Agenda item

The Committee was advised that Healthwatch Oldham had undertaken an End of Life Review to gather the experiences of families and carers who have supported a family member through palliative and end of life care in Oldham.  The review had been triggered by the highlighting of issues faced by carers supporting loved ones at the end of their life, comments about the lack of community bereavement support, mixed feedback from families accessing palliative and End of Life (EOL) care, and an increase in the number of Do Not Attempt Resuscitation (DNAR) complaints. 

The Review had been undertaken between July and December 2019 and sought feedback from the general public, from families with experience of supporting a family member at the end of their life, and from professionals involved in EOL care and support.  The detailed responses arising from the consultation, along with the key findings, were fully detailed in the Healthwatch Oldham report “Talking About Dying: A Review of Palliative and End of Life Care in Oldham“, a copy of which was appended to a submitted report.  The Healthwatch Oldham report made thirteen detailed recommendations aligned under the Greater Manchester Health and Social Care Commitments which sets out what individuals with palliative and end of life care needs can expect across Greater Manchester and provides a baseline to measure the quality of care provided in Oldham.  The Committee was advised that Healthwatch Oldham had also recently concluded a DNAR survey: while there had been a number of positive experiences reported, a number of more serious areas of concern had been highlighted which would add weight to the training recommendation within the Report.

Ben Gilchrist of Healthwatch Oldham invited the Committee to consider the Report and to provide any comments or observations as to the findings and draft recommendations prior to the formal conclusion and sign-off of the report.  The following matters were considered accordingly in respect of the recommendations –

Recommendation 6 – Hospice at Home – further to a query concerning the reliable access to pain relief 24 hours a day and the prescribing and supply of such medication, while it was understood medication would be administered by the District Nursing service, clarification as to the intentions behind the recommendation, including prescribing, would be sought;

Recommendation 8 - Crisis Care - further to a comment that promotional information in respect of EOL care needed to also be culturally sensitive as well as available in a range of languages, it was acknowledged the recommendation did not capture the detail and this would be looked at to make sure the issue was brought out more.  Ben Gilchrist undertook to refer a query to colleagues as to any consideration of the recommendations of a previous Voluntary Action Oldham study into the experiences of the Asian community;

Recommendation 11 – Training – A Member referred to an occasion they were aware of where carers for an individual with a DNAR notice in place had called an ambulance but then attempted resuscitation on the advice of the 999 service.  It was acknowledged that the circumstances highlighted not only a training need, but the need for electronic records, for clarity across services as regards to status etc.;

Recommendation 13 – Bereavement Support – Further to a query as to whether the Bereavement Support Team would comprise professionals or volunteers, the extent of training etc, the Committee was advised that the recommendation was concerned with the availability of bereavement support in general, and it would be for each provider to consider what was available and what was needed.

A Member commented generally, but with particular reference to Recommendations 4 (Communications) and 11 (Training), that there should be a requirement for additional communications with, and training for those dealing with EOL issues in respect of, patients with Special Educational Needs and Disabilities/ Aspergers.  It was accepted this was an important point to bring out and that Healthwatch Oldham always sought to ensure that training and recommendations put forward presented an holistic approach.

Addressing the recommendations in general when considering religious and cultural needs, the Chair noted as an example that for Muslims a funeral should be held as soon as possible, meaning that individuals needed to be released as soon as possible to the family.  Noting the respective roles of the Coroner and GPs, an example was reported where an arrangement with a local GP practice had failed due to the absence of the GP at the time of death.  The points raised were acknowledged and a focus to highlight religious and cultural practices, and the impact on service delivery, would be considered.

The wide ranging and comprehensive nature of the recommendations was noted, and the extent to which they were deliverable in current circumstances was queried, including whether there had been any exercise to match resources from the current EOL services.  The Committee was advised that Healthwatch Oldham recognised the challenging environment and always tried to develop recommendations and focussed solutions reflective of local circumstances.  For example, Recommendation 1 (Co-ordinated care) reflected existing health and social care working in the five clusters to build on the wider integration model.  With regard to training, it was known that services had workforce development arrangements and Healthwatch would look to these being adapted accordingly, meaning that the training proposal should be or be close to cost neutral.

The highlighted use of acronyms in the report was acknowledged and this would be addressed before publication.

With regard to a query relating to the timeline for taking the Review report forward, the Committee was advised it was hoped to formalise and publish the final Report by the end of July. Due to current circumstances there was a need to make specific plans to present the recommendations to the various decision making bodies over the course of the remainder of the year.  As such, it was unlikely that any update to the Committee could be made before the year end.  The Chair asked for the final draft of the Healthwatch Oldham report to be circulated to Members of the Committee and thanked Healthwatch for the undertaking of the Review and the presentation of the draft Report.

RESOLVED – That the comments of the Committee be commended to Healthwatch Oldham for their consideration, and Healthwatch Oldham be thanked for the undertaking of the Review and for the presentation of the draft Report to the Committee.