LIVING & DYING WELL : ACUTE HOSPITALS SLWG DR STAN WRIGHT, M.D. FRCP CONSULTANT RESPIRATORY PHYSICIAN - FORTH VALLEY CO-CHAIR ACUTE HOSPITALS SLWG

Challenge: Develop and sustain an Acute Hospital Palliative Care Service so that it is fully embedded in the culture and practice of the hospital.

Barriers: Workload too great for Specialist Palliative Care to deliver alone. Generalist staff not understanding role of Specialist Palliative Care. Specialist Palliative Care not always comfortable with non- malignant disease. Hospital system already overloaded with other priorities. Delivering education when rapid turnover of staff. Dependent on output of other groups eg. standards, guideline and referral criteria, assessment tools and advanced care planning. Co-ordinating with other strands of work eg. Scottish Patient Safety Programme, Better Cancer Care, Better Together, Scotland's Patient Experience Programme, Shifting balance of care, Improvement support teams eg. LTCG & 18 week RTT.

Advantages of Palliative Care in Hospital: 58% patients die in hospital. Better and more efficient control of symptoms. Orchestrates well planned discharges. Optimises investigations and drug treatment in advanced illness. Improves patient and family satisfaction. Provision of education. Eases burdens on staff.

Recommendations: 1. For individual Boards/Hospitals. 2. For Working Group.

Recommendations for Individual Boards/Hospitals: 1. All Acute Hospitals should establish a Palliative Care Programme.. Integration into Management Structure of Hospital.. Integration into Management Structure of Hospital.. Implementation Team.. Implementation Team. 2. Each Hospital has a Palliative Care Education Programme. 3. Every Hospital has an easily accessible Palliative Care Consultation Service. 4. There is a ward based Palliative Care Resource which is audited including: i) Pain Assessment system. i) Pain Assessment system. ii) Care Pathway for dying patients. ii) Care Pathway for dying patients. iii) Service Directory. iii) Service Directory. iv) DNACPR Policy. iv) DNACPR Policy. v) A means to communicate advanced care plans. v) A means to communicate advanced care plans. 5. Views of patients and families should be audited.

Recommendations for Working Group: Establish what Specialist Care Services are needed to support Generalists. Help develop Palliative Care Standards in Hospital. Support NES with regard to Palliative Care Education in Hospital. Work with Health Board Leads. Work with E Health on discharge documentation.

Conclusion: A long term project. Benefits for patients and hospitals.

Thanks: Pam Levack (Co-Chair) Mark Aggleton David Gray Liz Travers Tom McCarthy Alison Mitchell Euan Paterson Kirsty Boyd Flora Odea Michelle Gillies Alistair McKoeown Helen Morrow Catriona Rostron Elizabeth Ireland Heidi May Jackie Chaplin Maggie Grundy Marysia Williamson Nick Pace Patricia Wallace Peter Kiehlmann Sally Chisholm Sheena Kilpatrick Emma Dymond Gary Morrison