Agenda item

To receive an update on End of Life Care from Tracey Jones, Deputy Director Partnerships, Shropshire, Telford & Wrekin CCG.

Members received the update report of the Deputy Director: Partnerships, Shropshire, Telford & Wrekin CCG.

The Committee were informed that the report was an update on a previous report received by the Committee and that it covered the achievements of the review of end of life care to date and the next steps of the review.

The Deputy Director provided Members with an overview of the report. The first section of the report covered the background to the review. In the second section, the methodology of the review was laid out. The original idea had been to shortlist focus areas from data but there had been a decision to open up one of the focus areas to influence from the feedback received from those with lived experience. There was a desire to include symptom control as a focus. Section 3 of the report covered the four areas that formed the key areas of focus, while Section 4 set out the regional focus on palliative and end of life care. Section 5 focussed on next steps, in which working groups would seek to deliver change. Finally, Section 6 summarised where the review was.

Following the presentation, a discussion followed. Members asked a number of questions:

Who sat on the Community and Place Board?

Representatives from the main health providers, HealthWatch, and social care colleagues. The hospice was not involved but a representative was the Chair of the End of Life Group, so the hospice was involved.

Did the hospice contribute as an individual stakeholder?

It did.

Why had a generalist approach been favoured in the report to a specialist one?

Generalists needed support in end of life care as it was not something they usually dealt with. This would improve end of life care more broadly.

Could the term generalist be defined?

Generalists were staff that did not work in a specialist end of life care role.

Where was the CCG at with the Advanced Care Plan (ACP)?

This was outside of the area of expertise; however, the work was being led by the hospice in conjunction with oncologists from SATH. It was looking at producing an ACP.

Was the review of end of life care underpinned by a holistic approach?

The report was the result of engagement, holistic was not a term used in the report but the review was being approached holistically.

How close to fruition were information systems that shared data to avoid repetition of questioning patients?

Shared care records were not a part of the review, however, that work was progressing at pace.

For those who wished to die at home, there was an issue around support from GPs and district nurses. Was there anything in the report around supporting that choice?

In terms of the reviews, this was a routine end of life commissioning question. In those instances where individuals were unable to access the necessary equipment it was necessary to speak to service providers to find out why as equipment was commissioned. This was not an area fed back by service users as a particular issue.

Would Phase 2 of the review be able to influence equipment provision and the delivery and recovery of equipment from a patient’s home?

In each of the four key areas there would be a task and finish group established, COVID had enabled rapid change across a wide area as clinicians came together to examine the problem and had found active ways of solving it. Equipment could feature in a number of the task and finish groups’ conversations, looking at a solution focussed approach. Separately, issues around commissioned services, such as equipment, had to be reported and actioned as individual cases. Where people did not receive the equipment needed, they should report this to the CCG.

Who would be taking part in the task and finish groups?

For each area, there would be a lead clinician and a lead manager, membership would then be opened up; looking at healthcare providers, people with lived experience, HealthWatch members, and non-statutory areas involved in the specific area. It would depend on the area being looked at but a broad membership would be pursued.

Occupational therapists appeared to be in short supply but appointments with them were necessary prior to receiving equipment. Would occupational therapists be a part of the review?

The review and its outcomes would depend on the collective discussions about the questions posed. The therapy base in Telford & Wrekin was being assessed by the Telford & Wrekin Integrated Place Partnership. The review looked at how to improve experience but other pieces of work were looking at those other issues Members had raised such as the availability of therapists and the rapid response team.

Post-COVID with the build-up of waiting lists, staff shortages, and major financial problems in the health economy, were there any fears about the impact of these challenges on the end of life care process?

There had been concerns, but continued work on the paper had been secured at the Community and Place-Based Board in spite of those challenges.

Regarding Generalists, would they be able to identify gaps in the review? How would they feed that in? How long would the grace period for identifying gaps in service be?

The working group looking at that issue would generate the answer to that question.

Members expressed their intention to invite Professor Derek Willis to the Committee at the next stage of the process.

Members recommended revisiting this matter in September.

Resolved that –

i.          The completion of Phase One of the Review and the collaborative identification of the 4 areas of focus be noted.

ii.         The change of CCG leadership of the End of Life Review as it entered Phase Two and the continued commitment of system partners to engage in the improvement workstreams to address the four key areas, including clinical leadership for all four key areas be noted.

iii.        The regional NHSEI requirements regarding local system PEoLC group whose membership would include representatives from the voluntary sector   and people with lived experience be noted.

iiii,       The agreement that this refreshed PEoLC would act as the programme board for the four key improvement projects and report into the Community and Place based Board which in turn would report directly to the shadow ICS Board, thus ensuring prominent line of sight on the progress of the 4 working groups be noted.

iiiii.      The JHOSC would receive a report on the EOL task and finish group progress in September 2021.