Case study:

11 May 2010

End of Life Care Pathway for All Diagnoses in Nottinghamshire PCTs

Key points

Three Nottinghamshire PCTs and their local authorities have produced an end of life care pathway for all patients in the last year of life as well as their carers.

The document, produced by NHS Nottingham County, NHS Nottingham City and Bassetlaw PCTs together with the relevant local authorities, aims to set standards for consistently high quality end of life care to patients with any condition and across all settings.

The pathway contains sections on breaking bad news, advance care planning, information prescriptions and care after death. It will also incorporate the forthcoming national quality markers for end of life care. Pathway audit mechanisms are under development as part of the PCT delivery plan.

Producing the pathway involved a literature search as well as widespread consultations and finally a large workshop for all stakeholders including health and social care professionals, the voluntary sector, the chaplaincy, patients and carers.

The final draft was then approved by the key stakeholder group and agreed by all three PCTs. Finally a series of introductory events were held across the county to encourage stakeholders to disseminate the final pathway document.

One of the biggest challenges was ensuring all stakeholders’ needs were addressed. It was particularly difficult to engage with carers of non-cancer patients since often they do not see themselves as carers or have no links with carer groups in direct contact with the PCTs’ end of life teams.The support of PCT patient and public involvement staff and of specialist community nurses was vital in resolving this.

Each PCT is now developing a strategic initiative delivery plan for end of life care to ensure services are commissioned in line with the pathway.A version of the pathway is also being produced for the public to support informed choice and advance care planning.With the clinical leadership and support of the Next Stage Review project, it is hoped this will ensure the pathway becomes embedded in practice.