North West London - How are we going to deliver the new model of care for community-based specialist palliative care 27 November 2023

We would like to say thank you to everyone who attended the event.  Their thoughts and feedback will be used as evidence as we move forward to develop the future model of care.

View the recording of the meeting.

View the presentation.

Jane Wheeler (JW), Director of Local Care, NHS North West London (NW London) gave an introduction and presentation covering the development of the new model of care, the potential options for its delivery, and the decision making process.

Key points raised by attendees

  • Whether we could provide a clearer definition of, and more specific details on, the new model of care’s proposed enhanced end-of-life care beds.
  • Who will pay for the enhanced end-of-life care beds.
  • The location of the units with enhanced end-of-life care beds is a key issue.
  • Who runs the care homes where enhanced end-of-life care beds are based, how safe they are and who provides the staff.
  • Frameworks/methods for monitoring service quality and performance of these services in private care homes. 
  • Whether the bed/population projections within the model of care take account of long Covid and longer NHS waiting list impacts.
  • Whether the travel mapping takes account of reduced bus frequency post-pandemic.
  • It was suggested that the language around 24/7 specialist advice line should be changed to reflect the fact the number and provider may differ dependent on where in NW London you are calling from/ living, so as not to suggest that it is a single 24/7 specialist advice line for the whole of NW London.
  • Further detail requested on how integration will work within the proposed system, as opposed to being a series of silo’s that don’t talk to each other.
  • Further detail on who is ultimately in charge and how the proposed system will be staffed.
  • Whether there is a high risk of no substantial improvements to local services in the immediate term as implementation of the new model of care is not scheduled to be until 2025, and what the programme team is doing to achieve quicker change for those people who will need end-of-life care before 2025.
  • The high risk with a programme of this length and complexity that political, financial or other factors derail the changes.
  • The affordability of the proposals given less money available and growing population.
  • Whether the model should look 10 years not five years ahead.
  • Whether lymphedema services can be extended before 2025 so that people with this condition can be properly cared for in all areas on NW London.  
  • Whether we have consulted with atheists, humanists and pagans on the proposed new model of care.
  • Whether we have considered setting up a business change/implementation team to work across the NW London boroughs to help kick-start the changes we intend to make and make improvements that help evolve, rather than endanger, the business case we are putting together.
  • The need for further detail on sections of the model of care.
  • The need to make progress on service improvements whilst moving forward with the model of care.
  • It was noted that, for Hammersmith and Fulham and North Kensington, options that re-open Pembridge in-patient unit would have huge support and should that not be the decision, then residents would expect the decision to go to full public consultation.
  • How we are engaging with local populations on the model of care proposals.
  • Whether clinicians in Hounslow feel it is the right approach to exclude end of life rapid response services from the model of care proposals (noting there are commissioned rapid response services in all areas but the model of care working group could not reach agreement on a singular model for NW London)
  • Whether the enhanced end-of-life care beds be flexible in terms of increasing and decreasing numbers based on need.
  • Whether we can communicate and make more visible the criteria for hospice access etc.
  • Whether we see some of the softer services being offered in effect via link workers and social prescribing pathway from what will become GP hubs.
  • Whether we have worked with NHS Digital to improve our data.
  • The need for commissioning contracts to allow for increased and decreased bed commissioning without the need to go through additional business case development.
  • The lack of information on bed use by age and, for example how, many people over 18 but under 60 are requiring hospice care and whether these will usually be cancer patients.
  • Whether the demographic data shows that younger people tend to be day users of available services.
  • How we have sought to understand the needs of people with learning difficulties as these tend to be overlooked.
  • The role of paramedics with prescribing skills going out to home visits and the potential, effect of this on hospital admissions.
  • The critical role of advance care planning in informing those visiting patients at home of their needs.
  • The extent to which other NHS regions can help each other out in cases of shortage of resources.

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