1. Driving Change from Fragmentation to Integration:
North Manchester Macmillan Palliative Care Support Service (NMMPCSS)
Chris Mathewson, NMMPCSS Programme Manager
Alicia Waite, NMMPCSS Service Manager
Janette Hogan, Palliative Care Nurse Advisor (commissioning)

2. WiFi name: WifiLoveMCR Password: internet Join the conversation on Twitter using #DrivingChange

3. Why North Manchester? The base
Higher than national average no. of deaths in hospital
No Hospice in the geographical location of North Manchester
Higher no. of deaths from cancer and highest lung cancer death rate in the country
Crisis Driven Macmillan Team – due to sickness and under resourcing and nurses and therapists working as separate teams
District nurses struggling with high no’s of complex palliative care patients – also crisis driven
GP’s referring patients in crisis – registers not populated, no meetings

4. Key Ingredients

5. The Integrated Model layer by layer – not a soufflé!!

6. How to ‘bake’ the perfect team
A great team is more than the sum of its parts.
Staff are unique in what they can contribute
Critical role of leadership and culture should not be under estimated
Have a team that feels safe is a great start
The team goal needs to be clearly articulated
New staff members are hired with the team’s goals in mind

7. The North Manchester Macmillan Palliative Care Support Service (NMMPCSS)
Nursing and Therapy Team working as one
Enhanced team (Service Manager, Nurses, Therapists, Assistant Practitioners, Volunteer Coordinator, Admin)
8am-8pm – 7 day a week service
Medical Consultant led service
Single point of access – triage clinician

8. Primary Care Development
Palliative Care Registers populated – all life limiting illnesses and care homes
Re-establishment of palliative care meetings
Attendance of NMMPCSS member and District Nurses at palliative care meetings.
MCIP Local Commissioned Service – Cancer and end of life facilitators
Standards for General Practice - including palliative care
GP – one day a week with NMMPCSS
Enabled more supportive care, proactively for a greater amount of patients.

9. Community Services
District nursing review – enabled attendance at daily triage meetings with NMMPCSS
District nurse link role – enabled safer/timely discharge/increased hospital staff’s knowledge
District nurses key members on hospital Multi Disciplinary Team (MDT)
Crisis response team collaboration (frail elderly)
Intravenous Therapy Team (pathways for antibiotics, rehydration)
Respiratory Team, Cardiac Team – education and joint working
Work with Social Services – to ensure timely access

10. Acute Sector
Providers of NMMPCSS employed by Pennine Acute Hospital Trust – enabled the following redesign:
Redesign and development of acute Multi Disciplinary Team
District Nurse Link worker, new role – worked with ward staff and discharge team
Community Consultant in-reach – hospital consultant outreach
Spiritual team out reached to community – patient and staff support
One team approach to education and governance

11. Hospices 3 Hospices located outside Manchester border – commissioned
St Ann’s Hospice - Enhanced 24 hour helpline Development work with
Dr Kershaw's to reduce delayed discharges
Springhill Hospice – liaised with re. changes and how to access/liaise with NMMPCSS
NMMPCSS Developed a ‘Patient management system’ enabled them to ‘follow patients’ into hospices and hospital

12. Enhanced Support – The Icing on the cake
1. Volunteer model established
Phase 2 developments:
Complimentary Therapy
Lymphodema Service
Social groups developed

14. Impact – the difference made

20. Challenges Turning strategy into an operational model
Data – Gathering relevant data to demonstrate how the new service impacted on palliative care outcomes.
Many staff appointed at the same time – tight deadlines for implementation.

21. Key messages
Establish correct structures – with effective user involvement.
It is hard work and requires continuous commitment from all.
Don’t feel like you have to do it alone – matrix work – utilise all skills.
Its great when it all comes together and feedback demonstrates how well it is working for patients and staff.