The Community Transform programme was delivered by clinical educators from St Catherine’s Hospice to staff working in primary care and nursing and residential homes.
The two-year course ran from January 2015 to January 2017, and promoted the use of Supportive Care Registers, records of people thought to be in the last 12 months of life, which are designed to encourage collaborative working between the various professionals involved in their care.
The aim is that better joined-up working between health and social care workers such as GPs, district nurses and the Clinical Nurse Specialists leads to a better service for patients, delivered within an appropriate time frame, which can help avoid crises and inappropriate admissions to hospital.
Figures show in the first year of the programme the number of patients on the Supportive Care Register increased by 284 across both Greater Preston and Chorley and South Ribble Clinical Commissioning Groups (CCG)
The course has also contributed towards a reduction in the number of hospital deaths and an increase in deaths in a patient’s usual place of residence i.e. at home or in a care home.
Year on year statistics going back to 2005 show a gradual downward trend in the number of hospital deaths, and a gradual upward trend in the number of deaths in a patient’s home. Although other factors also contributed to the shift, following the start of the Transform programme, the gap between the two narrowed further in both CCG areas.
Topics covered on the course included advance care planning; end of life care, do not attempt CPR; and using electronic palliative care co-ordination systems (EPaCCS). A total of 1,811 people completed the training, including district nurses, North West Ambulance Service workers and community therapies staff. 44 GP practices and 49 nursing homes took part.
Lynn Kelly, Director of Knowledge Exchange at St Catherine’s Hospice, said:
“It is extremely encouraging to see the contribution the Transform programme has made in supporting GPs and other professionals to identify people in our community who need palliative care.”
“An increased use of the Supportive Care Register in both CCG areas is helping to ensure patients and their loved ones do not slip through the net, and can access the most appropriate care and support for their situation. The registers help ensure that the professionals involved in their care are informed, up to date and able to respond in a timely way to any changes in the patient’s circumstances – something which is particularly important in palliative care when time can be very precious.”
“We are also pleased to see the number of deaths in hospital decreasing in both areas. We know through the families we care for at St Catherine’s that most people do not want to die in hospital, and that many would prefer to be at home, surrounded by the people and things they know and love.”
“The Transform programme has equipped frontline health and social care professionals with the specialist skills to be able to help patients and their loved ones achieve this and other important things to them in the last 12 months of life. It is all part of our commitment to opening up the work of the hospice and sharing our expertise with others so that more local people can benefit.”
St Catherine’s Hospice is now delivering a new education programme called 4Elements targeted to nursing and care home staff. It covers four topics: advance care planning; do not attempt CPR; long term conditions at the end of life and managing symptoms with a syringe driver. For more information email St Catherine’s