Background
The Sheffield Citywide End-of Life-Care Group is a collaborative group of professionals from health and social care providers, and commissioning organisations, working to provide high quality palliative and end-of-life care, 24 hours a day, 7 days a week for people in Sheffield. The current aims and ambitions of the group exist in the wider context of:
- Changing patterns of illness resulting in more people, of all ages and with a wide range of conditions, who have palliative care needs – physical, psychological, social and spiritual.
- The Covid-19 pandemic and impact on palliative care, end of life care in the community, and bereavement.
- Longstanding inequalities in the provision of specialist and generalist-level palliative care.
- A need for collaboration of services, and commissioning to support this.
- Commitment in Sheffield to public health approaches in palliative care and community engagement in palliative care (Compassionate City).
The group started meeting in April 2020 and now meets monthly via Microsoft Teams.
Membership is nominated organisational leaders from Sheffield CCG, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield City Council and St Luke’s Hospice, Sheffield. Sheffield Children’s NHS Foundation Trust and Bluebell Wood Children’s Hospice have recently been invited as we move into the next phases of the pandemic and beyond. Membership is regularly reviewed and partners from other organisations invited when possible.
The principles of the group
The ambition of the group is to ensure that all dying people in Sheffield can make the last stages of their lives as good as possible, because everyone works together confidently, honestly and consistently for them and the people who are important to them, including their carer(s), informed by national policy and best available evidence during the COVID-19 pandemic. You can find more information here.
The group has responsibilities at the following levels:
- Tactical – identifying and ensuring a timely, agile response to changing need for palliative and end of life care through the phases of the COVID-19 pandemic and beyond in Sheffield with partners
- Operational – making recommendations to the organisational executive teams and/or command and control structures to implement the necessary service developments in all settings including primary care, community services, secondary care and specialist palliative care.
Challenges
The group consists of people from many organisations who all ensure that they put their organisational priorities aside and support one another to provide the best palliative care.
Pre-COVID-19, there was work to do to improve personalised, palliative and end-of-life care for everyone in Sheffield. The aims and ambitions of the group exist is in the wider context of:
- Changing patterns of illness resulting in more people, of all ages and with a wide range of conditions, who have palliative care needs – physical, psychological, social and spiritual.
- The mobility of resources that has come from the COVID-19 pandemic and impact on palliative care, end of life care in the community, and bereavement.
- Longstanding inequalities in the provision of specialist and generalist-level palliative care.
- A need for collaboration of services, and commissioning to support this.
- Commitment in Sheffield to public health approaches in palliative care and community engagement in palliative care (Compassionate City).
Achievements
The work of the group has included:
- Attendance at other relevant meetings including the Death Management Cell and the Care Home Cell
- Regular meetings with Primary Care Clinical Reference Group for Covid-19 end of life care
- Dissemination of national guidance
- Development of local guidance – palliative care formulary for Covid-19, regular medicines updates, verification of death, community resuscitation (DNACPR) policy
- Care at the time of death – review of verification of death processes, training and competence; working with the police and coroner to develop PMART
- Personalised care planning – Sheffield Teaching Hospitals summary Advanced Care Plan, Yorkshire Ambulance Service personalised care planning proposal (in progress), links with other ACP work in hospital and primary care
- 24/7 community services – STH regular review and reconfiguration of services to meet demand
- Palliative and End of Life Care Support for care homes (ongoing concern)
- Future planning including a focus on complexity, care planning, carer administration of medication, specialist medications at the end of life and management of enteral feeding in the community
- Leading national research into the experiences of primary care in EOLC during the pandemic, and building links for more research with the University of Sheffield and Sheffield Hallam University
- Commitment in Sheffield to public health approaches in palliative care and community engagement in palliative care, and the role of professional organisations in a Compassionate City.
The collaborative efforts of group members, and especially all of the frontline clinical staff in the delivery of palliative and end of life care in the community during the first phase of the pandemic are recognised and should be acknowledged.
Testimonials from those in the group
‘The Sheffield City-wide End of Life Care Group enables providers from all sectors to join together and explore the opportunities, challenges and barriers we face in the delivery of accessible and high quality end of life care across the city, and to identify collective actions to develop responses and services to better support our citizens, whether patients, families or fellow professionals. Honesty and transparency together with trust and integrity are fundamental to this process, as is the ability to listen to the quiet and considered voices which are often sidelined in the rush to ‘find solutions.’ The group has seen success across the pandemic by sharing, listening and addressing immediate needs with unanimity, leaving lower priority items for future consideration. Wisdom exists in the smallest of corners and the group has helped to find a voice for this to shape a successful response to the pressures we’ve faced.’
Peter Hartland, St Luke’s Hospice
