Is the End of Life care provided by external agencies adequate?
Many of us will have witnessed the death of loved ones who have passed away after a life-limiting illness. Such occasions are always sad, but the End of Life care and services available and received can make so much difference not to just the patient, but also their loved ones. And not just at the time of death but sometimes for weeks, months and even years to come.
The circumstances of each case will vary considerably, as will the End of Life care they will have received. (And just to clarify, we are referring to the End of Life care received from external agencies as opposed to family carers.) Stories will vary from those who have been fortunate enough to receive the best possible efficient and caring services to those who have been left totally shell-shocked by the inadequacies encountered at a time when they were at their most fragile.
In a society where we have an ever-increasing percentage of elderly’ where the NHS is stretched to its limits’ and where people are often isolated from friends and families’ what can be done to ensure those we love, whether elderly or much younger, receive the best possible care in the very last stages of their life?
It would seem that one of the most important aspects to ensure End of Life care is adequate is a ‘joined-up approach, with all the appropriate agencies working together effectively. This can be clearly evidenced by actions taken in South East Essex to improve the End of Life care delivered in the area, as shown in this case study:
End of Life Care in South East Essex
In 2018/19, the Care Quality Commission (CQC) rated End of Life care in the as ‘requires improvement.’ This led to the partnership between NHS Castle Point and Rochford Clinical Commissioning Group (CCG), NHS Southend CCG and Essex Partnership University Trust (EPUT). The Community Palliative Care Specialist Nurses Team and the Palliative Care Service Register Team integrated to become the EPUT Community Palliative Care Service, working together towards improving the End of Life care for people in South East Essex.
The integration of the teams now means that more patients are identified as being End of Life. Those patients are now located on one central register which can also be accessed by GPs to deliver more joined-up, safe and high-quality End of Life Care.
To support this partnership and upskilling of staff to deliver the very best advanced care planning the CCGs and EPUT have invested £600,000. The aim is to enhance the capacity of community specialist palliative care nurses and to address any necessary demands and delivering effective, high-quality care and support. The additional support will allow capacity to be enhanced with focused care and advanced care planning through the assignment of a keyworker for each patient.
The keyworker will ensure the patient receives the intervention NHS Castle Point and Rochford Clinical Commissioning Group NHS Southend Clinical Commissioning Group and support required through close liaison with other clinical and social care professionals in their own home environment. This improved co-ordinated approach will also reduce the demand on the hospital acute services for End of Life care which can be provided in the patient’s home.
Since the teams have been working together, the CQC has rated End of Life care that EPUT provides, as ‘outstanding’. EPUT is also rated as ‘outstanding’ overall for how it demonstrates ‘caring’. The CQC’s latest rating follows an inspection carried out during July and August 2019.
Paul Taylor, Associate Director of Partnerships and Integration, said:
It has been pleasure working with EPUT and the commitment and dedication of the Palliative Care teams to be able to improve care for End of Life patients which the CQC has acknowledged with an ‘outstanding rating’. The commissioning team with EPUT colleagues have worked with significant collaboration this year which is to be commended – well done all.
Kevin McKenny, Deputy Director of Integrated Services and Out of Hospital Care at EPUT, said:
Through partnership with CCG, we have managed to build a unique comprehensive community service for patients nearing their End of Life in South East Essex; a service that is fully integrated with our partners including GPs, palliative care hospital teams, Havens Hospices and social care, to provide high quality joined up care. The team are ‘over the moon’ to receive the ‘outstanding’ acknowledgement from CQC, which is credit to the hard work and commitment by every member of the team.
Clearly, this approach has made a significant difference. It is particularly reassuring that, in this example, steps to address the issues raised by the CQC were acted upon immediately resulting in End of Life care being transformed with speed.
As we said at the beginning of this article, every area is different and an element of ‘postcode lottery’ still remains. But hopefully, an increasing number of areas will already have, or will quickly move, to a more joined-up approach.
In the meantime, if you live in Essex you can find out more about the end of care services available to you via the Living Well Essex website.
The NHS website also includes a comprehensive guide to end of life care. It covers what to expect from End of Life care, sorting out money and benefits, planning your future care, and looking after your emotional and physical wellbeing.
If you have had End of Life care experiences you would like to share, do please let us know via the comments section below. Please do include the relevant geographical area as it would be interesting to see how the care varies between regions.