Position Paper
SALFORD ROYAL HOSPITALS NHS TRUST
SALFORD PRIMARY CARE TRUST
Implementation of the Salford & Trafford
Palliative Care Strategy for Adults (1998) in Salford
Introduction
This paper outlines the progress made to date with implementation of the Salford
and Trafford Palliative Care Strategy for Adults in Salford, and describes the
planned future developments required to continue the provision of a co-ordinated
approach to palliative care across all care settings within the health and social
care economy of Salford.
Background
In 1998, Salford and Trafford Health and Local Authorities endorsed the Salford
and Trafford Palliative Care Strategy for Adults following public consultation.
Prior to this, in 1997, Salford and Trafford Health Authority allocated £500,000
recurrently to implement the Strategy - the Palliative Care Reserve. These
monies have subsequently been devolved to the three Primary Care Trusts
(PCTs) within Salford and Trafford from April 2002; 55% was designated to
Salford PCT.
The Salford and Trafford Strategy Implementation Group (SIG) for Palliative Care
was established in April 1999, with multi-agency representation from statutory
local health and social services, the voluntary sector and user representation. In
October 1999, Salford and Trafford Health Authority appointed a Palliative Care
Coordinator (Local Implementation Officer) to project lead implementation of the
Palliative Care Strategy for Adults in Salford.
In June 2002, the SIG on behalf of the 3 PCTs agreed to review and update the
Palliative Care Strategy for Salford. The Local Strategy Group for Palliative Care
advises on strategic recommendations and service development in line with the
National Cancer Plan (2000), the Draft National Standards for Specialist
Palliative Care (2001), the Draft National Institute for Clinical Excellence (NICE)
Guidance for Supportive and Palliative Care – Part A (2002) and the Greater
Manchester and Cheshire Cancer Network Strategy for Specialist Palliative Care.
Implementation of the Palliative Care Strategy in Salford
The Palliative Care Strategy recommends how high quality; co-ordinated
palliative care should be provided (see Section 11 of the 1998 Strategy) and
outlines the priorities for implementation. The following section describes the
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progress made with implementation and the planned future developments for
palliative care in Salford.
Appraisal of Palliative Cancer Unit
Appraisal completed in April 2001. The Salford Royal Hospitals NHS Trust
Palliative Care services and the co-ordination of palliative care services were
commended in achievement of the Specialist Palliative Care Standards (Section
7 – Manual of National Cancer Standards, December 2000) by the Regional
Cancer Services Appraisal Team.
Development of Specialist Medical Provision
 Consultant in Palliative Medicine appointed in April 2002. Dr Stephanie
Gomm provides a service to Salford Royal Hospitals NHS Trust (Hope
Hospital), Salford PCT and St Ann’s Hospice, Little Hulton. The role of the
Consultant in Palliative Medicine is to provide clinical leadership and coordination of services across all sectors of care. In addition, Dr Philip
Lomax was appointed to the post of Hospice Consultant in Palliative
Medicine at St Ann’s Hospice, Little Hulton in August 2002, and this post
is also linked to Salford Royal Hospitals NHS Trust and Salford PCT.

In order to ensure that the future medical workforce for palliative care is
sufficient, the SIG has agreed to recurrently invest £17,000 per annum to
the Regional Specialty Training Programme for Registrars in Palliative
Medicine who are linked to the Hospice, Hospital and Community
Palliative Care Teams in Salford.
Specialist Nursing Provision
 November 1999 - appointment of a fourth Clinical Nurse Specialist in
Palliative Care to the Salford Community Palliative Care Team.

April 2001 – appointment of a further 1.5 whole time equivalent Clinical
Nurse Specialists in Palliative Care to the Salford Hospital Palliative Care
Team.

April 2001 – secretarial support developed for all palliative care teams.
Care at Home
 Community Specialist Palliative Care Team :
Consultants in Palliative Medicine 0.3 wte
Clinical Nurse Specialists 4.0 wte
Specialist Social Worker 0.5 wte

To enable choice for patients and their families to continue care at home,
and die at home if they so wish, there has been expansion of the
Community Nursing service, building on the existing District Nurse Teams,
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
Community Bank, Marie Curie Nursing Service and Rapid Response
Team. The Respite at Home Team for Salford was established in 1998,
and underwent further expansion in April 2001 in funding core team
members
Bereavement services
-community based eg CRUSE and Salford
Palliative Care Counsellors and St Anns Hospice bereavement service

November 2000 – establishment of 24 hour Advice Line for Specialist
Palliative Care, which provides specialist advice to Hospital and
Community professionals.

September 2001 – report on recommendations for improving Salford outof-hours palliative care provision.

August 2002 - New Opportunities Fund bid for out-of-hours care in Salford
to:
i.
ii.
iii.
iv.
Extend 24 hour Advice Line to patients and carers;
Provide access to drugs and equipment out of hours;
Improve co-ordination of Health and Social Service provision with
the appointment of a 3 year Project Lead;
Increase education and training to Community staff.
Note successful bid 3 year project to commence July 2003

March 2003 – Second edition of the Pain and Symptom Control
Guidelines.

December 2002 – Appointed GP Facilitator for Palliative Care.

January 2001 – The Integrated Care Pathway (ICP) for the Last Days of
Life Group established.

January 2002 – Pilot implementation of the ICP for Last Days of Life
across all healthcare settings of Hope Hospital, Salford Community and
the Hospice.

April 2003 – Implementation of the ICP for Last Days of Life to be
extended across the community of Salford with the appointment of an ICP
Co-ordinator.
Hospital Palliative Care
 Consultants in Palliative Medicine.0.5 wte

Clinical Nurse Specialists in Palliative Care 3.5
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
November 2000 - Access to 24 hour Specialist Palliative Care advice.

Integrated Care Pathway for Last Days of Life – implementation and
education of hospital staff commenced January 2002 for completion April
2003.


April 2002 - Palliative Care Database established on the Electronic Patient
Record (EPR) system.
June 2002 - Palliative Care Outpatient clinic commenced

November 2002 - Cancer Information Service – ‘Cancer & You’ ope
 March 2003 Second edition Pain & Symptom Control Guidelines.
.
Hospice Care
 Consultants in Palliative Medicine. 0.8 wte

Inpatient Unit – 30 beds.

Day Care provision – open 3 days per week. 45 patients / week

Supportive outpatients clinics – 5 days per week with provision of:





Medical advice.
Lymphoedema
Dyspnoea.
Stress and relaxation management.
Complementary therapies.

Bereavement Service.

Community Service – Clinical Nurse Specialists in Palliative Care. ( see
home care )

Community Social Worker ( see home care).
Development of Clinical Protocols/Pathways
 April 2000 - Publication of Palliative Care Pain and Symptom Control
Guidelines.

April 2000 – Publication of Palliative Care Service Directories.
Clinical Audit and Outcome Systems
 December 1999 - Establishment of Palliative Care Patient Information and
Clinical Audit Group.
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
January 2000 - Updating of palliative care databases and equipment.

Audit of pilot Care Path way Last Days of Life in hospice ,hospital and
community.
Co-ordination of Palliative Care Services
 October 1999 - Appointment of a Palliative Care Co-ordinator, whose role
is to project lead implementation of the Palliative Care Strategy for Adults.
Development of Palliative Care Education and Training
 December 1999 – establishment of Palliative Care Education Group.

March 2000 – pump priming of education and training in the Palliative
Care Approach for health and social care staff.

April 2001 – funding of care pathway education for hospital, community
and hospice staff.

February 2002– appointment of a Palliative Care Education and Training
Co-ordinator (2 year fixed term contract).

February 2003 – Macmillan GP Facilitator post in Palliative Care.
Information and Audit
 December 1999 0 Palliative Patient/Carer Information and Audit Group
established.

April 2002 - Palliative Care Service Directories published.

February 2001 - New Opportunities Fund Cancer Information Project
commenced.

November 2002 - Information Centre opened at Hope Hospital, with
Community Outreach in 2003.

2003 - Cancer Services Directory to be published

In progress - Analysis of data (pilot ) for Hope Hospital and for patients in
the community of Salford.
Bereavement.
 Hospice Bereavement Service.

Community Bereavement Service – Salford Palliative Care Counsellors.
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
Hospital – planning Bereavement Centre.
Voluntary Services
 Salford Cancer Aid Listening Line./ Carers support

St Ann’s Hospice.
Conclusion
The above sets out the current position in relation to palliative care and briefly
details plans for development. The Trusts will be pleased to provide further
information on request.
Sue Hill
Local Implementation Officer – Palliative Care
Salford & Trafford Primary Care Trusts
Dr Stephanie Gomm
Consultant in Palliative Medicine
Chair, Salford & Trafford Local Strategy Group for Palliative Care
March 2003
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