Agenda item

This report provides an update from the North West London Model of Care Working Group on the robust data it has gathered on population need and workforce data, intended support resource planning for high quality care and service provision.

Councillor Perez welcomed health colleagues who provided an update from the Model of Care Working Group. Jane Wheeler described the work and remit of the Palliative Care Model of Care Working Group which constituted clinicians, managers and residents drawn from all eight North West London (NWL) boroughs. Clinical practice was being informed by the needs of residents through engagement to ensure the best outcomes. The work had been precipitated by the suspension of the inpatient service at Pembridge Hospice several years ago.

The workforce provision within the model of care was described in the report within the context of mapping future demand across the borough. There were significant workforce challenges in London that hospitals and community providers were working innovatively to address but further analysis was required to understand gaps in provision. A further element was to understand travel planning and how people accessed provision using both private and public transport.

Phillipa Johnson explained that Central London Community Healthcare (CLCH) was a provider of specialist palliative care and provision including the Pembridge unit. The service had been suspended due to the lack of consultant cover, despite attempts to recruit such as collaboration with acute trusts and other hospice providers. The day service at Pembridge had recommenced following the pandemic. In addition to the inpatient unit day service, there was also a community nursing provision, with specialist palliative care provided in people’s homes.

It was reported that there had been increased activity, which was welcomed, as it indicated that people’s needs were being met at home. Commenting on the positive engagement at borough level, the support and input provided by HAFSON (Hammersmith and Fulham Save Our National Health Service) and other contributors had influenced the way in which CLCH communicated with residents, details of which were also included in the report. The Working Group had two main priorities, the first was to establish a directory of local provision and care available from voluntary sector providers. A second priority was to improve the interface between adult social care provision and community nursing to ensure more holistic provision in a person’s home. It was also recognised that carers would also benefit from specialist end of life support, so that they would be more equipped to support family members at home.

Dr Lyndsey Williams, a MacMillan General Practitioner, explained that she worked closely with a forum of clinical leads across the eight NWL boroughs, and also working with the NWL Last Phase of Life program. She welcomed the high level of engagement she had experienced during the course of the review and reflected that this had changed its trajectory focusing both on current provision and what the patient’s journey should be in terms of responding to need.

 There was now a greater focus on understanding a person’s lived experiences of receiving care. This had changed the narrative significantly and recalibrated what future provision could look like. Engagement had been extensive but had already offered solutions such as increasing 24/7 access to Pharmacy for anticipatory medication, and 24/7 telephone advice service for health professionals across NWL.

Keith Mallinson commented that he had visited Trinity Hospice and had been overwhelmed by the dedication of hospice staff. In the context of workforce challenges, he expressed concern about the health and wellbeing support services provided to staff, given the highly traumatic nature of end-of-life care provision. Phillipa Johnson responded that the health and wellbeing staff was a priority and a range of measures were in place including one to one support, webinars and flexible working hours. In addition, there were annual staff surveys and a wellbeing task and finish group consisting of staff members.

Jim Grealy commented that it had been a pleasure to engage with Phillipa Johnson and health colleagues throughout the process of informing the review. Staff “burnout” was fuelled by the high number of clinical vacancies across the NHS, and he asked how this was being addressed in terms of planning future services. There was a lack of integration across the health system with siloed thinking. Demand was increasing and it was important to also consider increased frailty, the impact of social isolation and loneliness, conditions such as dementia and the fact that more people lived alone or independently without local support networks.

Merril Hammer also commented on the positive experience of engagement with the review but highlighted the need for continuity and keeping residents updated. Jane Wheeler concurred with all of the views expressed and indicated that she would consider the frequency with which residents were kept informed. It had been hoped that the work could have been concluded during the summer period, but the process had not been linear and had taken much longer than anticipated. It was important to recognise that members of the Model of Care Group were falling a process, and whilst there was no intention to exclude anyone from this, it was not possible to provide more definitive answers at this time.

Merrill Hammer referred to the recent consultation on elective orthopaedic hubs, advocating a similarly comprehensive approach regarding travel planning and the difficulties experienced by families visiting loved ones receiving end of life care. It was suggested that a solution could be to fund travel where particular difficulties were identified. Jane Wheeler responded that this was a potential solution and could be considered as a mitigating factor in terms of planning access to services, recognising the difficulties that family members experienced. She concurred that more quantifiable and detailed travel mapping should inform planning but that the experiential element would be underpinned by data.

Lucia Boddington commented that she recognised the need for planning implementation of the service within five years but given the point made by Jim Grealy on the increased trajectory of deaths by 2040, proper resourcing of palliative care extended beyond funding the workforce. Dr Williams responded that it was important for the model of care to be fully developed and what it meant to provision end of life care from the Pembridge facility or in a person’s home. The way in which this could be structured needed to be designed and it would take until 2027 to implement any changes. There was greater transparency in focusing on the range of available options, recognising that H&F was the only borough to not have an end-of-life unit.

Councillor Ben Coleman referred to a public engagement meeting hosted by the Royal Borough of Kensington and Chelsea (RBKC) on end-of-life provision and how this had highlighted the strength of public feeling about the Pembridge unit. He endorsed the collective views of HAFSON that provision would be difficult to achieve without addressing the issue of travel. He enquired about the model of care being sought and anticipated that this should include a range of options, so that people could choose to die at home, in a hospice or a hospital. Jane Wheeler agreed with the importance of patient choice but recognised that there would be variation in need and that not everyone would require complex, wrap around care from a multi-disciplinary support team in a hospice. Councillor Coleman commended the positive change in approach and hoped that this would be replicated in future consultations.

Councillor Genevieve Nwaogbe sought further information about efforts to recruit a palliative care consultant, enquiring if there had been any attempt to recruit from overseas. It was noted that many different options had been considered and this had not included international recruitment. A fundamental challenge was that the future of the Pembridge unit was currently under review and this lower employment security to prospective employees.

ACTIONS:

1. For the Working Group to improve the frequency with which residents were kept informed of the groups work and activities.
2. For the Working Group to highlight further opportunities for residents to engage with the palliative care review work.

RESOLVED

That the update report was noted.