Rob Gandy

Development of the Carers’ Alert Thermometer (CAT) to identify family carers struggling with caring for someone dying at home: a mixed method consensus study

BackgroundThere is an increasing international policy direction to promote home death for dying patients which will impact on the demands placed on family carers. The early identification of carer needs and appropriate intervention can help avoid crisis situations for the carer and avoidable hospital admissions which are reported to be a global concern. The aim of the study was to explore what professionals and carers of patients with cancer and advanced progressive illness, in their last year of life, find burdensome and to develop an alert system for use by non-specialist staff.MethodsA mixed-method, multi-phased, consensus study sequentially utilising qualitative and quantitative data to develop and pilot the Carers’ Alert Thermometer (CAT). 245 people (117 carers and 128 professionals) participated in the study across a range of health and social care settings in the North West of England (2011–2014).ResultsA number of key domains were identified and prioritised by consensus for inclusion in the CAT. The 8 domains fit within two overarching themes of the reported carer experience; the support needed by the carer to provide care and the support needed for the carer’s own health and well-being. The resultant CAT is an evidence-based alert thermometer consisting of 10 questions, guidance on the possible actions for each alert and space for an action plan to be jointly agreed by the assessor and carer. Preliminary piloting of the CAT has shown it to be valued, fit for purpose and it can be administered by a range of personnel.ConclusionsThe CAT enables the identification of current and potential future needs so a proactive approach can be taken to supporting the carer as their role develops over time, with a view to enhancing their well-being and preventing avoidable hospital admissions; ultimately supporting patient choice to remain in their own home.

Demonstrating Access to Public Services Diagrammatically

The Nomogramma di Gandy is a practical analytical tool and presentational method that can be applied to the subject of access to public services, such as universities, prisons, and hospitals. Illustrative examples are provided. It is flexible, requires minimal data, and can compare access across many geographical areas in one presentation. It addresses the need to appreciate the dynamics that can exist behind summary statistical analyses that focus on net changes, and can show trends over time. Such visual scanning of multiple data points and their relative juxtapositions, enables many common thinking errors to be minimized, if not completely avoided.

Evaluating the delivery, impact, costs and benefits of an active lives programme for older people living in the community

Aim Age UK Lancashire received Big Lottery funding to deliver an active lives programme from January 2012 to December 2014 to the population of West Lancashire aged over 50 years. The overall aims of the associated evaluation were to measure older peoples experiences of participating in the programme, identify the impacts on their health and well-being and their suggestions for services development, and establish the costs and benefits of the programme. BACKGROUND The World Health Organisation recommends older people should be able to achieve physical, social and mental well-being throughout their lives, and that international, national and local policies should be developed to support older adults, promote their independence and well-being, and encourage physical exercise. Consequently, the West Lancashire programme was to establish preventative community support for older people to assist in improving their well-being and physical and mental health, particularly those isolated due to age-related illness or disability. It was to provide interventions not available from local social care providers. METHODS A mixed methods approach was adopted, with the qualitative evaluation utilising focus groups to establish peoples experiences, identify impacts on their health and well-being, and suggestions for services development. This paper describes the quantitative evaluation, which involved three surveys and a costs analysis. The surveys were scheduled to give timely feedback to management about programme delivery and content, and overall benefits of participation. Findings The active lives programme and groups offered a wide range of flexible and local activities that provided benefits for older people in terms of health and well-being, social well-being and quality of life, and reducing social isolation. There was interconnectivity between these benefits. The programme was delivered in an affordable and flexible manner. Such programmes should be made more widely available.

Using end-of-life care profiles to support advance care planning

In 2010, Liverpool PCT pioneered a care profiles approach to commissioning End of Life (EoL) services. This enabled comprehensive service requirements to be set in respect of skill mix, delivery, quality and outcomes for each stage of the EoL pathway. The project involved a series of action learning-related workshops, each targeting one EoL stage. Consensus was developed among participants with commissioning, provider and service user interests, with outputs evaluated by an external reference group. A number of innovations were introduced, and it was concluded that the basic service requirements for EoL care are the same irrespective of the related disease. The project was a success, with its recommendations used to commission EoL services across Liverpool. Care profiles are simple and flexible, and complement and augment integrated care pathways. They can support GP commissioning by providing clinically relevant and detailed information to specify and cost services. Commissioned EoL services will vary between PCTs, to reflect local geography, history, service models and resources. Therefore care profiles serve to clarify exactly what services are available locally. Summary information extracted from the care profiles, would be appropriately tailored and presented, and made available across all professionals and providers to ensure patients and carers receive consistent, detailed information irrespective of which discipline happens to lead on their advanced care planning. It follows that EoL care profiles can be used to support advanced care planning, by assuring the range, quality and consistency of information given to patients and carers, with any potential choices highlighted.