The project piloted 10 new initiatives in Leeds including the integrated health, social and personal care service and the palliative care ambulance service. Many of these services are now being sustained for the long term by NHS Leeds and its local partners.
Understanding local needs
During the project's scoping work on current end of life care services in Leeds, the team identified various key areas for improvements, including:
- Better coordination of care and access to flexible, responsive services in the community
- Timely discharge for patients from hospital to their preferred place of care
- Provision of palliative care in care homes
- Information and support for patients and carers
- Responsive transport service for end of life patients
- Learning resources for generalist professionals
Leeds is an ethnically diverse city and the project team identified a number of barriers preventing full access to palliative care services for minority ethnic communities. These include communication and language barriers, as well as a need for healthcare professionals to better understand religious and cultural beliefs.
Designing and piloting new services
The Leeds Delivering Choice project introduced 10 new initiatives to enable timely patient discharge from hospital, to improve information provision for patients and carers, to improve training for professionals, and to support patients cared for in the community.
Many of the project's new initiatives have been sustained for the long term by NHS Leeds and local service partners.
The Complex and Palliative Continuing Care Service team of specially trained health and personal care assistants provides health, social and personal care to patients and their families at home. Working closely with District Nurses, they can also respond to urgent requests for care. In addition to providing healthcare, the staff assist with everyday tasks such as washing and changing the patient, and preparing a simple meal. Integrating health and social care into one service has helped improve coordination between the two services, ensuring patients' care needs are met more effectively. On average, patients who used this service received two hour-long visits each day, and around 90 per cent of these patients were able to die at home.
The palliative care ambulance, operated by the Yorkshire Ambulance Service NHS Trust, provides a responsive transport for end of life patients. In its first two years of operation, the ambulance made more than 2,500 journeys to transport patients from hospital to their preferred place of care, as well as to urgent health appointments. The ambulance is specially fitted with a pressure relieving mattress, and all crew members receive specialised training.
A palliative care discharge facilitator works alongside ward staff and community teams to facilitate the timely discharge of end of life patients from hospital to their preferred place of care.The facilitator coordinates services so that patients have the appropriate care and support after discharge, and provides staff training in fast-track patient discharge.
Patients and carers who need support in the first 24 hours following discharge from hospital or a hospice are referred to the Meet and Greet scheme Marie Curie Nurses and Senior Healthcare Assistants provide patients and their carers with the initial care and reassurance they may need during this critical transition period from a healthcare setting to a home environment, preventing readmissions to hospital.
A black and minority ethnic palliative care link worker was appointed to work closely with the different minority ethnic communities and faith leaders to understand the issues around access to palliative care for these communities. Outcomes from this workstream included the development of transcultural resource packs for staff, training for interpreters, and community engagement to raise awareness on end of life issues.
A total of 33 care homes participated in the Care Homes End of Life Supportive Services (CHESS) scheme. The scheme was led by dedicated facilitators who supported care home staff in the delivery of palliative care to their residents through training workshops and facilitated local meeting groups.
The Leeds Palliative Care website provides local information and resources relevant to patients, their families and carers. The website also provides information on how professionals can access local palliative care education and training opportunities.
A palliative care education team developed and delivered training programmes for local health and social care professionals.
A palliative care coordinator was appointed to map out support services that are available for patients and carers in Leeds, as well as asking them improvements they would like to see. Recommendations from this workstream included a city-wide model of bereavement support and respite services for carers.
The South Leeds Specialist Day Care facility in Middleton is a joint partnership service with Sue Ryder Care Wheatfields Hospice and St Gemma's Hospice. The centre provides a range of hospice services closer to home for patients living in the area including outpatient assessments, and complementary therapies as well as nursing care and advice.
The Leeds project was independently evaluated by Lancaster University. This qualitative report, led by Professor Sheila Payne, evaluated two services from the project – the Care Homes End of Life Supportive Services (CHESS), and the Complex and Palliative Continuing Care Service (CAPCCS).
According to the Lancaster evaluation, the CAPCCS has had a significant positive impact on the way end of life care is delivered to patients in their own homes. It was generally acknowledged that, without this service, far fewer people would be able to die at home, especially those with little or no family or carer support. The evaluation found that the selection and training of staff are both crucial to the success of this service. With their good social, communications and caring skills, the staff were regarded as highly effective in their role.
The Lancaster evaluation found that the CHESS initiative has enhanced the quality of care in care homes. It has enabled some homes to set up effective internal procedures and processes for end of life care. As a result, more residents nearing the end of life could remain at the care homes if they chose to. Staff at care homes also gained skills, knowledge and confidence on end of life issues.