Agenda item

The Strategy sets out the collective ambitions we want to achieve across Surrey Heartlands as an Integrated Care System (ICS) to improve palliative and end of life care for our citizens. 

It is now for Integrated Care Partnerships (ICPs) and local partners to work together to deliver these improvements for their local communities.

Witnesses:

Dr Charlotte Canniff - Surrey Heartlands CCG Chair and HWB Deputy Chairman

Vicky Stobbart - Guildford and Waverley Director of Integrated Partnerships and Executive lead for PEoLC, Surrey Heartlands CCG 

Katherine Church - Joint Chief Digital Officer, Surrey County Council and Surrey Heartlands Health and Care Partnership

Dr Sian Jones - Guildford & Waverley GP Representative, Surrey Heartlands CCG

Sreya Pokkali - Research and Engagement Officer, Surrey Heartlands Health and Care Partnership

Key points raised in the discussion:

1.    The Deputy Chairman noted that living independently and dying well was a focus area under Priority One of the HWBS, noting the item at the June 2019 Board on the End of Life Care Partnership Project which was tasked with bringing together all services across Surrey that were involved with end of life care and palliative care. Its aim was to work collaboratively across the system and partners to improve the experience of Surrey’s citizens.

2.    The Guildford and Waverley Director of Integrated Partnerships and Executive lead for PEoLC (SH CCG) noted that:

·         Her role as executive lead was based upon the development of the Palliative and End of Life Care (PEoLC) Strategy 2021-2026, ensuring that all voices were heard and that it captured the collective ambition of partners and citizens.

·         The Strategy was centred on the importance of personalised care that was planned in partnership with the individual and their caregivers, which was particularly important during the pandemic.

·         The care that someone received at the end of their life had the power to bring comfort and peace, it was vital to get the approach right as the experience of end of life care may have a profound effect on the bereavement process and future trust in health and care services.

·         In Surrey there were 10,000 deaths every year, every single person counted, end of life care should be coordinated, personalised, and compassionate.

·         From initial discussions emerged the PEoLC Strategy Development Reference Group to work on the Strategy and work was underway to co-produce it, and there were many examples of excellent care provided by services across Surrey as well as honest reflections about areas where it had not gone well.

·         The five-year strategy and the high-level outcome measures reflected the ambitions to deliver change. The strongest theme to emerge from the engagement exercise was the significance of the person, including their circle of support, and sharing information so that everybody has a clear understanding of the person's wishes and needs. 

·         Further high-level outcomes included dying with dignity, that care was provided in the community where possible and after-death families were supported.

·         There had been an incredible response in the development of the Strategy, over twenty organisations had been involved in scoping, drafting and designing, with over thirty members of the monthly PEoLC Strategy Development Reference Group.

·         It was clear that across Surrey there was a real dedication and commitment to wanting to get the Strategy right.

·         She was pleased to have the support of the Surrey Heartlands Research and Insights Team which led a review of local, national and international literature and gathered views from a wide range of stakeholder groups across Surrey. In partnership with the voluntary sector, the team conducted twenty-five interviews with people from different population groups at the end of their lives.

·         Implementation plans would be drafted by the ICPs and local partners.

·         Outcomes would be measured and the ICS Performance team was working on pulling together the data sources.

·         The Strategic Quality and Performance Board as well as updates to the Health and Wellbeing Board, would ensure accountability and the Strategy would be shared through the newly established clinical and professional executive board and the Strategy Development Reference Group would be re-established.

·         The Surrey Caring to the End support website was launched a few weeks ago which provided resources and signposting to unpaid carers.

·         If approved the Strategy including a summary version and future easy read version would made available online on Surrey Heartlands ICS, Surrey County Council and Surrey Heartlands CCG websites, and would be shared with partners to be publicised.

·         A formal launch was planned to coincide with Dying Matters Week, between 10 - 16 May.

·         Thanked all those involved across the system for their support and collaboration including those interviewed, key officers involved in developing the Strategy and the Deputy Chairman.

3.    The Joint Chief Digital Officer for Surrey County Council and Surrey Heartlands Health and Care Partnership noted that:

·         It had been a privilege to be part of the Strategy and the collaborative partnership effort was inspiring.

·         Ensuring joined up care was vital, noting the digital principle ‘know me, know my needs’, the Surrey Care Record was live with 95% of GPs working on that and collaborating with Surrey’s acute providers. Surrey’s five hospices were to be incorporated into the Surrey Care Record with further integration planned with primary care and SECAmb ensuring access to ReSPECT forms across the system.

·         That the new Surrey Caring to the End website provided a range of services and the content would continue to be enriched.

·         That death was not the end of the journey for families; obtaining a death certificate swiftly and being able to carry out funeral rites was important, so work was underway to issue Medical Certificate of Cause of Death (MCCD) in a timely manner, which could be digitised through the national programme.

4.    The Guildford and Waverley GP Representative SH CCG noted that:

·         It was a privilege to be part of this piece of work and as a GP it was a privilege to be able to look after people at the end of their lives, working with their families and carers.

·         Welcomed the collaboration undertaken in the Strategy, in which primary care was a key part.  

·         47% of citizens or patients die at home or in their care home in Surrey, compared to the national trend towards deaths in hospital although that was reducing which was positive.

·         Hospices were important and supportive of primary care in allowing us to be able to look after people in their own homes, it was hoped that the Strategy would make end of life care equitable across Surrey.

5.    The Chairman explained that:

·         Regarding the second recommendation he had spoken with the chairman of the national Health and Social Care Select Committee, Rt Hon Jeremy Hunt MP, who had agreed that his select committee would be looking at end of life care later in the year.

·         There was an issue around the long-term funding of hospices, only 25% of which was statutory funding, the pandemic had shown the importance of hospices for PEoLC and community care along with the Voluntary, Community and Faith Sector (VCFS).

·         He was keen to send the Strategy to Rt Hon Jeremy Hunt MP to raise national support on PEOLC and review the allocation of resources to hospices.

·         Going forward discussions were needed on the provider collaboratives and how hospices amongst others, fitted into that within the ICPs.

6.    A Board member welcomed the emphasis in the Strategy to equal access to bereavement support. She noted that bereavement and loss were critical factors in relation to mental health issues and was a contributing factor to the risk of suicide. She stressed the importance of recognising that relationship and to prioritise that.

7.    A Board member commended the Strategy which was moving to read and was attentive to people’s needs and wishes.

·      She emphasised the importance of having a flexible boundary between children's and adult services, understanding that although the legal status of an individual changed from a child to an adult at 18 years old, their needs and environment remained unchanged.

·      She was drawn to ambition 4: care is co-ordinated, with different services working together - in which the insights in the strategy highlighted the difficulty in navigating the transition from child to adult services for end of life care. Noting that the right approach might be continuing to look after a young adult in a children’s service as opposed to try that transition; she highlighted the example in schools when care and education continues once a pupil turned 18 in their last stage of education noting the importance of honouring that approach across services.

-     The Chairman supported the need to look at the experience of those in that transition stage from a child to an adult.

8.    A Board member welcomed the complete and sensitive report, noting that it felt as though the PEoLC Strategy Development Reference Group and evidence base had the opportunity to look at both historic situations and examples of where things had not gone well and queried how such examples had been addressed in the Strategy, noting the polarised experience and challenge of Covid-19.

-       In response, the Research and Engagement Officer (SH HCP) noted that when individuals were interviewed they were asked about their experiences around supporting individuals and their families regarding end of life care in general, however Covid-19 had exacerbated some of the existing issues around the rigidity in choice and that IT systems were not joined up.

9.    A Board member welcomed the clarity of the report and the sensitive engagement of the links between the insight gathered and the actions. She welcomed the Surrey Caring to the End support website noting positive feedback from some of Healthwatch Surrey’s volunteers.

·         She further welcomed the clear outcomes and that it was interesting to see the differentiation between outcomes for individuals and families split out from outcomes for the system. Regarding delivery going forward with ICPs and local partners responsible to deliver the improvements, she sought further detail on how feedback from individuals and families would be tracked at ICP level as it was difficult to obtain.

·         She highlighted the potential risk that it would be simpler to measure performance against some of the system outcomes compared to the outcomes for individuals and families and asked whether there would be a framework for making sure that all those metrics measured across the ICPs were consistent and the outcomes were being delivered.

-       In response, the Guildford and Waverley Director of Integrated Partnerships and Executive lead for PEoLC (SH CCG) noted that when looking at the measurement of the metrics, it was recognised that a whole new way of measuring was not needed as there multiple existing surveys and qualitative information available for individuals and families, so the ICS Performance team was tasked with collecting all of those data sources and to look at amalgamating that to ICP level.

-       The Guildford and Waverley GP Representative (SH CCG) added that there had been discussions with the Senior Commissioning Manager - End of Life Care and Cancer (SH CCG) on the matter, noting that there were also national audits for end of life care that were used in acute trusts and different metrics used within hospices. Although those tools and sources were different they asked similar questions, so the ICS Performance team were pulling those consistent metrics together.

10.   Referring to the metrics, a Board member asked whether officers needed to discuss the Strategy in more detail at each of the ICP boards or whether that was in place.

-       In response, the Guildford and Waverley GP Representative SH CCG and Guildford and Waverley Director of Integrated Partnerships and Executive lead for PEoLC, Surrey Heartlands Clinical Commissioning Group (CCG) welcomed the opportunity to visit the ICP Boards; noting that ICP leads and providers were engaged in the development of the Strategy.  

-       The Deputy Chairman added that most of the people engaged in the development of the strategy were from the ICPs, including hospice chief executives, acute trust oncologists, palliative care consultants and charitable organisations.

11.  The Chairman thanked officers for their work on the strategy noting that it was an important piece of work and would be progressed across the system and with the national Select Committee.

RESOLVED:

1.      The Health and Wellbeing Board approved the Strategy.

2.      The Chairman of the Health and Wellbeing Board would write to the chairman of the Health and Social Care Select Committee, Rt Hon Jeremy Hunt MP, to share the PEoLC Strategy and seek clarification on the Government’s plans for a central strategy and the allocation of resources to hospices.

Actions/further information to be provided:

1.    Officers to work with Board members to discuss the Strategy in more detail at each of the ICP boards where appropriate.