Frances Badger

An evaluation of the implementation of a programme to improve end-of-life care in nursing homes

The Gold Standards Framework in Care Homes programme aims to improve the quality of end-of-life care for residents. The impact of introducing phase 2 of the programme to homes in England was evaluated. A pre–post survey design was adopted, focusing on indicators identified as markers of good end-of-life care. The 95 homes in phase 2 of the programme were invited to participate in the evaluation. Homes completed a baseline survey of care provision and an audit of the five most recent resident deaths. The survey and audit were repeated post programme completion. Forty-nine homes returned completed pre- and post-surveys, 44 returned pre- and post-data on deaths. Although some staff found completion of the programme challenging, homes that returned pre- and post-data demonstrated improvements in aspects of end-of-life care. There were statistically significant increases in the proportion of residents who died in the care homes and those who had an advanced care plan. Crisis admissions to hospital were significantly reduced. This evaluation indicates that appropriately funded structured programmes have the potential to assist nursing homes improve the provision of end-of-life care to older adults, in line with government health policy.

Asian elders’ knowledge and future use of community social and health services

Abstract Although there is evidence to suggest that black people are disadvantaged in terms of health, underuse of community services by black elders has also been widely documented. The views of Asian, Afro‐Caribbean and white elders on a wide range of issues associated with community care were studied as part of a larger research project in Central Birmingham. Analysis is still in progress and the focus here is on one selected theme: the knowledge and potential use of social and health services amongst Asian and white elders. The data show that although a large number of Asians had not heard of these services, once informed of their existence, many exhibited a preparedness to make use of them, should the need arise.

The role of general practitioners in children's end-of-life care: a survey of preferred involvement.

Improving end-of-life (EoL) care for children and their families is a national priority and the expansion of community services to support care closer to home is advocated. This is considered to be in the best interests of families and to have significant cost benefits. General practitioners (GPs) have an important role in this improvement strategy, providing essential symptommanagement and family support. They are also in a prime position to help families identify and co-ordinate the many primary healthcare services that may be required (including out-of-hours).However,whileGPs have established roles in supporting adults with terminal conditions, GPs are not routinely involved in children’s EoL care. To gain insight into GPs’ involvement in children’s EoL care, a postal questionnaire assessing professional characteristics, experience, preferences for end-of-life care provision, and perceived support needs was distributed to named palliative care leads or senior partners in each general practice within the Pan Birmingham Palliative Care Network (N1⁄4 348). GPs from 71 practices (representing a patient population of at least 348,920), returned questionnaires; a response rate consistent with other similar studies. These had been qualified for a median of 20 years (range 1–42 years), 58 (82%) were from practices implementing the Gold Standards Framework (i.e. nationally recommended EoL care pathway for adult patients nearing the end of their lives) and 16 (23%) reported a special interest in paediatrics. Thirty three GPs (52%) reported having seen children with life-limiting/threatening conditions in the last 5 years, but 38 (54%) had no means to identify relevant children within their practice. Most respondents wanted to be involved (directly or indirectly) in children’s EoL care (Table 1). However, few GPs rated themselves as having high confidence, knowledge or support to provide EoL for children and these perceptions were unrelated to years of experience or special interests. Barriers to involvement included lack of experience and training, insufficient time and resources, isolation from secondary care, lack of role-clarity, inappropriate gate-keeping, poor communication and co-ordination of care. Caring for children at EoL was perceived as emotionally challenging and seen to involve a complex network of services. This is the first survey to examine children’s EoL care from a GP’s perspective. Whilst it is unrealistic to expect GPs to develop expertise in children’s EoL care or assume lead roles, the findings endorse GP training in children’s palliative care, increased support for GPs and improved integration of children’s EoL care across the primarysecondary care interface. The EoL strategy advocates theGold Standards Framework (GSF) for adult patients and several GPs had applied it favourably to children, including using GSF tools to help staff identify relevant children, assess needs and structure care.While it may be possible to integrate a ‘children’s GSF’ within the existing GSF structure, this must recognize important differences between adult and children’s EoL care. What is clear, is that GPs will benefit from early notification of relevant children, updates at key transitions, access to care plans, information on family preferences and support from their specialist colleagues to ensure that they can work effectively to support EoL care for children.

Gold Standards Framework in Care Homes and advance care planning

The evaluation of the introduction of the Gold Standards Framework in Care Homes (GSFCH) should be considered in the context of the available guidance on end-of-life care at the time the fieldwork was conducted, and the early stage of Gold Standards Framework (GSF) development. The introduction of new legislation and guidance which impacts on end-of-life care means that the subject of advance care planning (ACP) should be introduced at an early stage and residents should not be excluded from this process on the basis of diagnosis. The programme helped raise awareness of the importance of end-of-life care and participants identified a number of positive outcomes. We would like to respond to the points made by Killick et al.