Aintree University Hospital NHS Foundation Trust is a large teaching hospital in North Liverpool.  We serve a population of around 330,000 in North Liverpool, South Sefton and Knowsley providing a range of acute and non-acute specialties, and work in partnership with other organisations to provide community-based services. We also offer specialist services with a world-class reputation to a population of 1.5m residents across the North West and are a Regional Centre for Oral and Maxillofacial surgery and the North Western Hepatobiliary Centre

The hospital has a Specialist Palliative Care Team who respond to referrals on the wards. We have close links with Woodlands Hospice, The Walton Centre for Neurology and Liverpool Community Health.  Together we are keen to the make Advance Care Planning Process as straight forward as possible to encourage our staff to feel knowledgeable and confident enough to have appropriate conversations with patients at the right time to enhance patient choice.

CDDFT is one of the largest integrated care providers in England. 7000 staff serve a population of around 650 000 people. Our vision is Right First Time, Every Time and our values are to provide Safe, Compassionate and Joined-up Care.

The trust comprises secondary services including two acute hospitals with Accident and Emergency Departments, six community hospitals and a wide range of Community services.

SPICT is being used in the Specialist Frailty Unit in Bishop Auckland Hospital, combined with the Clinical Frailty (Rockwood) Score to identify patients at the highest risk of mortality within 3 months, in order to prioritise "What Matters Most" conversations and Advance Care Planning with our inpatients prior to discharge.

A study conducted here showed that for patients with two or more SPICT general indicators and two or more clinical indicators and a Clinical Frailty Score of 6 or more, mortality risk was 50% within 3 months. As a result we now screen all inpatients using SPICT and CFS.

We are helping many more patients to develop Advance Care Plans. When our patients are discharged with high quality ACPs, they die in their preferred place of death.

This use of SPICT is being "rolled out" within two of our other community hospitals, and the Acute Frailty Teams at our acute hospitals in Durham and Darlington.

This QIP has been submitted as an abstract for the British Geriatric Society autumn conference. It is also being included in the new National Statutory Guidance on End of Life and Palliative Care for Integrated Care Board commissioners.

Palliative care services for our registered patients.

Within our palliative care MDT

Palliative Care Team offering ACP to all patients identified as last year of life.
New ACP initiative Trust-wide to increase identification of patients suitable for ACP, based on SPICT.
ACP offer in Pall Care outpatient clinic and accepted criteria for inpatient referrals.

ACP policy refers to SPICT tool for identification of patients.
SPICT app referenced in policy and at training sessions for junior doctors and consultants, as well as in ED training programme.

We are a hospice service providing inpatient care over 3 sites, community support for the entire East Kent health economy and input into the acute hospital trust locally(East Kent University Hospitals NHS Foundation Trust).

At Pilgrims hospices we are committed to providing fair access to all patients with needs, that are palliative and supportive irrespective of the diagnostic label of their progressive illness. Therefore we are using SPICT as an aide memoire to help triage referrals and aid discussions with referrers about their appropriateness.

We are also using SPICT to help navigate individuals through our service in helping judge prognostic awareness and in particular for non-malignant conditions to engage with advance care planning.

- District general hospital within Cornwall, offering services including ED, medical admissions, and outpatients.
- There are also outpatient services in oncology, and inpatient palliative care

- To identify deteriorating patients within general medicine (specifically eldercare), and planning to use it within the outpatient setting. It has yet to be trialled within the hospital, but our advanced care planning steering group would like to trial its usage within eldercare first, with an aim to then branch out into other medical specialities and surgery.

Acute hospital trust.

To assist clinicians identify the needs of elderly frail patients and patients with dementia in order to make appropriate decisions and have informed conversations with patients and families about the plan of care, their future and their end of life care needs.

Commissioning palliative and end of life care services in Sheffield

SPICT has been added to the Sheffield chronic disease review templates in primary care for COPD, Heart failure and dementia to help prompt review of decline and highlight if there is need for advanced care planning.
Teaching sessions for community staff to promote the use of SPICT to aid earlier identification of palliative patients for addition to the GP palliative care register.
There is a plan to share SPICT4All with hostel staff as a way for them to help recognise potentially palliative patients amongst the homeless community.

The Hospice are the lead for EPaCCS in Lincolnshire. This is a national directive and offers an opportunity to drive change in Primary and Secondary Care through clinical engagement, templates, care plans and education. We have chosen to do this as much as possible in an organisational agnostic fashion.

The Hospice runs a specialist in-patient unit in Lincoln, a hospice in the hospital in Grantham and a community hospice in Louth. We have a directorate within the main secondary care provider unit and offer support on the wards. St Barnabas also delivers day therapy, an out patients service and hospice at home across Lincolnshire.

The SPICT tool is attractive to us the emphasis is on identifying need rather than prognosis and it manages this on a single page. We have included this in our EPaCCS educational website www.eolc.co.uk and in our End of Life Brochure. These resources are for all Health and Social Care professionals. We are highlighting it to GPs when we visit or present at meetings. The consultants are discussing it throughout the secondary care trust.

EOLC-WEB.pdf

Palliative care services
Education

In education sessions

Thank you so much for your continued work on this great tool!