Centre for Palliative Care Inaugural Annual Lecture Dr Judy Dale FRCP

Transcription

1 Centre for Palliative Care Inaugural Annual Lecture Dr Judy Dale FRCP 1 st May 2014 A Personal Journey Towards Developing Specialist Palliative Care in Worcestershire: A Penumbra Roots Experiences in Learning Growth of Specialist Palliative Care Education and Research Our patients 1

2 Dr Havard s natural gifts were strengthened by an intense power of application and concentration of purpose. He possessed exceptional powers of perception, and a sympathetic appreciation of human life. His enthusiasm and devotion were characterised by extreme thoroughness and simple honesty St Thomas Hospital Medical School 3 rd year

3 d Total Pain You matter because you are you. You matter to the last moment of your life, and we will do all we can not only to help you die peacefully, but to live until you die. Dame Cicely Saunders Psychological Physical Spiritual Social Mud & Stars Robert Twycross 3

4 THROUGH A GLASS DARKLY It's lucky our eyes look outward We can't see how we look without mirrors. As our bodies diminish Or lose their shape It's the others who see it. We feel its limitations. How do we look in their eyes? Does it hurt our family and friends To see us changed so much? THROUGH A GLASS DARKLY As we move lifewards Through our dark internal glass we see clearly But the eyes of our friends cloud over. In their concern they recall us As we used to be, loving and alive But they seem unable to see the new life Rising within us. Brenda 28th June 1986 Home Care Team Day Hospice Family care Bereavement care Rose Hill

5 Hospital Macmillan Team 1993 Evesham Macmillan Unit 1995 St Richard s Hospice Education & Resource Centre GENERAL PALLIATIVE CARE Primary Care Community Hospitals Nursing Homes Acute Hospitals PATIENT & FAMILY SPECIALIST PALLIATIVE CARE Inpatient Unit Community Team Hospital Palliative Care Day Hospice Education Calman Hine Report 1995 Commissioning authorities should develop a local plan for delivering palliative care, bringing together all providers 5

6 Worcestershire Strategy for Palliative Care Services Part 1 Medical Manpower & Palliative Care Beds WHA Local and County-wide Multi-professional & Managerial Palliative Medicine Professor Ilora Finlay Chairman The Association for Palliative Medicine The GMC Specialist Register 97 vacant Consultant posts (1996) Specialist Palliative Care Services in Worcestershire 2000 Kidderminster Hospital Stourport Macmillan Team Kemp Hospice Alexandra Hospital Palliative Care Team Primrose Hospice Worcestershire Royal Infirmary Hospital Macmillan Team 1 Consultant in Palliative Medicine St Richard s Hospice Home Care team Evesham Macmillan Unit 6

7 Specialist Palliative Care Services in Worcestershire 2007 Kemp Hospice Primrose Hospice Princess of Wales Hospital Inpatient Unit Community Palliative Care Team 4 Consultants in Palliative Medicine 2 Specialist Registrars, FY1 Worcestershire Acute Hospitals Hospitals Palliative Care Team St Richard s Hospice Inpatient unit & Community Team Evesham Macmillan Unit DEVELOPING PALLIATIVE CARE EDUCATION STRATEGY for WORCESTERSHIRE 2001 Imagine a time when all health care staff whatever their discipline, level or work setting, will understand and be able to practice to a competent level the palliative care philosophy supported by education initiatives at the individual, group and organisational levels 7

8 Multi-professional Core Education Group 2001 Pauline Smith, West Mids Sth Workforce Dev Confederation Simon Chippendale, Senior Lecturer St Richard s Hospice National agendas WORCESTERSHIRE PALLIATIVE CARE SERVICES STRATEGY All partners Education general principles Louise Toner, Principal Lecturer, University College Worcester Pat Field, Cancer & Palliative Care Education Facilitator SWPCT Workforce development EDUCATION STRATEGY What needs to be in place Judy Dale Chair; Macmillan Consultant Pall Med SWPCT Other strategic directives Review of current provision Leads to outcomes in service delivery staged to support implementation of service strategy Strategic Model Multiprofessional Topic Needs Analysis Priorities for learning by Worcestershire GP s Mapping exercise Workforce planning Consultation Curriculum Planning Funding. 8

9 Palliative Care Personal learning needs assessment thanks to Simon Chippendale & Dr Richard Woof 1. The Disease Process 2. Practical Issues 3. Communication 4. Teamwork within Palliative Care 5. Ethical Issues 6. Cultural Issues 7. Social Aspects of Care 8. Psychological Aspects of Care 9. Symptom Control 10. Pharmacology 10 sections 56 topics! Pain Tick the box that most closely represents you A = full experience, confident + recent update B = full experience, confident, no recent update C = some experience and confidence, aware could improve 41% 4% 8% A B C D = limited/no experience, would value opportunity to develop further 47% D 9

10 palliative care Community Nurses PAM's GP's/Dr's Acute Nurses Pain Value of Team Support & Development BREAKDOWN BY PROFESSION 3% 9% A B C D 43% 45% A B C D Audit of Place of Death of Cancer Patients Where do patients choose to die? Preferred v Actual Place of Care Cancer Deaths at Home Townsend 49%...31 % Dunlop 53%...26% Townsend et al. BMJ 1990; 301: Dunlop, Davies. Hockley. Palliat Med 1989;3:

11 Worcestershire cancer deaths 37% cancer deaths at home Wyre Forest % Redditch & Bromsgrove % South Worcestershire % Audit of Place of Death of Cancer Patients Worcester City 2001 J Dale 2002 Total cancer deaths 254 Hospitals 44% Home 29% source: Office of National Statistics VS3 Identify the place of death if not 'at home Cancer patients who died in WRI in 2001 Feedback from primary healthcare teams Feedback from relevant specialist palliative care teams Data analysis for date of admission and length of stay Audit of hospital medical notes Audit of OOHs activity at Worcester Primary Care Marie Curie activity in Worcester City 2001 Challenges. communication discharge planning practical support at home availability of drugs out-of-hours referral to palliative care services EDUCATION 11

12 Worcester City Residents Analysis of Place of Death where underlying cause was "Malignant Neoplasm" (based on date of death) 60.0% Gold Standards Framework Hospice at home Out-of-hours care Hospice beds Education 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% % at Usual place of residence % in Acute Hosp % in Other (incl. Hospice) Thanks to Jan Harvey Information Analyst Specialist, Public Health Intelligence WCC Worcestershire Residents Analysis of Place of Death where underlying cause was "Malignant Neoplasm" (based on date of death) BBC NEWS 8 March % 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% % at Usual place of residence % in Acute Hosp % in Hospice % in Comm Hosp Some terminally ill patients are suffering unnecessarily because of poor access to pain control at home A report Marie Curie Cancer Care found delays for prescriptions and carers feeling "abandoned". A UK-wide online survey of GPs suggests many are worried about support for terminally ill patients at home. Thanks to Jan Harvey Information Analyst Specialist, Public Health Intelligence WCC 12

13 Audit & Research Centre for Palliative Care Education Education EDUCATION Centre for Palliative Care Founded 2013 And our Patients Michele Angelo Petrone The Emotional Cancer Journey 13

14 'I need to know that this body is my body And I need to know everything that is happening to my body But most of all I need to know that you know that within my body there is ME Michele Angelo Petrone The Emotional Cancer Journey 14

15 Thank you.. 15