In January 2008, district nursing teams across Leeds Primary Care Trust began to work in a common way to deliver the same standard of care to their patients who are suffering from a life limiting illness and wish to be cared for at home. This is a significant step forward in ensuring that patients can confidently choose to live at home until they die, assured that highly trained, skilled professionals will deliver the care they need.

The Department of Health published this document in July 2008. This document provides guidance and recommendations to organisations that plan and commission care for those people who are approaching the end of their life. This is regardless of the illness which has caused their ill-health.

The document demonstrates the Department of Health’s commitment to raising the standards of care for this special group of patients. It recognises that many patients wish to be cared for in their preferred place of choice, which may be their own home. It also pays particular attention to the support for informal carers, and to the provision of education and support for professionals to deliver a consistent and high standard of care.

The various documents can be accessed here.

Preferred Priorities for Care (PPC; formerly known as Preferred Place of Care) is an Advance Care Plan (ACP), in which individuals can write down their preferences and priorities for care at the end of life in order to help prepare for the future.

It was developed because The NHS Cancer Plan (DoH 2000) acknowledged that support for patients living at home with advanced cancer is sometimes poorly coordinated and may not be available 24 hours a day. Moreover, it acknowledged that cancer patients should be able to live and die in the place of their choice wherever possible.

The PPC is a document that individuals hold themselves and take with them if they receive care in different places. It has space for the individual’s thoughts about their care and the choices they would like to make, including saying where, if possible, they would want to be when they die. Information about choices and who might be involved in their care can also be recorded so any care staff can read about what matters to the individual, thereby ensuring continuity of care. If anything changes, this can be written in the plan so it stays up to date.

It is never too early to start a PPC plan particularly for residents in care homes, which for many is their permanent and final place of residence. The PPC provides an opportunity for care home residents and staff to work together to develop Advance Care Plans in accordance with the new Mental Capacity Act. Residents can initiate the PPC at any time and this will help staff follow their wishes and act as an advocate if the resident loses capacity towards the end of their life.

Source: www.endoflifecareforadults.nhs.uk

The LCP was developed by the Marie Curie hospice in Liverpool to guide healthcare professionals in whatever setting (including hospitals and patients own home) to ensure that all aspects of care are considered when they are caring for patients in the last days of life. It prompts good communication between the professionals, the patient and their families/carers, ensures everything possible is done to keep the patient comfortable and prepares the patient and carers for impending death. It also ensures support following death is provided for the family.

The Gold Standards Framework (GSF) is a community based programme to improve the organisation and quality of care (enabling a gold standard of care) for all people nearing the end of their lives. The aim is to aspire for the ‘best’ for ALL patients nearing the end of life, whatever their diagnosis, stage of illness or choice of where they wish to be cared for.

Implementation of the Gold Standards Framework across the 118 GP practices within the Leeds Primary Care Trust began in 2005 bringing together the GP, District Nurse, Clinical Nurse Specialist (Palliative Care), Community Matron, on a regular basis, to discuss the needs and preferences of their most seriously ill patients and the needs of those carers caring for them. A full nursing and medical assessment takes place where needs, symptoms, preferences and significant, important issues for the patient and carer are identified. Planning care around patients’ needs and preferences enables, where possible, patients to live and die where they choose.

For more information, log onto www.goldstandardsframework.nhs.uk and click on patient, carer information.