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Living _ Dying Well


									Living & Dying Well
           One Year on…

The Perspective of an Executive Lead &
 Chair of A Managed Clinical Network

    Robbie Pearson, NHS Borders
Dr Paul Cormie, Chair of Borders MCN
“How we care for the dying must surely be an indicator of
how we care for all our sick and vulnerable patients. Care of
the dying is urgent care – with only one opportunity to get it
right, to create a potential lasting memory for relatives and

                      Professor Mike Richards CBE
An Impetus for Change…

• Substantial achievement
• A step change in how we think and behave
• L&DW has provided a sense of focus & priority for NHS Boards
• L&DW Delivery Plans – sharing of good practice & common
• Executive leads providing a focal point for leadership in taking
  forward L&DW
• Direct Enhanced Service for Palliative Care: building an
  integrated network of care
• Shifting attention to tackling inequity in care and extending care
  to non-malignant conditions
From an NHS Borders
Executive Lead Perspective
• Active engagement, leadership and involvement of the Board
• Identification of successes and challenges from L&DW and Audit
  Scotland perspectives
• Leadership for priorities and delivery through the Managed
  Clinical Network
• With the video diary, using the perspective of the patients journey
  from diagnosis to the last days of life
• How we change our perspective on what matters & tailoring
  services accordingly
Sustaining That Impetus…

• Making palliative care matter, whatever the condition, whatever
  the care setting
• Giving a sense of coherence and making the connections to the
  other strands such as shifting the balance of care
• NHS Boards actively tracking & measuring progress – especially
  the experience of patients and their families with regard to
  communication and co-ordination in the last phase of life (eg
• How we introduce & implement the recommendations from the
  short-life working groups into the service is crucial – a
  continuation of L&DW, through into implementation
Perspective from an MCN

• Focus on specific areas of service delivery:
  workplans and timeframes
• Identify unmet need and plan to address
• Facilitate sharing of ideas
• Raise profile of palliative care at Health Board
  level and responsibility for implementation
Perspective from an MCN
Executive Lead

• MCN previously successful in implementing
  change where little or no resource required
• Reality check
• Development of business case
• Navigation through the Health Board process
Perspective from an MCN

• Non-malignant: initially COPD and heart failure.
  Now progressing to dementia and frail elderly
• End of life care pathway
• In-patient palliative care – benchmark to other
• Anticipatory social care
• OOH – handover sheet further developed to
  become Palliative Anticipatory Care Plan
Perspective from an MCN

•   IM&T for specialist palliative care
•   Kardex further developed – PRN chart
•   Drug boxes
•   Information: website, LTC, leaflets
•   Conference
•   Digital stories: individualising care
Perspective from an MCN

• 24 hour community nursing cover
• Equipment – an unexpected consequence of
  anticipatory care
• Resources: training and education both
  participation and delivery (DNAR, End of life
  care pathway), accommodation
• Keeping the momentum going

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