The focus of Dying Matters Awareness Week run by the Dying Matters Coalition is the question: Are We Ready?
Whilst the statistics reported by Dying Matters demonstrate the very real need to ensure we have open and honest conversations about preparing for the future, what these statistics do not include is an indication of how many people understand what palliative and end of life care they, or a loved one, may be entitled to.
What is palliative care?
Palliative care is the term used for the provision of care for anyone who has been diagnosed with a life-limiting illness.
The aim is to ensure care needs are met by the delivery of a comprehensive care package in such a way as to maintain quality of life by relieving discomfort or distress through pain management, psychological, social, spiritual and practical support.
Often the individuals GP and/or community nurses will co-ordinate and deliver palliative care.
What is end of life care?
End of life care is for people who are in the last 12 months of their life. The aim is to help the individual with the provision of an appropriate care package to live as well as possible and to die with dignity. It can be provided at home, in a care facility, hospice or hospital by a range of health and social care professionals.
A patient’s GP and/or community nurse usually coordinates end of life care provided at home or in a care facility. A multi-disciplinary team usually coordinates end of life care provided in a hospice or hospital.
Provision of end of life care should be coordinated through the implementation of an end of life care plan.
Fast Track Pathway Tool for NHS Continuing Healthcare
Many are not aware of what Fast Track funding is, the criteria used to determine if Fast Track funding is appropriate, and how to secure non-means tested NHS funding to ensure you, or a loved one is provided with free end of life care provision. To reiterate, this means they are entitled to free, NHS funded care provision to meet their needs until the end of their life.
What is the Fast Track Pathway Tool?
Individuals with a ‘rapidly deteriorating condition that may be entering a terminal phase’, can be ‘fast tracked’ for the purpose of assessment so that they can receive immediate NHS Continuing Healthcare provision and care.
The purpose is to identify individuals who need access to NHS Continuing Healthcare quickly and with minimum delay. To speed up the process there is no requirement to complete the Decision Support Tool.
The process to be followed in brief is as follows:
- A ‘Fast Track Pathway Tool‘ should be completed by an ‘appropriate clinician’, setting out clear reasons why the individual fulfils the criteria with evidence that the individual is both rapidly deteriorating and may be entering a terminal phase. This will be sufficient to establish eligibility.
- The ‘appropriate clinician’ must lodge the completed ‘Fast Track Tool’ with the Clinical Commissioning Group (CCG).
- The CCG must accept and immediately action a properly completed Tool upon receipt to ensure that appropriate funding and a care package which respects the patient’s preferred model of support is put in place within 48 hours.
- If there are concerns that the completed Tool shows the patient’s condition is not related to the criteria the CCG must urgently seek clarification to ensure the appropriate screening and eligibility assessments take place.
- Once a Fast Track funded care package has been implemented, the package must be kept under review.
Who is an ‘Appropriate Clinician’?
Any person who is:
- Responsible for the diagnosis, treatment or care of the individual in respect of whom a Fast Track Pathway Tool is being completed; and
- Is a registered nurse or registered medical practitioner. It can include clinicians employed in the voluntary sector with a specialism in end of life care (such as a palliative care specialist in a hospice).
What does ‘Rapidly Deteriorating’ mean?
‘Rapidly deteriorating’ should not be interpreted narrowly as only meaning an anticipated or short time frame of life remaining. ‘May be entering a terminal phase’ is not intended to be restrictive to only those situations where death is imminent.
The Tool should ideally include an indication of how the individual presents in the current setting, along with the likely progression of the individual’s condition, anticipated deterioration and how and when this may occur. CCG’s should not, however, require this information in order to establish eligibility via the Tool.
When will Fast Track funding stop?
If the patient is expected to die in the very near future, the NHS should take responsibility for the care package until the end of the patient’s life.
Fast Track funding should not be removed without eligibility being re-considered through the completion of a Decision Support Tool at a Multi-Disciplinary Team meeting.
The patient must be notified of any proposed changes in funding arrangements in writing. The right to request a review of the decision should be explained.
How can fast track funded care be personalised?
An individual can request a Personal Health Budget is provided by the NHS to give more choice about who provides care, where the care is received and the preferred place of death.
If you have been affected by any of the issues raised in this article, please contact the Community Care team for a no-obligation, free consultation today.
T: 02380 827483