Update on Palliative and End of Life Care

The below is an update from the national team working on palliative and end of life care.

  • CQC and GMC have published a joint statement on the use of medicines that are unlicensed or outside the terms of their existing license (‘off-label’) to support the NICE rapid guideline on symptom management. Although we are used to this situation, many of our non-specialist colleagues are not, and the purpose of this statement is to provide them with reassurance: https://content.govdelivery.com/accounts/UKCQC/bulletins/28518c1
  • In last night’s Primary Care Bulletin from NHS England and NHS Improvement, there was a piece about holding anticipatory medicines in local hubs rather than in individual patient’s homes or care homes:
    • Anticipatory medicines at the end of life

      During the COVID-19 emergency, there have been calls for care homes and individual patients be able to keep anticipatory medicines for end of life care to be used when normal supply might not be possible (e.g. out of hours or at the weekend). The decision to place medicines in care homes as anticipatory stock needs to be balanced with the impact of increased demand on the medicines supply chain. We advise that care homes or individual patients should not routinely hold anticipatory medicines stock and stocks should be centralised as much as possible.

      We are aware that some CCGs have already established local hubs to ensure rapid access to anticipatory medicines. Those that do not already have these arrangements in place should consider setting these up as a matter of urgency. These hubs could be community pharmacy, GP practice, community hospital, acute or other settings where palliative medicines (including controlled drugs) can be safely and legally stored and rapidly released when needed. The CCG Chief Pharmacist and their team are central to this action. CCGs should work with providers to ensure rapid access to end of life medicines for patients.

  • Hospice funding announcement

    On 8 April 2020, the Chancellor announced that up to £200m will be made available over the next three months, to enable hospices across England to continue to provide critical support to people at this time. Read the full Government announcement here and the Hospice UK response.

     

    Discussing unwelcome news – a framework for communication
    A number of short films have been developed by experienced clinical staff about how they would have a conversation relating to COVID-19 scenarios.  These resources have been shared on the HEE e-Learning for Healthcare (e-LfH) hub. Links to these resources are now also available on the Secondary Care and Community areas of the NHS E/I Coronavirus pages.

     

    Maintaining standards and quality of care in pressurised circumstances

    Chief Nursing Officer for England, Ruth May, and National Medical Officer, Steve Powis, jointly published a letter on 7 April 2020 and this includes important information about DNACPR orders – we encourage you to both read and share.

     

    Advance care planning guidance and templates

    Published as appendix 7 of the GP standard operating procedure update on 5 April 2020. We will also be sharing these as a standalone publication over the coming days.

     

    Updated guidance on COVID-19 prioritisation within community health services

    Community health services are vital to the COVID-19 response.  This guidance details which community health services should stop, partially stop or continue so that providers can release capacity to support the COVID-19 response, and has recently been updated in line with developing clinical advice.  To easily identify the most significant changes, it is accompanied by a change log which records additions, removals and changes to categorisation of services.

     

    Visitor guidance

    This was updated on 8 April 2020, and can be accessed here.

     

    Our NHS People

    This fantastic support and resource hub is regularly updated to help staff find out what support, guides and helplines are available. Current offers include free access to apps, a wellbeing helpline and text alternative to name a few. It’s so important that staff are reminded to manage their own health and wellbeing whilst looking after others.

     

    📄 Upcoming guidance

    We are working on a number of publications and we hope to be able to share the following with you over the coming days and weeks:

    • Symptom management for children and young people with COVID-19
    • Standard operating procedure for medication – alternative to syringe drivers
    • Standard operating procedure for community palliative care services
    • Standard operating procedure for children and young people hospice inpatient units
    • Standard operating procedure for verification of death in a period of emergency
    • Information to support unpaid carers looking after someone with palliative or end of life care at home

     

     

    📄 Publications and guidance produced by other organisations

     

    NICE rapid guidelines for community care

    Published 3 April 2020 – COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community.

     

    Wellbeing plan from the National Academy of Social Prescribing

    This Personalised Wellbeing Plan template has been developed to support people through COVID-19, particularly those who are self-isolating or shielding. It can be used by anyone who is self-isolating, family, friends, healthcare professionals and carers to summarise a person’s personal circumstances, and the things that matter most to them at this time.

     

    📄 Reminder of NHSE/I PEoLC guidance published so far

     

    Clinical specialty guide for palliative and end of life care in secondary care  published 28 March 2020.

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