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Is system level data being brought together? How is it being used?  Where are the gaps and variations in services?

Are the palliative, end of life and bereavement needs of the population understood?  How do we know that service provision is addressing these identified needs?

Which diverse groups have been involved in the design and planning of local services? Are they accessing local services? Does local strategy include priorities around equality and diversity?

Are patient outcome measures being consistently used to evaluate and improve local services? Are patient outcome measure tools accessible to diverse groups?

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What does good education in communication skills and Advance Care Planning look like? How is it accessed? Who needs to have it?

How are patients identified as palliative/ end of life in various care settings? How is this then communicated across these settings?

In what ways are members of the public supported to engage in end of life care conversations?  What activities are most likely to engage people and how do we engage?

Who is best placed to have personalised care planning discussions, and what do we need to do to create the right conditions for these to happen?

How do we know that a person has been encouraged to be an active partner in their care? How do we know that they were informed what to expect?

How are personal health budgets being used in end of life care and who needs to know about these?

Who has access to what information? Where are the gaps? Are electronic systems being routinely used and updated? Are advance care plans being shared?

How quickly are people being assessed? How are statutory and voluntary services working together to respond to patient needs?

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Frame things for a patient- in language that can speak to them

Add 'provider' to driver diagrams  in terms of their responsibilities e.g. ACST providers have a responsibility of knowing what they have in place

Importance of measurements within the commissioning standards - how do you assess in your organisation

Communication skills- is it worth grouping staff educational needs - overlap with educational standards work that is being done -Delivered by specialists may be ideal but don't want to be restrictive

Good quality training is the key - alignment with rest of L&SC education work - move to ambition 5 discussion

Identification- EARLY tool, what we do with the list of patients- time constraints- team of people employed at ?PCN level to hold and coordinate the regular GSF meetings. One practice in Darwin have done this. SHADOW tool within Care Homes - used in ward rounds

Mayfly-Training

Communication- clinic space and long enough appointments- Patient expects: having a conversation that feels unrushed in a quite private space

Equity across the areas
Steering group to coordinate palliative and end of life with representation from all settings - including looking at faith needs and population conversations

Patients and families can identify themselves but what is the process for them to prompt a conversation with a health professional

Equality - this is a topic in Ambition 2

Building in the best project 5 clear enablers - could this be a format for defining what we are wanting to commission/provide

Coordination of Care Identification- GSF/PIG
Future care planning
Dealing with uncertainty
Respecting choice
Care of the Dying
Education underlying all of this

We should think about describing what we are already doing- thinking about statements SIMPLES!!!

Access to ACP- different tools and what would meet the needs (MyWISHES) online ACP tool - can choose to share with GP much broader than EPaCCS - what would this look like, what might patients need access to

Must Do's list

Look through the lens of a patient and family

patient and family education needs to feature in the journey - different needs for various faith groups
recognising challenges for different faith groups

Need to focus on processes to put in place and then incorporate this within the education

NACEL

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Suggested wording ….

Identification
- utilise tools and have processes to support identification for example : early, GSF meetings & champions in PCN

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Could we look at whether we would want to consider investing in some advance care planning tools for patients.  We started to explore MyWishes in Central Lancs it is patient accessed, can be adapted to the questions/ info for our locality, automatically links with GP EMIS or could be linked to LPRES to share info.  The main issue was that the cost of developing it would be prohibitive- but if we are aiming for outstanding this might be a route to go.

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MyWishes: Free Will Writing, Digital Legacy, Advance Care Plan & Funeral Software

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Make plans for the important people and possessions in your life for free

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IS this the kind of statement we are thinking about:
There is a process for recognising patients approaching those end of their lives:
- patients approaching the  end of their life are identified by use of EARLY tool / shaddow/ GSF prognostic indicators
- Gold Standard Framework is used to register those thought to be be coming to the end of their life. Monthly meetings improve communication between GP/SN/SPC
-EPPACS is available across different organisations

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Identification-
Site specific MDT - curable/incurable, for treatment, for BSC etc.
Palliative care representative at MDT will help enhancing identification

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access to care and what care is available - care is commissioned 24/7 -  SPC advice, DN's

Medications- Pharmacy opening hours - stocks of eol drugs - access in a timely manner people that can prescribe

patients are assessed- people that are skilled and access to 7 day SPC.

access/utilisation- Treatment escalation plans

teaching about symptom control

regular review of care- overlaps with coordination - who does the review of the over-arching care plan . If your care is coordinated only tell story once and systems well enough linked together to respond when patients and families need them.

Holistic care- access to palliative therapy teams , physio, OT clinical psychology (minimum) - special interest or additional training that can deliver rehabilitative interventions

Rehabilitative- proactive palliative rehab is reliant upon access to dedicated therapy services - St Christopher's Case Study (outstanding version)

have a baseline within this framework and use best practice examples as the outstanding element . use building blocks so we have 4 headings under each ambition-

7 day access consistency across care settings and place

Palliative care social workers - to support social distress

Palliative care hubs- single point of access

Minimum needs to reflect 'good' with incremental stage for outstanding

a lot of this ambition is about access

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regular review of care- overlaps with coordination - who does the review of the over-arching care plan . If your care is coordinated only tell story once and systems well enough linked together to respond when patients and families need them.

Patients being able to share their ACP- commissioned service or platform

H professionals who are making anticipatory clinical management planning decisions sharing these with others including DNACPR

outstanding- automated electronic sharing - centralised place where everyone knows to look for this information

EPaCCS - using LPRES

Could some of the commissioning standards cross cut more than one ambition

single point of access - shared records, access to holistic care and assessment , one phone number , coordinate medical, therapies, social etc . Include weekends, nights and BHolidays

Clear written Information that we give out to patients and carers (agreed and in different languages)

Care Homes- involved in shared records and coordination

All ages, all conditions approach - what we expect for everyone

Not get too detailed in the what so we have flexibility at place level

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Ambition 5

Linking to education standards framework- don’t repeat content

Access to education that meets the education standards

Supervision and support for staff- reduce variation (best practice) – management vs clinical supervision- social care won’t have this level

Clarity – CCG don’t currently commission education –

Educational- supervision - ensuring people in management adequate time for appraisals and identify development needs - resources commissioned

How do we define what is commissioned and what is expected as part of usual provision?

Specification – competent to deliver a service is an expectation

How people go about that is down to them- expectations of education – rolling programme – adopt standards for all providers

Careful wording

[13:25] MANSELL, Ceri (NHS CHORLEY AND SOUTH RIBBLE CCG)I agree with Miriam. I think that there is an expectation that staff will recieve clinical supervision ans that is something CQC wouls expect too

[13:25] Stewart Katherine (LTHTR)

Is there something about commissioning a large enough workforce for people to have time to attend training?

Adequate workforce- Enough staff to allow time for staff release for CPD and to deliver training to others

Education is first thing to go when pressures are high

Workforce planning- demand

Differences across L&SC re how end of life is commissioned – some are via grants and some contracts

Social care- funding isn’t always considerate of end of life training – expected to do it in their own time

The quality of education needs to be considered – not just eLearning and in your own time

Wider implications and of the workforce training not just ad hoc funds – needs sustainable models of delivery and responsive to changing needs

Domiciliary care - education needs to go across health and social care - anyone who is paid to do the job as well as the unpaid carer

System response- trained up family carers to give medication

Board representation - ICB/Trust eol leadership

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Unpaid carers and family training – responsive

Nothing specifically commissioned by the CCG

Hospices leading compassionate communities

If health commissions this, it shouldn’t be done in isolation

Public health campaigns- funded through adult social care. Aside from population needs assessment.

Importance of it being included in the framework even if it isn’t commissioned by health – next text book about to come out on public health and palliative care

Place based end of life groups

Last aid project- needs commissioning and development

seek best practice examples from nationwide

what about social prescribers - engagement and commissioning - raising awareness

personal health budgets

volunteers- use voice to raise awareness , recruitment to the topic and helping the compassionate communities approach

key area engagement in discussions-  Wales have an advance and future care planning attended by different organisations that are helping with the conversations. where does the responsibility lie for this to be done.

[14:00] DIXON, Victoria (BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST)

is there something around resource to engage with public campaigns like dying matters/national grief week etc?

[13:53] BAIRD, Miriam (NHS MORECAMBE BAY CCG)

There will be Last Days Matter which the Lancaster compassionate community is creating, 5 videos run a bit like ~Dementia Friends which covers all aspects of death and dying importance of not making it too clinical

[13:54] BAIRD, Miriam (NHS MORECAMBE BAY CCG)

Public Health need to be included as well as County council commissioning who would be commissioning dom care staff

[13:55] BAIRD, Miriam (NHS MORECAMBE BAY CCG)

here is the project in North Cumbria which has has just had funding to do a Lets talk bereavement to help enable staff in services to be able to talk with people

[14:00] DIXON, Victoria (BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST)

is there something around resource to engage with public campaigns like dying matters/national grief week etc?

need to get public health engaged.

Variations across areas- clarity of who we need involved. Variations in county council engagement.

Palliative care hub- cascading some of this work to be led and coordinated- focal point . Importance not just during dying matters but throughout the year.