Community Focused Palliative Care in Bala

Community Focused Palliative Care in Bala

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

Background

• 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

Aim

• 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

Methodology

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?

Results

• 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

Conclusions

• 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

• Numbers small

• Public groups may not be representative

• Expressing interest not the same ask changing practice!

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