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Projects 2015-16

Network focus: Supporting the people of Cheshire and Merseyside to live well before dying with peace and dignity in the place of their choice

How people die lives on in the memory of those left behind.”  Dame Cicely Saunders (1918 - 2005), founder of the modern hospice movement

Care of the Dying Evaluation (CODE) 

In 2015-16 the Cheshire & Merseyside Palliative and End of Life Care (PEoLC) Network, in partnership with Marie Curie Palliative Care Institute, undertook a survey of bereaved relatives to understand the experience of care their loved ones received in the last days of their life and the support offered to them as carers.

The aim of the Care of the Dying Evaluation was to establish the current quality of care provided, along with the level of family support, and included the experiences of patients dying in hospitals, hospices and at home.

19 organisations took part in the survey which asked 41 questions relating to experiences around pain relief, communication, whether the patient died in the right place and the support given to relatives.  Each of the Clinical Commissioning Group ares within Cheshire and Merseyside received a CODE report with the information local to their participating organisations.  If you would like to read the full report this can be found here.

What next?

To help address the issues raised in the report, a People’s Voice sub group has been established. Made up of Patient and Public Representatives who are members of the Network's People's Voice, the group will be working in collaboration with the Hospital Transform Group and the Education Strategy Group at improving information around what to expect when someone is dying and supporting clinical teams in improving end of life care in the hospital setting.

Advance Care Planning

Advance Care Planning (ACP) is an integral part of end of life care and is important to consider for a wide range of patients, particularly those with progressive chronic conditions.

ACP involves a series of discussions which help a person decide on their future care whilst they have the mental capacity to do so. When a patient’s preferences and wishes are recorded and made accessible to all health and social care professionals involved in their care, their wishes and preferences at the end of their life are more likely to be met, including where they would like to die.

In 2015 the PEoLC Network adopted a ‘planning for your future’ patient-centred approach to ACP.

In partnership with Marie Curie Palliative Care Institute, the PEoLCN developed a framework to support health and social care staff to implement Advance Care Planning. Teams across Cheshire and Merseyside have since adopted the framework and put in place the recommendations, which include education and training for health and social care staff.

The ACP framework endorses a consistent approach to training which has been addressed through the Network's Education Group.

Multiprofessional Education and Training (MPET)

In June 2014 the Leadership Alliance for the Care of Dying People published One Chance to Get it Right a guidance document for improving people’s experience of care in the last few days and hours of life. This guidance recommended that all staff who have contact with dying people, both clinical and support staff, should have the skills to do so effectively and compassionately.

The Cheshire & Merseyside PEoLC Network has endorsed this recommendation through their Vision 2020 for training and education in end of life care, developed through the network’s Education Strategy Group.

Working in collaboration with Health Education England and supported by multi-professional and education training (MPET) funds, the Education Strategy Group has delivered a programme of education consistently across the network covering communication skills, symptom management and Advance Care Planning.

The skills, knowledge and confidence of staff are measured before and after their training using a standard evaluation form, developed through the strategy group and used across all education programmes.  If you woudl like to know more you could read the MPET Year-End Report.

Electronic Palliative Care Co-ordinating Systems (EPaCCS)

For health and social care to be co-ordinated and for patients’ wishes and preferences to be met at the end of their life, records need to be shared electronically.

Ambitions for Palliative and End of Life Care

Electronic Palliative Care Co-ordinating Systems (EPaCCS) have been developed as a means of sharing patients’ end of life wishes and care records electronically so that end of life care can be coordinated across care providers.

The system uses a data set of patient demographic information and care details, transferring captured information electronically across settings.

How EPaCCS can improve patient end of life experience

  • Fewer emergency admissions to hospital at the end of life
  • Improved patient choice:
    • Reduced length of stay in hospital
    • More patients cared for, and dying, in their preferred place
    • Less miscommunication between professionals
    • Lower risk of inappropriate resuscitation & hospital admission
    • Avoiding frustration amongst patients & loved ones because of repeated difficult conversations

To support the implementation of EPaCCS across the patch, the Cheshire & Merseyside Palliative and End of Life Care Network has commissioned a project manager who has previous experience working on one of the successful national pilot sites.

The Project Manager is assisting localities to progress EPaCCS locally using an implementation guide and its eight steps to having a fully compliant EPaCCS system. They also provide technical expert advice to local IT teams.

Eight steps for EPaCCS implementation

  • EPaCCS Task Group
  • EPaCCS recording
  • Information governance
  • EPaCCS sharing
  • Palliative care meetings
  • EPaCCS reporting
  • Sharing electronic patient documentation
  • Scale of EPaCCS implementation

The EPaCCS project manager is leading an active Network Implementation Group (NIG) for EPaCCS, supported by the PEoLC Network. All areas in Cheshire and Merseyside are represented on the NIG. Every quarter a RAG rated report is collated detailing the progress made and, so far, all areas have moved from red to at least amber.

The group has also supported the production of a video Why EPaCCS?’ for the national PEoLC policy team and hosted a successful conference in March.

What we did

What’s the impact?

Facilitated a Care Home Summit for health & care professionals


Sharing of innovative ideas & best practice to inform the development of an end of life care strategy for improved care in care homes

Facilitated a focus group for patients to input into the development of P&EoLC standards & guidelines

Strong public involvement in the development of robust palliative care guidance for specialist & generalist care that will be submitted for NICE accreditation

Supporting local implementation of the national Transforming End of Life Care in Acute Trusts programme through an established sub group with dedicated facilitators

All 9 acute hospitals in Cheshire & Merseyside participating & working towards implementation. Education of generalist staff

Compile & distribute The Loop, a fortnightly electronic news summary

300 specialist & generalist staff kept up-to-date with local & national policy information, news, local initiatives & how they link to national policy & priorities

More information can be found in the Network's full Annual Report.