Quality requirement 9: Palliative care

The framework was established by a Macmillan GP facilitator at John Taylor Hospice in Birmingham and has now been rolled out across the UK as part of national policy. The GSF improves the supportive palliative care of people towards the end of their life, and is used by primary health care teams to optimise the care provided for people living in the community, so that most care is delivered at home or to people attending GP surgeries. It is now being piloted in care homes and will be piloted in community hospitals in the future. It is being used increasingly with people who have long-term conditions. The facilitator is willing to share a number of resources.

People with motor neurone disease in West Dorset can have their follow-up appointment in a joint neurological and palliative care clinic based at the hospice. The clinic is held every three months and people can see the consultant neurologist, consultant in palliative care and a palliative care nurse. The team has developed a checklist of potential issues to be considered at clinic visits, including life-prolonging interventions and end-of-life preferences.

This multidisciplinary team provides co-ordinated care to people with MND. Team members include a range of palliative care practitioners. Specialist palliative care staff are involved at or very soon after diagnosis. The team holds monthly meetings to review both new referrals and the existing caseload. They have developed a number of resources which they are willing to share.

The Motor Neurone Disease (MND) Association funds a network of twelve MND Care Centres based in regional neuroscience centres. They deliver high quality coordinated assessment and management of care to all people with confirmed or suspected MND in line with the Association’s Standards of Care. The individual centres have developed a number of resources and different ways of working which they are willing to share including fast-track diagnostic clinics, nurse-led clinics, taped consultations, development of advance directives and preferred place of care for specific use in MND, MND care pathways and review processes, carers’ information days, links with local ambulance services, use of volunteers in clinics, and education for staff in primary and secondary care.

A team at the Department of Palliative Care and Policy have developed a new demonstration project to improve palliative care for people with primary and secondary progressive multiple sclerosis.

St Peter's serves mainly people with cancer but increasingly sees people with other conditions, particularly motor neurone disease and other neurological conditions. Services include: domiciliary visits by specialist nurses; a day hospice; inpatient care (including respite care); intensive hospice care at home and an education department, which will organise appropriate and supervised attachments for relevant professionals. People whose condition is stable attend the day hospice once a week. Some people are admitted for respite care and at times of crisis.

The NHS End of Life Care Programme commenced in November 2004 and the aims are to improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice. The proposed outcomes of the programme are: greater choice for all patients in their place of care and place of death; decreased numbers of emergency admissions for patients whose preference is a home death; decreased numbers of patients transferred from a care home to district general hospital in last week of life; generalists skilled in the use of care models to improve end of life care. This will be achieved by providing health and social care staff practical solutions on how they can improve end of life care for all.  Programme information: tel 0116 2225103, or:

• NHS End of Life Care Programme (opens new window)
• Email: information@eolc.nhs.uk

There are a number of ‘end of life’ tools which certain organisations have produced and are willing to share. Please visit the sites or make contact with the person named below:

• Liverpool Care Pathway (opens new window)
• Email Deborah Murphy (Royal Liverpool and Brodgreen Hospitals) about the Liverpool Care Pathway
• Preferred Place of Care Plan on the Lancashire Cancer Network website (opens new window)
• Preferred Place of Care Plan on the Cumbria Cancer Network website (opens new window)
• Email Lee Storey (University of Central Lancashire) about the Preferred Place of Care plan
• Email Chris Pemberton (Cumbria & Lancashire SHA) about the Preferred Place of Care plan