NHS Greater Glasgow & Clyde - DOC

							                              NHS Greater Glasgow & Clyde
                                  Palliative Care MCN
                               Note of meeting, Thursday 9th February 2012,
                                             Dykebar Hospital
                                               10am – 12pm

      PRESENT:
      Christine Ashcroft               Adult Services Manager - Glasgow North East Sector
      Thelma Bench                     Inverclyde CHCP
      Elaine Burt                      Head of Nursing, RAD – NHS Greater Glasgow & Clyde
      Beth Culshaw                     General Manager - NHS GG&C RAD
      David Gray                       Consultant – Renfrewshire CHCP
      Lorna Hood                       Team Leader, Children and Families, East Dunbartonshire CHP
      Brian Hunter                     Senior Nurse Adult Services – Accord Hospice
      Sandra McConnell                 Consultant - Ardgowan Hospice
      Mairi-Clare McGowan              Consultant – St Vincent Hospice
      Alistair McKeown                 Consultant - Prince & Princess of Wales Hospice
      Ellice Morrison                  Senior Nurse - Glasgow North West Sector
      Helen Morrison                   Beatson West Of Scotland Centre
      Maire O’Riordan                  Consultant - Marie Curie Hospice
      Maggie Riordan                   Community Specialist Nurse, West Dunbartonshire CHP
      Janet Trundle                    Area Pharmacy Specialist - NHS GG&C Pharmacy

     IN ATTENDANCE:
      Paul Corrigan, Information Officer - NHS GG& C, RAD
      Claire Donaghy, Health Promotion – NHS Greater Glasgow & Clyde
      Euan Paterson (Chair), General Practitioner, General Practice
      David Thomson, Deputy Lead Community Pharmacy, NHS Greater Glasgow & Clyde
      Jan Whyte, Planning Manager - NHS GG&C RAD
      Shona Jenkins, Planning Officer - NHS Rehabilitation and Assessment Directorate

1   Apologies – were received from Keith Saunders and Val McIver

2   Note of meeting November 2012
    This was agreed as an accurate note.

3   Note of any AOCB
    The following items were added at members request for discussion under AOCB
        Case Boxes (Pharmacy)
        Guidelines (Pharmacy)
        CHAS
        National Guideline
        Pharmacy Post (Janet Trundle)

4   NHSGG&C Palliative Care Action Plan 2010-11
    Action 9 - Consider how patients’ and carers’ preferences and experiences can be used to inform
    service planning – (BoP 12)
    As part of the PFPI Framework Claire Donaghy remit is to get feedback from patients and carers on a
    regular basis in order top determine how services can be improved. As part of this programme, the Prince
    and Princess of Wales Hospice held an open day in October 2011 when patients and carers were
    interviewed about their experiences especially in relation to the hospice. Some of the stories were
    videoed and have provided some very valuable material. Claire tabled a copy of the report from the event
    for the MCN to consider. The main area which was highlighted is the difference between service
    provision and culture in a hospice setting and that of an acute setting. It was noted that this could link to
    the work of the Acute sub group. BC informed the MCN that at a recent meeting of the Acute sub group
    it was noted that Andy Crawford, Head of Clinical Governance has been given a remit to look at
    standards within older peoples services. BC offered to convene a meeting to include Andy and to
consider this report and its findings including the DVD which was made of the interviews.

Members were invited to contact CD if they had and questions or comments on the report. The report
initiated a discussion on how we use and learn from feedback and complaints and how they can be used
to improve services and drive change. Much of this work should be supported by the Rapport approach
developed and to the quality agenda. It was also noted that letter of satisfaction should be used as a tool
for reinforcing good practice and give positive feedback.

Action 1 - To ensure that any decisions about palliative care service provision do not exacerbate but
reduce the relative inequity within NHSGGC
It is recognised that inequity is inevitable in the process for the implementation of Change Fund. Change
Fund is short term (4 years) funding for which there is a reporting process on a quarterly basis within
each partnership however there is concern that no formal Board wide reporting mechanism. JW has
pulled together a draft list of Change Fund approaches being developed within each partnership and has
raised the issue of Board wide report with Anna Baxendale and Lorna Kelly. Many of the services are
still to be established and there have been issues around recruitment.

Monitoring is in place to determine what is making a difference. The partnership with Glasgow City
Council has stated that it will withdraw funding if an initiative is not working. A Glasgow City Plan is
being developed including a monitoring report. JW offered to investigate if a summary of the
plan/monitoring report on approaches impacting on end of life care could be developed and if it would be
beneficial to share it/them with the MCN. The role of the Palliative Care MCN is to be aware of what is
working as not all of the initiatives impact on Palliative Care.


Action 12 - Introduce ACP in all care settings in line with national guidance and local need – (BoP
6,7,8,16 & 17)
A number of the new change fund and other initiatives mention and aim to address ACP but there is no
common understanding or framework for these approaches. An ACP draft check list drawn up by the
Primary Care Practice Development Sub Group was circulated prior to the meeting. The MCN were
asked to endorse the paper in order that it could be shared with Lorna Kelly in the anticipation that the
key components and format could be adopted across the Board in an attempt to achieve consistency and
to influence the Change Fund process. Consideration is to be given to how we promote the patient held
communication tool - ‘My Thinking Ahead and Making Plans’ as extensively as possible. Members were
asked to share the list with constituencies and to forward comments and views to Shona Jenkins
(shona.jenkins@ggc.scot.nhs.uk) by 24th February.
It was noted that the next step will be to consider how we share/communicate the transfer of information.

BC reported that one ACP SPAR nurse is now in post and a second is about to take up post.

EP has spoken with a lawyer who is involved with the development of Living and Dying Well and
Building on Progress regarding ‘power of attorney’ (POA) and will report back to the MCN in due
course. Change Fund monies are being discussed around voluntary organisations and raising awareness
of POA with carers. Claire Curtis – Heath Promotion has been approached to take this forward.

Action 2 - To address specialist and generalist palliative care provision in the acute sector where
most people die – (BoP 9)
The Acute Group has now met on two occasions to consider the wide agenda. A wider session is to be
held in April to discuss the potential of setting up of a professional advisory group. Gillian Sherwood, the
new Lead Nurse for Palliative Care is to take up post at the beginning of March.

Action 3 - To review how inequities in access to specialist in-patient beds can be addressed across
NHS GGC – (BoP 4)
DG has spoken to AH regarding the reporting mechanism for this group and it has been agreed that the
group will report to the Board through the MCN. Discussions around inequalities will be taken forward
along with the development of a common language. JW is to produce a report for AH to go to the next
Board meeting. The appointment of a new chair is still to be resolved, in the interim, DG is to reconvene
the group to look at tools for assessing admissions.
Action 4 - To review access to specialist palliative care medical, pharmacy and nursing resource
and consider how inequities can be addressed across NHS GGC – (BoP 4&9)
Nursing - awaiting the appointment of a lead nurse.

Pharmacy – Karen Menzies has been appointed for 3 days a week to help cover for EH’s maternity
leave. Cover is being provided for the enquires received via EH’s mobile however there is still concern
that this has not been conveyed to staff on the ground particularly district nurses. Members present were
asked to make this known to them. In preparation for JT’s retiral in April discussions were taken forward
with the Pharmacy and Prescribing Support Unit to increase the post from 0.73 WTE to 1 WTE. This post
will cover clinical services for the whole of NHS GG&C including PPOW, SMOSH and the 3 Clyde
Hospices. The post is to be advertised at the end of the week. Funding has also been secured for a further
post .6WTE.

Medical – Discussions are ongoing regarding the review of the palliative medical resource and the lead
clinician role and will be shared with the MCN in due course.

Action 5 - To maintain the use of the Palliative Care Register in primary care and roll out a similar
approach into the care home and NHS Continuing care setting – (BoP 5,16 & 17)
A comprehensive update was provided in EP’s letter. SPAR is doing well and proving popular.

Action 6 - Review provision of palliative care to those with non malignant disease and work jointly
with other disease specific planning groups to implement appropriate assessment and care planning
approaches – (BoP 5,6,7,8,9,16 &17)
Numbers are below what would be expected at this stage. Other MCN will be contacted and enquiries
made as to any palliative care progress. Renal services are involved in pilot work at the New Victoria
Hospital and Marie Curie Hospice has been approached regarding end stage renal patients in the North
regarding the sharing of good practice.
It was reinforced that a routine system should be in place for constituencies/partners to provide a regular
update of developments in their areas. PC informed the group that the Communications Group are
looking to develop a template for reporting. It was agreed that each representative should submit
summary of developments to PC approximately 2 to 3 weeks before each MCN. The summary will give
a brief update of progress and developments and include contact details for further information/enquiries.

Action 7 - To implement the Liverpool Care Pathway in all settings – (BoP 5,6,7,8,9,16 &17)
A detailed summary paper was circulated with the agenda. Implementation progress has been impressive.
Work is ongoing within the group on producing an audit tool. Gillian Sherwood’s role will have an
impact particularly around the gap in Clyde following the departure of Kate Lennon.

Action 8 - Review provision of generalist palliative care services in the community in particular
issues arising from need due to deprivation an increase in dementia and lone person households –
(BoP 5,6,7,16 &17)
A brief report produced by Kevin Fellows was circulated with the papers. Additional reporting from
community planning groups will add to this for the future.

Action 10
Roll out ePCS – (BoP 13 & 4)
This is progressing well – further encouragement and support has been offered to the non participating
practices.

Electronic referral
This is also progressing well in the community. Hospice referrals from BOC are still paper based and the
different specialist providers have different forms specific to their service. Commonality of paper form
and eventual migration to electronic referral are the aim but in the meantime it was agreed that as long as
a specialist palliative care referral form is used the details would be the same and so acceptable to all
hospices.

Action 11 - Roll out national approaches to DNACPR when agreed including approach to training
on communication skills – (BoP 14)
Concerns were raised regarding DNACPR implementation. EP is to meet Kevin Fellows and John
Dickson to discuss the community aspect. Training will continue to be a priority. MO’R indicated that
    Marie Curie would be happy to facilitate this and to encourage discussion. EP offered to email Dr
    Dickson regarding the MCNs concerns around uptake, audit and systems in place. This was agreed as an
    action point.


    Action 13 - Review how palliative care is provided to children and adolescents particularly at
    transition in light of recommendations of SLWG 6 – (BoP 10/11/15 & 18)
    Funding for Karen Sinclair’s role will cease at the end of March. The MCN will continue to have contact
    with the Womens’ and Childrens’ Directorate initially through Elaine Love.


    Action 14 - To review outputs of all national working groups and prioritise recommendations for
    implementation in NHS GGC
    Developments within our Board area are covered within Building on Progress. There are few new
    developments at a national level. At a local level we need to consider how we launch ‘Good Life, Good,
    death, Good Grief’. It was suggested that there is a real place for using a number of social media
    websites. PC indicated that the Board is bringing out a social media policy. Claire Donaghy and PC are
    to take this forward with the Communications Group.

    Action 15 - Develop NHSGGC Education and Training plan including review of existing training
    and education to remove duplication – BoP 19,20,21,24 & 25)
    Covered in items above

5   Action 16 - Bereavement Action Plan – (BoP 19,20 & 21)
    The group has met twice and a template bereavement action plan has been produced and circulated with
    the meeting papers. A range of work is ongoing within the 6 hospice consortium. Drop in sessions for
    carers who have been bereaved will be developed in all CHCP/CHP areas – one telephone number will be
    made available to wards for signposting. In addition there will be staff training on bereavement available
    through a range of mediums at 3 levels. Further details will be shared when available

6   Reference Groups –
    Therapeutics – JT reported that the NES design team who are formatting the draft of the GGC version
    of the McKinley T34 guidelines have had major IT problems, which is delaying progress. Whilst JT will
    endeavour to complete this work before her retiral, this is dependent on meeting deadlines for submission
    to ADTC, and their subsequent approval.

    Communication Group – Paul Corrigan will build on this approach through establishing a virtual/email
    group that will review the MCN constituency reports and collate key points to inform the Websites latest
    additions update.


7   T34s
    Funding has been resolved for the financial year 2011/12 but clarity is sought on the future process
    regarding recurring maintenance costs and on an ongoing plan to include replacing pumps. It was noted
    that the provision and maintenance of these pumps is a critical part of maintaining people at home. JW is
    to talk to Murdoch Macdonald about costings. It is not clear what outlay there has been so far this year
    for maintenance. JW and JT to take these matters forward with the Therapeutics group and produce a
    paper for the May MCN.

8   Change Fund
    Covered above

9   Website update
    Professional – ongoing
    Public – NHS Inform Palliative Care Section was launched a few weeks ago and feedback was sent to the
    SPPC. It is anticipated that there will be more detail on the content in the near future. The challenge is
    now to encourage the public to use the website and its comprehensive links.
10   AOCB
        Just in Case Boxes (Pharmacy) – work is underway with district nurses who currently use the
          Community Palliative care cardex to produce new community documentation. First proof has
          been achieved but the roll out cannot go ahead until we have got the written information to be
          included as this is vital for patient safety.

           Guidelines (Pharmacy) – 2 pallets of guideline booklets (3 – 4 years supply) have recently been
            moved from Lightburn to Drumchapel Hospital. JW offered to look into the numbers and how
            these should/can be distributed. It was suggested that these should be delivered in as pro rata a
            fashion as is possible to the MCN constituencies to ensure that their further distribution is as
            comprehensive as possible.

           CHAS - JT has been working with Robin House to resolve some recent pharmacy issues that
            went to the clinical forum. The CHAS Board have agreed to fund 2 post (for Rachel and Robin
            House) JT and DT will meet with CHAS to take this forward.


           National Guideline – DG gave a brief overview of the national position. 28 topic guidelines have
            been agreed. A steering group has been convened. No funding is available for producing the
            guidelines. All NHS Boards be able to have 2 representatives and have agreed to release staff.
            Every Board will use the Lothian Guidelines and will work in conjunction with colleagues in
            Edinburgh that will act as advisory body. The national steering group will provide the guidelines
            and will ensure that there will be an electronic format. A printed version and/or an ‘App’ will be
            produced at each Boards discretion. DG agreed to provide a brief note for circulation.

           Pharmacy Post (Janet Trundle) – dealt with under item agenda item 4, Action 4


     Date of next meeting – It is anticipated that the May meeting will be held at Dykebar Hospital as
     previously indicated. Due to the pending closure of Ward 15 at Dykebar, alternative accommodation is
     sought for future meetings. Brian Hunter offered to check availability at Accord Hospice.

     Tuesday 15th May 2012, 10am – 12pm, Ward 15 Dykebar Hospital
     Wednesday 22nd August 2012 – 10am (venue to be agreed)
     Thursday 15th November 2012 – 10am (venue to be agreed)