To receive a report from the Senior Commissioning Manager for Trafford CCG.
The Senior Commissioning Officer from Integrated Commissioning Unit told the Committee that although the current position seemed as though the figures were static there had actually been a reduction in the number of people who had died in hospital since 2015. The Committee were informed that Trafford was the highest performing area in Greater Manchester for the percentage of people who had three hospital admissions or more in the last three months of life who died at home.
The CCG had performed a self-assessment of End of Life (EOL) care looking at the whole health and social care system and evaluating it against the ambitions for palliative care. The self-assessment had been completed in partnership with key stakeholders from care homes, primary care services, and hospitals. This exercise had identified a number of barriers within the system and an action plan had been drawn up to address them. Advanced care planning, end of life prescribing, and training of primary care staff were all identified as key elements to improve palliative care.
Since the self-assessment was done there had been a number of improvements made. This included all those involved in end of life care using Emiss, the development of advanced care plans, and improved forms and questions used by GPs. The next stage was to develop a one person profile which would capture who a person was and their wishes for the end of their life. This work was being done with two Trafford Care Homes which had been identified as providing high quality care.
In order for palliative and end of life care to be improved work needed to be done to tackle the stigma around talking about death. This was needed so that the discussions could begin sooner enabling planning to be completed in a timely manner. There had already been a number of community engagement events across Trafford and more were planned going forward. The Senior Commissioning Officer informed the Committee of the education and training programmes would help to address some of the issues around a lack of knowledge within care homes.
Chair asked about none recurrent funding mentioned on page five of the report and whether that could be recurrent. The Senior Commissioning Officer responded that the funding was £12000 for a role which was to train champions within care homes. These Champions would then be able to train other staff within the care homes and so the funding did not need to be recurrent.
Councillor Bruer-Morris asked what the impact had been of getting all those who worked in palliative and end of life care to use Emiss. The Senior Commissioning Officer described how Emiss supported the palliative care information systems and ensured that the information was available for GPS and professionals. The Committee were told that this development had been an improvement and had enabled a more person centred approach.
Councillor Bruer-Morris asked a follow up question about the levels of staff turnover.
The Corporate Director of Adults Services informed the Committee that whilst there was a lot of movement of staff across Trafford most of the people that left simply switched employer rather than leaving the borough. The Council were working with Trafford CCG on a training offer which would track staff across Trafford this would enable a better understanding of the true staff turnover in the area. The system would also mean that when someone moved from one provider to another they would not need to have repeat training.
Councillor Haddad noted that this work aimed to replicate the success of St Anne’s in a care home setting and she asked whether this was possible. The Community McMillan Nurse (Karen O’Connor) responded that there were a number of homes already delivering this level of end of life care. She recognised that in order to get homes to this level requires some investment in resources and training and the team were focusing upon supporting those homes that were yet to get this in place.
Councillor Haddad asked whether the Care homes were able to provide the equipment needed for this care. The MacMillan Nurse replied that as long as homes had a syringe driver and trained staff they were able to deliver the care that they were talking about.
The Chair of HealthWatch Trafford asked how many people had died within Care Homes compared to how many died within hospital. The Senior Commissioning Officer did not have the figures at the meeting said that they would be provided afterwards.
Councillor Duffield asked about personal health budgets and whether they were being used within Trafford. The Senior Commissioning Officer informed the committee that there had been a lot of work done around personal health budgets and working closely with partners across Greater Manchester. The offer in relation to palliative care was still in its infancy and being developed in partnership with St Anne’s Hospice.
Councillor Duffield then asked about Trafford’s housing strategy and whether there was adequate development to support people to be able to stay in their own homes rather than going into care homes or hospital. The Associate Director of Commissioning informed the committee that the ICU had been asked to be involved in the older persons housing task and finish group and would update the committee on the work of that group at a later stage rather than give an uninformed opinion.
1) That the report be noted.
2) That the numbers of people dying in care homes and hospital be provided to the Committee.