Strategic Group Meeting Minutes
Meeting in Public - Southampton Voluntary Services
Tuesday 2nd August 2016
6:00pm - 8:30pm
Name / 06/16 / 07/16 / 08/16Anabel Hodgson / A / A / ü
Harry Dymond / ü / ü / ü
Steve Beal / A / ü / x
Jo Ash / ü / ü / A
Lesley Gilder / A / ü / ü
Anne Cato / ü / ü / x
Paula Barnes / ü / ü / ü
Strategic Group absent (no apologies given) / Strategic Group apologies / Healthwatch Southampton supporting staff
JA / Rob Kurn (Manager)
Ben Grace
18 Declaration of interests / None
18.1
Planned Developments at Southampton General Hospital / Matthew Hine was due to give an update on improvements to car parking issues at Southampton General Hospital but sent his apologies, he could not attend due to illness. Harry Dymond to arrange for MH to give presentation at a future meeting .
Peter Hollins explained that the issue lied not with funding but with traffic flow. There are plans for a car park with 800 spaces, due to be commissioned in Autumn 2017.
18.2
DNACPR – Ben Chadwick / Karen Hill / Rob Kurn presented a SurveyMonkey questionnaire that was sent out to HWS members around the subject of DNACPR. Chrissie Dawson queried whether results would be duplicated across other forums.
Ben Chadwick gave a presentation about policy and practise of DNACPR at UHS. He showed the group a blank DNACPR form explaining that DNACPR forms are carbon-copy, three-tier forms. DNACPR forms are filled out for one of three reasons:
1A) CPR is likely to be unsuccessful
1B) CPR may be successful but quality of life could be unreasonable
1C) Patients wish
Karen Hill discussed the results of their internal audit into DNACPR forms. The current threshold of discussion with patient/family is 80%, this has been improved historically but remained steady for the past few years. UHS have been looking in how to improve that number.
Karen Hill noted that one issue is carbon-copy forms become separated making it harder to prove that a discussion has taken place.
Karen Hill gave a breakdown of the results of internal auditing process of DNACPR forms:
· 1996 forms were audited last year
· 94% were appropriated dated
· 85% of DNACPR forms were classified as 1A, 15% as 1B and 0.6% as 1C
· 52% of forms we’re marked as being discussed with patients
· 38% identified no discussion had occurred with the patient on writing the form
· 12% did not document whether a discussion had occurred
· 79% were marked as being discussed with family members
This audit led to a further deeper audit pulling all the medical notes of the patients where the initial audit had identified a discussion had not been documented as occurring on the audit sheet.
Coming from audit, Karen Hill pulled the medical patient notes of DNACPR forms that lacked documentation that a discussion had taken place:
· 277 sets of patient notes were pulled for this reason.
· 172 contained justified reasons as to why there was no discussion with the patient i.e unconscious
· 38 had in fact been discussed with the patient but not marked on the DNACPR form, there was clear documentation in the medical notes of these discussions.
· 19 couldn’t find copy of DNACPR in patient notes (this may have been because patients have several sets of notes).
· 3 patients refused to have a discussion
· 28 set of notes didn’t arrive in time to be audited,
· 4 were not discussed with patient.
Karen Hill also pulled the patient notes of DNACPR forms that lacked documentation that consultants had reviewed the DNACPR:
· 102 sets were audited,
· 74 had been verified by consultants
· 5 sets weren’t made available
· 14 sets were not verified by consultants.
HD noted that while the auditing may be sufficient to avoid legal issues, there may be public perception issues with family members becoming distressed when not being informed about the existence of a DNACPR form until an emergency arises. He asked how the form could be improved.
KH/BC noted the flaw in the process is when the forms are seperated and noted a potential improvement would be a transfer to electronic DNACPR – currently not in use due to concerns with set-up issues, transferring this information across healthcare providers and how it would be shared.
PB asked whether there is a sufficient review/cancellation process for DNACPR
Discussion about how early GPs could be talking to the public about DNACPR when patients are in a better state of mind – this came across in the survey that respondees favoured early discussion.
PB said that there is a fear that a DNACPR is an excuse to not offer enough treatment to patients and let them die, not getting invasive treatment that it is more than just saying just restart my heart. PB said there should be improved literature outlining what a DNACPR does/doesn’t mean, reassuring patients.
Chrissie Dawson noted that they’re looking at improved training across services and asked whether auditing could be shared across services.
RK asked what the review process is. BC said that there is a review section on the form which can reviewed at any time.
PB asked whether a DNACPR could be sent to a GP so that a discussion could be offered after the acute issue has been resolved. KD said that is not currently an option however all DNACPR are reviewed. Discussion on how a GP could be informed about new DNACPR to discuss.
HD asked what proportion of patients that die have DNACPR – BC/KD did not have the data to hand but will find out and advise. This has been submitted the HD
AH asked about DNA/CPR for children. KE said only 4 Advance Care plans were written last year.
Information/statistics to be shared on Healthwatch website. BG to produce statistics/facts, HD to write text. BG to email to double check statistics
18.3
End of Life care at UHS – Carol Davis / Carol Davis gave a presentation about the current End of Life climate
National backdrop – NHS business plan is now including end of care within their budget, being taken much more importantly nationwide.
Chrissie Dawson asked about the practicalities of guidance stating a goal for end of care is for patients to ‘live as well as they wish’ ‘live as well as they can’ would be better, raised hopes?
Carol Davis discussed the 5 Priorities for improvement.
Discussions about commissioning specialist palliative care are ongoing.
Carol Davis spoke about using radiotherapy for pain management – after putting in a successful bid, it’s been running since April, patients given option of attending one-off appointment, meet ing radiotherapy specialists and being advised whether one-off radiotherapy treatment would improve pain controls. Previously this would have happened over 3 appointments but has been managed to take place over one day, proven successful, Carol Davis hoping to continue this after funding comes to an end (1 year funding) –RAMPART clinic? (rapid access)
HD talked about CQC noting end-of-life care could be involved. HD was involved in that process, talking to patients and family members. The review process run by UHS is positive.
Carol Davis said full review results hadn’t arrived yet but early results look positive, some issues, security issues at Mountbatten House, concerns with care of the elderly – will advise when full review results come in.
HD talked about how the results found that there were issues with one/two departments, one being the emergency department. Carol Davis noted that end-of-line don’t currently have a great profile in emergency and are looking at how they can improve awareness in that area.
There was a discussion about lack of side rooms across the hospital for end-of-life patients and how that could be improved.
Carol Davis brought the Individualised End of Line Care Plan for the Last DAYS OR Hours of Life document that she’d designed and implemented which was discussed in depth, feedback was positive, noted for its wide scope and ability to personalise, sensitivity and ease of use.
No concrete data on how many patients expected to die are using this plan, however Carol Davis believes it to be around 80% with a view to improve it.
PB asked about retrospective painkillers, using yesterday’s painkiller amount to set the base-level amount for the next day. Carol Davis noted that in some cases, pre-emptive painkillers are administered where patients have a known pain issue. Carol Davis said that on the whole, this system works well but needs to flexible and is down to the best judgement of staff.
UHS has funded staff placements based on the success of grants funded by Marie Curie for end-of-life care giving and education.
Carol Davis will be working in partnership with the Daily Echo to promote awareness of end-of-life care.
Carol Davis mentioned that UHS have finalised a survey to gauge feedback to family members after end of life care.
18.4
Minutes and matters arising / HD suggested having all meetings becoming formal meetings. RK noted the difference currently is that only formal meetings are open to the public. To discuss further on Monday at Priorisation Planning Meeting.
GP strategy – HD to invite
Subjects to discuss in September meeting – to discuss on Monday
Website – on track 24th August
Peer-to-Peer young persons
Wessex Community Voices – showcased in NHS England annual report (page 36)
To discuss the issue of fluoridation and ensure proper public consultation is carried out and that the public are well informed.
Date of next meeting
Tuesday 6th September – Informal meeting, 6.00-8:30pm, Southampton Voluntary Services.