Community Focused Palliative Care in Bala

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Community Focused Palliative Care in Bala

  • (Or how relevant is the ‘Big Society’ concept to the delivery of Palliative Care in the Community?)


  • Previous Needs Based Assessment

  • Rurality and isolation = Bala

  • Increasing demand and expectation for services

  • Drive to deliver services closer to home

  • Resources (financial, staffing, transportation)

  • ‘Big Society’ concept

  • New technologies


  • To analyse provision of palliative care for a range of life limiting conditions in a rural community with a view to establishing what enhancements to care could be provided by the community themselves

  • To identify what enhancements / changes in delivering care were thought to be useful and / or acceptable

Concerns about project

  • Impact on Public

    • Generating expectations from the community
    • Adverse media / stakeholder reaction to possible shortfalls in services
  • Impact on Health Care Professionals

    • Service review ‘fatigue’
    • HCP perceptions of purpose of project


Community Groups

  • Themes discussed:

    • Population demographics
    • Sense of community in Bala
    • Ability to deliver more care for each other in the community
    • Differential access to services
    • Potential for skilling up volunteer lay people in elements of care
    • Potential use of technology

Health Care Professionals

  • Semi-structured questionnaire

    • Patients population
    • How identify?
    • Who delivers care?
    • What were the strengths of the palliative care provision?
    • How could arrangements be improved (within existing resources)?
    • How easy was it for patients to remain at and die at home?
    • What were potential barriers to this?


  • Community Groups

    • Bala Rotary
    • Bala Age Concern
    • Merched Y Wawr
    • Identified local community members
  • Health Care Professionals

    • Medical (GPs)
    • Nursing (DNs, CDN, H@h, SPCCNS)

Community Groups (1)

  • Significant shift in demographics in rural areas in North Wales

  • Public do not see a role in delivering personal care for others

  • Public acceptance to see routine tasks performed by support workers

Community Groups (2)

  • Recognise the potential benefits and keen to exploit opportunities of technology

  • Community eager to discuss health solutions

  • Travelling is a significant issue

Health Care Professionals (1)

  • Patient Populations

    • Seen as range chronic diseases however patients with dementia were less likely to be perceived as palliative care patients.
  • How identify

    • Wide range of routes
    • Regular meetings (MDTs and GSF)

Health Care Professionals (2)

  • Who delivers care

    • Seen as responsibility of all, though cancer still perceived as more likely to have SPCT involvement by generalists
    • Other resources for some of the other conditions or ported out
    • Dementia seen predominately the responsibility of mental health team

Health Care Professionals (3)

  • What were the strengths of palliative care provision

    • Close knit community and teams
    • DN team
    • Communication between teams
    • H@h
    • MDT meeting
    • Flagging to OOH services

Health Care Professionals (4)

  • What were the weaknesses of palliative care provision

    • Night cover, W/E, BH
    • Access to I/P facility
    • DN staffing
    • When acute deterioration occurred admit to Wrexham
    • Logistics

Health Care Professionals (5)

  • How could arrangements be improved (within existing resources)?

    • Syringe Drivers
    • Access to respiratory nurses (O2)
    • Skype
    • More staff particularly Night cover, W/E, BH
    • Logistics (Liability arrangements, 4X4!)
    • Access to I/P facility
    • Appointment of new consultant

Health Care Professionals (6)

  • How easy was it for patients to remain at and die at home

    • Generally yes BUT…
  • What were potential barriers to this

    • Lack of family / staff
    • Mental health issues
    • Difficult symptoms
    • Patient choice


  • Demographics different and changing

  • Public and HCP view demographics differently

  • The ‘Big Society’ appears to have a limited role in delivering health care

  • There remain concerns about EoLC within existing resources

  • Dementia in particular appears to be regarded differently in rural areas

  • The public appears to be keener to look at the role of newer technology than HCPs

Limitations of study

Next Steps

  • Feed back to teams

  • Development of needs based coding for a range of life limiting diseases

  • Focus on management of dementia

  • 3 Pilot projects on the use of telehealth to support

    • Palliative care in community hospitals
    • Care homes
    • Rural communities

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