Cancer and Palliative Care Update

1
Cancer and Palliative Care Update

• Advance Care Planning
• Gold Standards Framework (GSF) in Crae (Nursing)
  Homes
• Feedback from Bedford Cancer Local Implementation
  Group (LIG)
• Significant Events

2
Advance Care Planning

• Expression of preferences
• And is not a legally binding directive nor set in
  stone
• Why?
• How?
• When?
• Where?
• Communicating and sharing ACP

3
Initiating conversation about future care

• One suggestion
• So that we can look after you as well as you
  would like us to, it would be really helpful to
  know if you have any thoughts about your future
  care. Is there anything that you would or would
  not like to happen?

4
GSF in Care (Nursing) Homes Project for
Bedfordshire

• Financed by End of Life money
• 2 year programme with GSF central team
• Taster on 2nd October
• Year 1 workshops every 3 months attended by
  nursing home champions
• Year 2 embedding with continued facilitation by
  local and central GSF team
• Accreditation

5
GSF in Nursing Homes

• Nurse-led but some GP input and support
• Register (all patients but prioritised)
• Regular meetings to discuss patients
• Advance Care Planning
• Communication with OOHs
• Pre-emptive prescribing
• Liverpool Care Pathway
• After Death Analysis (ADA)

6
Why GSF in Nursing Homes?

• 20 of deaths in nursing home
• Current GSF is practice-based and excludes
  nursing home patients
• Shown to reduce
• - hospital admissions by 12
• - hospital deaths from 18.2 to 10.6

7
Bedford Cancer LIG

• Skin cancer
• Communication
• Mortality Data
• Hospital Multidisciplinary Meetings (MDTs)

8
Skin Cancer

• Dr Burova
• NICE guidance (attached)
• Any doctor involved in treating cancers
  (including solar keratoses and Bowens disease by
  cryotherapy) should attend MDTs at hospital
  every 3months

9
Hospital/GP communication

• Results of Hospital MDT meetings
• ?how useful
• Outpatient letters
• 10 working day SLA
• ?acceptable

10
Mortality Data

• Lack of transfer of information re date and cause
  of death between Hospital and GPs and vice versa
• Audit of Deaths
• One point of contact at hospital
• ?Service level agreement
• Death administration protocol example