End of Life and Advance Care Planning

Hospice Contact Details

 Medical Examiner Service contact details

The medical examiners service is a service provided to help streamline the process for getting a death certificate and scrutinising deaths in the community.

Advance Care Planning

Advance Care Planning allows a person to plan their future care and support. This can include medical treatment, DNAR’s and any forms of care that may be required as they reach the later stages of their life. Advance care plans should be done while the person in question has capacity to make their own decisions.

Whilst not everyone will want to make an advance care plan, it may be especially relevant for people at risk of losing mental capacity (i.e. through progressive illness) and people whose mental capacity fluctuates (i.e. through mental illness.)

Click here for the HCPA Advance care planning documents summary
For more resources, please refer to the NICE Guidelines and Toolkit
Click here for a video from Garden House Hospice Care answering questions about Advance Care Planning

Treatment Escalation Plan

A Treatment Escalation Plan (TEP) is a communication tool which is helpful in hospital when a person with serious illness has the potential for acute deterioration or may be coming towards the end of their life.  Sometimes doing everything possible may actually lead to harm – to more suffering and distress rather than less – and without any particular gain. What can be done and what should be done may not necessarily be the same thing. Treatment Escalation Plans should be discussed and made based on personalised realistic goals rather than ‘one size fits all’ treatment.

Crucially, a TEP provides on-call hospital staff with immediately accessible guidance about how to respond to an individual in times of crisis, especially out of hours and at weekends. A TEP becomes particularly important when there is agreement that interventions or referrals for more intensive care that are contrary to a person’s wishes or are futile or burdensome should not be undertaken. Equally in many patients who may have an agreed DNACPR, a TEP clarifies all the treatments and care that should continue.
Click here for a Treatment Escalation Plan form

Universal principles for advance care planning

The Universal Principles for Advance Care Planning has been jointly published by a coalition of partners, including SCIE. Advance care planning is a voluntary process of person-centred discussion between an individual and their care providers about their preferences and priorities for their future care.

Click here for the Universal principles of advance care planning document

ReSPECT

ReSPECT stands for Recommended Summary Plan for Emergency Care and Treatment.

The ReSPECT paperwork (Recommended Summary Plan for Emergency Care and Treatment) was rolled out across East and North Hertfordshire in September 2022 and is now being rolled out across South and West Hertfordshire to cover the whole county with a consistent approach to Advance Care Planning documentation.

ReSPECT forms not only include a decision on CPR on the paperwork but enable service users to have a holistic conversation around end of life care plans with their healthcare professionals. Individuals coming out of hospital who may have previously had a DNACPR form in place are now likely to start coming out with the purple ReSPECT forms instead. It is therefore important that those who support individuals at the end of their life have an awareness of the new paperwork to enable you to best support individuals. 

Click here for a summary poster 001_ReSPECT-A4-Leaflet_Redesign_03.pdf (resus.org.uk). Further details on Respect can be found on the national website here https://www.resus.org.uk/respect and a summary video can be seen below. 

The Hertfordshire and West Essex ICB Frailty board has endorsed the implementation and adoption of ReSPECT as the preferred advance care plan (ACP) document for use across Hertfordshire by all providers of health, mental and social care, including all NHS, Local authority, social care, private, charitable, and voluntary providers in Hertfordshire. The ICB would like all providers in the system to:

• Officially adopt ReSPECT as the preferred advance care plan document.
• Support ACPs including documentation and training.
• Support the ReSPECT rollout process.
• Expect all organisations to engage with the development and implementation of digital ACPs.

Click here to view the full letter

Care professionals across adult care providers (residential nursing homes, homecare and supported living) need to have an awareness of the ReSPECT forms, where these are kept for each individual they support, and the significance of these documents including an understanding that these count as a DNACPR forms. Managers of care providers need to ensure all staff are aware of and have had training on how to interpret these forms, as well as how to use them in emergency situations.

E-Learning education is available to build care staff and manager knowledge of the document:

• Level 1 Click here – For all staff
• Level 2 Click here – For senior and managers

Respect documentation is included in All HCPA and Hospice end of Life education.

To find out more about the ReSPECT forms, please click here for FAQ’s.

Community Hubs

The Community Hubs and Health Memory Café provide a welcoming, friendly space for people to come along for a cup of tea and a chat, talk to and be listened to by one of the Garden House Hospice team members.

At the Hospice, they feel passionate about reaching more people earlier in their journey to receive their support and care, giving them confidence to live well and enjoy life to the fullest.

Community Wellbeing Hubs

The community are welcome to join a team of Hospice Volunteers for a chat, meet new people and get some support and advice in four Hubs across the area.

These weekly drop-in sessions are an opportunity to:

• Join the team for a cup of tea and a chat
• Talk and be listened to by one of their team members
• Gain information about their therapies and support services
• Join in a seated exercise group
• Take part in creative and fun activities that promote health and wellbeing
• Feel more in control and live life to its greatest potential.

Click here for more information about the community hubs

Hertfordshire Compassionate Neighbours Schemes

Compassionate Neighbours offers emotional and social support for people living with a serious or terminal illness and are who experiencing loneliness or social isolation. Throughout Hertfordshire the local hospices offer varying schemes for their location.

Click here to find a summary of the different support available.

CQC quality and equality assessments

The Care Quality Commission (CQC) plans to start assessing the quality and equality of end-of-life care provided by adult social care services. The move follows a review that found some groups of people get poorer quality care at the end of their lives because health and care services do not understand or fully consider their needs.

These groups include ethnic minorities, the homeless, the frail, prisoners and people with mental health conditions, dementia or learning disabilities. The CQC’s A Different Ending review found that a lack of understanding of the specific needs of these and other groups of people is preventing good care for the dying. People with dementia, for example, “need the opportunity to talk about their end-of-life care wishes and preferences before the last year of life as they will progressively lose the capacity to make decisions”.

In response to the findings, the CQC said it now intends to start assessing the quality and equality of end-of-life care provided by services, including adult social care, that are not currently given ratings for their work in this area.

This, the review said, means CQC inspections will “include an assessment of the quality of end of life care and whether it is meeting the needs of everyone, including people from equality groups and people whose circumstances may make them vulnerable, and report on this consistently”.

End of life and Nutrition

Please click here for information of end of life and nutrition

Resources and Webinars

The following information is intended to offer resources for staff within Adult social care provider services when working with people with care and support needs, including their carers to help people feel supported around end of life conversations and care planning.

• Supporting staff with difficult conversations
• Holding difficult conversations guides and resources
• End of life Palliative care resources and organisations
• Bereavement counselling and resources
• Hospices in Hertfordshire

Click here to download the HCPA End of Life Care Guidance and Resources

Webinars

Further resources: