Liverpool Care Pathway, such issues had been discussed at a meeting of the Local End of Life Care Planning Commissioning Group and it had been identified that, regardless of the Government’s views on the Liverpool Care Pathway, there was a need for improvements in terms of communication with patients and their relatives.

·               The reference to the word ‘inequitable’, when describing the main barriers in terms of access to Home Care support, referred to the fact that there were about 40 different providers commissioned to provide different levels of care at different points in the patient’s last year.  It was hoped that the problems arising from this would be addressed under the new Home Care Model.

·               Good End of Life Care ought to be part of the revalidation of GPs.  The GP Quality Outcomes Framework (QOF) does require GPs to have a register of Palliative Care patients and to meet them every three months. It was possible that these two requirements would be developed further for 2013/14.

·               The decision on when to stop providing patients with food and drink was taken by clinicians and based on the individual circumstances of each patient.  Health staff would not stop providing food and drink if it resulted in the patient suffering in any way.

7.5

RESOLVED: That the Committee:-

(a)      notes the contents of the report now submitted, together with the responses to the questions raised; and

(b)      requests:-

          (i)      that the business case for the new End of Life Care Home Care Model be referred to the Clinical Commissioning Group and the City Council’s Cabinet for approval;

          (ii)     the Scrutiny Policy Officer to arrange a joint meeting of this Committee and the Children, Young People and Family Support Scrutiny and Policy Development Committee to discuss the issues regarding End of Life Care for children up to the age of 18;

          (iii)    that consideration be given to how the issues relating to the End of Life Care could be included in the revalidation process regarding GPs;

          (iv)    Kate Gleave to attend a future meeting of the Committee in 12 months to provide a further update on the new End of Life Care Home Care Model, including an update on local and national data; and

          (v)     the Council’s Communications Service to look at how the Council could publicise the ‘Talk About Death’ campaign.