Author: Katie Lazell

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Overview of the work of the
National GSF Centre in End of Life care
enabling a gold standard of care for all people in the last years of life

Gold Standards Framework gives outstanding training to all those providing end of life care, to ensure better lives for people and recognised standards of care.

Overview Winter 2015/16
info@gsfcentre.co.uk www.goldstandardsframework.org.uk
The GSF Centre, Victoria Mews, 8-9 St Austin’s Friars, Shrewsbury, SY1 1RY 01743 291891

The GSF Centre in End of life Care
Our Core Purpose is to train and support frontline staff to enable a gold standard of care for people in the last years of life

The GSF Centre team has, for over fifteen years, helped generalist frontline staff care better for all people in the final years of life, enabling them to live well until they die. Many thousands of doctors, nurses and carers have received training, affecting the care of several million people over the years to ensure they are more likely to live well and die well in the place and the manner of their choosing.
The GSF Centre, led by its founder and National Clinical Lead Prof. Keri Thomas, provides nationally recognised training and accreditation programmes enabling transformational cultural change that leads to a ‘gold standard’ care for people nearing the end of life. This includes care for people with any life limiting condition (including frailty, multi-morbidities , dementia and other non cancer conditions) , in any setting (home, care home, hospital and others) at any time in the last years of life.

GSF aspires to enable frontline health and social care providers to give the right person, the right care, in the right place, at the right time, every time.

GSF helps to improve -
Quality of care experienced by people
Coordination across boundaries
Outcomes, enabling more to live well and die well ,reducing inappropriate hospitalisation.

To achieve this, GSF provides -
Training programmes in all settings
Tools and resources to support change
Measures of progress and attainment
Support and coaching for local implementation

What is GSF?
GSF is a practical systematic, evidence based approach to optimizing care for all people nearing the end of life, given by generalist front-line care providers.
GSF is all about quality care– quality improvement with training, quality assurance with standards of care and quality recognition with accreditation.

GSF and National Policy.
The UK has again been voted top country in the world for End of Life care (Economist 2015) The GSF Centre both influences national policy developments, and helps put policy into practice, supporting practical grass-roots change in line with NICE Guidance, DH EOLC Strategy, NHSE Ambitions in End of Life Care Care Quality Commission (CQC), Skills for Care and others.

Professor Sir Mike Richards presenting the Quality Hallmark Award for GSF accreditation hospitals

GSF and the regulator CQC
“GSF is a very important tool that I do believe, if people are doing the things that are in GSF, they will find that they come out very well on CQC inspections - ”-Prof Sir Mike Richards, CQC Chief Inspector of Hospitals
“What is fantastic about the Gold Standards Framework, is that it is focusing care homes staff minds on how can they make that (end of life care) experience the best it possibly can be” -Andrea Sutcliffe, Chief Inspector Adult Social Care, CQC

Achievements of GSF
What we are known for

One of the UK’s longest established end of life care organisations, well known and active for over 15 years, and now a not for profit social enterprise or CIC.
Spread to all health and social care settings with training for staff in all areas and improved cross boundary integration
Influencing national policy and implementing it in practice, contributing to the UK being the leading nation in EOLC
Enabling and motivating staff – boosting the confidence and competence
GSF is internationally recognised with GSF affiliated projects in over 8 countries
Transformational change – teams are assessed less by what they know, but more by what they do, leading to long-lasting culture change. Accreditation quality assurance & quality recognition with hundreds of organisations having received the GSF Quality Hallmark Award
GSF Accreditation in 5 settings is externally recognised by CQC, NICE, RCGP, BGS, and the Community Hospital Association.
Compassionate care – integrating compassionate care and spiritual awareness in all programmes, affirming their vital importance in all we do.
Developing integrated cross-boundary care across a wider community through training, strategic planning and support.

Improving integrated cross boundary care
Gold patients are special! GSF helps put patients at the heart of care.

Awards to GSF for its work
in End of life Care
National Skills Academy – Excellent Providers for Social Care
BMJ Education Award Finalist for Primary Care Programme
CQC– the only recognised information source for end of life care for CQC Hospital Inspectors

Outcomes include:-

Earlier identification of patients declining or in the final year of life, leading to more proactive care for those with life limiting conditions.
More advance care planning discussions.
Earlier assessment and better listening to patients’ wishes through advance care planning discussions and providing care to meet their needs.
More dying in their preferred place of care.
Halving hospital admissions and hospital deaths – more dying where they choose and fewer dying in hospital (see below)
Greater staff confidence, job satisfaction, boosted morale, staff retention ‘culture change’ more compassionate care.
Better carer and relative satisfaction with care.
Better integrated cross boundary coordination - better communication with GPs, care homes and hospitals to improve health & social care interpretation.

GSF Accredited care homes showing halving hospital death rate at accreditation 2011-15

Current GSF projects across the UK

North
Lancashire / Morecombe Bay – 15 practices, 1 whole Hospital Trust with over 30 wards (XBC)
Locala, Kirklees – 5 care homes (GSF Regional Centre)
Tameside and Glossop –
12 GP practices
Cumbria – 13 community hospitals
Wrightington Wigan & Leigh Trust - 1 ward
Durham, 44 Care Homes

Airedale, Yorkshire – I whole hospital, 30 GP practices, XBC Foundation Site
Manchester – 2 acute hospitals 4 wards, 10 Domiciliary care agencies
Wirral – 6 GP practices
Merseyside - accredited hospice, 1 whole hospital (Clatterbridge)
Doncaster CCG - 1 Acute Hospital - 4 wards
Bury CCG - 33 practices

Central
Nottingham – 30 Foundation Level, 1 acute hospital - 2 wards, 2 Hospices, 12 GP practices, XBC Foundation Site

Derbyshire - 6 GP practices
Warwickshire – 36 GP practices, 19 Care Homes
Northampton – 5 Care Homes (Foundation Level)
Stoke & North Staffs - 16 GP practices

Lincolnshire - 19 GP practices
Shropshire – 26 care homes
Wolverhampton – 1 acute hospital, 2 wards
Staffs & Surrounds - 14 GP practices

London / South East
South East London, St Christopher’s Hospice - 9 care homes (Regional Centre)

Barking Havering Redbridge – 70 GP practices, 5 hospital wards, 60 care homes (XBC Site)

St Francis Hospice, Romford—8 Care Homes
(GSF Regional Centre)
Stanmore Royal National Orthopedic Hospital, 4 wards
North East Essex – 42 GP practices, 3 care home cohorts

Chelsea & Westminster Hospital - 6 wards
North London (Regional Centre) – 7 GP practices
Esher, Princess Alice Hospice 17 care homes (Regional Centre)

South West
Dorset (Regional Centre) -14 community hospitals, acute hospitals 3 wards, 11 GP practices, XBC Foundation Site

Cornwall – 14 community hospitals
Devon – whole Acute hospital
Cotswolds, Longfields - 11 Care Homes (Regional Centre)

Somerset – 15 GP practices (previously 89 care homes)
Exeter– Royal Devon and Exeter Hospital—all wards
East Sussex, St Michaels & St Wilfrid's Hospice -
10 Care Homes (Regional Centre)

GSF Regional Centres
Cross Boundary Care Pilot Sites
Care Homes Projects
Domiciliary Care Projects
Primary Care Projects
Community Hospitals project
Acute Hospital Projects
GMC GSF Projects

12 GSF Regional Centres - Delivering training mainly to care homes in their areas:
Arthur Rank Hospice, Cambridgeshire
Locala, Huddersfield, Yorkshire
Longfield Hospice Care for the Cotswolds, Gloucestershire
North London Hospice
Princess Alice Hospice, Surrey
Pilgrims Hospice, Kent
St Christopher’s Hospice, SE London
St Francis Hospice, Romford
St Richards Hospice, Worcester
St Wilfrid’s Hospice and St Michael’s Hospice, East Sussex
Weldmar Hospice, Dorset
St Mary’s, Birmingham

6 Cross Boundary care sites
Dorset, Notts, Airedale/Bradford, Barking Havering Redbridge,
Morecambe Bay/ Lancaster, Jersey
Plus international GSF projects & Collaborative Centres:
Jersey (XBC site), 16 Care Homes and 6 Domiciliary Care Agencies, 1 Hospice, 12 GP Practices, 1 hospital
Ireland, St Johns Hospital , 7 Care Homes
Australia & New Zealand South Africa , China Hong Kong, Singapore, Japan, Canada , Holland , Belgium

10 Current GSF Training Programmes

Primary care
• Since 2000, all GP practices now use Foundation Level basic GSF principles (palliative care registers and meetings) – now next stage GSF Going for Gold programme for 500 practices with Accreditation Quality Hallmark Award (partner RCGP) and Silver programmes.
Care homes
• Almost 3,000 care homes trained since 2004 (25% of all nursing homes) with plus 500 accredited with Quality Hallmark Award (partners Care England, NCF, NCA, RNHA) and 194 re-accredited 3 years on. GSF Care Homes recognised by CQC as examples of best practice. Training delivered via VLZ, DVD and workshops.
Acute hospitals
• 42 hospitals involving individual wards and 5 whole hospital projects, many attaining Foundation Level and moving to accreditation and the Quality Hallmark Award in 2015 (partner British Geriatrics Society). The hospital accreditation process is recognised by CQC as the ONLY Information Source in EOLC in hospitals.
Community hospitals
41 hospitals in 3 areas- Cornwall, Dorset, Cumbria, 17 currently accredited. Conference programme supporting community hospitals with accreditation co-badged by community hospital association.
Domiciliary care
• Train the trainers cascade programme. Via VLZ. Currently 42 agencies in training with over 1600 care workers achieving certificates so far. Radical organisational changes demonstrated plus improved confidence of staff and better collaboration with primary care.
Dementia care
• Phase 3 with 49 registered candidates is now under way through VLZ distance learning, focusing on end life care, improving pain assessment, care planning and reducing hospitalisation.
Hospice Support
• 6 hospices - mainly home care/day care units supporting use of GSF for patients at home, and improving cross boundary care. First hospice accredited September 2014.
Clinical Skills Course
• Re-launched Summer 2015 – via VLZ for nurses, healthcare assistants and later for GPs, improving clinical skills in caring for residents in care homes and at home.
Spiritual Care Course.
Workshops and in-line 4 modular course , emphasizing spiritual assessment and comprising care, self-care resilience. Distance learning programme a VLZ plus tailored workshops for all health and social care providers, including enhancing compassionate care.
Prisons
A new programme supporting people in prison receive top quality end of life care. Progressing to Accreditation in 2016.

How is training delivered?

Our training is delivered through:-
Interactive workshops .
One of our GSF Regional Centres.
Distance Learning filmed programmes on the GSF Virtual Learning Zone.
Blended learning (combination of the above)
Fast track programmes.
Foundation Level, (Silver) Enhanced level, leading to Accreditation and the GSF Quality Hallmark Award.

How is impact evaluated?

Quantitative and qualitative assessments in all programmes
1. Key outcome ratios showing impact of change before
and after GSF against key metrics.
2. Comparative audits – patient level (online After Death
Analysis - ADA), staff confidence, organisational questionnaire, patient/carer views.
3. Portfolios for accreditation – evidence of best practice.
4. Visit/interview for quality assessment.
Reports of cumulated evidence published in journals.

Progress achieved—examples from GSF accredited teams

Measures of attainment from GSF Key Outcomes Ratios in different settings

Setting	Identify	2.Assess	3.Plan Living well	4.Plan Dying well
	Early recognition of patients- aim 1% primary care 30% hospital 80% care homes	Advance Care Planning discussion offered to every person	Decreased hospitalisation + improved carers support	Dying where they choose using personalised care plan in final days
GP practices	70% patients identified (0.7%)	75% offered ACP discussion	Halving hospital deaths , 65% carers support	63% die where they choose ,75% using 5P plan final days
Acute Hospitals	35% identified early for hospital register	85%-100% offered ACP discussion	Length of stay reduced , carers support improved	More discharged home, 80% 5Ps care final days plan
Community Hospitals	45% identified	98% offered ACP	improved carers support	More discharged home 97% 5Ps care final days plan
Care Homes accredited	100% identified, 81% identified in dying stages	All offered 95% uptake	Halving hospital deaths+ admissions 97% carer support	84% dying where choose, 90% using 5Ps care plan

For more information contact us on info@gsfcentre.co.uk www.goldstandardsframework.org.uk 01743 291891

	Identify / patients early	2.Assess needs and preferences	3.Plan Living well	4.Plan Dying well
	Identification rate average nearing the 1% ,30%, 80%	Advance Care Planning discussion offered	Decreased hospitalisation + carers support	Dying where they choose using personalised care plan
GP practices	0.63%	75%	? / 65% support	63%
Acute Hospitals	33%	85%	Length of stay decreased
Community Hospitals	45%	x	X / x	X / x
Care Homes 1st accredited

	Identify / patients early	2.Assess needs and preferences	3.Plan Living well	4.Plan Dying well	Numbers this Round Sept 15	Average accumulated from accredited teams
	Identification rate average nearing the 1% ,30%, 80%	Advance Care Planning discussion offered	Decreased hospitalisation + carers support	Dying where they choose using personalised care plan
GP practices	0.63%	75%	? / 65% support	63%	4 practices
Acute Hospitals	33%	85%	Length of stay decreased		3 wards
Community Hospitals	45%	x	X / x	X / x	6 wards
Care Homes 1st accredited
Care Homes 2+3rd accredited