Case study:

11 May 2010

District nursing service delivery framework for end of life care in Leeds PCT

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Key points

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Leeds PCT has introduced an end of life service delivery framework to improve care and reduce variations in practice across 80 district nursing teams based in 42 separate health centres in the city.

The change has led to improved communications and more consistent recording of information as well as increased use of end of life care tools.

It has also meant that more palliative care patients receive personal care from district nursing teams rather than agency staff.

And a new, simplified system for ordering equipment means that increasingly district nurses rather than continuing care lead nurses are able to authorise equipment loans for palliative care patients.

There is now a shared understanding across all organisations of the district nursing role in palliative care provision.

The framework was developed over seven months with district nurses involved at every stage.

Launched in November 2007, the framework outlines five key areas for nursing intervention and links these to the recording of district nursing activity on a community information system.

An easy to use electronic audit form is linked to the community information system, which collects data on palliative care patients and their preferred place of care.

It then measures this against their actual place of care, and where there is a mismatch indicates why this has happened.

Meanwhile all 80 district caseload holders in Leeds PCT Care Services are expected to have attended mandatory education outlining their roles and responsibilities as caseload holders by January 2008.

All this has been taking place at the same time that five separate PCTs have been merging into one single organisation.

It has been a huge challenge to develop equity in service provision across the entire network but it has also presented opportunities.

For example, the whole district nursing service is now able to access a generic bank of health and social care workers.

Previously this was available – in a limited fashion – to just two of the PCTs.

The new staff bank, which is funded by Leeds PCT, Marie Curie and some continuing care money, is an integral part of the district nursing workforce and reports directly to district nurses.

The trust plans to evaluate the service to ensure it is fit for purpose with clinical staff themselves being closely involved in this review.

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