End of Life Care Programme

This is a major programme of cross organisational change to radically improve end of life care in Lambeth and Southwark. As a result of the project 80 per cent of known end of life care patients living in Lambeth and Southwark have been enabled to die in the community rather than in hospital.

The £4.8 million End of Life Care Programme (Modernisation Initiative) involved local people, hospitals, health, social care, voluntary and independent sector organisations working together to identify gaps in care and develop systems to improve end of life care (EOLC) services. Up to 3,000 residents in Lambeth and Southwark die each year and it is thought that up to 70 per cent of these individuals require EOLC support. The Charity investment reflected the importance of improving care for both individuals and their families. The three-year programme received £4.5 million from the Charity with combined funding of £300,000 from King's College Hospital Charity and South London and Maudsley Charitable Trustees.

The programme has developed the nationally acclaimed 'AMBER care bundle' which has been adopted on wards at Guy's and St Thomas NHS Foundation Trust (GSTFT) and King's College Hospital NHS Foundation Trust. AMBER enables clinicians to identify patients whose recovery is uncertain and who may have end of life care needs to prepare them to make decisions about future care. The impact of AMBER in King's College Hospital is being independently evaluated by the Cicely Saunders Institute. Further information can be found on the AMBER Care Bundle website. AMBER also won a GSTFT Innovation Award In November 2011.

The Programme set up a groundbreaking single online patient register which identifies patients with end of life needs and shares information between GPs, hospitals and out of hours services 24/7 - a precursor to the pan-London register.

A number of bespoke training and development programmes have been delivered through the Programme for a range of health and social care professionals to improve their recognition of EOLC needs and to provide appropriate care. For example, 500 care home staff in the local boroughs have been trained to recognise and alleviate pain in people with dementia and over 1,500 health professionals have been trained in end of life care best practice.

As well as informing improvements to services, local community groups took part in a performing arts project led by arts charity Rosetta Life and in collaboration with the British Museum to capture their memories and views about death and dying, culminating in public performances to live audiences.

Programme resources to download

This End of Life Care team developed a range of resources and leaflets that have been adopted by health services in Lambeth and Southwark and can be downloaded below. Project Summary Reports provide more detail about particular workstreams within the programme.

*the content of all resources was correct at time of publication (2010-2011)

Description Leaflet Video DVD Resource WWW

Project Summaries

 - read and download summaries from the following workstreams:

  • Dementia workstream
  • Hospitals workstream / the AMBER care bundle
  • Responsive services workstream
  • Communities workstream

 

      X  

Difficult Conversations

 - guidelines for staff in breaking difficult or uncomfortable news to patients and carers

X        

What to do after death

 - guidance for GPs and nurses on tasks that must be carried out after death if they are at the scene

X        

Liverpool Care Pathway

 - a guide for GPs working in primary care

X        

Cardiopulmonary Resuscitation

- information for patients and their families

X        

GP End of Life Care Resource Pack

 -containing EOLC leaflets and GP specific guidance and resources

To follow soon
X        

End of life care nursing competencies

- competency framework developed by St Christopher's Hospice in collaboration with GSTFT hospital and community services and KCHFT

      X  

Hospitals

The AMBER care bundle

 - AMBER provides a systematic approach to manage the care for hospital patients who are facing an uncertain recovery and who are at risk of dying in the next one to two months

www.ambercarebundle.org

        X

PEACE: Proactive Elderly Advance CarE

 - advance care planning for patients admitted from nursing homes to hospital.

         

Dementia

Future care planning leaflet for SLaM Memory Service

X        

Dementia

Planning for the future flowchart

 - outlines the steps that professionals need to take to enable planning on behalf of the patients in line with the Mental Capacity Act

To request s a copy email: miendoflifecare@gstt.nhs.uk

      X  

Dementia

Facing the Future leaflet and information

 - peer support service run by volunteer former carers. Call 0207 735 5850 if you have a carer who you think might benefit from this excellent service. 

X     X  

Dementia

Doloplus-2 DVD

 - supports better management and recognition of pain in people with dementia

To request s a copy email: miendoflifecare@gstt.nhs.uk

    X    

Syringe Driver Plus

Description and photo to follow by Thurs 8 Dec

X        

Video

Let's Talk About It

 -view our innovative community outreach work exploring how the creative arts can be used as a tool to give people the confidence to talk about death and dying

avi file to follow by Friday 9 Dec
  X      

Video

The View From the Street

 - humorous, touching and poignant; Lambeth and Southwark residents talk about what death means to them and in different societies

  X      

Video

Talking About Dying

 - highlights the importance of effective communication among patients, carers and healthcare professionals 

  X      

Video

This is important… please listen to us

 - residents of a local care home talk about what end of life care means to them

  X      

Video

Our Hearts in the Balance

 - innovative community performance by people with dementia at The British Museum

  X      

 







  • Key facts

    Organisation lead:
    Guy’s and St Thomas’ NHS Foundation Trust

    Award:
    £4.8 million

    Start date:
    June 2008

  • Program Resources

    This End of Life Care team developed a range of resources and leaflets that have been adopted by health services in Lambeth and Southwark and can be downloaded below. Project Summary Reports provide more detail about particular workstreams within the programme.