1. Regional Reporting – Q2 Overview North Midlands and East London South
MOU Signed
[G]
Q1/Q2 Funding Released
[A]
Q3 Funding Released
Deliverable 1
Deliverable 2
Deliverable 3

2. Deliverable 1
Clinical and managerial participation in the quarterly national clinical network face to face meetings chaired by the NCD for End of Life Care.
Region
Meeting(s)
North
13 Sep - Representation at PEoLC Network meeting
Midlands and East
London
13 Sep – Representation at PEoLC Network meeting, feedback was due to be provided to Clinical Leadership Group members on 03 Oct.
South

3. Deliverable 2
Support local clinical engagement through mechanisms (and frequency) to be identified by the regional team.
Region
Date
Meetings
North
25 Jul
04 Sep
07 Sep
19 Sep
21 Sep
10 Jul
26 Sep
17 Jul
05 Sep
Greater Manchester Eastern Cheshire
North West DNACPR Oversight Group
GMEC with GM Cancer Palliative and End of Life Care Advisory Group
North West Operational Group Meeting
GMEC Educators Network
GMEC Workshop to the palliative and end of life care board
Yorkshire and Humber
Y&H Clinical leads meeting
Clinical leads/HEE teleconference
Regional joint event with HEE to scope EoLC training priorities
North East
Northern England Clinical Networks meeting - half day event (45 delegates), to share the findings of the scoping project of the two regional initiatives: Deciding right and the Caring for the Dying Patient document
Lancashire & South Cumbria
Palliative & End of Life Care Network Clinical Advisory Forum
Midlands and East
West Midlands (Engagement via the following groups, dates not available at the time this report was produced).
West Midlands Palliative Care Physicians Group
Midlands Regional Action Group (Transition taskforce)
West Midlands Paediatric Palliative Care Network

4. Deliverable 2 continued
Region
Date
Meetings
London
03 Jul
12 Sep
TBC
Quarterly Clinical Leadership Group meeting - Clinical network updates were presented to the CLG and there was a presentation from Steven Pruner (Personalised Care Group) and discussion on personal health budget for EOLC.
Regular regional commissioners network meetings - agenda included: CMC, Urgent Care Planning: Driving spread and adoption in care homes, My CMC Update.
STP and CCG engagement and support. STP clinical lead recruitment for north London complete , meetings to commence Oct 18.
South
18 Sep
19 Jun
South West
EoL Expert Reference Group representative of commissioners and clinicians
South East
Themed quarterly meetings - EPaCCS (not reported in Q1 report)
Themed quarterly meetings - Personalisation

5. Deliverable 3 A choice of one (or more) of the measures of success.
Region/ Sub-region
Deliverable
Progress (Highlights)
North - Lancashire and South Cumbria
North - Cheshire & Merseyside
North - Greater Manchester Eastern Cheshire
North – North East
Increase in the number of people identified, offered personalised care and support planning, included in the GP’s supportive/palliative care register and offer for inclusion in local EPaCCS.
Metric selected: metrics being scoped.
Reduction in the number of people who have 3 or more emergency admissions in the last 90 days of life from care homes.
Increase in the number of people identified, offered personalised care and support planning, included in the GP’s supportive/palliative care register and offer for inclusion in local EPaCCS
Metric selected: GP Palliative Care Register (TBC)
Refer also to EoL test site project
Increased access/ usage of shared digital records (EPaCCS)
Metric selected: Work in progress; data reporting streams are in place, the practice support has yet to go around and upload the EPaCCS resource.
Trying to secure a project lead and link into the STP digital plan – see issues
Pre-project workshop held to implement the framework Enhanced Health in Care Homes (EHCH)
Data required – see risks
Need to establish project team – see risks
Using STP SRO to link deliverable with the cancer centre pilot (delivering enhanced supportive and palliative care across C&M)
Position paper with the GM Digital Collaborative for consideration (further to deep dives in all localities re the EPaCCS situation).
Submitted a LHCRE bid for EoLC to be considered as a use case, awaiting a decision though early indicators are that it will not be prioritised in this phase.
Dash board in development with business analyst team
Advance Care Planning and communication skills training trainers trained and 251 attended one day programme
A first test run of the process and information sharing was successful.
A second, high level, dataset has been developed with the capability to collect KPI information on a month by month basis.

6. Deliverable 3 continued
Region/ Sub-region
Deliverable
Progress (Highlights)
North - Yorkshire & Humber
Embed PEoLC priorities within STPs
WY&H
Progressing the NHSE EoLC test site project
Co-ordinating specialist palliative care support for Yorkshire Ambulance Service (YAS)
Established Supportive Care scoping project with WY&H Cancer Alliance
HCV
Agreement that STP area will use same four key drugs in order to reduce issues of crossing boundaries / ensure safe prescribing and administration.
Ongoing implementation of ReSPECT process (potentially looking to roll this out across the STP)
In discussion regarding use of eSCR with addl info as an EPaCCS (and trying to promote this)
SY&B
Seminar being planned, the aim being to gain insight and sharing of locality priorities in relation to national/ regional EoLC deliverables as well as to understand common barriers
Project ECHO developed (provide training opportunities for YAS to advance personal development of staff and for managers to identify the training needs of their workforce with easily accessible solutions)

7. Deliverable 3 continued
Region/ Sub-region
Deliverable
Progress (Highlights)
Midlands & East:
East Midlands
East of England
West Midlands
Embed PEoLC priorities within STPs.
Metrics selected:
Update not available at the time this report was produced.
An exercise has been completed in East of England to establish the position with regard to the embedding of PEoLC within CCGs/STPs. Priorities for clinical lead are being identified.
A series of 10 minute films to support improvement in community based pain management produced
All six STPs have PEoLC in their plans (and an MoU exists between NHSE and each STP for PEoLC support to deliver for 18/19)
London
Increase in the number of people identified, offered personalised care and support planning, included in the GP’s supportive/palliative care register and offer for inclusion in local EPaCCS
Metrics selected: GP Palliative Care Register/ number of CMC records .
Planned future collection date(s): CMC data published monthly, GP Palliative care register annually.
Other metrics to be collated:
% of care home deaths in London (annual)
% of hospital deaths (annual)
Since the project launch Outer NEL STP has now agreed to use CMC as EPaCCS .
Other highlights include:
EOLC survey outlining the availability of essential and desirable elements of care for EOLC by CCG and by STP has been published (Sep 18)
A project which focusses on the EOLC of care home residents is underway, the project team has been formed and work will commence in Q3.
A single signposting document for bereavement support was signed off in Sep pilot sites have been secured to test the document.
Supporting NHS England with ‘access to medicines in the community’ project.

8. Deliverable 3 continued
Region/ Sub-region
Deliverable
Progress (Highlights)
South - South East
South - South West
South - Thames Valley
South - Wessex
Reduction in the number of people who have 3 or more emergency admissions in the last 90 days of life.
Personalisation: Number of personal health budgets at the end of life.
Improved outcomes and experience (ONS-VOICES) in end of life care for people
Metric selected : Voices Survey data and data from various parties such as McMillian, Marie Curie, Diabetes Research, Mental Health charities, Kings Fund reports, Care Quality Commission reports.
First 2 training events held - Delivery of training courses to care homes on ACP
Launch of Sussex ResPECT Collaborative (14 Sep)
NEW Devon EoL PHB (fast Track) site
Works streams have been prioritised to what can be realistically achieved – see risks..
24/7 provision of specialist palliative care - one month of data collection has shown potential gaps in services and the use of Special Patient Notes which will support the EPaCCS report findings.
UEC for EoL - recommendations have been developed
Update not available at the time this report was produced.

9. Mitigation (please also highlight if NHS E can support)
Risks
Risks Identified (rated Amber or above)
Risk
RAG Rating
Mitigation (please also highlight if NHS E can support)
North - Greater Manchester and Eastern Cheshire
Allocation of funding to support the GMEC work stream for EPACCS not in place. AR
Position paper for EPACCS developed and will go to the GM Clinical Reference Group 4TH October.
North – North East
EPaCCS slippage time (acknowledged at the start of the project) continues to push back the time scales with significant delays to date which have largely been due to the large organisations that are part of the project and the many changes that are ongoing at strategic level. AG
Working with the IT provider Black Pear their resource has been adapted to pull information directly from the primary care records into a plan where further details can be added as necessary. This plan can then be seen by other organisations and written into where appropriate.
We have helped shaped their product by highlighting functions we wanted which have now been included in their product.
North - Cheshire & Merseyside
Need data which shows where patient is admitted from, reason for admission and link to whether ACP in place (Reduction in the number of people who have 3 or more emergency admissions in the last 90 days of life from care homes).
Need to establish project team/ further refine project definition (A recommended working model for Specialist Palliative Care and acute hospital admissions)
Need to establish project group (A plan for C&M which supports roll out of electronic transfer of information to support of end of life care) A
Q2 activity has been around the STP work, this has resulted in some additional resource being secured (to work solely on EoL for the next few months).

10. Mitigation (please also highlight if NHS E can support)
Risks continued and Issues
Risks Identified (rated Amber or above)
Risk
RAG Rating
Mitigation (please also highlight if NHS E can support)
South – South East
Due to lack of contracted hours (managerial support on 7.5 hrs per month and clinical lead providing voluntary support):
No CCG meetings have been attended (CCG EoL Steering group meetings across the region to support EoL and STP)
Unable to attend locality ReSPECT meetings
Compassionate Communities Network has not been reinstated due to reduced capacity of man power resources AR
Midlands and East
Work is progressing to establish formal engagement of clinical leads in East of England and East Midlands with Region AG
Additional Leads being appointed, regional support identified.
Issues
Description
Date raised
Date resolved
Actions
South - Thames Valley
UEC for EoL – work to update pathway with recommendations/actions and scoping tool has been delayed (due to be completed Jul 18)
Q2 Report
(05 Oct)
Recommendations have been developed, proposed to the Chair and Lead for presentation to the Board.
North - Lancashire & South Cumbria
No project plan for L&SC which supports roll out of electronic transfer of information to support of end of life care
(15 Oct)
Trying to secure a project lead and link into the STP digital plan

11. NHS England RAG Guide - Risks
To calculate your risk RAG rating you should identify the likelihood and impact score from the tables on the left, the RAG is as per the table above (where the scores meet).