Colin Smart (left) and Jake Kerrigan are two of the Ambulance Care Attendants who operate Tayside's new dedicated palliative care ambulance service - one of the initiatives being piloted by the Marie Curie Delivering Choice Programme.
Tayside has a population of 400,000, covering an area of 300 square miles and is found just to the north east of central belt Scotland. The region’s relative rural prosperity is contrasted with areas of high deprivation in the city of Dundee.
The Marie Curie Delivering Choice Programme in Tayside is now well into Phase III, with service improvements being piloted across the region with the single overriding aim of supporting more patients with terminal illnesses in choosing their place of care.
Scroll down to read more about the service improvements being tested in Tayside.
Scotland's first dedicated ambulance service
Operated by the Scottish Ambulance Service and 100% dedicated to transporting patients nearing the end of their lives to their preferred place of care, the palliative care ambulance is helping more patients to spend their final days in their place of choice.
The vehicle is equipped with specialist medical equipment and has a reclining chair, room for a companion to travel with the patient, relaxing colour scheme, pressure-relieving mattress and other features designed to make patients feel as comfortable as possible on what can be a stressful journey.
It is manned by a crew of two ambulance care attendants, who have been trained in palliative care.
Support for carers
Supporting carers is critical to mitigating crisis events before they arise. Carers also feel more empowered and able to cope in caring for someone at home if they are properly supported.
The Tayside project is boosting the availability of support for carers through two key initiatives:
More respite for carers
People who are caring for a loved one at home need regular breaks in order to maintain their own health and ability to cope. The programme is increasing the availability of respite across Tayside to ensure that carers are able to take the regular breaks they need.
Respite for patients with social care needs is provided through Crossroads, and respite for patients with nursing care needs is provided through the Marie Curie Nursing Service. These are both excellent existing services - what the programme is doing is commissioning additional hours to make the services more widely available.
Support workers for carers
Support workers are being appointed through the Princess Royal Trust to cover Angus and Dundee, and through Perth & Kinross CHP to cover Perth & Kinross. Their role is to put processes in place to identify 'hidden' carers in the community and set up support mechanisms for them, including support groups.
Improving hospital discharge
Excellent work is being done within the acute setting to discharge palliative patients to their preferred place of care, however there are some barriers which are leading to delays and need to be addressed.
A Discharge Liaison Nurse has been appointed in Ninewells Hospital, Dundee, to improve and facilitate hospital discharge of palliative patients by: improving the knowledge of hospital staff of the range of community services available to patients; promoting coordinated discharge plans; and improving communication between hospital and community professionals.
Scotland's first Palliative Care Electronic Patient Register (PCEPR)
The PCEPR, a clinical specification for which is underway, will give clinicians access to details of patients' preferences for place of care.
Improving rapid response in the community
Rapid response nurses have been introduced across Tayside to enhance existing out of hours emergency services. They work closely with palliative care providers and out of hours teams to provide nursing care to palliative patients in their homes during the twilight and out of hours periods and support their carers and families. The nurses also provide phone support and guidance.
The rapid response nurses are also undertaking a scoping exercise to assess current service provision to identify examples of good practices and areas for improvement.
Communication and education
A couple of initiatives are being rolled out to improve communication and education for people working in palliative care. They are as follows:
Practice educator
A dedicated practice educator has been appointed to facilitate and provide opportunities for education and training for Marie Curie Nursing staff across Tayside, as well as new clinical staff employed through the Marie Curie Delivering Choice Programme.
Messaging system
A password-protected messaging system is being introduced to improve thoroughness of patient handovers between Marie Curie Nurses and District Nurses. The system enables DNs to leave messages for Marie Curie Nurses on a secure NHS Voicemail account, giving them important patient information before they start their shift.
