Requires improvement
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End of life care services required improvement as whilst the local teams worked exceptionally hard to meet the needs of patients the end of a person’s life some improvements were required with the supporting systems. There were delays in discharges throughout the trust which affected the care provided to people at the end of their life with particular delays being noted in the fast track discharge processes which was not always quick and this impacted on patient care.
People had a choice in their care; they could make
decisions where mental capacity allowed on their preferred place of death, resuscitation status and treatment options. The chaplaincy team provided an exceptional
bereavement service with their model of bereavement provision being adopted in other NHS organisations as an example of good practice.
The mortuary team were responsive at managing capacity within their service and worked well with neighbouring trusts to manage capacity of mortuary space for
Cambridgeshire. There were concerns noted around the longevity of being able to maintain the capacity of the service when a local mortuary merges with the one at Addenbrooke’s in future and the plans for managing this had not been determined.
Service planning and delivery to meet the needs of local people
• The SPCT took referrals from the whole of East Anglia with an estimated population of 752,900 people.
• The SPCT were acting and responding to new referrals in a timely fashion with 95% of new referrals being seen within 24hours.
• The chaplaincy service was on-call 24 hours a day and recognised all denominations.
• Due to the ongoing concerns with information access on the EPIC system there has been lack of development enabling the palliative care department to extract patient data to monitor and improve patient care as the data they require is not accurate or accessible.
Endoflifecare
• “Fast track” discharge planning could take anywhere up to three weeks to arrange due to lake of community resources.
• A consultant from the specialist palliative care team told us that they had close working relationships with community teams across East Anglia and aimed for seamless care for patients transferring between services. The specialist palliative care team had redesigned the service, cutting consultant hours to pay for two band six nurses to review patients without complex needs and to support the ward staff in their care and fast track
discharge planning.
Meeting people’s individual needs
• National research on bereavement had led the Lead Chaplain to devise a “One stop appointment” for bereaved families to alleviate further distress. One appointment was made for family members to, collected the death certificate, registered the death, discussed any concerns around the death and view the deceased if required all at one appointment. Research had shown that at around six weeks after death loved ones started asking questions. Due to this the
chaplaincy sent out letters six weeks after death offering relatives the opportunity of an appointment to come in and discuss any concerns around the persons treatment or death. 23% of relatives responded to the letters and 13% asked for a meeting. The system was set up nine years ago at Addenbrooke’s and has proven to be effective in reducing both anxieties and complaints. The system has been rolled out to other hospitals as an example of good practice.
• Multi-cultural faiths were catered for within the
chaplaincy with the chapel closing every Friday between 13:15 and 14:15 to facilitate Muslim prayer.
• There were prayer matts and multi faith books available such as the Quran and an ablution area for Muslims to wash themselves in prior to prayer.
• We saw evidence of poor discharge summaries with very little information on them.
• Information for people their families and carers was available. We saw leaflets and booklets explaining symptoms and treatment options. The chaplaincy and bereavement service carried many books on for example “What happens next”. Information was also available for people with different ethnicity via
“language line” or information staff accessed for them
• One negative comment we received was that there were not enough quiet rooms for breaking bad news on some wards especially for bed bound people. Where this was the case staff told us “We are doing our level best to promote privacy and dignity wherever we can. • Translation services were available 24 hours per day
through a telephone service.
• Staff and families had access to specialist services and nurses trained in caring for people living with dementia and people with learning disabilities, when a patient nears the end of their life.
• The needs of people who required end of life care were prioritised within the hospital wherever possible. However we were told that side rooms were not always available for end of life patients but staff would do their best to make them available wherever possible.
• The environment on the older wards was variable. For example the elderly medical assessment unit had little natural light due to the prefabrication design of the building. This ward environment was not suitable for people receiving end of life care due to the very poor natural lighting and little space for equipment.
Access and flow
• There was an identifiable flagging system on EPIC for “End of life care.” However there was no way to identify these people if they were re-admitted to hospital. We spoke with one relative who told us that their loved one had been readmitted and put on the elderly assessment unit. She felt was inappropriate for an end of life care patient due to its cramped conditions and extremely poor natural lighting. The trust has recently begun work to ensure that patients at the end of life are flagged on the system.
• We were informed that discharges were often delayed which placed additional pressures on hospital beds. We did not see any recorded evidence around delayed discharges for end of life care but we were told by staff they believed it was linked to poor discharge planning and delays in discharge letters being received by GP’s. • The SPCT informed us that due to resource constraints
in the community that fast track discharges for patients requiring end of life care were often delayed, we were told for up to six days, though there was no data routinely collected on this.
• We were provided with an example of one patient who was delayed for three weeks in receiving a fast track
Endoflifecare
discharge which was linked to limited resource availability in the community. Their relative had been responsible for collecting equipment which they had found hard due to their own disability.
• The current mortuary capacity is continually around 80% with links to local funeral directors to support them with storage of the deceased during times of increased activity in the hospital. The service has good links with other hospital and services to maintain their capacity at a stable level. They also have an additional storage spaced they can use if demand requires it.
• The mortuary is due to be merged with another
mortuary when a hospital in Cambridgeshire moves on site. The current mortuary will not be moved as part of the new development and there is no room to expand the space in the mortuary further. There is a concern that the capacity for the mortuary will not cope with increased demand on the service when the two mortuaries merge.