Palliative Care Services - Case Study Example

NSF-Revised Every child who needs health, palliative and hospice care has a right to receive it. It is human and civilized to attend on the needs of the individual child, irrespective of whether the care is delivered in the hospice movement, in hospital, at home or in any other environment.This makes every child to enjoy his right to health and dying child to die peacefully. I choose my area of practice to deliver future citizens their right to live and grow healthily and disabled children to get their deserved attention, which in turn makes them responsible citizens in future. The denial of these rights and privileges to children is barbaric and it is a pleasure and privilege to me to avoid that barbaric nature in the society. High quality palliative care services should be available for all children and young people who need them. A network of agencies, including the NHS, children’s hospices, the voluntary sector and social care and education services, provides palliative care services. Co-ordination and close liaison between agencies, is therefore essential. Palliative care services were given the necessary importance in NSF. It should guarantee that every child who deserves palliative care should get it. Committed individuals who choose the area of practice in this field and statutoy support from government will ensure that every child shall get the required palliative care, health care and hospice services. In this context primary care trusts can implement framework in place whereby they can guarantee that every child in the area will receive the individualised palliative care that is necessary.  It was also impotant to get a general uplift of funding for the hospice movement. The voluntary organistions which are offering hospice are running out of funds as a major contributor for funding of these organisations withdrew their contribution in march 2006 and it is about to effect the hospice services severely if Government does not extend statutory support regarding funds to these orgnisations. So it is crucial to strengthen these organisations by giving statutory support regarding the financial matters. Though it may result in the bureaucratic problems to these organisations but it was the need of the hour for these organisations to get support from the government . There is a problem in engaging with multiple PCTs, but the two mechanisms can help resolve it. First, in many areas within a strategic health authority, the PCTs they are used to commissioning specialist services that cross many boundaries will often appoint one PCT as the lead negotiator. Secondly, the Government can introduce a director of childrens services who can have a duty to examine services for children across an entire local authority area. One of those duties is to co-operate with PCTs in developing plans for childrens services. It applies vice-versa, as PCTs have a duty to co-operate with the director of childrens services. If such a director believes that there are gaps in the palliative care provision in the local area, he may instruct PCTs to deal with the gap in their local delivery plans. That could lead to increased support for a local hospice movement and the PCT could even decide that the most practical person to lead the negotiations with the local hospice movement is the new director. The childrens hospice movement should succeed, but it just cannot happen with only with centrally designed solutions. Childrens palliative care needs go far beyond centrally imposed solutions. A primary care trust could not be expected to ensure a proper balance of provision or full availability of home care in the area if it were told that, irrespective of what it needs, it must fund an arbitrary proportion of hospice costs even though it had no strategic role in planning those hospices or commissioning their services. If we insist on more money into the hospice movement, there will be less left for other forms of childrens palliative care. The national service framework for children, young people and maternity services will serve the cause upto the need. A module in NSF focused on support for the disabled child, with a section specifically setting out vision for palliative care and the support of children with life-threatening illness. Using that we must be able to clearly identify the high quality palliative services are available to deserved children and young people. Palliative care services must be provided by a network of agencies, including the NHS, childrens hospices, the voluntary sector, and the social care and education services. Co-ordination and close liaison between agencies is therefore essential. It also notes the importance that we attach to recognising the changing needs of young people receiving palliative care as they move through and on from childrens services. Using NSF guide lines, PCTs and NHS trusts are to ensure that palliative care services provide high-quality, sensitive support that takes account of the physical, emotional and practical needs of children or young people, and their families, including siblings. Services must be sensitive to the cultural and spiritual needs of the child, young person and family. Services must also maximise choice, independence and creativity to promote quality of life, and they must be delivered where the child and family want—in the home, hospital, hospice, or other setting. Services must include the prompt availability of equipment to support care, access to appropriate translation services, and workers skilled in using communication aids. Palliative and terminal care services must be regularly reviewed with parents or care-takers, children and young people, and gaps in provision identified and addressed. Short-term breaks, palliative and community health services and social care services for children and young people with life-limiting conditions and/or complex health needs must be planned in partnership with voluntary sector providers and children and young peoples hospices, in the localities they exist. To help in achieving this standard, a practical guide to childrens palliative care for PCTs must be published, reinforcing the need to commission a range of services to meet the palliative care needs of local children. I am mindful of the invaluable contribution that childrens hospices make towards the needs of children and young people who have life-threatening illness. It has to aim to ensure fair, high quality and integrated health and social care for children, from pregnancy through to adulthood. The framework contains national standards for health and social care services. This includes five standards that apply to the health and social well being of all children, and six that are more specific, relating to, for example, children who are I (standard 6) and disabled children (standard 8). The NHS and local authorities will be assessed on the quality of their services for children and how well they are progressing towards meeting the standards. In particular, the more general standards about the need for services should be coordinated around the individual needs of each family, making account of their views and recognising the central role and expertise that parents have in the care of their children. There should be a commitment to improving services for life-limited and life threatened children and their families. Children’s palliative care must be now recognised as a part of mainstream health and social care as reflected in the following phrase: “High-quality palliative care services should be available for all children and young people who need them.” This identifies the various agencies, which provide support in children’s palliative care, including the NHS, children’s hospices, the voluntary sector and social care and education services. There is recognition of the fact that it is essential for these agencies to work together to provide an integrated service. The particular needs of young people as they make the transition to adult services also should be addressed. Provision of services includes, where appropriate: a) 24-hour access to family care is available; b) 24-hour expertise in paediatric palliative care is available; c) Pain and symptom control; d) Psychological and social support; e) Spiritual support which takes account of the needs of the whole family; f) Where required, formal counselling or therapy; g) Arrangements to avoid unnecessary emergency admission to hospital are in place; h) Protocols for immediate access to hospital, if needed are in place; i) A process for keeping the general practitioner informed. The care of children and young people with life-threatening diseases is informed by evidence of best practice. The section on the death of a child contains the following standard: Local Authorities, Primary Care Trusts and NHS Trusts should ensure that: Following bereavement parents and families are given the time, space and information to make practical arrangements and decisions, and receive ongoing support to cope with their loss. It should also encourage seeing that there is clear acknowledgement of the contribution of the voluntary sector, in particular children’s hospice services, and a commitment to including the voluntary sector in the planning process. Families should have 24-hour access to professionals trained in children’s palliative care. There should be a system that specifically target at disabled adults and children and their caretakers. Key practitioners take time to establish better working relationships with parents and with each other. Local Authorities, Primary Care Trusts and NHS Trusts ensure that: Families are offered a range of appropriate family support services, through multi-agency packages of care, These packages are flexible and responsive to children’s and families’ needs (including those of fathers and siblings), provide positive and stimulating experiences for disabled children, and promote their inclusion in the local community. Services are provided by both universal and specialist agencies, and are available for all disabled children, including those with complex health needs, autistic spectrum disorders and multiple disabilities such as deaf-blind children; The options of receiving direct payments or services are equally available; Training in managing sleep and behaviour problems is offered at an early stage to parents who need it, and children leaving hospital and requiring continuing care receive co-ordinated multi-agency packages of care according to individual need. Short-term breaks A break from caring is one of parents’ most frequently reported un met needs, and many children also appreciate a break away from their family. Short-term breaks can provide a positive experience for children by enabling friendships to form with other children and by encouraging social activities, new experiences and supportive relationships with carers. Good short-term break services are associated with reductions in maternal stress and reduction in marital problems and breakdowns. Local Authorities and Primary Care Trusts ensure that: Timely, appropriate, accessible and accurate information is provided to enable children and young people, parents or carers to make choices about the treatment, care and services they wish to use; Specific information is provided to siblings of disabled children; Information is provided in community languages and appropriate formats; Specific information pertinent to particular conditions should be provided, and Contact details for key national support organisations, such as the Family Fund and Contact a Family, are provided. Key workers Parents of severely disabled children or those with high levels of need require a single point of contact with services and an effective, trusted and informed named person (a key worker or Care Manager) to help them obtain the services they require. Studies of key workers consistently report positive effects on relationships with services, fewer unmet needs and greater family well-being. However, fewer than a third of families with severely disabled children have a key worker. Information for Parents and Children Information is one of the most valued services, and parents and disabled children and young people consistently request more information about services and about the childs condition and treatment. Parents from minority ethnic groups are least well-informed. Efforts need to be made to provide information in appropriate formats and language. Duties under the Disability Discrimination Act need to be taken into consideration when considering the provision of information in appropriate formats and language (including sign language). Local Authorities, Primary Care Trusts and NHS Trusts ensure that: Disabled children and their parents are routinely involved and supported in making informed decisions about their treatment, care and services, and in shaping services; They have an ongoing service user involvement programme for disabled children and young people, in line with the NHS Patient and Public Involvement. This should include targeted support for minority ethnic families; NHS Patient Advice and Liaison Services ensure that their services are promoted to, and accessible by disabled children and young people, and their families; and they are included as representatives on the local Patient and Public Involvement Forum, and Facilities, equipment, and skilled workers are available to enable children who do not use speech, children who find engagement and interaction difficult. Contact A Family Listening to and responding to children and their families Disabled children want staff to listen to them, ask them for their ideas, take notice of what they say and give them choices. Children can contribute unique and essential knowledge during decision-making. Parents of disabled children also want to be involved in decisions about the services and treatments their children receive. Involvement of children and their parents in planning services results in the provision of more appropriate services. However, disabled children are less actively involved in decision-making than children who are not disabled. Therefore, professionals should ensure that disabled children, especially children with high communication needs, are not excluded from the decision-making process. In particular, professionals should consider the needs of children who rely on communication equipment or who use non-verbal communication such as sign language. Many disabled children have special educational needs that impact on their education. Some miss out on educational opportunities due to prolonged absences from school because of ill health and because of frequent attendance at clinic or hospitals. For these children, taking part fully in school life, whether in mainstream or special schools, requires good communication between health, social care and education services so that the childs needs are understood and met. The right school policy or approach can transform the life of these children. High quality palliative care services should be available for all children and young people who need them. Palliative care services are provided by a network of agencies, including the NHS, children’s hospices, the voluntary sector and social care and education services. Co-ordination and close liaison between agencies is therefore essential. It is important to recognise the changing needs of young people receiving palliative care as they move from children’s services. Death in childhood may be sudden and unexpected, for example, as a result of a road accident, or may occur at the end of a long-term illness. Whatever their circumstances, it is very important that families receive care which is sensitive, and appropriate to their individual needs. Choosing Health identifies the health of children and young people as a key Priority. So that we start people on the right path to health and provide parents With the support they asked for in giving their children a healthy start in life. This will mean action in a number of areas: More childrens centres have to enhance the health and well being of children; an increased number of extended schools, to help make the school a force for health in every community; encouraging healthy eating and restricting the promotion and marketing of food high in fat, sugar and salt to children; providing more opportunities for sport and physical activity; new support and information to young people on sexual health; preventing the sale of alcohol to children; preventing the sale of cigarettes to children; and the development of personal health plans for all children. The basic delivery cycle for the NHS consists of: assessing the needs of children, young people and pregnant women; identifying priorities: targets and standards; Planning services; commissioning services to meet those needs, and managing performance, assessing and inspecting outcomes. These stages can be seen as a continuous cycle of improvement and mirror those which children’s trusts will follow in planning and commissioning services. Assessing the needs of children, young people and pregnant women Assessing the needs of their population for health and social care is key to the work of PCTs and local government. Data from various sources can inform this process; the first steps, working with partners as appropriate, are to: Evaluate the current health status and well-being of the population, including that of particular groups of children and young people; Identify where children, young people and their families are; and Establish the needs of the population in relation to achievement of outcomes. The aim is to gather, analyse and interpret information to plan, negotiate and improve services systematically Identifying Priorities: Targets and Standards Local priorities will emerge from the local analysis of need and will also be informed by national targets and standards. Local Action has seen a reduction in the number of nationally set targets in order to give more local ‘headroom’ to work on local priorities. Unless otherwise specified, the national targets set out in National Standards, Local Action apply to all age groups; how these impact on children, young people and pregnant women in relation to each of these will therefore need to be considered The national targets include some new commitments, such as tackling childhood obesity and having the under-18 conception rate, and a restating of the existing commitment to ensure there is a comprehensive Child and Adolescent Mental Health Service by 2006. The Department of Health will not monitor local targets or prescribe what they should cover. The Department’s only requirements for local targets are that they should conform to the six principles for local target setting described in the Planning Framework. In their scrutiny of their PCTs’ Local Delivery Plans (LDPs), Strategic Health Authorities (SHAs) will expect assurance that local targets adhere to the six principles: In developing local plans, PCTs should ensure they are in line with population needs; address local service gaps; deliver equity; are evidence-based; are developed in partnership with other NHS bodies and LAs, and offer value for money. In ensuring that local targets are evidence-based, organisations will need to be guided by a range of evidence, including NSFs. Modernisation and Improvement To establish and embed the Every Child Matters, Change for Children programme in the NHS and local government should take place. This will build on the lessons learned using existing tools, techniques, and initiatives such as user experience. Primary Care Trusts can reduce therapy waiting lists from about one year to zero, for assessment and treatment. All three Trusts should achieve this through changing their administrative and clinical processes. The timescale for reducing waits to zero can be fixed as six months. Delivery of services across a whole health economy and should focus in particular on the relationships between different parts of the local service. This type of network differs from Specialist Clinical Networks. There must be a provision for asylum seeking and refugee mothers the independence and confidence to access the services they need to promote their own, and their children’s health and well-being. The Service can be delivered by trained and supervised volunteers who are matched one-to-one with a pregnant woman, new mother or mother of young children and their family. The below tables of SWOT analysis and Pharmacy strategy were made according to the theme provided in wandswarth Web site. SWOT Analysis of Primary Care STRENGTHS Good practice managers Good people & services/good will Innovation, energy, talent, commitment Same IT system in GP practices i.e. (EMIS) PEC, structure & processes Patients forum & local groups Locality structure Quick start-good user involvement NSFs – common standards Financial stability & 3 year knowledge High % PMS practices WEAKNESSES New capital projects overspend Poor integration services Haven’t unlocked full workforce potential No system or incentive for GPs) staff capacity Insufficient workforce Poor integrated IT in PCT, Social Services & Mental Health Locality (potential for fragmentation) Relatively new organisation Communication to all parts IT literacy & training professionals/public Tribalism/organisational traditions Too much/insufficient time Too many targets Disparate nursing in com/GP No strong voluntary sector Shared services (SSP etc) OPPORTUNITIES Lots of sites Diversity CHI review Appraisal: revalidation User/Public involvement Integrate Nursing GP Contract LIFT Work with L A on affordable housing CHI Contractor relationships in primary care e-booking Staff turnover-skill mix Practice Managers-support others THREATS Not enough people Retention of staff Agency usage (cost & quality) Lack of interface 1°/2° SGH finance PCT interface over boundaries NSFs are target driven not patient focused 3 year budget lacks flexibility GP contract Foundation Hospitals Shortage of locum GPs (& other staff) EPR (in relation to existing IT) Acute driven targets pre-2005 Out of hours ‘opt out’ (esp. Sat morning surgeries) Info & priority overload Marginalise non IT users This plan and strategy is able to deliver the deserved health care, palliative care and hospice services for children, young people and maternity services. It will give new direction to the present situation in making children, their parents and families to gain access to health care and palliative care services. By implementing the statutes in NSF and projects of NHS the country’s future health needs are also met as the children grow as healthy citizens. References and bibliography http://www.cademedia.com/archives/MCHB/leadership2004/transcripts/session08a.htm http://www.cci.scot.nhs.uk/cci/cci_display.jsp;jsessionid=EBEEE028A194E01007B34C8EDFFF1476?pContentID=2619&p_applic=CCC&p_service=Content.show www.ids.ac.uk/ids/particip/information/key. And tables from wandswarth. Community Pharmacy Strategy Action Plan Work Stream Objective Key Milestone/Tasks By When Lead Responsibility Cost Creating healthy individuals and communities/health promotion To utilise pharmacy premises as an information service and to provide out reach services from other health care professionals. Explore potential for development in line with PCT & national health promotion campaigns and service targets Explore monthly health promotion packages that are delivered by community pharmacists. Accreditation of pharmacies to provide service including training & premises To coincide with key campaigns-dates to be advised e.g. flu campaigns PICD & Public Health To be determined Smoking Cessation Services: To develop the community pharmacy based smoking cessation service to improve quit rates. Increase the number of smoking cessation trained community pharmacists from 16 Discuss with Public Health options for Pharmacists running group clinics and sessions in GP surgeries to increase capacity. Develop PGDs for NRT products so that pharmacists can provide products on a voucher system Ongoing February 04 June 04 Public Health, with smoking cessation service and PICD PICD PICD Explore potential cost shift from prescribing budget as service would be outsourced from general practice Explore the involvement of community pharmacists in running integrated screening services e.g.: Diabetes Asthma Warfarin monitoring Cholesterol Blood Pressure Weight Management Osteoporosis Explore development, of service to link in with joint work between PCT and St George’s around chronic disease management Also looking at health maintenance and promotion Piloting one area initially e.g. diabetes Provide training would be necessary May 04 PICD, Public Health & relevant steering groups To be determined Develop medicine management services tailored around the NSF’s/PCT guidelines Reduction in Medicine wastage. Explore role for involvement of community pharmacists. e.g. ensure compliance with medication regimes used in the prevention of coronary heart disease Review local implications arising from the Pharmaceutical Service Negotiating Committee (PSNC) national pilot July 04 To be determined PICD PICD Services to drug mis-users: Develop, redesign and extend current ‘needle exchange and supervised administration of methadone services to be more patient focussed. Training provided and community pharmacy database established Ongoing update PICD & DAT teams Costs to be determined Patient centred primary care services Medication review for patients over 75 years Development of a medicines management services for elderly/vulnerable patients that would include a compliance assessment. Supply of compliance aids Medicine management services to nursing a residential homes Via LPS Pilot and medicines management pilot Development of current MDS scheme through LPS contracts with 12 pharmacists Medication services to be provided to link with with single assessment’ process Medication review delivered via PCT protocols as per NSF for the elderly Development of SLA with Nightingale House to provide medicines management service On going June 2004 April 2003 PICD PICD PICD £28,960 top slice from prescribing fund already identified £108,635 draw down from the pharmacy global sum due to reduction in seven-day scripts if pilot bid successful with £12,565 contribution from the PCT – already identified. £30,000 already identified Repeat Dispensing and prescribing services Improving patient experience. Better access to services Review and explore possibilities August 04 PICD Collection and Delivery services to house bound patients who have difficulties accessing pharmaceutical services due to illness or incapacity. Assess current provision and identify gaps. Consider potential as part of the new pharmacy contract Dependant upon date and content of new pharmacy contract. PICD To be assessed Use of supplementary prescribing regulations to allow trained nurses and pharmacists to work with an independent prescriber to manage the prescribing of chronic diseases Assess potential areas for development Community pharmacists and diploma nurses apply for training Assess training needs and provide September 04 PICD To be assessed Better access Explore the potential & affordability for community pharmacists to have access to telephone interpreting services Scope possibilities June 2004 PICD To be determined Out of hours: National Plan aim to provide a service were NHS prescriptions can be dispensed any time in a 24hour period. Plus access to unusual or infrequently prescribed drugs Access to palliative care in and out of hours Models of out of hours pharmacy provision to be reviewed. In hours 11-12 community pharmacist stock a palliative care formulary. Develop models for out of hours provision for palliative care August 2004 Ongoing March 2004 . PICD PICD PICD and Trinity Hospice, To be determined £15,000 already identified from prescribing budget Minor ailment schemes allow patients to access Pharmacy Medicines from community pharmacies without taking up a GP appointment. Pilot initially in Putney and Roehampton linked to Putney Primary Centre Development Consider potential for roll out to rest of PCT March-April 2004 (Pilot) June 2004 PICD Approximately £7,000 for pilot but should be direct transfer from existing prescribing budget plus some funding for pharmacist fee. Costs for roll out across the PCT £60,000. Contribution to promotion of sexual health through provision of emergency hormonal Contraception supplied by community pharmacists using Patient Group Directions. Bring proposals to the PEC Target delivery via community pharmacy to areas of greatest need. July 2004 PICD To be assessed Developing the infrastructure Workforce Development of Community Pharmacists to include access to PCT training courses, clinical and corporate Governance. To be based on clinical governance Baseline assessment Monthly information meetings, toolkit and workshops set up. Training & information to ensure that community pharmacy understand PCT policies; managing public money, service level agreements. Ongoing Review annually Ongoing PICD IM&T Explore opportunities to integrate community pharmacy into the PCT IM&T network. November 04 PICD Premises Consult with local pharmacists on the development of premises including LIFT, Primary Care Centres Continued involvement of pharmacists in the development of the Putney Primary Care Centre and other developments Ongoing PICD Read More