Agenda item

Dr Victoria Bradley (Clinical Lead for and Consultant in Palliative Medicine, Oxford University Hospitals NHS Foundation Trust) has been invited to present a report with an update on Palliative/End of Life Care in Oxfordshire.

There are TWO documents attached to this item:

1.     A report containing an update on the Rapid Intervention for Palliative and End of Life Care (RIPEL) project.

2.     A report providing a BOB Integrated Care Board Update on Palliative and End of Life Care.

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

Dr Victoria Bradley (Clinical Lead for and Consultant in Palliative Medicine, Oxford University Hospitals NHS Foundation Trust) and Zo Woods (Program Lead, BOB ICB) presented a report with an update on Palliative/End of Life Care in Oxfordshire.

The Chair invited registered public speaker Cllr Stefan Gawrysiak to address the Committee.

Cllr Gawrysiak highlighted his personal positive experiences with the home and outreach palliative care services, emphasising their excellence. However, he identified a significant gap: the lack of residential palliative and respite care beds. Cllr Stefan argued that the Committee should address this shortfall, noting that the existing reports failed to mention residential palliative care. He urged the Committee to advocate for the inclusion of residential care details in the report to ensure comprehensive palliative care coverage across Oxfordshire.

The Clinical Lead for and Consultant in Palliative Medicine provided an update on the project's progress and achievements. She highlighted the significant improvements made in patient and family experiences due to the specialist services introduced over the past two years. These improvements were attributed to funding from Macmillan and the Sobell House Hospice charity, which had enabled much-needed advancements in palliative care. Despite challenging financial circumstances, the service had managed to save more resources within the system than it spent. She emphasised the profound impact of enabling patients to die at home, in accordance with their wishes, rather than in less preferred environments.

Question on the involvement of the community and coproduction in the service design:

The Committee asked about the involvement of the community and stakeholders, and how deeply coproduction was embedded in the service design. The Clinical Lead acknowledged that while the service had always prided itself on being close to the community, there had been limited formal coproduction in the initial setup due to the speed required to implement changes. Moving forward, there was a strong emphasis on involving patients, families, and bereaved relatives in a more structured manner. This approach aimed to ensure that future service developments were closely aligned with the needs and preferences of those directly affected.

Question on ethnic minorities accessing palliative care:

The Committee raised a question about the underutilisation of palliative care services by ethnic minority groups. The Clinical Lead explained that an Equality Diversity Inclusion Officer, funded by charity partners, was actively working to identify key groups and engage with them to understand and address barriers to service access. This included outreach efforts to culturally specific communities, such as the mosque in Banbury, to discuss culturally competent end-of-life care.

Question on extending enhanced palliative care hub hours:

The Committee enquired about the justification for not extending the palliative care hub hours beyond the standard 9 AM to 5 PM. The Clinical Lead explained that while recognising that health crises occur outside regular working hours, pilot projects had shown minimal demand for extended hours. Embedding a specialist nurse within the Oxford Health single point of access from 5 PM to 8 PM resulted in very few additional calls, indicating that resources could be more effectively allocated elsewhere.

Question on transport:

The Committee asked whether there was any additional support to pilot dedicated palliative transport services, and how confident the Trust was that they could access the resources for this. The Clinical Lead highlighted the significant distress caused by long waits for ambulance services, particularly for patients needing urgent transfers to hospices or their homes. To alleviate this, a pilot scheme funded by Sobell House was proposed to provide dedicated transportation options, aiming to improve patient and family experiences and assess the feasibility of long-term implementation.

Question on relationships with care homes:

The Committee asked about the relationship between palliative care services and care homes, and how contact was initiated. The Clinical Lead explained that the service maintained close ties with care homes, offering support through various means, including direct referrals and training for care home staff. The goal was to ensure that both patients and their families were aware of the available palliative care options and how to access them.

Question on medicine shortages:

The Committee touched on the critical issue of medicine shortages, which had been identified as a high risk to hospice outreach standards. The Clinical Lead acknowledged the challenges in ensuring the availability of key injectable drugs, which were often in short supply at local pharmacies. Efforts were being made to work closely with the ICB to address these gaps and improve access to essential medications, recognising the profound impact on patient care and dignity.

Question on sustainable funding for the RIPEL project:

The Committee asked how confident the Trust were in securing ongoing and sustainable financial support for RIPEL from June 2025 onwards. It was responded that despite the project's demonstrated cost-effectiveness, securing continuous funding remained a challenge. Discussions with the ICB and other partners were ongoing to develop a sustainable business case for the project’s continuation.

Question on links with key referrers:

The Committee asked how the service would ensure it had strong links with key referrers such as 111, Acute General Medicine and Emergency Departments. The Clinical Lead emphasised the importance of building and maintaining personal relationships. While communications efforts like email bulletins and posters were useful, direct engagement with healthcare professionals was crucial for fostering understanding and collaboration. Professionals involved in the service placed value on spending time talking to people to get the message across to others.

Question on support for carers:

The Committee enquired how the Trust would increase support for carers and whether any specific areas of improvement had been identified. The Clinical Lead outlined ongoing research to better understand the needs of unpaid carers and the various support tools available. The aim was to ensure that carers were aware of the professional and community resources at their disposal, acknowledging the invaluable role they play in patient care.

Question on palliative care in Wantage:

The Committee asked about the status of the HOSC recommendations for improving palliative care services in Wantage, particularly regarding the provision of crisis palliative care beds. The Program Lead explained that the focus was on ensuring that community beds were generalist-led but specialist-supported, as demonstrated by the model implemented at Wallingford. Discussions were ongoing to determine the best approach for meeting the needs of the Wantage community.

The Committee AGREED to issue the following recommendations to Oxford University Hospitals NHS Foundation Trust:

1.    To ensure that carers receive the necessary guidance as well as support in being able to maximise the support they provide to palliative care patients.

2.    To secure sustainable sources of funding and resources for the RIPEL project, as well as Palliative Care Services more broadly.

3.    To secure additional and sufficient resourcing and support for palliative transport services. It is recommended that transport services for palliative care patients are organised in a manner that avoids delay and distress for patients.

4.    To ensure that feedback by palliative care patients and their families/carers is not only received and acknowledged, but that such feedback is acted upon in as appropriate a manner as possible.