10062009 - NHS in Bradford and Airedale

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					                       Bradford & Airedale
                         Palliative Care
                     Managed Clinical Network
           Minutes of a meeting of the Planning Working Group at the Marie Curie Hospice on
                                             10 June 2009


Mike Hughes, Manorlands & AGH – Chair
Rosemary Lennard, Marie Curie & Bfd Hospitals
Andrew Daley, Marie Curie & Bfd Hospitals
Jane Edgeley, Marie Curie
Charlotte Rock, Bfd Hospitals
Catherine Scoggins, MCN
Helen Livingstone, Manorlands & Airedale Community
Linda Wilson, Manorlands & AGH
Ian Fenwick, NHS Bradford and Airedale
Pat Holford, Bfd Community
Sarah Holmes, Marie Curie
Steve Davison, Manorlands
Laura Middleton-Green, Bradford Community
Belinda Marks, Bfd & Airedale Community
Lesley Sterling-Baxter, Equality & Diversity Team
Lynne Carter, Equality & Diversity Team
Mahroof Akhtar, Airedale Hospital
Isabelle Hudman, MCN


Lesley Booth, Planned Care Services manager, NHS Bradford and Airedale
Christine Harker, NHS Bradford and Airedale
Jean Gordon, Marie Curie
Vanessa Taylor, Bradford University
Pat Mowatt, Airedale Community

1. Minutes of the last meeting

The minutes of the last meeting were accepted. However, it was requested that an amendment be made
to the information concerning the availability of syringe drivers across the district (item 6): Bradford area
NHS Bradford and Airedale (tPCT) be changed to 40 syringe drivers, bringing the total to 170.

2. Matters Arising

Any matters arising are included in the agenda

3. Equality & Diversity Team, NHS Bradford and Airedale Pacesetter Project

Lesley Sterling-Baxter and Lynne Carter attended the meeting and presented a brief outline of their
project. They were hoping the Planning Group would be able to provide advice on how to take the
project forward and also possibly provide volunteers to join the steering group.

NHS Bradford and Airedale have obtained a Department of Health grant from its Equality and Diversity
initiative. There are to be 4 projects. The 2 that involve palliative care are a data project and then the
project being presented today which is on improving palliative care services for Muslim patients with
cancer. They are using a methodology called experience based design. This will involve
1. collecting information from service users via semi structured interviews and focus groups
2. understanding the information
3. development of small scale interventions

They hope to interview approximately 20 service users .

There was a general discussion around the specific needs of Muslim patients from previous and current
research which has been undertaken. It was agreed that members of the Planning Group would forward
any useful information by email (contact details available from Isabelle). For the steering group, at
present members include Lesley Sterling-Baxter, Lynne Carter, Wali Naz and Ian Fenwick. Following the
discussion Rosemary Lennard and Steve Davison volunteered to join. The timescale is yet to be finalised
but they hope to start collecting information and talking to service users over the summer. They have a
budget of £15,000. If anyone is interested they can contact the project via Isabelle.

4. Feedback from the End of Life Project Board

The definition workshop took place on 20 May and all the information gathered/notes have now been
circulated. It is hoped that the work streams will be finalised and the next steps clarified at next weeks
End of Life Project Board meeting. The Project group will then meet regularly for updates on the work

Andrew Daley reported that there are plans with the IT department at NHS Bradford and Airedale to
development a register for palliative care patients and that a bid is to be submitted to join a pilot for this
register. £50,000 is available for the pilot. It would appear that there are no technical barriers to the
register, just barriers around the training of staff and how to persuade primary care to input the
information needed. Part of the bid for the pilot involved a part time post of trainer in advance care

There was a general discussion around the importance of advance care planning and which work stream it
would best fit into. It was agreed that all the work streams potentially would involve issues around
advance care planning. Jane Edgeley agreed to discuss this issue at the Project Board meeting next week.
Helen Livingstone feels there needs to be an advance care planning group separate to the work streams to
ensure a consistent approach across the district.

5. Managed Clinical Network (MCN)

Met last week, 4 June 2009. The main points raised were:
 A meeting has been planned to clarify the relationship between the MCN and the End of Life
   Programme for the 22 July at Douglas Mill. It was agreed that a clear pathway between the work
   streams, Project Board and the Planning Group needs to be established.
 Management structure to be revised and presented to Planning. A few amendments were suggested.
   A new structure will be produced and circulated.
 Terms of Reference and agenda of Planning meetings to be reviewed and a new Chair elected. The
   group were asked to forward nominations to Mike Hughes for the next meeting.
 Clinical Governance/Research Group to be restarted after the summer with Rosemary Lennard as
   Chair. Belinda Marks said she would take on role as Vice Chair.
 Mental Health Group encouraged to continue in some form.
 Annual Report for April 2008 to March 2009 to be completed as soon as possible.

Action: Management Structure to be amended and circulated by IH.
Action: Summaries from each sub group for Annual Report to be forwarded to Isabelle by end of
       August 2009.

6. Syringe Drivers

The situation concerning the recommended change of the syringe driver used in the district is no further
forward at this time. The information has been provided and it is now up to NHS Bradford and Airedale to
make a decision (see report from Charlotte Rock on page 4). This needs discussing at the End of Life
Project Board. Mike Hughes will raise this at the next meeting. Charlotte Rock reported that the district
wide syringe driver policy is in need of review. She will be liaising with members of the Syringe Driver
Group to do this.

Action: Mike Hughes to raise the subject of syringe drivers at the next End of Life Project Board
7. Update on out of hours care

At the last Planning meeting it was felt that with the change on out of hours providers the quality of
provision of care for palliative patients has significantly deteriorated and we have been asked to report
any critical incidents to Jane Edgeley and Linda Wilson. Ian Fenwick has been analysing the prisms on
critical incidents and there have been no palliative care incidents reported. The same was true for issues
around transport. The question was asked, “Does this mean there is no longer a problem or are we under
reporting critical incidents?” The group felt the latter was more likely and it was agreed we need to be
more pro active in reporting critical incidents and sending copies to Ian Fenwick, Linda Wilson and Jane

8. User Involvement

This has not yet been progressed. Mike Hughes has yet to form a sub group.

Action: Mike Hughes to arrange first sub group meeting before end of July.

9. Reports:

Mental Health & Palliative Care Services Links Group

The group last met on 7 May 2009 to discuss:
 Directory of mental health services now updated on the palliative care website.
 Critical incident highlighted re ongoing difficulties obtaining urgent psychiatric support, in particular,
   liaison services seem to be difficult to access. Critical incident to be followed up by those involved.
 Education session for palliative care professionals on mental health services arranged for 23
   September 2009. Contents of the session to be circulated soon.
 Directory of support services is nearing completion. To be finalised, will be produced in leaflet form
   and on the website.
 As attendance at the mental health group meetings is declining the question as to whether or not the
   group should continue was raised. If the group were to stop then members could redirect their efforts
   to the appropriate work streams. This needs to be discussed at Planning and with full membership of
   the sub group.

Bradford Network for Palliative Care for People with Learning Disabilities

   The group continue to meet regularly (last met 12 May) liaising with regional and national groups.
   There is to be a regional conference organised by the National Network for Palliative Care of People
    with Learning Disabilities in Huddersfield on 1 July 2009.
   The group are looking for a research project as we‟ve had the offer of assistance from some
    psychology trainees. Ideas to Dr Graham Bayliss via Isabelle Hudman please.
   The job description for the proposal for a Specialist Learning Disabilities/Palliative Care post is being
    finalised and a business case prepared to present at the appropriate work stream.
   MENCAP have produced a useful guide. A link is available via Isabelle Hudman or website.


Pat Holford reported that a review is being carried out on the blue leaflet – Palliative Care. A guide to
services in your area. Members as asked to check their own team details and bring any amendments back
to the next Planning meeting.

Sub-Regional (Yorkshire) Palliative & End of Life Care Group (previously YCN Palliative Care Group) –
reported by Charlotte Rock

 Sub-Regional (Yorkshire) End of Life Care Group
The first meeting of the new sub-regional (Yorkshire) Palliative and End of Life care group has met. Terms
of reference and the work plan are currently being agreed.

The key role of the group is to undertake work on behalf of the Yorkshire and Humber SHA regional EoLC
steering group and the Locality EoLC groups on a do once and share basis e.g. Quality measures / issues,
Education programmes/ strategy, Research activity
Money is available for a Project Manager for each sub-regional group (fixed term). Job description is going
out for consultation

Recommendations / ideas are welcome from localities on the work that should be undertaken at network

Pat Featherstone, Dr Ian Fenwick, Dr Linda Wilson & Charlotte Rock are currently Bradford & Airedale
representatives. Also joining the group will be Liz Moore, AHP Lead Commissioner for B & A (new post)

Happy to share draft Terms of reference if anyone wishes.

 Syringe drivers.
No agreement was reached about regional approach to procurement of syringe drivers. Each locality is at
different stages of consideration of future plan. Some areas are undergoing further trials as Alaris have
refined their machine further. Agreed to discuss again at meeting on 7th July.

 YCN Symptom Management booklet.
Reviewed. Currently out for 2 week consultation prior to print order. Distribution will be led through area
lead clinician (palliative medicine).

Education – reported by Catherine Scoggins

   Specialist Education Events

This year‟s evening education sessions have been focused on Advance Care Planning. 4 evening sessions
have been held across the district and 60 have attended. These sessions will be followed up with 2 whole
day workshops for those people who wish to be ACP „champions‟ in their workplace.

A one day conference is being organised on Wednesday 4 November 2009 year at the new Lecture Theatre
at the BRI. The conference theme will be „Living and Dying with Dementia‟ again will be around Advance
Care Planning, dementia and palliative care for elderly patients.

   Palliative Care and End of Life Care Education Team.

5 Care Homes have been selected to provide enhanced palliative care beds in Bradford and Airedale. It is
hoped that these Care Homes which will meet the new Quality Markers for Care Homes, defined by the
Department of Health End of Life Strategy, 2008. The homes have been selected based on their
commitment to palliative care, their geographical location and the number of beds offered. As part of the
programme, more in depth palliative care and end of life care education will be offered e.g. Advance Care
Planning, symptom management. In addition, once a death has occurred in the Care home, there will be
support for staff to review the circumstances surrounding the death.

   Core Competencies

Work is nearly complete on the mapping of the KSF and the application of the core dimensions to the
palliative care context. The indicators of 4 Core dimensions - communications, personal and professional
development, service improvement and quality have been mapped at all 4 levels. Health and Wellbeing 2
and 5 are also being mapped.

As a result of the End of Life Strategy, Skills for Health have produced „common core competencies‟ for
the health and social care workforce when providing palliative and end of life care. CS and CH have been
part of the pilot sites to map these principles against the palliative care education courses delivered by
Christine Hawksworth. These new „competences‟ are being launched nationally at the end of June

   District Nurse Education

Plans are in place to deliver palliative care education to community and district nurses using a programme
developed by Surrey, West Sussex and Hampshire Cancer Network. This will start in the Autumn 2009

   Education and Workforce Development

Following the Achieving the best health for all; Commissioning programme End of Life event at the Cedar
Court on 20 May, the next stage is for those involved in the Education/Workforce Planning work stream to
hold a meeting. This is planned for July 2009.

COPD Group reported by Rosemary Lennard

District MDT continues. Marie Curie Centre Breathe Better Group continues. Palliative care in COPD -
presentation at Yorkshire Thoracic Society meeting June 12th.

Flu planning reported by Rosemary Lennard

This pandemic so far looks like having high infectivity with low mortality - which may mean we can keep
services open. There is national planning going on with the Department of Health and GP committee at
BMA re the need for pharmacy 'comfort in flu' packs - which can be used for terminal care in flu at home
or in nursing homes. The packs would contain no injectables and no CDs - so would be easily dispensed.

10. Any other business


The group agreed there are still outstanding issues concerning transport and palliative care patients. The
group have been advised by NHS Bradford and Airedale that „Transport‟ which was originally to be a work
stream is now being addressed independently of the work streams. There still appears to be no response
to complaints. Ian Fenwick commented that complaints do not appear to be directed to the correct
department. It was suggested that Ian Fenwick details exactly how and where complaints should be
directed. This information will then be circulated to the group via Isabelle

Action: Ian Fenwick to e-mail Isabelle Hudman with complaints procedure for ambulances and then
        Isabelle to circulate to Planning Group.

11. Dates and venues of future meetings:

Wednesday 29 July 2009 at Manorlands 3pm

Wednesday 9 September 2009 at the Marie Curie Hospice 3pm


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