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