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Transforming End of Life Care in Acute Hospitals: News and Updates

Chaired by Anita Hayes Quality Improvement Lead The National Council for Palliative Care today's conference focuses on improving end of life care for people in hospital. Through national updates and learning from the NHS Transform Programme, and case studies demonstrating improvement in practice the conference will support you to meet the six national ambitions for end of life care within hospital, and improve care and outcomes for patients and their families.

Tony Bonser Chair People in Partnership The National Council for Palliative Care and Dying Matters & Member Baroness Neuberger’s Independent Review Panel on the Liverpool Care Pathway opens the conference with an update on 'Putting personal experience first' and will discuss

• end of life care in hospital: a personal journey 

• ensuring engaged, informed individuals and carers

• improving information about what to expect at the end of life

Pre conference abstract:

Patients are people too. I am involved in EoLC because of my personal experience caring for my son during his terminal illness. I dream we can work towards a system of fully integrated, holistic care for those near death. This will involve a culture-change in the relationship between medical professionals and patients/carers, in line with the patient-centred philosophy embodied in the NHS Constitution, and with the recommendations of the Francis Report, the Neuberger Report, “One Chance to Get it Right,“ and the NICE guidelines 2016, seeing patient and professional in a partnership, defining and meeting the perceived needs of the patient. Communication will be central to this development. This will involve professionals and patients evolving a common language comprehensible to both, and an atmosphere in which patients and carers feel empowered to become involved in the decision-making process, and thus to take back some control of their condition and its management. Great sensitivity on the part of the professionals as to the emotional effects of their discussions on patients will be needed along with an understanding that everyone is an individual, with specific and personal needs, and that “one size fits all,” will not meet their needs.

Tony's Biography:

Tony is Vice-chair of trustees of St Catherine’s Hospice, Preston and a trustee of the National Council for Palliative Care, for whom he chairs the People in Partnership User Group.  He is also North West Local Champion for the Dying Matters Coalition and a member of the Lancaster Compassionate Communities project. As a member of the Independent Review Panel for the Liverpool Care Pathway he co-wrote the report and helped to monitor the implementation of the Leadership Alliance’s guidelines. He was a lay member of the RCP Audit of deaths in Acute Hospitals. He is involved in a number of research projects relating to End of Life Care. He speaks and writes on end of life care issues, and campaigns for better communication between professionals and patients.  He has broadcast on television and local and national radio on end of life care issues. 

Tony's full powerpoint presentation

In his presentation Tony stated: 

"As a parent, as a carer, what do I really want?"

"Doing ACPs is not an event it's a process........ people always have the right to change minds"

"Statistics matter to medical professionals, they don't matter to individuals"

The morning continues with an update from Jacqueline McKenna MBE Director of Nursing - Professional Leadership NHS Improvement on 'Learning from the Transform Programme: Supporting frontline clinicians and leaders for the work required to transform end of life care in acute hospitals'.  Jacqueline's presentation will cover:

• what does good look like?

• meeting the six ambitions for end of life care within acute hospitals

• learning from the Transform Programme: case studies

Pre conference abstract:

This presentation will describe what good end of life care looks like and how consistently good end of life care can be delivered. Good end of life care will be described in terms of findings from the CQC inspections and also by NHS Improvement’s interactions with trusts. The presentation will conclude with examples of good practice and a discussion on how NHS improvement can support organisations to improve the end of life care provided.

Jacqueline's Biography

Jacqueline trained as a registered nurse at King’s College Hospital, London and had a clinical career in gynaecology. Jacqueline achieved a Masters in Medical Science in Clinical Nursing in 1995 and a doctorate from the University of Greenwich in 2016. Jacqueline is currently the Director of Nursing for Professional Leadership at NHS Improvement, and prior to this was the Deputy Director of Nursing at the NHS Trust Development Authority from April 2013 to March 2016. Before this she held Director of Nursing posts at the Medway NHS Foundation Trust and at Southmead NHS Trust in Bristol. She implemented the first British model of shared governance which improves staff involvement in 1994, and won the HSJ award for patient safety in 2005 for the development of the Medway Nursing and Midwifery Accountability System – an improvement framework for nursing. Jacqueline received an MBE for services to nursing and health care in the 2010 Queen’s birthday honours list. You can follow Jacqueline on twitter @mrsjmckenna.

Jacqueline's full powerpoint presentation

In her presentation Jacqueline stated: 

"If staff have good leadership they are not afraid to break the rules to give better care"

"If you are internally focused you are only aware of what you are doing, you're not learning from other organisations"

"End of Life care is everyone's business"

"Patient experience is getting better in End of Life care but it needs to be more integrated, we get most of our learning and understanding from the relatives"

Professor Adrian Blundell Member, Guideline Development Group, Clinical Guideline on Care of the Dying Adult NICE concludes the morning with an extended session entitled 'Predicting the end of life and managing uncertainty'.  His presentation will cover:

• what can multi professional teams do to reduce the impact of uncertainty of recognising when a person is entering the last days of life? 

• managing patients whose recovery is uncertain 

• identifying how the uncertainty of recognising when a person is entering the last days of life influences information sharing, advanced care planning and the behaviour of healthcare professionals 

• ensuring all staff can recognise signs and symptoms that indicate that adults are likely to be entering their final days of life; or that they may be recovering? 

• managing and communicating uncertainties

Professor Blundell's Biography:

Adrian Blundell is a Consultant and Honorary Associate Professor in the Medicine of Older People based at Nottingham University Hospitals NHS Trust (NUH). His clinical time is split between the acute trust and the community. He graduated from the University of Nottingham and spent higher specialist training in Australia and the East Midlands. He was the geriatrician representative on the “Care of dying adults in the last days of life” guideline development group. In addition to his clinical work he is Director of Postgraduate Medical Education and Clinical Lead for the Undergraduate Electives Module.

In his pressentation Professor Blundell stated: 

"If you're 95 and you die, is that really an unexpected death?"

"If your last few weeks are hell on Earth due to the treatments then that isn't really the good death we speak about"

"One of the problems we had  with the LCP was not seeing an experienced clinician"

"If you are giving maximal therapy and things are still getting worse then that's a warning sign"

"Organising escalation plans is very helpful"

Future conferences of interest:

Effective Non-Medical Prescribing in End of Life Care
Friday 24 February 2017 
De Vere West One Conference Centre, London

Effective Nurse Prescribing in End of Life Care
Friday 24 February 2017 
De Vere West One Conference Centre, London

End of Life Care: Legal Issues Masterclass
Monday 13 March 2017 
De Vere West One Conference Centre, London

Nurse Prescribing in Cancer Care
Monday 5 June 2017 
De Vere West One Conference Centre, London

20 January 2017


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