Agenda item

This report summarises the work and findings of the JSNA on End of Life Care, including recommendations for key partners.  The report also summarises the local direction of travel for End of Life Care in Hammersmith and Fulham, and continuing progress made against the JSNA recommendations since publication of the report. 

Councillor Vaughan welcomed a number of officers, both commissioners and providers: Colin Brodie, Public Health Knowledge Manager, Public Health, LBHF, Toby Hyde, Head of Strategy, H&F CGG, Matthew Mead, Integrated Care Programme Manager, H&F CCG, Holly Ashforth, Deputy Chief Nurse and Director of Patient Experience, CLCH, Darren Jones, Associate Director of Quality, CLCH, Anthony Clarke, Senior Social Work Practitioner, H&F CCG, Megan Veronesi, Head of Service Development and Communications, Trinity Hospice, Viv Whittingham, Head of Service Care and Assessment, Adult Social and Vanessa Andreae, H&F CCG.

This was a detailed, technical document which summarised the joint work undertaken by the local authority and the CCG on the JSNA on End of Life Care.  It was signed off by the LBHF Health and Wellbeing Board in March 2016 and provided an overview of the provision of end of life care across the three boroughs.  The following key points of the discussion were noted:

• End of life care was not simply care during the last few days or weeks, but could cover a period of months or years, usually following a serious long term condition.  It should cover physical, emotional and social needs, cross cutting across a number of different sectors;
• Paragraph 3.8 of the report set out five key recommendations.  This was primarily about a culture shift of moving on from the provision of palliative care to an open discussion, addressing issues such as individual choice, control and exploring broader options;
• There was a shift in terminology from “end of life” to “last phase of life”, noting that there was now greater likelihood of functional or gradual, decline spanning a number of years;
• A primary recommendation was that each individual received an easily accessible and agreed care plan, that had been consulted upon with friends, family and clinicians;
• CLCH – it was important to support staff to enable them to have difficult conversations about last phase of life care;
• Events were planned throughout “Dying Matters” week, planned for 8-14^th May.  The 2016 event had been well received, however, it was also acknowledged that there needed to be improved communication and information provided about workshops and events;
• There was significant variation across the three boroughs in terms of raising awareness of the issue;
• A key issue was about empowering staff based in for example, sheltered housing accommodation and not just about offering palliative care. It was about how to facilitate a humanitarian and compassionate approach alongside professional care.  This ought to be a shared and informed decision making process, making people feel comfortable and avoiding a fear of retribution culture; 
• Recognising that cognitive decline often pre-empted last phase of life, it was acknowledged that not everyone was able to engage and that there was a need for earlier intervention, with preparation or planning being a prerequisite in much the same way as a funeral plan.  This was not the same as simply having a conversation with your GP;
• The provision of last phase of life care was inclusive of all age groups, including young people, for whom tailored co-ordinated care plans could also be provided.  It was important to not generalise about cultural or religious factors and again, these were difficult conversations to facilitate, making it important to ensure that staff were fully supported, particularly in dealing with young people;
• It was noted that the majority of GP practices have multi-disciplinary team meetings, to examine patient cohorts and to understand their future preferences.  These were undertaken on rolling basis and contained inherent challenges, depending on the ability or cognisance of the individual.  This progress development in LBHF has been organic over the past three years offering ample opportunities for sharing learning;
• It was noted that there were approximately 25,000 people the last phase of life, based on the current data, with only a small portion of that number having an agreed end of life care plan;
• It was acknowledged that carers perceived experience was also important to understand and contextualise;
• The 28 beds provided by Trinity, covering a 5^th of Hammersmith and Fulham.  The majority of people wanted to die at home.  The issue was not about the number of beds but that 80% of care was provided in the community;
• The immediate focus of the JNSA was the need to ensure 24/7 access to clinical advice, with information as to who to go to and at what point in the day this should happen.  There was recognition of the need for better co-ordinated care to reduce the variation in experience and a need to improve training;
• The challenges of moving resources and facilitate people’s wishes to die at home; and
• The increase in extreme aging was highly challenging, requiring the co-ordination of different medical interventions and identified needs, ideally taking place with the least disruption.