South East London Delivering Choice project
Covering six London boroughs and a population of 1.5 million people, the South East London Delivering Choice project introduced an integrated end of life care model and new services are being delivered by the Greenwich Care Partnership.
The project, which launched in 2007, also developed a comprehensive end of life care education and training strategy for South East London.
Understanding the local needs
Following the scoping phase across the six London boroughs of Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark, the project team identified areas for improvement. These included:
- Coordination, communication and integration of care between agencies and services in the community, and between specialist and generalist providers
- Support for families and carers in respite care, bereavement and information
- Training for professionals on palliative care competencies and tools
- Training for staff in care homes, including on the use of end of life tools
Designing and piloting new services
The South East London Delivering Choice project introduced an integrated end of life care model in Greenwich and a number of new initiatives to support carers, as well as looking at improving training for professionals and care home staff.
Greenwich's integrated end of life care model
The integrated care model in Greenwich aims to improve the coordination of community care, so that patients who are nearing the end of their lives have access to services that are tailored to their needs, any time and day of the week.
A new service partnership – the Greenwich Care Partnership – was launched in May 2011 as part of this integrated care model.
The Greenwich Care Partnership comprises four services which are provided by Greenwich and Bexley Community Hospice in partnership with Marie Curie Cancer Care and Oxleas NHS Foundation Trust. These services include:
- A new palliative care coordination centre, which acts as the central point of communication for professionals and patients, and is responsible for organising planned packages of care
- A new 24/7 rapid response service providing emergency and planned nursing visits for patients who are being cared for at home, as well as telephone advice and support
- A planned night care service providing overnight nursing care in patients' homes
- A multi-visit personal care and support service (hospice at home) to help with personal care, short breaks for carers and practical tasks
As part of this integrated care model, the project team also supported the formalisation of the key worker role – a care professional acting as the main point of contact as well as taking the lead in communicating and coordinating the patient's care with other care professionals.
The Greenwich Care Partnership has helped a significant number of terminally ill patients to achieve their preferred place of care and death. In the first 13 months of operation, the partnership provided services to 541 patients. Of those who died (337 patients):
- 56 per cent were able to die at home or in a care home
- 25 per cent died in the hospice
- 19 per cent died in hospital
Education and training strategy
The South East London palliative and end of life care education and training strategy was published in October 2009. The strategy was drawn up to identify the skill levels and knowledge needs of care professionals involved in delivering care for end of life patients, and how these needs can be best met through better access to education and training.
This strategy, one of the first of its kind in the UK, has been cited by the national End of Life Care Programme and is recommended as best practice in Healthcare for London's Guidelines for Commissioning End of Life Care Services.
It comprises a detailed analysis of the education and training courses offered in South East London, and lists recommendations for all staff groups involved in delivering care to end of life patients including commissioners, local authority providers and domiciliary care providers. The 160-page education and training strategy and its abridged version – containing the executive summary, quick reference recommendations and implementation plan – are available as downloads below.
Work has continued to develop tools to support the commissioning and delivery of end of life care training and education in South East London. For more information, contact Vicky Robinson at King's College Hospital.
Palliative care in care homes
This workstream aims to reduce inappropriate hospital admissions by increasing the confidence and competence of care home staff in end of life care provision.
Led by St Christopher's Hospice and Greenwich and Bexley Community Hospice, this initiative has seen significant reduction in hospital deaths for care home residents through the continued implementation of the Gold Standards Framework for Care Homes, and the increased use of the Liverpool Care Pathway, advance care planning and recorded DNAR forms.
Support for patients and carers
There have been three main components to this workstream:
The end of life care information website hosted by St Christopher's Hospice aims to provide patients and carers with a one-stop access to a range of information including symptom management; advance care planning; carer support services; carers' rights and benefits; carers' health and well-being; and bereavement.
Carer befriender pilots in Lewisham and Greenwich
In Lewisham, a new carer support service was provided by Carers Lewisham. The Yew Tree Project offers carers with practical help such as carer assessments, benefit checks, basic advocacy and signposting to services as well as emotional and bereavement support. Information and support is mainly provided over the phone or through email, and face-to-face contact if required. Carers who used the service commented that the service increased their confidence in finding help and in their ability to cope with their caring role.
A befriending service provided by trained volunteers was piloted by Greenwich and Bexley Community Hospice. These volunteers visit local carers to offer them one-to-one emotional and practical support – a listening ear, information about local services or to give them a short break from their caring role.
The project developed a quick reference guide for care professionals, offering useful prompts on considering the support needs of carers. A carers' checklist was also developed for carers to record relevant information about the person they are caring for.