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'Living Matters:Dying Matters'. A Palliative and End of Life Care Strategy for Adults in Northern Ireland

Mr Michael McGimpsey, Health Minister launched 'Living Matters : Dying Matters'. A Palliative and End of Life Care Strategy for Adults in Northern Ireland on Thursday the 18th March 2010. Click here to view the Strategy

The Strategy identifies palliative and end of life care as a continuum of care that can evolve as a person's condition progresses. This is an integral part of care delivered by all health care professionals, and indeed by families and carers , to those living with , and dying from any advanced, progressive and incurable condition. Palliative and End of Life Care focuses on the person rather than the disease and aims to ensure quality of life for those living with an advanced non- curative condition.

This  5 year strategy provides vision and direction for service planning and delivery. It has been developed and should be implemented within the existing legal framework. 

The Strategy builds on current and predicted demographics, intelligence and consultation which have informed the implementation of other Departmental policy areas, Service Frameworks, and Priorities for Action Targets and takes into account policy context from the other United Kingdom (UK) countries and the Republic of Ireland (RoI).
 
The Strategy sets out a vision for palliative and end of life care across all conditions and care settings, based on what people value most and expect from such care. This vision emphasises the importance of:
 
  • Understanding palliative and end of life care;
  • Best and appropriate care supported by responsive and competent staff;
  • Recognising and talking about what matters;
  • Timely information and choice;
  • Co-ordinated care, support and continuity.   
 Click here to see vision in more detail
 
Driving the service improvement expectation of this vision, requires ownership and leadership from across all commissioners and providers. The roles of public, independent, community, and voluntary sector organisations, and the collaborative arrangements that exist between them are essential to quality palliative and end of life care. The Strategy reinforces the need to continue to strengthen these creative partnerships, through local and regional infrastructure and strategic plans.
 
It is estimated that two thirds of the people in Northern Ireland would benefit from palliative and end of life care prior to and during their last year of life. Added to these are the supportive needs of the family and carers. Greater public and professional understanding of palliative and end of life care will ensure that patients, carers, families, communities, and staff will have the right knowledge and skills available at the right time and in the right place to deliver compassionate, appropriate and effective generalist and specialist palliative and end of life care.
  
A number of specific tools and frameworks to direct service planners and providers to key areas of service improvement have been included within the Strategy. In addition a number of exemplars also feature to illustrate good practice already happening in Northern Ireland or elsewhere.
 
The 25 recommendations emanating from this Strategy have been built into an Action Plan to enable the planning and delivery of quality palliative and end of life care over the next 5 years. 
 
Palliative Care services can be categorised into two distinct but complementary levels

General Palliative Care

 The majority of palliative care is delivered by your usual health and social care team within your own home, hospital or care home. The aim of general palliative care is to provide:
  • Information for the person and their carers, with "signposting" to relevant services.
  • Accurate and holistic assessment of a person's needs and priorities
  • Coordination of care teams in and out of hours and across boundaries of care
  • Basic levels of symptom control
  • Psychological, social, spiritual and practical support
  • Open and sensitive communication with patients, carrers and professional staff

Specialist Palliative Care Services

 The General Palliative Care Provider may seek advice and support from colleagues with recognised specialist training, skills and knowledge where symptoms are difficult to manage or distress is severe. 
{**link to directory of specialist palliative care services}
Specialist palliative care services are delivered through
  • Hospice Inpatient Beds
  • Specialist palliative care teams within hospital
  • Specialist palliative care teams in the community
  • Out Patient Services
  • Day Hospice

 Click here to view a map of specialist palliative care services

Frameworks Supporting Palliative & End of Life Care in Northern Ireland

The DHSSPS are developing Service Frameworks which will provide a structure for service improvement as they contain standards, outcomes and target dates for achievement with the aim of:-

  • Improving the health and social wellbeing of the population of Northern Ireland;
  • Reducing inequalities and promoting social inclusion;
  • Improving the quality and safety of care;
  • Safeguarding vulnerable individuals and groups; and
  • Improving partnership working with other agencies and sectors.

The DHSSPS have identified five priorty frameworks, with the first three having been developed, 

and the other two are in Mental Health and Learning Disability.
 
Each framework has a set of overarching standards for Supportive and Palliative Care.
 
These standards are:-
  • Health and social care professionals, in consultation with patients, should identify, assess and communicate the unique supportive, palliative and end of life care needs of that person, their caregiver/s and family.
  •  Patients, carers and families should have access to responsive, integrated services, which are co-ordinated by an identified team member according to an agreed plan of care, based on their needs.
  • People with advanced progressive conditions, their caregivers and families, should be informed about the choices available to them, by an identified team member, and have their dignity protected through the management of symptoms and provision of comfort in end of life care.

In Northern Ireland minimum health and social standards of care are being developed and monitored through a new Regulation and Quality Improvement Authority. 

The aim of RQIA is to improve the quality of health and social services in Northern Ireland by inspection of those services and formal review of services.

 

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