Improving palliative and end of life care for Warrington patients

Sue BurkeBy Dr Sue Burke, Macmillan GP and Primary Care Lead for Cancer and End of Life Services at NHS Warrington Clinical Commissioning Group 

In the past, we know patients have experienced issues with palliative and end of life care being poorly co-ordinated. To help resolve this, NHS Warrington Clinical Commissioning Group and Macmillan Cancer Support have been working hard over the past two years to further improve care for people who are receiving palliative or end of life services.

What is Palliative care?

‘Palliative Care’ describes the physical, psychological, and social care and support given to people who have an illness or disease that cannot be cured, aiming to achieve the best possible quality of life for patients to ‘live as well as they can for as long as they can’.

Unfortunately, data showed many patients in their last year of life experience unplanned, and often unnecessary, emergency admissions and long hospital stays which are frequently not conducive to good quality living, dying and normal grieving.

Identifying patients who needed more specialist care

In a given population 1% of people will die every year, 30% from a cancer cause and 70% a non -cancer illness. We cannot provide good care if we do not identify people who need it. As part of the project, we worked with GPs to help identify those likely to be in their last year of life, not just cancer patients but people with advanced lung, heart or neurological conditions including dementia providing equity of care whatever condition a person was dying from. These patients are now proactively managed though a Supportive Care Register and team meetings involving many different healthcare professionals are held to address their individual needs for care. Before the project 361 people in the borough were offered this enhanced care but now after making these changes, this has increased to 2,004 people.

Listening to patients

To improve services, we knew it was vital to understand the views of patients and their families, local charities, community and voluntary organisations.

Patients told us they did not want to have repeat their story to different people involved in their care. As a result, we encouraged GP practices to use a new electronic system called EPaCCs to record, communicate, and share with other professionals, individual patient’s wishes and preferences.

We were told opportunities to plan and talk about death, hopes and wishes for care and their preferred place to die were not offered or offered too late. Talking about death and dying was taboo. 

We have responded by:

  • Setting up a working group and developing a strategy to ‘socialise death and dying’ and make talking about death part of normal life.
  • Carrying out education in schools and colleges
  • Having useful information on NHS Warrington CCG and My Life Warringtonwebsites
  • Having documentation and training programmes available for professionals to support them to have these crucial conversations with patients.

Before the project only 17% of people expected to die had Advanced Care Planning in place but this has now increased to 61%. Similarly, 43% of people were achieving their preferred place of death but this has now increased to 86.2% of people ‘expected to die’.

Developing a single point of contact to support patients

Patients told us when they asked for help they were often desperate, they wanted to know what help was available and a ‘single point of contact’ where all their needs could be considered by a team of experts and care delivered by the right person first time in a timely way.

In response, we established the Palliative Care Hub based at St Rocco’s Hospice and delivered in partnership with Bridgewater Community Healthcare NHS Foundation Trust. Healthcare professionals can refer patients, or patients and relatives can contact the hub directly and speak to a nurse who will address any concerns, and work with them, their GP, community and hospice services. Daily meetings between different healthcare professionals take place at the hub to respond to patients’ needs – rapidly when necessary. You can call the Hub on 03333 661066 between 9am-5pm Monday to Sunday. 

We will also be shortly launching a Palliative Care ‘directory of services’ on the NHS Warrington CCG website to make care easier to find.