Clinically Based Education
and Training Initiative
DR LINDA WILSON (CONSULTANT, AWC)
LIZ PRICE (CNS, BRADFORD)
WENDY LAYCOCK (FACILITATOR, AWC)
AIREDALE,WHARFEDALE AND CRAVEN (AWC) END OF LIFE PATHWAY
IDENTIFY
ASSESS Scene
LAST
CARE
DISCUSS
SUPPORT &1 Airedale
Background
DAYS
AFTER
Likely prognosis ≤
12 months, add to
GSF register
 PCTs
Dr L Wilson/ AGH EOL group
Holistic
assessment
(advance) care
planning
COORDINATE
CCG reconfigurationCARE Physical,
DEATH
psychological, social,
NICE QS2
and
emotional,
financial, and

Airedale
hospital
–started
GSF
for acute
hospitals programme
spiritual support. Access
NICE QS1
to drugs and equipment,
BEREAVE
NICE QS3
NICE QS 11
24/7 . Reduce avoidable
 Airedale hospital -Transforming
community
services,MENT
EOL as 1
hospital
admissions and
shorten number of bed
of 5 workstreams -EOL strategic group
days
 EOL Pathway developed
NICE QS4, 5, 6, 7,8,
9, 10
OF LIFE
NICE QS 12, 13,
14
 Health Foundation Shared Purpose Project
STAFF SUPPORT AND EDUCATION NICE QS 15,16
 Communication skills training (Sage and Thyme)

EPaCCS

Gold Line
CARER SUPPORT
 System
1 adopted within
Airedale
Hospital
all GP practices
INFORMATION
FOR
PATIENTS
ANDand
CARERS
in AWC (16/17, last one May 14)
SPIRITUAL CARE
 Non-recurrent funding bid for GSF in 30 Care Homes
SOCIAL CARE
Synergy: Several individual events coming
together
Background 2
 Managed Clinical Network (MCN)
 Non recurrent funding for Gold Standards
Framework (GSF) in 30 Care Homes and
subsequently in Going for Gold in 12 GP Practices
 National Transforming End of Life care in acute
hospitals programme
Background 3: Bradford Hospitals
 Pilot Last Year of Life Project
 Baseline audit
 4 Workstreams developed to implement project
 Identification of patients in the last year of life
 Discharge & SystmOne – sharing information
 Education
 Patient & carer experience
 Roll out across Trust
 Repeat audit
How we used the MPET Funding
 GSF facilitator Airedale Hospital
 GSF facilitator AWC community
 GSF facilitator Bradford community
 Incorporated to Specialist Palliative Care CNS role in
Bradford Teaching Hospitals
Facilitators promoting GSF as a way to encourage Identification,
Assessment and Planning of Care
MPET in Community Posts
Audit and
evaluation
EPaCCS Template training
GP’s /DNs / Practice teams
• Baseline
questionnaires and
data
• GSF Good Practice
Guide
Communication Skills
training
Supporting GSF
meetings
Gold Line
Service
• EPaCCS training-EOL
template for all
practices
• 2 day Mandatory
training DNs and others
Key Outcomes so far
• Airedale /Bradford Community
•
•
•
EoLC Template training -194 nurses and 42/87 GP practices
Articles and information at events
GSF meetings attendance, 17 registered for Going for Gold
• Airedale Hospital
•
•
•
Audits- LYoL, MPET
Increasing confidence to identify and offer ACP
Flag system and increased liaison of EoLC information
• Bradford Teaching Hospitals
•
•
•
Increased number of patients identified as being in their last year
of life
Greater sharing of information across primary & secondary care
Communication skills sessions for senior clinicians
Lessons learnt
 A vision for the whole pathway but broken down into
manageable parts
 Joining up primary and secondary care
 High level “buy in” – executive support from
hospital; commissioner involvement
 Communication- consider all stakeholders
Lessons learnt cont…
 Persistence and resilience
 Engaging staff / knowing your audience
 Collaboration: within and between organisations
 Data to support, convince and provide ongoing
funding
 Be realistic!
Challenges/Future issues
 Keeping the dream alive
 Education, Education, Education – competencies???
 Media misinterpretation of LCP etc…
 Social Care agenda still to address
 Short term non-recurrent funding
How do you eat an elephant ?
Questions?