Agenda item

The report gives an overview of palliative care provision in Brent and the End of Life Care Strategy for Brent, which seeks to reduce the number of patients with end of life need dying in hospital.  The report outlines some of the related areas that have been invested in during 2012/13 and lists the service providers, with a brief summary of the services provided and an explanation of how the service is funded.

The report gave an overview of palliative care provision in Brent and the end of life care strategy which sought to reduce the number of patients dying in hospitals.  Cherry Armstrong, GP, informed the Committee that 64% of people in Brent currently passed away in hospital opposed to only 19% at home.  The end of life care strategy sought to reduce the number of patients dying in hospitals by investing in the following areas; end of life register to coordinate social and health care, building up workforce capacity and capability through increased training, supporting primary care clinicians in increasing capacity and capability, and working with contract leads and stakeholders.  It was highlighted that a multi-disciplined approach with all involved in providing the care of the patient was required.

Four sites across Brent offered specialist end of life provision including St John’s Hospice, St Luke’s Hospice, Pembridge Unit and Marie Curie all of which were funded by the NHS block contracts.  It was noted that the end of life care strategy was essential to ensure that the patients choice was shared and that a central communication portal allowed information sharing and for patients choices to be carried out.  The Liverpool Care Pathway was used to ensure a good formal pathway of care for all where an equitable model of care could be used wherever the patient was dying.  An after death review would also take place to ensure the family received a good level of support and to explore if improvements could be made, ensuring a proactive rather than reactive approach.  The approach was holistic taking into account patient’s wishes, culture and religious beliefs.

Mike Howard, Chief Executive of St Luke’s Hospice informed the Committee of the services the charity provided and the types of patients they cared for.  The Hospice provided a day and medical centre, hospice at home service and training of health care professionals providing care predominantly for cancer patients but also for other terminal diseases.  Mike Howard felt that the charity provided a greater level of service than that commissioned and relied heavily on donations to meet the funding demand which, contrary to the suggestion he felt was being made that it was 100% funded by the NHS, was nearer to 33% funded.  To enable the Hospice to offer the level of care it did it currently relied on the help of 850 volunteers and community services.  Additional services provided by the Hospice included after death support for the family, psycho social support as well as providing university accredited training.

Members noted the greater need for palliative care with an aging population but queried how this could be achieved in the current financial climate and how the success of the scheme would be measured.  Cherry Armstrong explained that the scheme was currently still in the infancy stages of training and had not been fully rolled out so the success of the scheme could not yet be measured.  There was currently anecdotal evidence from GPs highlighting greater communication and awareness of patients care as well as planning care.

Members queried how the costs of a patient choosing to stay at home would be managed.  It was explained that the hospices would provide the relevant care if it was suitable for the patient to remain at home and services such as respite would also be available to the carers and in house care providers sent round.  It was noted that if a patient was to be placed in hospital this would also be of a cost and the scheme did not necessarily reduce costs but realigned costs to enable patients not to pass away in hospital.  Members queried what health and social care would be provided and at what cost.  It was explained that all health care costs provided would be free of charge, however any social care services would have the usual social care costs.  The type of care provided would be dependent upon the needs of the patient and the carers but would also focus on pain relief to make sure no patient was uncomfortable or in pain.  Members queried the period of the strategy.  It was clarified that the strategy would be rolled out in April and be used indefinitely to enhance local service provision.  Members were disappointed with the lack of detail in the report and requested that an updated and more detailed report be provided following the roll out.  A copy of the Brent End of Life Strategy was requested to be circulated to members of the committee.

RESOLVED:-

(i)            Members noted the report;

(ii)          That an update report be provided.