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.
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.
A Partner SPICT tool has been used as the basis for a new electronic alert for the local clinical database. Specialists working in the fields of palliative medicine, cardiology, respiratory medicine, oncology, haematology, neurology, elderly care, nephrology and old age psychiatry have supported the development. The electronic clinical alert flags patients who are being managed with a supportive and palliative care approach.
Robust clinical governance measures ensure that only senior clinicians who have received the online training about using the Partner SPICT can upload an alert. The online learning module also provides accessible training covering some aspects of palliative and end of life care including how a new alert is communicated to the primary care team and the importance of appropriate investigations and management of such patients.
The Coordinate My Care pathway uses an electronic solution (a shared, secure online patient plan) to delivery fully integrated, personalised end-of-life care. The CMC record can be accessed 24/7 by all health and social care professionals directly involved in the care of the patient. See Resources for the paper describing the development and outcomes of CMC.
Difficult Conversations, London
Difficult Conversations workshops provide experiential, multi-professional training to generalist NHS and social care staff on how to have compassionate conversations; covering issues such as a new diagnosis e.g. cancer or dementia, deteriorating health and dying.
Training improves patient choice, professionals confidence and skills addressing difficult conversations, knowledge of key legal issues, identification of at-risk patients, and the quality of care-planning and discussions around these common themes. The training is quality assured, endorsed and a nationally scaling programme.
There are two training models:
Standardised ½ day workshop, delivering training to up to 20 multi-professionals, by 2 experienced trainers.
Train the Trainer, 2 day training for up to 6 local, multi-professionals. This offers sustainability.
Uses of SPICT
SPICT is highlighted in our workshop presentation and a copy is handed to each attendee as part of their delegate pack.
We are providing specialist palliative care across the health locality and are leading the implementation of our local End of Life Care plan. Locally we have agreed that we would like to use SPICT across the hospital and community to help guide identification of the last year of life.
Ipswich Hospital Trust is an acute trust with a regional cancer centre
Uses of SPICT
Ipswich Hospital palliative Care Team is exploring the use of the SPICT tool in education and training material throughtout the trust with the aim of improving recognition of people at risk of dying and recognition of when to offer advance care planning and additional support.
Rotherham Doncaster and South Humber NHS Trust St Johns Hospice
St Johns Hospice provide Specialist Palliative Care and End of Life care via a ten bed Hospice In patient Unit,Fifty place Hospice Daycare, Community Macmillan team,Hospice at Home, Living Well Information team and Counselling Team
The tool will be used to assist staff to identify and focus on patients in the last year of life to populate the newly developed EPPACS in Doncaster
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.
Uses of SPICT
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.
In 2013, South Central Birmingham CCG, Sandwell and West Birmingham CCG, and Solihull CCG collaborated to provide training for GPs on breaking bad news (using Sage and Thyme sessions) and informing them of SPICT as an alternative prognostication tool in addition to the GSF tool.
GPs were informed that they should register with the website if they were using the SPICT tool.