National Standardsfor Specialist Palliative CareCancer Services2005

G/356/04-05 January Typeset in 12ptISBN 0 7504 3654 9 CMK-22-02-014 © Crown copyright 2005

Contents

1. Introduction to the Cancer Standards 1

2. Methodology 2

3. Format 3

4. Introduction to Specialist Palliative Care 4

Topic: Organisation 6

Topic: Patient-centred Care 12

Topic: Multidisciplinary Team 16

Topic: Initial Assessment and Palliative Treatment 20

1

1. INTRODUCTION TO THE CANCER STANDARDS

1.1 These Cancer Standards replace the previous Minimum Standards issued

in 2000 and continue the process of regularly reviewing and revising standards

to maintain their relevance to the NHS in Wales.

1.2 Cancer Standards define the core aspects of the service that should be

provided for cancer patients throughout Wales. The Standards should be used

in conjunction with other requirements for example from the Health and Safety

Executive, NHS, Royal Colleges and the National Institute for Clinical Excellence

[NICE] recommendations and guidelines that cover patient care, facilities and

staff. Trusts may provide or aim to provide additional services and work to

more rigorous and/or wide-ranging standards. This should be encouraged.

1.3 Since 2000 there has been significant change in organisational structures

within Wales. Further, both the NHS Quality Improvement Scotland and

Department of Health have issued cancer standards and NICE is part way

through a programme of issuing cancer service guidance for commissioners.

There was therefore a pressing need to revise the existing Standards.

1.4 The Cancer Standards build on those published in 2000 and take account

of the NICE cancer service guidance. The Minimum Standards of 2000

therefore form the basis of this set of Standards with a limited number of

additional new standards. In some cases the new standards, supported by

evidenced-based national guidance, are developmental and will be challenging for

example those involving surgical re-organisation. It is recognised that such

changes take time and resource to implement and it will therefore be important

that the process of implementation is planned to start as soon as possible.

Commissioners and providers, as Cancer Network stakeholders, will need to

work with each Cancer Network core team of Lead Clinician and Manager to

plan and deliver the service changes required.

1.5 Ongoing implementation of the Cancer Information Framework1 will

support the implementation of these new Standards as it focuses on the clinical

information required for cancer teams and discussed at the team meeting.

1 Cancer Information Framework WHC(2000)40 Apr 2000

2. METHODOLOGY

2.1 The Welsh Assembly Government tasked the Cancer Services Co-

ordinating Group [CSCG] to oversee the development of cancer standards. For

this latest revision the Cancer Standards Group of the CSCG has worked with

the CSCG clinical cancer site steering groups and patient forum to develop the

standards. Membership is at Annex 1.

2.2 Work commenced in April 2003 with each steering group reviewing the

Minimum Standards of 2000 in the light of subsequent national guidance and

cancer standards. Cancer Networks were involved in the process via

representation of Network clinical leads on the all Wales clinical steering

groups. During this time, a number of draft and/or cancer service guidance

documents were published by NICE which needed to be considered. Finally, a

six-week consultation phase was run during February/April 2004 with

completed Standards submitted to the Welsh Assembly Government in

July 2004.

2

3. FORMAT

3.1 The standards are presented as a series of Topics. These address the

organisational requirements that are key to effective delivery of care and then

follow the main stages in the patient journey.

3.2 Within each Topic, a Rationale is presented that provides the context to

the specific standards that follow.

3.3 Attached to each standard are monitoring criteria. The monitoring

criteria are included in this document as indicative of the monitoring required.

A separate and more detailed monitoring tool will be developed and piloted

prior to release.

3

4

2 Improving Outcomes: Supportive and Palliative Care, NICE, 20043 Improving Health in Wales.A Strategic Direction for Palliative Care Services in Wales. Cardiff:Welsh AssemblyGovernment. February 2003.

4. INTRODUCTION TO SPECIALIST PALLIATIVECARE STANDARDS

4.1 All services caring for patients with progressive life-threatening disease have aresponsibility to provide care with a palliative approach.These skills should be a corecompetency of every health care professional. Standards covering communicationand information with respect to the needs of patients and professionals areincorporated as generic standards in the cancer site specific standards.

4.2 The palliative approach may be applicable at any stage of a patient's illness fromdiagnosis to terminal phase, including bereavement support. It is informed by aknowledge and practice of palliative care principles and supported by specialistpalliative care.The goal of palliative care is the best possible quality of life for patientsand families.

4.3 These standards are the core requirement for specialist palliative care. Theyare intended for application in all settings where specialist palliative care is delivered:

in-patient hospice/specialist unit

advice about a hospital patient in a non-specialist bed

day hospice

home care

4.4 It is intended that these standards form the platform for the development oflocal protocols and standards.

4.5 Specialist palliative care is the total active care of patients with advancing non-curable disease and limited prognosis, and their families, by a multi-professional teamwho have undergone recognised specialist palliative care training.The supportprovided is holistic, encompassing physical, psychological, social and spiritual support,and will involve practitioners with a broad mix of skills including medical and nursingcare, social work, pastoral/spiritual care, physiotherapy, occupational therapy andpharmacy. Some patients may need palliative care input from the time of diagnosis.

4.6 The specialist palliative care team is a resource of advice and support to otherprofessional staff and develops education, audit and research activities with the focuson patients with progressive disease.

4.7 It is recognised that extensive palliative care, extending beyond that for cancerpatients, is provided in primary care and standards will need to be developed thatlink to these specific standards for specialist palliative care and are in-line withnational guidance2,3.The standards for Specialist Palliative Care Teams detailed in thisdocument support a generic standard for palliative care that is incorporated in allthe cancer site specific standards.

Key References

• Improving Supportive and Palliative Care for Adults with Cancer, the Manual.National Institute for Clinical Excellence. [March 2004].

• Improving Health in Wales. A Strategic Direction for Palliative Care Services inWales. Cardiff:Welsh Assembly Government. [February 2003].

• Improving Health in Wales. A plan for the NHS with its partners. Cardiff:WelshAssembly Government. [January 2001].

• Improving Health in Wales. Structural change for the NHS in Wales. Cardiff:Welsh Assembly Government. [July 2001].

• Bristol Royal Infirmary Enquiry. Learning from Bristol: the report of the publicenquiry into children’s heart surgery at the Bristol Royal Infirmary 1984-1995.[The Kennedy Report] Command Paper: CM 5207. [July 2001].

• Cancer Services in Wales. A Report by the Cancer Services Expert Groupchaired by Professor I Cameron [1996].

5

TOPIC: ORGANISATION

OBJECTIVE 1: TO STRUCTURE CANCER NETWORKS SUCH THAT THEY BRING

TOGETHER KEY STAKEHOLDERS IN BOTH COMMISSIONING AND PROVIDING

CANCER CARE,WITH AN OPEN AND TRANSPARENT MANAGEMENT STRUCTURE.

Rationale: A Cancer Network is an organisational association between

primary, secondary, tertiary and voluntary sector partners, social services and

commissioners with care delivered by multidisciplinary clinical teams within a

geographic area. Regular meetings between commissioners and providers, as

stakeholder organisations, will facilitate review of service provision and ensure

uniform standards of care are applied across the Network. The Network will

need mechanisms in place to action reorganisation of services where

appropriate.

Each Network should produce a Services Development Plan [SDP]4 that will

inform the commissioning process and involve Local Health Boards and Health

Commission Wales as appropriate. It is recognised that where appropriate the

SDP will need to involve collaboration between Networks.The development of

the SDP will involve all stakeholder organisations and be advised by the

Network Palliative Care group that is multidisciplinary and represents the

Specialist Palliative Care Teams [SPCT] within the Network.

The Chief Executive of the organisation on whose premises care is being

delivered remains the accountable officer for the quality of care. Where a

clinical team provides care to more than one organisation, clear agreements will

be required between organisations about how clinical governance

responsibilities are to be carried out. In relation to team working, the

recommendations made at the team meeting are advisory, and the responsibility

for clinical decisions and actions always rests with the senior clinician under

whose care the patient is at that point of their journey.

6

4 Service and Financial Framework target 2003-2004 - WHC(2003)001

7

STANDARD MONITORING CRITERIA

1.1 Network management arrangements andaccountability should be documented.

1.1 The establishment agreementdetailing Network managementaccountability to be held by theRegional Office.

1.2 Agreements on clinical governance lines ofaccountability for clinical teams providing care inmore than one organisation should be clearlydocumented.

1.2 Documentation detailingagreements on lines of accountabilityfor clinical governance.

1.3 The Network should produce a SDP, whichtakes account of local and the all Wales prioritiesand policy and is updated annually.

1.3

a. The Network SDP, approved bythe Network Board, is availablefor external peer review.

b. The Network to report to theRegional Office onimplementation of service plans.

1.4 Commissioners and providers asstakeholders of the Cancer Network shouldwork with the Network team to identifypriorities, taking account of all Wales CancerStandards, NICE and other national guidance andagree an appropriate programme forimplementation.

1.4 Regional Offices to monitorimplementation of Networkpriorities.

OBJECTIVE 2: CARE PROVIDED BY TEAMS SHOULD BE WELL CO-ORDINATED TO

PROVIDE AN EFFICIENT, EFFECTIVE SERVICE TO PATIENTS.

Rationale: Palliative care involves a number of different specialists working

together as a team. To effectively work as a team, particularly across

Departments within a Trust, co-ordination and clinical leadership is required.

The Trust Cancer Lead Clinician [TCLC] is accountable to the Trust Board via

the Medical Director or Executive Lead for cancer and is responsible for

identifying requirements to ensure cancer teams comply with the cancer

standards.The TCLC needs to be supported by a senior management team.

The SPCT Multidisciplinary Team [MDT] Lead Clinician is accountable to the

TCLC of the Trust/s where services are provided and is responsible for

identifying requirements to ensure the team complies with the Specialist

Palliative Care Standards. Where the SPCT provides services within the

voluntary sector there needs to be clear agreement between the SPCT lead

clinician and Chief Executive of the organisation to allow identification of

requirements to ensure the SPCT complies with both the Standards for

Specialist Palliative Care for Cancer Services and those of the Care Standards

Inspectorate.

8

9

STANDARD MONITORING CRITERIA

2.1 Each Trust should have an identifiedCancer Management Team that reflects themanner in which cancer is treated across themanagement structures. Each team shouldinclude at a minimum

a. A Trust Cancer Lead Clinician.

b. A designated Lead Manager.

c. The lead Cancer Co-ordinator.

d. A nominated Executive Lead.

e. A designated Lead Cancer Nurse/Allied

Health Professional.

2.1 Documentation detailing names anddesignation and a description of how themanagement team relate to internalmanagement structures.

2.2 The TCLC should be appointed by theTrust Chief Executive and have recogniseddedicated sessional time with administrativeand senior management support.

2.2 Job plan to detail role, sessionaltime and management support for TCLC.

2.3 The TCLC should attend both Trustand Network cancer meetings asappropriate.

2.3 Detailed in Job Plan.

2.4 The SPCT lead clinician should beconfirmed by the Cancer Network Board inconsultation with their respective TCLC andMedical Director or Executive lead.

2.4 Network documentation.

2.5 The lead clinician for each voluntarysector SPCT should be a formal appointmentby that organisation’s Chief Executive andconfirmed by the Cancer Network Board.

2.5 Network documentation.

2.6 The SPCT lead clinician should

a. Have overall responsibility for teamworking, the team meeting, clinical audit.

b. Provide clinical advice and co-ordinateany modernisation projects that areassociated with working of the MDT.

c. Have dedicated administrative andsecretarial assistance to support thefunctioning of the MDT.

d. Attend both Trust and Network cancermeetings as appropriate.

2.6 Responsibility detailed in job planwith evidence provided of

a. Regular team meetings withattendance register.

b. Clinical audit undertaken.

c. Service modernisation e.g. processmapping and capacity/demand studies.

d. Dedicated administrative andsecretarial support.

e. Attendance at Trust and Networkmeetings

10

STANDARD MONITORING CRITERIA

2.7 Each Trust or voluntary sector organisationproviding specialist palliative care services should adopta process, involving representatives from the CancerNetwork5, by which the organisation or the TrustCancer Management Team report to their Board atleast annually on compliance with the cancer standards.

2.7

a. Outline of process for annualassessment.

b. Minutes of Board meetingcovering report oncompliance to standards.

2.8 An analysis of the reasons for non-compliancewith standards should be undertaken with action plans,agreed by the Cancer Network, drawn up as a result.

2.8 Trusts/voluntary sectororganisations to providedocumentation of agreed actionplans.

5 Network representatives may include members of the Network core team, local LHBs and User Groups.

11

TOPIC: PATIENT-CENTRED CARE

OBJECTIVE 3:TO ENSURE THAT PATIENTS AND OR THEIR CARERS HAVE SUPPORT

AND ALL THE INFORMATION THEY REQUIRE REGARDING THE DIAGNOSIS,

TREATMENT OPTIONS AND TREATMENT CARE PLAN.

Rationale: Appropriate information, whether provided in written form or via

face-to-face communication, is required to support patients and their carers

throughout the cancer journey. All healthcare professionals need to be sensitive

to potential problems with communication with information being tailored to

the needs of individual patients. Patients need appropriate information to make

informed choices about their treatment. Special training can improve

communication skills in general and will provide for effective communication of

the diagnosis, treatment options and treatment care plan.

The psychological needs of patients are often not addressed6. People cope with

distressing circumstances in a number of ways however for those facing the

diagnosis of initial or recurrent cancer a number will experience significant

levels of anxiety and depression and may benefit from specific psychological or

psychiatric therapy.

12

6 National Service Framework No 1. NHS Cancer Care in England and Wales, Commission for HealthImprovement, 2001

13

STANDARD MONITORING CRITERIA

3.1 The SPCT should agree a communicationpolicy regarding

a. Communication between members of theteam.

b. Communication between the team membersand the patient and their carers.

c. Communication skills training for teammembers with direct patient contactespecially those involved in breaking badnews.

d. Adequate time for patients to considertreatment opt

3.1 Detail of SPCT communicationpolicy to include

a. Evidence of communication skillsassessment.

b. Evidence that the MDT hasconsidered the views of itspatients or carers regarding theappropriateness ofcommunication.

3.2 Written information should be offered toeach patient or carer accessing the SPCT.Theinformation should be in a language and formatappropriate to the patient or carer and shouldcover

a. General background information aboutspecific symptoms or interventions.

b. Detail of treatment options, specific localarrangements including information aboutthe SPCT and support services and whomthe patient should contact if necessary.

c. Details of local self-help/support groups andother appropriate organisations.

3.2 Copies of documentationprovided to patients/carers.

3.3 The SPCT should nominate a person to beresponsible for ensuring written information isoffered to all new patients.

3.3 Name of responsible personand detail of provision of writteninformation within thecommunication policy.

3.4 A designated person/s should beresponsible for ensuring that writteninformation is generally available in appropriatewards/outpatient areas and is checked andreplenished when necessary.

3.4 Name of responsible person/s.

3.5 Providers of specialist palliative careshould ensure all communication with patientswith special needs in relation to language,culture and physical or learning disabilities isaddressed.

3.5 Detail audit of providercommunication policy.

14

STANDARD MONITORING CRITERIA

3.6 There should be access to a private room or areawhere patients and or their carers can discuss thetreatment options and care plans in conditions ofadequate privacy with the appropriate member of theSPCT.

3.6 Details should be providedof facilities available.

3.7 Patients found to have significant levels of anxietyand or depression7 should be offered prompt access tospecialist psychological or psychiatric care capable ofproviding level 3 and level 4 psychological interventionsas defined in the NICE Supportive and Palliative CareGuidance.

3.7 Detail accessarrangements.

3.8 Cancer Networks should facilitate a Networkwide approach to psychological support services asrecommended in the NICE Supportive and PalliativeCare Guidance.

3.8 Networks to detail accessarrangements.

7 Supportive and Palliative Care Guidance for Adults with Cancer, NICE 2004

15

TOPIC: MULTIDISCIPLINARY TEAM

OBJECTIVE 4: SPECIALIST PALLIATIVE CARE SHOULD BE PROVIDED BY

DESIGNATED DISCIPLINES WORKING IN TEAMS WHICH PROVIDE THE

DIAGNOSTIC,TREATMENT AND CARE SKILLS REQUIRED TO MEET THE SPECIALIST

PALLIATIVE CARE NEEDS OF PATIENTS WITH LIFE THREATENING DISEASE.

Rationale: Patients with life threatening illness may require a range of

palliative care services at different points in their illness.To ensure that individual

patient’s needs are recognised and provided for, care should be provided by a

multidisciplinary team.Team structure should provide a range of expertise from

different professional groups to allow for integrated provision of high quality

care.Team working and collaboration between teams will support cover for

annual leave, sick leave and holidays. Adequate cover will enable the SPCT to

function at all times. Smaller providers may want to co-operate to achieve

sufficient activity to maintain a specialist team with appropriate resources.

Commissioners will need to work closely with the Cancer Network to avoid

overlap in service provision. Services will need to evolve, and move towards

providing a seven day, rather than a five day service.

Team membership will need to be reviewed following national guidance to

ensure appropriate input into the management of patients and to reflect new

roles such as advanced practitioners as they become established.

A programme of audit, defining performance against the cancer standards, will

provide the Cancer Networks, SPCT, health commissioners, the public, and the

Welsh Assembly Government with the information needed to maintain and

improve cancer services.

Identifying and rewarding areas of strength are important for morale and

motivation. By developing an effective audit programme, Networks and SPCTs

can also define whether any weaknesses are due to organisational factors or to

resource issues, a distinction that is of the utmost importance in seeking the

appropriate remedy.

16

17

STANDARD MONITORING CRITERIA

4.1 The SPCT should include thefollowing:

a. Palliative medicine consultant who is onthe specialist register, with at least oneother doctor with a postgraduatequalification in Palliative Care in support.

b. Palliative care nurse specialists.

c. Social worker or other staff memberwith specialist training in providingpsychological and social support andadvice on benefits, with designated timefor working with palliative care patients.

d. SPCT coordinator/secretary.

4.1

a. Detail names of designated SPCT anddetails of post-registrationqualifications appropriate to theirprofessional role.

b. Designated time for palliative carework.

c. Detail arrangements for co-ordinationand secretarial support.

4.2 The SPCT should be sufficientlystaffed to allow direct assessment of patientswith life-threatening illness in all caresettings during normal working hours, asagreed with the Network, seven days aweek.

4.2 Detail of,

a. Categories of staff who will providethe service.

b. Categories of patients and carers whomay access the service.

c. Types of assessment and interventionprovided by the service.

d. Safe visiting protocol.

e. The geographical area and serviceunits covered by the service.

f. Information to users on how toaccess the service.

g. Named person responsible forproducing and maintaining the on-callrota.

h. The contribution of the SPCT to theon-call rota.

4.3 The SPCT should make arrangementsfor direct patient assessment by core teammembers in exceptional circumstancesoutside normal working hours.

4.3 Detail access arrangementscovering outside normal working hours.

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STANDARD MONITORING CRITERIA

4.4 The SPCT should, in agreement withthe Network, ensure access to specialistpalliative care telephone advice 24 hours aday 7 days a week.

4.4 Detail of,

a. Categories of staff who will providethe service.

b. Categories of staff to whom theservice is available.

c. Availability of the service to patientsand carers.

d. The geographical area and serviceunits covered by the service.

e. Information to users on how to accessthe service.

f. Named person responsible forproducing and maintaining the on-callrota.

g. The contribution by the SPCT to theon-call rota.

4.5 If not already core team members, theSPCT should have access to:

a. An occupational therapist andphysiotherapist, with specialist training asdefined by the NICE guidance onSupportive and Palliative Care anddesignated time to assess and providepalliative rehabilitation.

b. Appropriate mental health specialist toprovide specialist psychological and/orpsychiatric intervention at level 3 andlevel 4 as defined by the NICE Guidanceon Supportive and Palliative Care.

c. A suitably qualified spiritual careprovider, such as an authorizedhealthcare chaplain, to provide supportand liaise with local faith leaders.

d. Input from site-specific cancer MDTs.

e. A named pharmacist with a specialinterest in Palliative Care.

f. Other appropriate Allied HealthProfessionals: Dietician and Speech andLanguage therapist.

4.5 Job plans to include,

a. Names of the specialists designated towork with/advise the SPCT.

b. Details of post-registrationqualifications appropriate to theirprofessional role.

c. Details of designated time.

d. Arrangements for cover.

e. Access arrangements to these supportservices.

19

STANDARD MONITORING CRITERIA

4.6 The Cancer Network/s and theirSPCTs should work together to ensureadequate sharing of specialist resourcesbetween SPCTs to meet patient need.

4.6 Detail arrangements by which thedevelopment of shared resources maybe coordinated across different coreservices and localities to meet patientneed.

4.7 Nurses and allied health and social careprofessionals working as part of the specialistteam should have a post registrationqualification in palliative care appropriate totheir professional role.

4.7 Details of qualifications [e.g.certificate in palliative medicine andother courses as developed] andprofession-specific competencies.

4.8 Each SPCT within a Cancer Networkshould have access to specialist palliative careinpatient facilities capable of addressingcomplex symptom or other needs not readilymet in other settings.

4.8 Cancer Network details ofaccessible specialist palliative care beds;capacity defined against nationalstandards such as those of NationalCouncil for Hospice and SpecialistPalliative Care,Association of PalliativeMedicine of GB and Ireland.

4.9 Specialist inpatient units should havesufficient core staff to provide 24 hourmedical cover.

4.9 Details of employment of palliativemedicine consultants supported byexperienced medical staff, sufficient tocomply with employment directives.Where necessary, details of formalarrangements between providers toensure adequate cover of neighbouringunits.

4.10 All cancer patients referred to theSPCT should be discussed by the team at thefirst available meeting.

4.10 Audit of case notes.

4.11 The SPCT should agree mechanisms forcollection of the Welsh Palliative CareMinimum Dataset on each of its patients.

4.11 % completion of Welsh PalliativeCare Minimum Dataset.

4.12 The SPCT should participate in allWales clinical audits as specified by theCSCG All Wales Palliative Care CancerSteering Group.

4.12 Reports of All Wales PalliativeCare Cancer Steering Group.

4.13 The SPCT should participate inNetwork-wide clinical audit as specified bythe Network Palliative Cancer AdvisoryGroup.

4.13 Network annual report to detailNetwork-wide audit programmes andresulting action plans.

TOPIC: INITIAL ASSESSMENT AND PALLIATIVETREATMENT

OBJECTIVE 5: PATIENTS REQUIRING SPECIALIST PALLIATIVE CARE SHOULD BE

REFERRED AND TREATED IN A TIMELY APPROPRIATE FASHION.

Rationale: Clinicians need to be aware of the appropriate indications for

referring patients with specialist palliative care needs and need to know what

the agreed care pathways are. It is believed that outcomes will be optimised if

all clinicians are working to the same set of agreed clinical policies and

protocols.

20

21

STANDARD MONITORING CRITERIA

5.1 SPCTs within each Cancer Networkand their referring clinicians should agreereferral criteria, and where appropriatedischarge criteria, for core palliative careservices [inpatient care, outpatient clinics, daycare facilities and community-based care] inline with the recommendations of the NICEguidance.There should be, within eachNetwork, a service directory clarifying thecontact points for, and types of serviceprovided by, NHS and voluntary palliative careservices.

5.1

a. Documentation confirming that theNetwork Manager,Trusts and alllocal GPs in the area have a copy ofreferral guidelines.

b. Evidence that a copy of the servicedirectory is available to health andsocial care professionals, patients andcarers.

5.2 The agreed referral pathway mustprovide explicit information on how to accessservices not directly provided by the SPCTincluding psychological support services,spiritual care, family and carer supportservices and complimentary therapy services.

5.2 Documented in agreed carepathways.

5.3 The Network should ensure thatreferral pathways are adhered to particularlywhere pathways cross Trust or Networkboundaries.

5.3 Networks to provide evidence ofreview of agreed referral pathways.

5.4 Patients referred to the SPCT forurgent review of uncontrolled symptomsshould be assessed within 2 days of referral.

5.4 Audit of patient records.

5.5 The Network should agree with itsSPCTs time limits for initial and follow upassessment, treatment and care of patientsand carers referred for non-urgent evaluation.

5.5

a. Written policy agreed with theNetwork, detailing arrangements.

b. SPCT audit of waiting times.

OBJECTIVE 6: PATIENTS WITH LIFE-THREATENING ILLNESS SHOULD HAVE ACCESS

TO PALLIATIVE CARE OF A HIGH STANDARD WHICH IS DELIVERED IN AN

INTEGRATED WAY.

Rationale: A cohesive and systematic approach is needed if the palliative care

needs of patients with life threatening illness are to be adequately recognised

and provided for. Designated disciplines should work together in such a way that

patients needs are regularly and uniformly assessed.

22

23

STANDARD MONITORING CRITERIA

6.1 Written, locally agreed, clinical and serviceguidelines should be provided by the Networkpalliative care advisory group for use by NetworkSPCTs. These should incorporate the NICE guidanceon Supportive and Palliative Care and be consistentwith the clinical guidelines recommended by the AllWales Palliative Medicine Consultants Group.Theseclinical and service guidelines will need to takeaccount of new NICE and other national guidancepublications when issued.

6.1 Network Manager to havea copy of the agreed clinicalpolicies and clinical standardsand guidelines.

6.2 The SPCT should work to guidelines, agreedwith the Network, for patient assessment in relationto the following potential needs:

a. Symptom control.

b. Functional.

c. Psychological.

d. Social.

e. Spiritual.

f. Those of the carer.

6.2 Written Networkguidelines as agreed by thepalliative care advisory group.

6.3 The SPCT should work to guidelines, agreedwith the Network, for management of palliative careneeds in at least the following situations:

a. Control of specific symptoms.

b. Common palliative emergencies.

c. End of life care8, to include families and carers.

6.3 Written Networkguidelines as agreed by thepalliative care advisory group.

6.4 The SPCT should support research into modelsor types of intervention and measurement ofoutcomes important to patients and carers.

6.4 Patient recruitment intoapproved research studies.

8 The All Wales Care Pathway for the Last Days of Life

OBJECTIVE 7: PATIENTS SHOULD RECEIVE SPECIALIST PALLIATIVE CARE WHEN

REQUIRED AND IN A WAY WHICH INTEGRATES WELL WITH OTHER CANCER AND

SUPPORTIVE CARE SERVICES.

Rationale: People with life threatening illness may require palliative care

intervention at times when many other services are involved.There should be a

co-ordinated approach to the provision and progression of this care.This is

difficult to achieve and requires that professional colleagues communicate

effectively in ensuring excellence of information transfer between services,

patients and carers. Professional carers must work within the boundaries of

their knowledge and competence and be alert to patients’ changing needs over

time. Care should be taken in avoiding overlap in providing for needs, with as

few professionals as possible involved, consistent with need.

24

25

STANDARD MONITORING CRITERIA

7.1 The SPCT should have rapid access tocurrent clinical information on individualpatients.

7.1 Audit of critical events.

7.2 There should be clear co-ordinationbetween agencies, across statutory andvoluntary sectors, responsible for meetingpalliative and supportive care needs.

7.2 Evidence of formal links such as:

a. Multiprofessional meetings onindividual patient care withrepresentatives from differentorganisations.

b. Joint or parallel clinics.

c. Participation in site-specific MDTmeetings.

7.3 The SPCT should be adequately staffedto provide education to other professionalcolleagues including care homes and primarycare teams.

7.3 Details of SPCT contribution toeducational programmes on generalpalliative care.

26

ANNEX 1

Cancer Standards Working Group

Professor Malcolm Mason,Velindre NHS Trust [Chair]

Dr Paul Birch, Consultant Radiological Clinical Director, North West Wales NHS

Trust

Dr Anthony Byrne, Consultant in Palliative Medicine, Marie Curie Centre Holme

Tower Hospice

Mr Mike Chare, Consultant Surgeon, Swansea NHS Trust

Ms Anwen Davies, Chemotherapy Nurse Specialist, Swansea NHS Trust

Professor Glyn Elwyn, Professor of Primary Care, Clinical School, University of

Wales Swansea

Mr Robert Hall,Vice Chair,Association of Welsh CHCs, Gwent CHC

Dr Jane Hanson, CSCG, Programme Co-ordinator

Mr Damian Heron, Manager, North Wales Cancer Network

Dr Fergus Macbeth, Consultant Oncologist,Velindre NHS Trust

Mr Hywel Morgan, Manager, South East Wales Cancer Network

Mrs Pamela Parkhouse, Patient Representative

Dr David Salter,Acting Deputy Chief Medical Officer,Welsh Assembly

Government

Mrs Glynis Tranter, Manager, South West Wales Cancer Network

Professor Geraint Williams, Professor of Pathology, University of Wales College

of Medicine

27

All Wales Palliative Care Medicine Consultants Group

Welsh Association of Palliative Care

Membership of the Patient Forum

Mr Robert Hall [Chair]

Mr Sheikh Ahmed

Mrs Vanessa Bryant

Mr Neil Formstone

Mr Walter Oaten

Mrs Pamela Parkhouse

Mr Roger Smith

Mrs Rosemarie Williams

28