Presentations FINAL ALL.ppt - buckshealthcare.nhs.uk even… · MDT’s Development of cancer 1999 2ww GP referral process introduced (Currently 6500 referrals seen in Trust per year)

Welcome

Graham EllisGraham EllisChairman

Date here October 2009

Introduction

Anne EdenAnne EdenChief Executive

Date here October 2009

Cancer services in our hospitalsAn overview

Lead Cancer Clinician - Dr Faeqa HamiLead Cancer Nurse - Jeanette TebbuttLead Cancer Manager - Janet Linacre

Date here September 2009

NCPR 2wwTVCNNCAT Cancer TVCN

GP’s SMHMDT’s WH PCT’s

MTVOpenExeter Oxford

CNS’sCQUINSExeter

Accountability

Department of HealthCANCER ACTION TEAM

NATIONAL CANCER PEER REVIEW

CANCER ACTION TEAM

NATIONAL CANCER PEER REVIEW(NCPR)

THAMES VALLEY CANCER NETWORK(TVCN)PCT’s

Cancer Centres (Oxford & Mount Vernon)& Cancer Units (Bucks)

TUMOUR SITE SPECIFIC GROUPS(TSSG’s)

MDT’s

( )

Development of cancer

1999 2ww GP referral process introduced(Currently 6500 referrals seen in Trust per year)

2000 Manual Cancer Standards2001 Introduction National Cancer Peer Review

2000-3 Rapid development in staffing- Cancer Unit WH opened- CCHU extended SMH

08/09 2,000 diagnosed cancers in Trust

Multi Disciplinary Teams “MDTs”

• Breast• Urology• Lung• Gynaecology• Haematology• Colorectal• Upper Gastro Intestinal (UGI)• Palliative Care• Skin

MDTs weekly / fortnightly

• Video conference facilities at: SMH, WH, AHOxford MTV H&WPOxford, MTV, H&WP

• OncologistsSurgeons/physicians• Surgeons/physicians

• PathologistR di l i t• Radiologist

• Palliative care C i li t (i h)• Cancer specialist nurses (inc. research)

• MDT co-ordinator

Background / “back stage”

• Government targets - 2ww31 day- 31 day

- 62 dayAll breast referrals in 2 weeks by Dec 2009• All breast referrals in 2 weeks by Dec 2009

• MDT data collection into Infoflex and National Open ExeterO f d C I t lli U it (OCIU) d N ti l li i l• Oxford Cancer Intelligence Unit (OCIU) and National clinical databases

• Cancer Reform Strategy - PCT• CQUIN database

Peer review ‘good practice’

• Laparoscopic surgery offered in urology, gynaecology, colorectalcolorectal

• Sentinel node biopsy – breast care• Patient surveys• Patient surveys• Patient support groups • Rapid access pathways• Rapid access pathways• Patient information

‘Moving on’ group• Moving on group

Very active patient partnership group• Very active patient partnership group

Supporting care

“Cancer care is like the London ndergro nd“Cancer care is like the London underground without the connecting stations”

Quote from a patient

Pain Bleeding Lump

Cough

Screening

RSurgery RecurrenceSurgery

Nausea andV iti

Recon- structionVomiting

Diarrhoea

DisfigurementLossHairBurning

Radiotherapy

ChemotherapyUnemployment

CANCER JOURNEY

ColostomyInfertility

Colostomy

Cure

Clinical Nurse Specialists (CNS)

The clinical nurse specialist works closely with hospital nurses doctors and other healthcare professionals tonurses, doctors and other healthcare professionals to maximise the independence, dignity and quality of life of people suffering from cancer. They also liaise with community g y ycarers and family doctors (GP) to ensure the highest quality of care at home. There are CNSs in:

• BreastLung

• HaematologyGynaecology• Lung

• Upper GISkin

• Gynaecology• Colorectal

U l• Skin• Palliative care

Ch th

• Urology• Rarer cancer

• Chemotherapy

Cancer information and support service

Gives support and information to anyone who has concerns about cancer.• Free booklets, DVDs, audio tapes• Free guided internet accessee gu ded te et access• Macmillan Citizens Advice Bureau advisor• Wig supply and support serviceWig supply and support service• Clinical psychology• DietitianDietitian • Breast prosthetics fittings• Support meetings• Support meetings• Website• Complementary therapies• Complementary therapies

Complementary therapies

Different therapists offer different treatments according to theirtreatments according to their qualifications. At present, we have therapists giving treatments in:

• Reflexology

therapists giving treatments in:

• Massage - back/neck/full body• Aromatherapyy• Reiki• Indian head massageg• Relaxation

Thank you for your timeThank you for your time

Implementing the end of life care strategy in Buckinghamshire

Dr Faeqa Hami DA FRCPC lt t i P lli ti M di iConsultant in Palliative Medicine

Clinical/SDU lead for CancerChair, TVCN Specialist and Supportive Palliative Care Group

Date here October 2009

Aims and objectives

• The documentation• Strategy headlines• Strategy headlines• National / regional / local overview

Definitions• Definitions• Current provision in Buckinghamshire

Work plan / quality measures• Work plan / quality measures• Group work

The documentation

• EOLC strategy: published July 2008

Quality Measures: published July 2009• Quality Measures: published July 2009

• First Annual Report: 2009

EOLC strategy

• Published July 2008

• 1 of 8 clinical pathways in Darzi review

• EOLC steering groups from all SHAs contributed to the document

• Quality markers consultation document

EOLC strategy headlines

• Half a million people die in England each year

• Two thirds over 75

• Majority of deaths follow a period of chronic illness

• 58% of deaths occur in hospital; 18% occur at home; 17% in care homes; 4% in hospicescare homes; 4% in hospices

Why is it important?

• We are not meeting wishes for preferred priorities of care• Need to improve care for those patients who choose / p p

need to stay in hospital• Approximately 50% of complaints nationally are related to

EOLC d i iEOLC admissions• Complicated bereavements lead to:

complaints• complaints• increased morbidity in the bereaved (short and long

term)term)• More effective systems may free up bed capacity• Death is a certainty, and only one chance to get it righty y g g

“How people die remains in the memory ofHow people die remains in the memory of those who live on”

Dame Cicely Saunders

National EOLC TeamNational EOLC Team

SHA groups

“Locality groups”Locality groups

Specialist Palliative Care Networks

National Council of Palliative Care (NCPC)

Definitions

• Palliative carethe active total care offered to a patient with• the active total care offered to a patient with progressive illness and their family when it is recognised that the illness is no longer curableg g

• Specialist palliative care• palliative care delivered by a multiprofessional teampalliative care delivered by a multiprofessional team

who have undergone recognised specialist palliative care training

• End of life care

Important overlap

Generic palliative careSpecialist palliative care EOLC

Current provision of specialist and supportive palliative care in Buckinghamshirepalliative care in Buckinghamshire

• 1.7 WTE palliative care consultants• Hospital multidisciplinary palliative care team:

• 7 day workingy g• Community:

• Macmillan palliative care nursesp• Iain Rennie Hospice at Home• Marie Curie

Current provision

• Inpatient hospice: Florence Nightingale House Hospice• Florence Nightingale House Hospice, Aylesbury

• Access to Sue Ryder, Nettlebed; St Francis, Berkhamstead; Thames Valley Hospicecare, Windsor

• Day hospice• Primary healthcare team• 24/7 specialist palliative care telephone advice• 24/7 specialist palliative care telephone advice

Current specialist palliative care practice

• Weekly MDTs• Palliative care information leafletPalliative care information leaflet• Place of care leaflet (work in progress)• Hospital palliative care discharge summary• Hospital palliative care discharge summary• Integrated care pathway for the dying adult• Rapid discharge policy• Rapid discharge policy

Important overlap

Generic palliative careSpecialist palliative care EOLC

Work plan for Buckinghamshire

• PCT EOLC group (met 30 Sept 2009)

• Hospital EOLC steering group (met 12 Oct 2009)

• Work plans based on EOLC quality measures

The end of life care pathway

Discussions as end of life approaches

Discussions as end of life approaches

Assessment, care planning and review

Assessment, care planning and review

Delivery of high quality servicesDelivery of high quality services

Care in the last days of lifeCare in the last days of life Care after deathCare after deathCoordination of

careCoordination of care

Step 1 Step 2 Step 3 Step 6Step 5Step 4

approaches approaches reviewreview

• Strategic coordination

• Coordination of individual patient

• Identification of the dying phase

• Review of needs and preferences

• Recognition that end of life care does not stop at the point of death.

• High quality care provision in all settings

• Hospitals,

• Agreed care plan and regular review of needs and preferences

• Open, honest communication

• Identifying triggers for discussion individual patient

care• Rapid response

services

and preferences for place of death

• Support for both patient and carer

• Recognition of wishes regarding

p• Timely verification

and certification of death or referral to coroner

• Care and support

Hospitals, community, care homes, hospices, community hospitals, prisons, secure hospitals

d h t l

p• Assessing needs of

carers

for discussion

g gresuscitation and organ donation

of carer and family, including emotional and practical bereavement support

and hostels• Ambulance

services

support

Support for carers and families

Information for patients and carers

Spiritual care services

Thank you!

Any questions?

Priorities – your views

G di iGroup discussions

Date here October 2009

Introducing our service standards

S d H ttSandra HattonDirector of Human Resources

and Organisation Developmentand Organisation Development

Date here October 2009

Listening to patients – what are their needs?

We ran three In Your Shoes events, each with 20events, each with 20 patients and 20 staff

Patients said they wantPatients said they want…• Clean and safe hospitals

A caring helpful and• A caring, helpful and respectful attitude

• Respect for their time• Respect for their time• Comfortable facilities,

good access

These are our five patient promises

good access• The best clinical care

These are our five patient promises

Service standards – to improve patient experience

Our five promises to our patients include a commitment to provide:include a commitment to provide:

‘A helpful and respectful attitude from all our teams We will listenfrom all our teams. We will listen to you, involve you in decisions about your care, and be sure ’ l b t h t t t ’you’re clear about what to expect.’

I was treated like a valued customer rather than just

another patient.pLetter received by Buckinghamshire

Hospitals during 2008

Introducing our service standards

• Consistent standards of behaviour for all staff - every interaction, every patient or colleague, every day

• Part of recruitment, induction, appraisal and day-to-day line management

• Why is this important?

• patient advocacy in a world of choice and competitionp y p

• clinical outcomes through better patient involvement

• positive environment for staff• positive environment for staff

• our patients deserve the best

• We use imagination to help us – how might a patient or colleague be feeling and why?

What we are doing, and how• Launched April 2009• Engagement events across the organisation to introduce the

t d d i t th di i i d i tistandards into the divisions and organisation• Driven through the divisions with nine month timetabled

rolloutrollout• “Mainstreamed” into the organisation through existing

practices; recruitment induction appraisal recognitionpractices; recruitment, induction, appraisal, recognition, complaints and is reported monthly at divisional level

• Working on integrating it into our patient satisfaction /Working on integrating it into our patient satisfaction / feedback mechanisms

• Delivering these service standards is EVERYONE’S gresponsibility

Delivering the trainingT i i i d t• Training is mandatory

• 80+ champions/facilitators have been trained to facilitate the learning in their divisionslearning in their divisions

• Flexible programme - can be tailored, recognising that no two environments are the same

• Facilitator takes into consideration specific needs of the service: eg radiology, corporate services, trained nurse update days, nursery

• Training materials include: presentations, DVD, challenging scenarios role plays - mix and match approachscenarios, role plays mix and match approach

• All staff attend facilitated training session and receive handbook and DVD (real patient stories)

• Uses imagination to consider good and bad example of service –asks delegates to consider how patients/carers might feel coming to hospital/having treatmentto hospital/having treatment

Service standards

Taking our patient experience fromTaking our patient experience from good to great