Agenda item

The purpose of this paper is to share the Medway End of Life Care Strategy for Adults with the Health and Wellbeing Board. This sets out the vision for end of life care for the next three years (2017 to 2020) and has been agreed at both the Clinical Commissioning Group (CCG) Commissioning Committee and Governing Body meetings in September 2017.

Discussion

The report was introduced by representatives from NHS Medway Clinical Commissioning Group. An End of Life Programme Board had been established. There were three key workstreams. These included a focus on developing an End of Life Strategy, improving partnership working and organisational processes across the wider health economy and improving communications and engagement with patients, families and their carers.

Work had been undertaken to standardise advanced care planning.

Engagement had taken place with carers’ groups and other stakeholders to find out how care should be provided. This had included two public forums and an event targeted at BME and East European and traveller communities. Written guidance had been produced for carers and families.

Areas of focus informing the development of the End of Life Strategy included ensuring that  healthcare professionals received adequate training, creating new models of care, improving systems to ensure that people received consistent high quality care and that they were supported to die in the place of their choice.

A Board Member shared the personal experience of an elderly family member who had died after spending a number of hours lying on the floor in significant pain. Although the development of an End of Life Strategy was welcome, the Member felt that it would not ensure that similar situations were avoided in the future. Poor communication between organisations had been a significant factor in the case of the Member’s relative and it was considered that the  outsourcing of out of hours care to Medway on Call Care (MedOCC) was a weakness due to a resulting difficulty in communications. The Member also felt that medical ethics had been misguided with visiting GPs having not been willing to administer painkilling medication..

The CCG representatives advised that the situation described was something that it was hoped to avoid through implementation of the Strategy, the creation of a Pallative Care Register and through advanced care planning. Gps should help the patient with appropriate pain management. Feedback from key professionals had been taken into account and had informed Strategy development. It was recognised that engagement with GPs in relation to end of life care was an area that needed to improve.

A Board Member said it was clear that there would not be a universal offer at end of life and asked what the key issues and gaps were that needed to be

Addressed to ensure that services and outcomes reflected the needs of the local population. The Member also wanted to understand what the drivers for change to End of Life Care priorities were and to be provided data to demonstrate whether the required changes were on target. The Medway Clinical Commissioning Group representatives agreed to provide further information in relation to this for circulation to the Board.

Another Board Member noted that there had been a positive response to God’s Waiting Room,  a play about End of Life that had been presented by the CCG, and asked whether it would be repeated. The Member also wanted to understand how conversations about End of Life in Medway compared to other areas. An electronic survey had been sent to attendees at a recent event in order to ascertain their priorities. This had identified that staff felt anxious when discussing issues related to end of life. A future play or event may be considered but it was important to first address the issues already raised. If available, information on how Medway compared to other areas in talking about death would be provided to Board Members.

Decision

The Board offered its support to the Medway End of Life Care Strategy for Adults.