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Position Paper

SALFORD ROYAL HOSPITALS NHS TRUST

SALFORD PRIMARY CARE TRUST

Implementation of the Salford & Trafford

Palliative Care Strategy for Adults (1998) in Salford

Introduction

This paper outlines the progress made to date with implementation of the Salford and Trafford Palliative Care Strategy for Adults in Salford, and describes the planned future developments required to continue the provision of a co-ordinated approach to palliative care across all care settings within the health and social care economy of Salford.

Background

In 1998, Salford and Trafford Health and Local Authorities endorsed the Salford and Trafford Palliative Care Strategy for Adults following public consultation.

Prior to this, in 1997, Salford and Trafford Health Authority allocated £500,000 recurrently to implement the Strategy - the Palliative Care Reserve. These monies have subsequently been devolved to the three Primary Care Trusts (PCTs) within Salford and Trafford from April 2002; 55% was designated to Salford PCT.

The Salford and Trafford Strategy Implementation Group (SIG) for Palliative Care was established in April 1999, with multi-agency representation from statutory local health and social services, the voluntary sector and user representation. In October 1999, Salford and Trafford Health Authority appointed a Palliative Care Coordinator (Local Implementation Officer) to project lead implementation of the Palliative Care Strategy for Adults in Salford.

In June 2002, the SIG on behalf of the 3 PCTs agreed to review and update the Palliative Care Strategy for Salford. The Local Strategy Group for Palliative Care advises on strategic recommendations and service development in line with the National Cancer Plan (2000), the Draft National Standards for Specialist Palliative Care (2001), the Draft National Institute for Clinical Excellence (NICE) Guidance for Supportive and Palliative Care – Part A (2002) and the Greater Manchester and Cheshire Cancer Network Strategy for Specialist Palliative Care.

Implementation of the Palliative Care Strategy in Salford

The Palliative Care Strategy recommends how high quality; co-ordinated palliative care should be provided (see Section 11 of the 1998 Strategy) and outlines the priorities for implementation. The following section describes the progress made with implementation and the planned future developments for palliative care in Salford.

Appraisal of Palliative Cancer Unit

Appraisal completed in April 2001. The Salford Royal Hospitals NHS Trust Palliative Care services and the co-ordination of palliative care services were commended in achievement of the Specialist Palliative Care Standards (Section 7 – Manual of National Cancer Standards, December 2000) by the Regional Cancer Services Appraisal Team.

Development of Specialist Medical Provision

Consultant in Palliative Medicine appointed in April 2002. Dr Stephanie Gomm provides a service to Salford Royal Hospitals NHS Trust (Hope Hospital), Salford PCT and St Ann’s Hospice, Little Hulton. The role of the Consultant in Palliative Medicine is to provide clinical leadership and co-ordination of services across all sectors of care. In addition, Dr Philip Lomax was appointed to the post of Hospice Consultant in Palliative Medicine at St Ann’s Hospice, Little Hulton in August 2002, and this post is also linked to Salford Royal Hospitals NHS Trust and Salford PCT.

In order to ensure that the future medical workforce for palliative care is sufficient, the SIG has agreed to recurrently invest £17,000 per annum to the Regional Specialty Training Programme for Registrars in Palliative Medicine who are linked to the Hospice, Hospital and Community Palliative Care Teams in Salford.

Specialist Nursing Provision

November 1999 - appointment of a fourth Clinical Nurse Specialist in Palliative Care to the Salford Community Palliative Care Team.

April 2001 – appointment of a further 1.5 whole time equivalent Clinical Nurse Specialists in Palliative Care to the Salford Hospital Palliative Care Team.

April 2001 – secretarial support developed for all palliative care teams.

Care at Home

Community Specialist Palliative Care Team :

Consultants in Palliative Medicine 0.3 wte

Clinical Nurse Specialists 4.0 wte

Specialist Social Worker 0.5 wte

To enable choice for patients and their families to continue care at home, and die at home if they so wish, there has been expansion of the Community Nursing service, building on the existing District Nurse Teams, Community Bank, Marie Curie Nursing Service and Rapid Response Team. The Respite at Home Team for Salford was established in 1998, and underwent further expansion in April 2001 in funding core team members
Bereavement services -community based eg CRUSE and Salford Palliative Care Counsellors and St Anns Hospice bereavement service

November 2000 – establishment of 24 hour Advice Line for Specialist Palliative Care, which provides specialist advice to Hospital and Community professionals.

September 2001 – report on recommendations for improving Salford out-of-hours palliative care provision.

August 2002 - New Opportunities Fund bid for out-of-hours care in Salford to:

Extend 24 hour Advice Line to patients and carers;
Provide access to drugs and equipment out of hours;
Improve co-ordination of Health and Social Service provision with the appointment of a 3 year Project Lead;
Increase education and training to Community staff.

Note successful bid 3 year project to commence July 2003

March 2003 – Second edition of the Pain and Symptom Control Guidelines.

December 2002 – Appointed GP Facilitator for Palliative Care.

January 2001 – The Integrated Care Pathway (ICP) for the Last Days of Life Group established.

January 2002 – Pilot implementation of the ICP for Last Days of Life across all healthcare settings of Hope Hospital, Salford Community and the Hospice.

April 2003 – Implementation of the ICP for Last Days of Life to be extended across the community of Salford with the appointment of an ICP Co-ordinator.

Hospital Palliative Care

Consultants in Palliative Medicine.0.5 wte

Clinical Nurse Specialists in Palliative Care 3.5

November 2000 - Access to 24 hour Specialist Palliative Care advice.

Integrated Care Pathway for Last Days of Life – implementation and education of hospital staff commenced January 2002 for completion April 2003.

April 2002 - Palliative Care Database established on the Electronic Patient Record (EPR) system.
June 2002 - Palliative Care Outpatient clinic commenced

November 2002 - Cancer Information Service – ‘Cancer & You’ ope

March 2003 Second edition Pain & Symptom Control Guidelines.

Hospice Care

Consultants in Palliative Medicine. 0.8 wte

Inpatient Unit – 30 beds.

Day Care provision – open 3 days per week. 45 patients / week

Supportive outpatients clinics – 5 days per week with provision of:

Medical advice.
Lymphoedema
Dyspnoea.
Stress and relaxation management.
Complementary therapies.

Bereavement Service.

Community Service – Clinical Nurse Specialists in Palliative Care. ( see home care )

Community Social Worker ( see home care).

Development of Clinical Protocols/Pathways

April 2000 - Publication of Palliative Care Pain and Symptom Control Guidelines.

April 2000 – Publication of Palliative Care Service Directories.

Clinical Audit and Outcome Systems

December 1999 - Establishment of Palliative Care Patient Information and Clinical Audit Group.
January 2000 - Updating of palliative care databases and equipment.

Audit of pilot Care Path way Last Days of Life in hospice ,hospital and community.

Co-ordination of Palliative Care Services

October 1999 - Appointment of a Palliative Care Co-ordinator, whose role is to project lead implementation of the Palliative Care Strategy for Adults.

Development of Palliative Care Education and Training

December 1999 – establishment of Palliative Care Education Group.

March 2000 – pump priming of education and training in the Palliative Care Approach for health and social care staff.

April 2001 – funding of care pathway education for hospital, community and hospice staff.

February 2002– appointment of a Palliative Care Education and Training Co-ordinator (2 year fixed term contract).

February 2003 – Macmillan GP Facilitator post in Palliative Care.

Information and Audit

December 1999 0 Palliative Patient/Carer Information and Audit Group established.

April 2002 - Palliative Care Service Directories published.

February 2001 - New Opportunities Fund Cancer Information Project commenced.

November 2002 - Information Centre opened at Hope Hospital, with Community Outreach in 2003.

2003 - Cancer Services Directory to be published

In progress - Analysis of data (pilot ) for Hope Hospital and for patients in the community of Salford.

Bereavement.

Hospice Bereavement Service.

Community Bereavement Service – Salford Palliative Care Counsellors.

Hospital – planning Bereavement Centre.

Voluntary Services

Salford Cancer Aid Listening Line./ Carers support

St Ann’s Hospice.

Conclusion

The above sets out the current position in relation to palliative care and briefly details plans for development. The Trusts will be pleased to provide further information on request.

Sue Hill

Local Implementation Officer – Palliative Care

Salford & Trafford Primary Care Trusts

Dr Stephanie Gomm

Consultant in Palliative Medicine

Chair, Salford & Trafford Local Strategy Group for Palliative Care

March 2003

Position Paper on Palliative Care for Adults in Salford

INSIDE INFORMATION CHANGES IN COMPOSITION OF THE
JOB DESCRIPTION POSITION COMMUNITYBASED REHABILITATION COORDINATOR
NAME POSITION FIT  PENDING GP

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