Agenda item

To receive a presentation from Dr. Jane Povey, Medical Director for Shropshire Community Health NHS Trust, Julie Davies, Director of Performance at Shropshire Clinical Commissioning Group and David Evans, Accountable Officer for NHS Shropshire CCG and NHS Telford & Wrekin CCG.

The JHOSC received a presentation from Dr Jane Povey, Clinical Lead for the Shropshire, Telford and Wrekin Sustainability and Transformation Plan (STW STP) and Dr. Julie Davies, Director of Performance for Shropshire Telford and Wrekin Clinical Commissioning Groups (STW CCG) outlining the proposed approach for undertaking a system review on End of Life Care. The authors stressed that they were not bringing a finished approach rather that they were hoping to co-create the approach through discussion in the meeting. The meeting covered the following topics:

·         Background
- Where the need for the review came from
- Conversations with healthcare partners
- Chief Executive leadership provided by David Evans, Accountable Officer for STW CCG and David Stout, Chief Executive of Shropshire Community Health NHS Trust.

·         What was done as a system so far
- Established End of Life group with strategy.
- System wide implementation of Recommended Summary Plan for Emergency Care and Treatment (ReSPECT)
- 24/7 palliative care helpline

·         Local Health Economy End of Life and Palliative Care Strategy for Shropshire, Telford & Wrekin.

·         Purpose
- Outlined the reasons as to why the review was needed.

·         Principles
- Outlined the principles which would guide the review.

Members noted the refreshing approach that was being taken by the presenters, however outlined that one of the key issues faced by patients was that there wasn’t a smooth transition through the system.

Members reflected on the struggles faced on accessing End of Life care in Shropshire, Telford & Wrekin in cross-border situations. The Director of Performance recognised that more work needed to be done to link up the out-of-area network to ensure a smooth transition in and out of Shropshire, Telford & Wrekin End of Life care, if that was the wishes of the patient.

Lynn Crawley, Chief Executive of Healthwatch Shropshire asked if staff were trained to have these difficult conversations with patients in relation to end of life care. The Clinical Lead for the STW STP responded by saying that training had occurred but had not reached every single member of staff, and additional support was available from other teams. The Clinical Lead for the STW STP continued by saying the end of life conversation with a patient needed to occur at the earliest point possible, when it became clear that a curative approach cannot be taken, and instead anticipatory medicine should be prepared.

The Chief Executive of Healthwatch Shropshire was invited to responded, and said that a Healthwatch Shropshire report made reference to examples whereby patients hadn’t been recognised as end of life. The Clinical Lead for the STW STP agreed and continued by saying there needed to be a recognition of the language used, which is why they referred to end of life conversations as “important” rather than “difficult”.

Members suggested that there be a centralised complaints or feedback system. The Accountable Officer for STW CCG welcomed the suggestion as complaints were made to individual trusts or the CCG and that there wasn’t a joined up approach to the way feedback is received and processed in the relevant organisations. The Director for Performance STW CCG supported the suggestion made by members. She added that there was a timing issue on collecting feedback as it was not appropriate to attain feedback immediately following the passing of a patient, but then some families feel they leave it too long to give feedback.

Members felt it was important that domiciliary care workers were trained to be able to have the end of life care conversation as some patients did not have family members to do this with. The Clinical Leader for the STW STP agreed that it was important to train domiciliary care workers and that community teams across the system were training carers to do this, along with trainers that were funded through the Shropshire Partners in Care (SPiC).

Members asked for more information about the ReSPECT forms. The Clinical Lead for the STW STP responded by saying these were available online to download and print out but also from health and care practitioners. Members were advised that patients could choose who they spoke to about the forms and that it needed to be signed off by a senior clinician. Members were directed to the hospice website to find more information about it.

Members asked for clarification regarding the use of anticipatory medication. The Clinical Lead for the STW STP explained that this was a process used to predict the types of medication a patient may need if they were deteriorating in order to make them more comfortable. She also explained that it was there for the attending clinician to make a decision with the patient if it was needed, without the need to wait for a doctor to write a prescription. The Director for Performance STW CCGs added that the end of life medication was important for supporting patients who were in care homes, as this was where many chose to pass away.

Members reflected on anecdotal experiences of end of life care, where the community team was not available and therefore the patient had to spend extra time in the hospital. The Director of Performance for STW CCG responded by outlining the discharge to assess process and recent changes that had occurred in response to COVID-19, which meant that the discharge to assess took less than 24 hours. The Clinical Lead for STW STP added that the changes also meant that patients received care closer to home quicker.

The Chief Executive for Healthwatch Shropshire reminded members of the Committee as well the item presenters that one of the central points of Healthwatch was to receive feedback about any type of healthcare service and that there was a difference between lodging a complaint and feedback within NHS providers of care. The Chief Executive for Healthwatch Shropshire added that the Independent Complaints Advocacy Service had been set up in Healthwatch Shropshire to help patients under what feedback and complaints can be made and what a reasonable response would be.

Members asked whether there was input from different cultures and religions in response to end of life care. The Clinical Lead for the STW STP responded by saying that they currently didn’t have a plan for this but agreed that the engagement with staff and all the community needed to be inclusive.

Members asked for more details about leadership and governance of the end of life review. The Accountable Officer for STW CCG’s responded by saying that it would go through the STW STP, however if there was financial implications or changes to how services were delivered, it would need to go through the necessary statutory organisations. However, all of the Chief Executives in the area are part of the Chief Executives group and the Integrated Care System shadow board.

Members wondered whether the item presenters could elaborate on the time frame for the review. The Director for Performance STW CCG responded by estimating that it would take around six months but this could be subject to delay due to Winter and COVID-19. Likewise, it was added that the STW CCG would seek to get the formal support for the Terms of Reference from the JHOSC as well as an update around three months into the review. It was added that in the course of the review, if any problems were unearthed, these would be amended in real time rather than at the end of the review.