The service will ensure that its services are provided to the highest quality achievable and that the quality and clinical governance standards meet best practice requirements set out by the Department of Health (DH), Inspection Bodies and Ealing and Harrow Community Services.

Services will be provided with reference to the following:

Guidelines on Cancer Services;
National Council for Hospice and Specialist Palliative Care;
West London Supportive and Palliative Care Network;
NW London EOLC strategy and action plan;
Transforming Communities (2009);
National Institute for Clinical Excellence (NICE).

The specialist palliative care service underwent a rigorous service improvement review over 2007/08 with Partnership UK (PUK) who reviewed the service with stakeholders and users. This service came out top of all local provider services of which we are very proud. The outcome was a detailed development action plan to address those areas that we can improve or develop.

Local Key Performance Indicators are used in influencing the delivered service. Where concerns are raised over the quality of clinical services at Meadow House, the provider, and commissioner, Ealing PCT, Hounslow PCT and, if necessary, the Strategic Health Authority would investigate using formal procedures laid down by these organisations.

The Provider will ensure:

Both clinical and non-clinical audit is carried out on an on-going basis within the Service. The audit programme is updated twice yearly and adheres to the requirements of the PCT’s Clinical Audit Working Group. Outcomes of all audits will be reported within the annual service report and made accessible on the Specialist Palliative/End of Life Care Service website.

QUALITY INITIATIVES

The National Institute for Clinical Excellence (NICE) defines specialist palliative care as: the active holistic care of patients with advanced progressive illness. Management of pain and other symptoms, alongside provision of psychological, social and spiritual support, is paramount.

Compliance with the Core Standards of the Standards for Better Health (SfBH)

The Specialist Palliative/End of Life Care service will maintain the core standard of the Standards for Better Health as part of their high quality service and monitor that there are sufficiently robust systems of internal control to provide the necessary ‘assurance’ to the Trust Board on this issue through the Provider Services Clinical Governance (PSCG) working group.

Annual Health Check 2009/10- ‘Standards for Better Health’ (SfBH) - Quality Care Commission (QCC)

The Senior Management Team (SMT) works with the services directorate to maintain compliance with the core SfBH for 2009/10 and link into the PCT’s wider programme to achieve the developmental standards for the next annual healthcare check.

Liverpool Care Pathway (LCP) for the Dying Patient

The Liverpool Care Pathway for the Dying Patient (LCP) was developed for use in hospitals but can be used in other care settings. The specialist palliative care teams lead the training for LCP. Once implemented the LCP empowers generalists to care for the dying and can be transferred to patients.

The Ealing and Harrow Community Services Alliance is participating in a national audit of care of the dying in individual hospitals in England that are routinely using the Liverpool Care Pathway (LCP) in the dying phase. The Inpatient Unit at Meadow House has successfully implemented LCP.

Gold Standards Framework (GSF)

The Gold Standard Framework (GSF) was developed over five years with a multidisciplinary reference group and pilot projects. It aims to improve palliative care provided by the whole primary care team. It enables those approaching the end of life to be identified, their care needs assessed, and a plan of care with all relevant agencies put in place. The framework focuses on optimising continuity of care, teamwork, advanced planning (including out of hours), symptom control and carer and staff support. Although developed for use in primary care it can be used in care homes and for all disease groups.

The Preferred Place of Care (PPC) patient held document was designed to facilitate patient choice in relation to end of life issues. Good communication and by documenting patient and carers choices, they become empowered to exercise choices, through the sharing of this information with all professionals involved in their care. The explicit recording of patients/carers wishes can form the basis of care planning in multi-disciplinary teams and other services, minimising inappropriate admissions and interventions. The PPC is a process, which facilitates service review, helping professionals to negotiate service requirements on behalf of patients.

Local Implementation

Ealing and Harrow Community Services Alliance is participating in a national audit of care of the dying in individual hospitals in England that are routinely using the Liverpool Care Pathway (LCP). The Inpatient Unit at Meadow House has undertaken the initial stages of implementation of the LCP, and there is an action plan to roll out an improved programme for 2009/10. The Specialist Palliative/End of Life Care service unit applies NICE guidance to relevant practices and policies.

NHSLA Risk Management Standard for Primary Care Trusts applies to all PCTs and covers factors such as incident reporting and investigation, infection control, health records and the validation and monitoring of professional registrations. The PCT has achieved levels 1a/1b assessments and in 2007 level 1 and in March 2008 level 2 of the new NHSLA risk management standard for PCTs.