Driving Change from Fragmentation to
Integration:
North Manchester Macmillan Palliative Care
Support Service (NMMPCSS)
Chris Mathewson, NMMPCSS Programme Manager
Alicia Waite, NMMPCSS Service Manager
Janette Hogan, Palliative Care Nurse Advisor
(commissioning)
WiFi name: WifiLoveMCR
Password: internet
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Why North Manchester?
The base
• Higher than national average no. of deaths in hospital
• No Hospice in the geographical location of North Manchester
• Higher no. of deaths from cancer and highest lung cancer death rate in the
country
• Crisis Driven Macmillan Team – due to sickness and under resourcing and nurses
and therapists working as separate teams
• District nurses struggling with high no’s of complex palliative care patients – also
crisis driven
• GP’s referring patients in crisis – registers not populated, no meetings
Key Ingredients
Willingness to
embrace change by
clinicians and
managers
Patient - highlighted
poor choices at end
of life
Midhurst model
principles
Local commissioned
service (LCS) - end
of life facilitators Enabler
Improving palliative
care - Key strategy
Macmillan Cancer
Improvement
Partnership (MCIP)
and North
Manchester CCG Funding
District nursing
review undertaken multidisciplinary
working and 24 hour
service. Crisis
response team
established
The Integrated Model
layer by layer – not a soufflé!!
How to ‘bake’ the perfect team
A great team is more than the sum of its parts.
• Staff are unique in what they can contribute
• Critical role of leadership and culture should not be under estimated
• Have a team that feels safe is a great start
• The team goal needs to be clearly articulated
• New staff members are hired with the team’s goals in mind
The North Manchester Macmillan Palliative
Care Support Service (NMMPCSS)
• Nursing and Therapy Team working as one
• Enhanced team (Service Manager, Nurses, Therapists, Assistant
Practitioners, Volunteer Coordinator, Admin)
• 8am-8pm – 7 day a week service
• Medical Consultant led service
• Single point of access – triage clinician
Primary Care Development
• Palliative Care Registers populated – all life limiting illnesses and care
homes
• Re-establishment of palliative care meetings
• Attendance of NMMPCSS member and District Nurses at palliative care
meetings.
• MCIP Local Commissioned Service – Cancer and end of life facilitators
• Standards for General Practice - including palliative care
• GP – one day a week with NMMPCSS
• Enabled more supportive care, proactively for a greater
amount of patients.
Community Services
• District nursing review – enabled attendance at daily triage meetings
with NMMPCSS
• District nurse link role – enabled safer/timely discharge/increased
hospital staff’s knowledge
• District nurses key members on hospital Multi Disciplinary Team (MDT)
• Crisis response team collaboration (frail elderly)
• Intravenous Therapy Team (pathways for antibiotics, rehydration)
• Respiratory Team, Cardiac Team – education and joint working
• Work with Social Services – to ensure timely access
Acute Sector
Providers of NMMPCSS employed by Pennine Acute Hospital Trust – enabled
the following redesign:
• Redesign and development of acute Multi Disciplinary Team
• District Nurse Link worker, new role – worked with ward staff and
discharge team
• Community Consultant in-reach – hospital consultant outreach
• Spiritual team out reached to community – patient and
staff support
• One team approach to education and governance
Hospices
3 Hospices located outside Manchester border – commissioned
• St Ann’s Hospice - Enhanced 24 hour helpline Development work with
• Dr Kershaw's to reduce delayed discharges
• Springhill Hospice – liaised with re. changes and how to access/liaise
with NMMPCSS
• NMMPCSS Developed a ‘Patient management system’
enabled them to ‘follow patients’ into hospices and hospital
Enhanced Support – The Icing on the cake
1. Volunteer model established
Phase 2 developments:
• Complimentary Therapy
• Lymphodema Service
• Social groups developed
Impact – the difference made
Practices with Palliative Care MDT meetings
40
35
30
25
20
Without
15
10
5
0
Start of project
End of project
With
Referrals to the NMMSPC team
160
140
120
100
80
60
40
20
0
Q1
Q2
Q3
2015/16
Q4
Q1
Q2
2016/17
Challenges
1. Turning strategy into an operational model
2. Data – Gathering relevant data to demonstrate how the new service
impacted on palliative care outcomes.
3. Many staff appointed at the same time – tight deadlines for
implementation.
Key messages
1. Establish correct structures – with effective user involvement.
2. It is hard work and requires continuous commitment from all.
3. Don’t feel like you have to do it alone – matrix work – utilise all
skills.
Its great when it all comes together and feedback demonstrates how
well it is working for patients and staff.
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[email protected]
[email protected]