Chris Morley (NHS Devon ICB), Jane Bullard (Senior Commissioning Manager, NHS Devon ICB), Karen Burfitt (Marie Curie), Tricia Davies (St Lukes) and Shaen Millward (UHP) delivered the End of Life Care update to the panel and discussed:

a)    The Panel had conducted a two day meeting to review End of Life Care in the previous municipal year. Having identified concerns, the panel had issued recommendations to NHS Devon, and this report provided an update on this progress;

b)    NHS Devon and partners recognised the need for improvement in some areas of End of Life Care provision, and programmes of work were underway both locally and regionally;

c)    Within the Plymouth area, around 2,600 deaths occurred per year. This figure continually rose with a growing and ageing population;

d)    The End of Life Locality Plan detailed the progress of specific work streams;

e)    Estover had been selected as a project site following identification of a high demographic of over 65s presenting in the Emergency Department for End of Life Care. The project aimed to improve the knowledge and culture around dying, death and bereavement, as well as working with health and social care professionals to improve early identification to enable the most appropriate care provision;

f)     Enhanced assessments had been conducted with over 70 patients, with a senior nurse embedded in the local GP practice. ‘Life Cafes’ had also seen success under a community engagement approach, encouraging early conversations and reducing the taboo around death and dying;

g)    Following success, the project was now being expanded to all five of the surgeries within the Sound Primary Care Network ( PCN);

(A UHP video of End of Life Care, was played at this point - https://youtu.be/nhrADQnIPMA)

h)    UHP had undertaken programmes of education to improve End of Life care, including staff training on Treatment Escalation Plans (TEPs) and the rollout of Electronic TEPS (ETEPs), as well as webinars and educational  packages on ‘recognising dying’;

i)     Mount Gould had 4 beds dedicated to End of Life Care, supporting an average of 17 patients per month;

j)     The Palliative Care Team received 1,621 requests for specialist advice, provided approximately 4,500 face-face contacts with patients and relatives, and supported around 700 deaths in the Trust per year;

k)    Through a project between ED staff and Marie Curie, 440 patients had been supported during end of life care in a 15 month period, with 86% supported to die outside of ED. This was a significant improvement on previous figures;

l)      77% of patients had received a review of their TEP document to ensure there was a clear plan for their future onward care;

m)  Deaths at Mount Gould had increased, in correlation with a decrease in deaths at Derriford (12%). This provided assurance that the pathway had been strengthened;

n)    Further opportunities would be explored to develop partnership working with Marie Curie, to proactively identify patients who would benefit from choice, and out of Hospital End of Life Care;

o)    The Mount Gould pilot would be expanded to provide up to 12 beds dedicated to End of Life Care;

p)    St Lukes had conducted a consultation with the community to identify the needs of end of life care, with responses highlighting a need for improved ‘coordination’. As a result, St Lukes would be introducing a new telephone system with a dedicated number for end of life care support and expertise;

q)    It was recognised that many patients entered end of life care late in their journey, and this did not allow sufficient preparation or choice of care;

r)    System partners would be adopting the Gold Standard Framework (GSF);

s)     St Lukes would be presenting their work on the ‘Compassionate City’ approach at the Hospice UK Conference in Glasgow in November, having been nominated for National Presentation following their peer support with two other hospices;

t)     St Lukes had also driven a ‘Compassionate Schools’ approach, providing dedicated space and support for students to talk about death and dying;

u)    The draft Housing Needs Assessment outlined the needs and expectations for individuals in end of life care, and the final publication would be available to the Panel;

v)     NHS Devon had recently funded the Falls Management Exercise Programme with a specific focus on Plymouth, launched a ‘Steady on Your Feet’ website, and funded maintenance groups.

In response to questions, the Panel discussed:

w)   Recognition of progress made across the system since the report in the last municipal year;

x)    The development of a local End of Life Hub;

y)    Trauma and emotional support for staff providing end of life care, including provision of chaplaincy services, resilience based supervision, and required time and space for staff;

z)    The future expansion of the Estover project across the city, utilising Wellbeing Hubs and community wellbeing coordinators;

aa)  The TEP form was now available online via the Devon and Cornwall Shared Care Record. Future ambitions were to enable access via the NHS app.

The Panel agreed:

1.    To note the improvements made in the provision and performance of End of Life Care in Plymouth;

2.    To support the continued improvement and development approach being undertaken within the city, and support partners with its delivery;

3.     To help raise awareness of death literacy and promote the importance of talking about deaths, to support the development of Plymouth as a compassionate city;

4.    To thank the presenters today and staff across the system working to improve end of life care provision.