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Gold Standards Framework - First awards for hospitals in Exeter and Morecombe

The CQC Inspector has praised hospitals for improving end of life care for patients using the Gold Standards Framework and Programme and presents them with the first GSF BGS Quality Hallmark Awards.

The Gold Standards Framework (GSF) Centre started in 2000 in primary care, now runs GSF programmes in end of life care in all settings. The biggest and most comprehensive of these aims to improve care at the end of life. One of its key elements is to offer everyone the chance to record an Advance Care Planning discussion to clarify their needs and preferences. The GSF accreditation for Acute Hospitals is endorsed by the British Geriatrics Society (BGS) who also partnered in assessments.

Two wards at Royal Devon and Exeter Hospital and one at Royal Lancaster Infirmary, part of United Hospitals of Morecombe Bay, are the first to be accredited by the National Gold Standards Framework Centre (GSF). 

All three wards at the two hospitals demonstrated key improvements to the quality of care for all patients in the final year, months, weeks and days of life, the coordination of their care as well as, crucially, enabling more people to live and die at home if that is their choice. 

Staff from the two hospitals were in London at the end of March to receive their awards from Professor Sir Mike Richards, Chief Inspector of Hospitals at the Care Quality Commission.

Sir Mike congratulated the two hospitals for leading the way in the care of patients approaching the end of life and urged other hospitals to follow their example. He said: “End of Life Care is a central focus in our inspection process of all hospitals. We know that many hospitals struggle to identify patients in the last year of life and consequently find it difficult to coordinate their care adequately. 

He said: “By delivering earlier recognition and more effective communication with the patients themselves and other professionals in the community, the Gold Standards Framework enables better care for people in the last months of their life.” 

Yeo and Yarty wards at Royal Devon and Exeter, oncology and haematology wards respectively, and Ward 23 at Royal Lancaster Infirmary, a stroke ward, provided evidence of measurable change to the way they systematically organise their care, and the impact on patients and their relatives and carers and staff. 

They demonstrated early recognition of decline (with more than a third all patients identified as being in the final year of life), offering advance care planning discussions to all and improved communication with GPs, with more patients discharged to live and die at home where appropriate. 

The wards undertook several on-line evaluations, assembled a portfolio of evidence demonstrating the attainment of five key standards and underwent a visit from the GSF assessment team.

In an interview with Dr Pradeep Kumar, he said, all the scaremongering about the Liverpool Care Pathway meant that as soon as people heard those words, they panicked. But GSF is a way of engaging patients and starting a conversation with them, where possible, and with their relatives from an early stage  – looking at their preferred place of death and long term care where indicated. 

Recently, we had a patient who’d had a severe stroke and had cancer. We were in little doubt that he was coming to the end and was going to die very soon. So, we immediately coded him ‘Red’ on GSF, got all the documents in place and initiated discussions with the family. The family decided that it would be best for him to be cared for at home.  So we fast-tracked his discharge – coordinating with his GP and district nursing team. He went home within 24 hours and died there peacefully, two or three days later. This was the best possible outcome and we received fantastic feedback from the family. It is very unlikely this would have happened prior to us doing GSF.

The key driver has been the feedback we have received from patients and their families that their voices were not being heard. GSF has then given us the framework to engage with relatives and put things in place to ensure the outcome they want for their relative. It has also helped us form closer working relationships with GPs and district nurses.

I think the biggest change has been the culture change – knowing that it’s not about the nurses and doctors taking a paternalistic approach. Rather, it’s about getting patients and their families to take ownership of their care. GSF is the framework that allows us to make that happen. 

The best bit is making sure that patients receive the care they want, where they want it, when and how they want it and the satisfaction they and we get from that. 

I have been working on this unit for ten years and we have had a number of complaints in that time. Over the last three years we’ve had none and I anticipate that with GSF this will continue because of the improved communication.

Dr Martin Vernon, BGS End of Life Care lead, said: : “The vast majority of patients approaching the end of life are cared for by generalist doctors, nurses and other members of the multi-disciplinary care team rather than specialist palliative care professionals. Hospitals increasingly care for greater numbers of people towards the end of their life with frailty and complex health conditions. 

“That’s what makes this such a milestone event, as staff on the wards that have been accredited will feel more empowered to provide the coordinated care this most vulnerable of patient groups require. GSF accreditation in the general hospital setting helps to drive up quality in the delivery of end of life care by ensuring recognised standards are maintained for providers.” 

The successful hospitals are among more than 40 to have completed the GSF Acute Hospitals Training, a two year programme which aims to enable the provision of integrated tailored care, by helping generalist frontline staff better recognise decline, anticipate and meet their needs in line with patients’ preferences. In turn, this has helped them, where appropriate, to reduce the length of patients’ hospital stay and improve the discharge process, leading to better outcomes once the patients return home.

In Yeo oncology ward more than half (57 per cent) of patients are being identified as being in the last year of life, which has helped staff then initiative conversations with patients about their wishes so care can be planned and given in line with those wishes.

Em Wilkinson-Brice, Chief Nurse/Chief Operating Officer at the Royal Devon and Exeter NHS Foundation Trust, said: “We are thrilled to have received the Gold Standards Framework (GSF) Quality Hallmark Award in End of Life Care. Achieving this accreditation is a testament to the hard work and dedication of all the staff and End of Life teams on Yeo and Yarty who daily provide safe, high quality and compassionate care for our patients.”

Professor Keri Thomas, GSF National Clinical Director, said: “Caring for patients nearing the end of life is one of the biggest challenges facing the acute hospital sector. What these two hospitals have proved is that by implementing a structured systematic approach such as GSF with earlier recognition, improved communication with patients and fellow professionals, and better coordinated care, it is possible to provide a higher quality of care for people in the final year of life wherever they are. We hope others will aspire to this standard, as others have in primary care and care homes also thereby developing a national momentum of best practice for all people nearing the end of life everywhere.” 

Tom Tanner
Freelance Writer

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