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Moray Palliative Care Day Centre – Operational Policy
Updated version 12th January 2007
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Moray Palliative Care Day Centre – Operational Policy .......................................................................... 1
Introduction .............................................................................................................................................. 3
Aims and Objectives: ............................................................................................................................... 5
“Drop-in” Information and Support Service ............................................................................................. 6
Specialist Palliative Care Day Unit .......................................................................................................... 7
Catchment Area ................................................................................................................................ 7
Patient Groups .................................................................................................................................. 7
Routes of Referral............................................................................................................................. 7
Admissions Policy ............................................................................................................................ 7
Discharge Policy............................................................................................................................... 8
Communication ................................................................................................................................ 8
Established clinics and services ................................................................................................................ 9
Palliative Care Clinic ........................................................................................................................ 9
Chronic Oedema Clinic .................................................................................................................... 9
Complementary Therapy Clinic ....................................................................................................... 9
Moving on Clinic .............................................................................................................................. 9
Breathlessness Clinic ...................................................................................................................... 10
Other Services ................................................................................................................................ 11
Volunteer support ................................................................................................................................... 12
Liaison with existing Primary Health Care Services .............................................................................. 13
Communication and Liaison with Existing Palliative Care Services ..................................................... 13
Administration and Management ........................................................................................................... 14
Hours Available ...................................................................................................................................... 14
Medical Input ......................................................................................................................................... 14
Clinical Governance ............................................................................................................................... 14
Audit, Evaluation and Research ............................................................................................................. 15
Training, Development, Education and Support for Staff and Volunteers ............................................. 15
Complaints Procedure ............................................................................................................................ 15
Clinical Risk Management ..................................................................................................................... 15
Health and Safety ................................................................................................................................... 16
Catering Services .................................................................................................................................... 16
Pharmacy Service ................................................................................................................................... 16
Domestic Services .................................................................................................................................. 16
Secretarial Services and IT Systems ....................................................................................................... 16
Gardening ............................................................................................................................................... 16
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Introduction
One Grampian resident in three will develop cancer in their lifetime and one person
in four will die from cancer.
(Grampian Health Board “Review of Cancer Services in Grampian”, January 1997)
Cancer is likely to remain one of the major causes of morbidity and mortality for
some time to come. As such, cancer and palliative care services will continue as a
priority area for development for the Health Services.
In Moray
(a) around 400 residents are diagnosed each year as having a malignant
tumour;
(b) about half of these patients will die of their disease, either within a short time of
diagnosis, or many years later because of complications or recurrence;
(c) in 1994, 235 people in Moray died of a malignant disease, some of which will
have been diagnosed years earlier;
(d) 90% of cancer deaths were of people aged 55 or over.
(MHS Cancer Services Review 1996).
In 1997, the Hospice in Moray (H.I.M.) Steering Committee published their proposals
for a Day Hospice in Moray. The efforts of the H.I.M. campaign have been key to the
development of this project. In 1998, the Scottish Health Feedback Action Research
report was published. One of it’s key recommendations was also the provision of a
Day Hospice/Resource Centre in Moray. There followed the establishment of a
Grampian Health Board Working Group, chaired by Dr. Gordon Paterson, to put
together proposals for improving cancer and palliative care services in Moray, and to
look at the issues around the setting up of a Day Hospice.
The Oaks Palliative Care Day Unit opened 2nd June 2003 and then was officially
opened by HRH Prince Charles on 5th August 2003 with the full support of Grampian
Health Board, NHS Grampian Trust, the Moray Hospice Steering Group, and
Macmillan Cancer Relief.
The facility aims to provide increased support to patients being cared for at home,
and to their carers. In providing this support it is hoped to enable more people to
spend longer being cared for at home, and for that time to be of better quality.
More than 70% of people wish to die at home; less than 30% of people actually do.
The over-riding aim is to provide an holistic approach to care which will meet
the most important needs of individual patients and their carers at any particular time.
The key elements to the type of care provided are well described in the World
Health Organisation definition of palliative care, viz. “the active total care of
patients…..the goal of palliative care is achievement of the best quality of life for
patients and their family….palliative care affirms life,…..provides relief from pain
and other distressing symptoms, …..integrates the psychological and spiritual aspects
of patient care, ….offers a support system to help patients live as actively as possible
until death,…. offers a support system to help families cope during the patient’s
illness and in their bereavement”. This will involve providing clinical care and
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treatments in an outpatient setting, with access to specialist staff, encouraging
rehabilitation, providing psychosocial and spiritual support, and providing respite for
carers. The integration of all these various elements of supportive care will be the
exciting challenge of the Palliative Care Day Centre. The Day Centre will function as
a sister unit of the specialist palliative care services based at Roxburghe House,
Aberdeen.
Though a focal element of the Centre is a Specialist Palliative Care Day Unit, the nonclinical elements are considered equally important – the Centre incorporates a “dropin”/ information and support service; volunteers and the local community are
encouraged to be intimately involved in supporting this aspect of the Palliative Day
Centre. The Centre also offers clinic space and acts as an educational resource.
The Palliative Care Day Centre for Moray is just one element in an integrated set of
proposals for improvements in cancer and palliative care services for the region. The
key to this whole process is the provision of expert supportive care to all patients by a
team of multi-professionals and volunteers. Elements of the services available within
the Day Centre are outreach in nature, with some team members being able to visit
patients in other care settings, and with carers and professionals from other settings
gaining experience in the Unit which they can bring back to their own places of care.
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Aims and Objectives:
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To develop further the existing supportive and palliative care services for Moray,
focusing on enabling people with cancer and other chronic illnesses to live as
independently as possible in their own homes and communities.
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To reduce the need for admission of patients to hospital for terminal care.
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To provide specialist palliative care in a day unit setting.
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To provide other care and treatments in an out-patient setting.
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To be actively involved in the rehabilitation of patients, where appropriate.
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To provide a range of activities to suit individual needs and abilities.
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To provide psychosocial and spiritual support to patients and their carers.
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To provide access to specialist staff, including medical, nursing and AHPs
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To offer respite to carers.
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To improve communication and liaison between Primary Care and Specialist
Palliative Care.
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To provide information on cancer and progressive illness to patients, their carers,
the general public and health care professionals.
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To support the educational needs of Primary and Secondary Care professionals in
Moray.
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To provide a facility available to the community for varied activities related to
promotion of health and healthy living.
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“Drop-in” Information and Support Service
The key to the ongoing success of the Palliative Care Day Centre is the extent to
which the community of Moray have a feeling of “ownership” of it, and the extent to
which they use the Unit for a wide range of activities.
The Information and Support Service is open to the general public, Monday - Friday
each week from 0930am - 1630pm. The day-to-day running of the Information and
Support Service is co-ordinated by the Information Support Nurse, though the Unit
Manager retains overall management responsibility. The Information and Support
Service incorporates:
An Information Centre
See Appendix 1 for a copy of the Operational Policy for
the Cancer Information and Support Service.
Reception area
Staffed by volunteers
Providing welcome and direction to people
arriving at the unit.
Answering phones, and directing calls
Basic admin support
Café and lounge area
Provisions include: tea/coffee/soft drinks and
snacks. The setting is informal, serviced by
trained volunteers and managed by the
Volunteer Services Manager.
The lounge area incorporates a children’s area.
Seminar Room
A separate seminar room allows for activities to
take place at any time during the day or evening.
To be used for lectures and educational
activities, and for support groups to meet. This
large room is capable of being sub-divided into
two to allow smaller groups to meet. No more
than 25 people can be accommodated. This
room is accessed by unit staff and Macmillan
teams.
Light refreshments are available to people
attending sessions in the Seminar Room with a
minimum donation.
The building may be used out-of-hours for
lecturing, groups to meet, and other associated
services at the discretion of the Centre Manager.
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Specialist Palliative Care Day Unit
Palliative care should be an integral part of all patient’s care. Specialist palliative care
is required by a significant minority of patients. The Specialist Palliative Care Day
Unit within the Day Centre provides one element of an integrated Specialist Palliative
Care Service for Moray, complementing the existing community Macmillan Nursing
service.
Catchment Area
The Specialist Palliative Care Day Unit offers a service to those who live across
Moray or within a reasonable travelling distance from Elgin, and for whom travel
arrangements are possible.
Patient Groups
All patients admitted to the service must have cancer and/or palliative care needs.
This service is aimed at anyone over the age of 18. The Centre endeavours to provide
information and advice to support the needs of sick children and their families in an
appropriate way.
Routes of Referral
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Community/ hospital based Macmillan Nurses
Primary Health Care Team
Palliative Care Team
Oncology Teams
Acute Service Teams
Hospital Palliative Care Team based at Aberdeen Royal Infirmary
Specialist Nurses
Social Work Department
Self
Admissions Policy
Though a referral to the SPC Day Unit can originate from any source, all referrals
should be discussed with the relevant GP or consultant prior to the referral
proceeding.
For all patients, the GP remains the lead clinician in caring for patients who are in the
community.
All referrals to the SPC Day Unit must have specific palliative care needs, and referral
must be discussed with the patient and their carers.
Patients and carers are encouraged to visit the unit at time of referral.
A medical member of the team will be available to examine the patient at an
appropriate time following their referral to the Unit.
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Discharge Policy
On admission to the SPC day unit, a plan for care will be discussed with the patient
and carers. This plan of care is reviewed on an ongoing basis every 8-12 weeks to
ensure appropriate care. For some patients, if their condition stabilises, and the
problems leading to referral have been resolved, ongoing follow-up might better take
place through another element of the palliative care service, (e.g. Primary Care Team
with or without the support of the community Macmillan nursing team; the “Drop-in”
service and the variety of clinics). These patients are discharged from the SPC day
unit, but referral again in the future may be an appropriate part of their ongoing care.
Patients may be discharged from the SPC day unit for the following reasons Transfer to another service
 Moving outwith the area
 Due to deteriorated condition patients are unable to travel any more
 Initial referral reason has been resolved and needs met
 Improvement or “plateau” reached in condition, so that Day Care becomes
neither desired nor beneficial
 Severe confusion when this condition cannot be safely managed, or where,
despite intervention undue distress is being caused to others
Decisions on discharge are discussed and agreed with the Palliative and Primary
Health Care teams, with the Nurse Manager taking a lead role, alongside the patient
and/or carer.
Communication
Effective verbal and written communication is essential to the efficient functioning
and integration of the service.
The team members working in the Day Unit ensure frequent communication with
members of the Primary Health Care Team as appropriate. In particular, any changes
in a patient’s condition and any recommendations regarding changes in treatment is
communicated directly to the patient’s GP by the appropriate team professional.
Effective communication within the Day Unit is critical – individual case notes are
kept up to date for each patient. Patient records are kept in the Nurse Managers room
in a filing cabinet that can be securely locked. The case notes of patients no longer
attending the SPC Day Unit are stored within a locked/ keypad room within the
centre.
Communication with social services and secondary care is also important. IT
communication links are established with Dr. Gray’s Hospital.
Website
Information regarding The Oaks services and clinics, general information and forms
can be accessed via NHS Grampian homepage. The
05/06 Annual report will be available electronically via
the website in June 2006.
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Established clinics and services
Palliative Care Clinic
Dr Tim Morgan provides a symptom control/ palliative care clinic every Thursday. At
this clinic he assesses all day patients that attend the unit and reviews individuals
following assessment by nursing staff. As well as the day patients Dr Morgan sees
outpatients and carries out domicilliary visits in Moray with the Macmillan nursing
team or General Practitioners. The referrals for this service are managed by The Oaks
Centre Manager / secretary depending on priority of need stated by the referrer.
Chronic Oedema Clinic
The Chronic Oedema clinic in Moray was set up in 1998. The clinic moved from Dr.
Grays to The Oaks when it opened. A Community Macmillan Nurse runs the clinic on
a Wednesday weekly. Treatments include skin care, massage, compression and
exercise. Following the initial phase of assessment and treatment patients are offered
regular monitoring. Treatment can be adapted or changed if required. The referring
doctor/nurse is kept informed of the patient's progress.
Complementary Therapy Clinic
The Oaks Complementary Therapy clinic has been set up to benefit people in Moray
who are affected by cancer by providing a range of complementary therapies at a
reduced cost.
Those attending the clinic must have either a cancer diagnosis, be an immediate carer
of a person with a cancer diagnosis or be seen at the discretion of the therapist. The
clinic runs on Fridays between 10am and 4pm and currently offers the following
treatments:
 Reflexology
 Aromatherapy
 Massage including: Swedish and Indian Head Massage
 Reiki
 Hypnotherapy
 Art Therapy
The Clinic was set up in February 2004 and uses a variety of therapists.
An initial consultation is charged at £20 and all further individual treatments are
charged at £15 per session which is payable to the therapist. Each session lasts up to
an hour. It should be noted that these charges go directly to the therapist and that The
Oaks receives no profit from the clinic.
A letter informs the GP of each client who is attending and receiving Complementary
Therapies.
Moving on Clinic
The moving on course has been set up to facilitate the safe discharge of a small group
of patients from the specialist palliative day care unit.
The course runs for six-week sessions and incorporates relaxation, group and
individual discussions and the opportunity to access complementary therapies. Much
of the focus of the group is on regaining confidence and managing anxiety.
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Breathlessness Clinic
It is recognised that breathlessness is a problem commonly experienced by people
with lung cancer. Reported in 75% of patients, it is a symptom that is often poorly
controlled. The aim of the breathlessness programme is to provide a supportive
intervention to people with lung cancer experiencing breathlessness, to assist them to
achieve their physical, emotional, social and spiritual potential.
A flexible four week programme is provided which includes breathlessness
assessment using the assessment guide developed by the Centre for Cancer and
Palliative Studies. The focuses on rehabilitation and introduction of strategies to help
people cope with the experience of breathlessness like breathing control, activity
pacing and anxiety management, including relaxation and visualisation that are
offered in a supportive environment.
The programme is supported with a series of booklets and CD on breathlessness
produced by Macmillan Cancer Relief.
The Specialist Palliative Care Physiotherapy Clinic
January 9th 2006 saw the start of this outpatient service operating on Mondays at the
Oaks. It had become evident in the last year that a number of patients discharged from
day care (who still required some physiotherapy follow up) or those not appropriate
for referring to Day Care might still benefit from specialist outpatient physiotherapy.
The referral criteria are stated as:
'Any person with cancer or any life limiting illness requiring physiotherapy treatment
as an outpatient, who would be more appropriately treated in a Specialist Palliative
Care setting.'
Symptoms might include: pain, fatigue, poor general mobility, post-operative joint
stiffness or muscle weakness, non-healing of surgical scars, hot flushes.
Look Good Feel Good Clinic
The Look Good Feel Good clinic is available to any female undergoing or having
recently completed cancer treatments. The aim of the clinic is to offer emotional
support and help with confidence building for the individual to move on in an
empowered manner.
Each person is invited to a one day session. (Previously, two afternoon sessions).
Throughout the day, women who attend will be treated to beauty therapy, scarf tying
and scalp care, hand or foot massage, relaxation, dietetic and general support. The
sessions are backed up with written information wherever possible.
Living with Cancer Clinic
Having become increasingly aware of a need for such a service (e.g. nature of
enquiries to information services, feedback from regulars and local support groups)
the team at The Oaks developed a course on living with cancer.
The aim of this 6 week course is to provide structured information, education and to
raise awareness of available local support for people learning to live with cancer. The
course can cater for approximately 8 people.
Each week's session lasts about three hours on a weekday afternoon, light
refreshments are provided.
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Family and Friends Course
This was developed to help support the close family or friends of patients attending
day care. Led by the unit physiotherapist and information and support nurse it
involves attending an afternoon session for 6 consecutive weeks. There is a different
discussion topic each week. These discussions are chosen by the participants and
usually include: healthy eating, Moray Carers Project, Complementary Therapies and
the emotional impact of serious illness within the family. Each session features
relaxation, stretch and tone.
Other Services
The following services are delivered through the same sources, and in the same
manner as for Dr. Gray’s –
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Supplies, clinical and non-clinical
Control of Infection
Equipment
Linen Service
Maintenance Service
Waste Disposal
IT
Pharmacy
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Aromatherapy
Massage inc. Indian Head Massage
Reflexology
Art Therapy
Hypnotherapy
Acupuncture
Reiki
Hairdressers
Beauticians
Therapies
Creative Therapies
 Art
 Diversional Activities
 Cookery
 Gardening
Occupational Therapy
 Functional Assessment
 Equipment
 Relaxation
 Fatigue Management
 Anxiety/ Anger Management
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Physiotherapy
 Rehabilitation
 Assessment
 Treatments
 Exercise Programmes
 Relaxation
 Acupuncture
Dietician
 Support, advice and education
Religious Support
 Patients and visitors to the Unit have access to the retreat room at all times.
A chaplain provides spiritual support and arranges services regularly.
Snoozelen Relaxation
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Sensory relaxation equipment has been installed into the day bedroom area,
offering an alternative type of relaxation.
Volunteer support
Volunteers have always been considered valuable members of any palliative care
team. The aim of the volunteer team co-ordinated by the Volunteer Administrator and
managed by the Centre Manager is to strengthen the work of the professional team in
the Centre and to enable the service to extend the practical and supportive care that
can be offered to patients, relatives and carers.
Volunteers are placed in various areas throughout the unit, depending on where a need
has been identified. The appropriate role and duties of volunteers are agreed between
the Voluntary Services Manager and the Unit Manager and the multi-disciplinary
team.
The range of services provided by the volunteers could include:
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Drivers; patient transport
Reception; administration, telephone answering, hospitality, Café
Supporting the Information Service
Day Care Activities; supporting the nursing team, arts and crafts
Therapeutic care; Hairdressing / Beauticians/ Complementary Therapists
Gardening/ Handy Man
Guest speakers and Talkers
Volunteers are trained to the appropriate level for all of these various roles.
Volunteer Training
11 volunteers have completed the Macmillan Cancer Support certificate, an award
ceremony is to be held in March 06. Further training;
including Moving and Handling has been developed.
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Liaison with existing Primary Health Care Services
As a resource aiming to support patients and families in the community, the service is
fully integrated with community services.
The GP and other members of the Primary Care Team remain the primary carers of
their patients. Any recommendation regarding changes in treatments for individual
patients will be discussed with the Primary Care Team. New medications, for
example, will only be commenced by the GP.
The community-based Macmillan nursing team will be based within the unit.
Staff in community hospitals and primary care teams will be encouraged when
appropriate to rotate through the SPC Day Unit to gain experience in palliative care in
that setting.
District nurses are…
Invited to visit the SPC Day Unit if any of their patients are being seen there.
Contacted as soon as possible, and involved in any discussion relating to a
change in the condition or treatment of their patients
Encouraged to communicate, either verbally or in writing, with the SPC Day
Unit, about any aspects relating to their patient’s care
General Practitioners are….
Involved in any discussion relating to a change in the condition or treatment of
their patients
Encouraged to communicate, either verbally or in writing, with the SPC Day
Unit, about any aspects relating to their patient’s care
Invited to visit the SPC Day Unit if any of their patients are being seen there,
in particular, and if possible, to coincide with the specialist medical
assessment of their patient.
Communication and Liaison with Existing Palliative Care Services
The community-based Macmillan nursing team will have their office within the unit.
A liaison meeting between the Nurse Manager and community / hospital based
Macmillan nurses is attended weekly.
There are close links between the services provided at the SPC Day Unit, the
specialist palliative care unit based at Roxburghe House in Aberdeen and the day unit
at Highland Hospice in Inverness, Macmillan House in Perth, Macmillan Centre
Stracathro and Roxburghe House in Dundee
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Administration and Management
The Centre integral part of Specialist Palliative Care services in Grampian.
It functions as a sister unit of Roxburghe House in Aberdeen. As such, it functions
administratively within NHS Grampian Trust, and adheres to all Trust policies,
procedures and guidelines.
The Unit Manager is responsible for the co-ordination of services and input into
clinical development. There is secretarial support in the unit.
Hours Available
The Centre is operational 5 days per week including the SPC Day Unit, which is open
for Tuesday, Wednesday and Thursday each week.
The SPC Day Unit caters for 10-12 patients per day. Patients attend Day Unit from
10.00am to 3.30pm.
Individuals are encouraged to organise their own transport. For those unable to do this
transport can be arranged. This is provided by volunteer drivers (co-ordinated by the
Volunteer Administrator) or an alternative as appropriate.
An answering machine is available outwith working hours – patients are referred to
their own general practitioner if medical advice is needed.
Medical Input
Medical staff have a supportive and consultative role.
The GP remains the lead clinician for each patient.
A doctor will be available to provide a medical assessment of patients as appropriate,
or when requested to do so by the Nurse Manager, or by the patient’s own GP.
An out-patient service is provided for patients not attending the SPC Day Unit, but
who require specialist palliative care and symptom control review.
Clinical Governance
Continuously assessing and improving the quality of care provided by the service,
safeguarding high standards of care, by creating an environment in which clinical
excellence will flourish.
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Audit, Evaluation and Research
Audit, evaluation and research based practice is ongoing.
Evidence based practice and the use of SIGN Guidelines and best practice statements
are encouraged.
Where appropriate, certain aspects of care are guided by protocols. Some of have
been drawn up in other specialist palliative care settings in Grampian. Patient carer,
volunteer and staff feedback is also encouraged and recorded.
Training, Development, Education and Support for Staff and Volunteers
There is a period of induction and team building for all new members of staff and
volunteers.
All staff and volunteers play an active part in identifying and meeting their own and
others educational and developmental needs.
A system of staff /volunteer support is established. Therapists in particular are advised
to contact the Centre Manager or Lead Nurse if required.
A staff room is available, with access to kitchen facilities for meals.
Meals for staff are provided by the same system as chosen for the patients.
A staff library is available, alongside a separate patient library.
A suitable / preferred system of clinical supervision is adopted
Complaints Procedure
Local resolution – this procedure is when a problem is sorted out straight away when
a complaint is reported to someone close to the cause, eg doctor, nurse or receptionist.
A complaint can also be given in writing or by telephoning the designated complaints
officer. The NHS attempts to reply within 4 weeks from receiving of a complaint
Unsatisfied local resolution complaints can be taken to an Independent Review within
4 weeks of local resolution action outcome. Support can be given for this by Local
Health Council.
If still dissatisfied with NHS complaints procedure, the Health Service Commissioner
(the Ombudsman) can be asked to investigate your case.
Clinical Risk Management
There is an identification of hazards; if possible the hazards are eliminated or the
degree of the risk associated with any hazard is minimised.
Staff members who have undergone a trust training programme to carry out Risk
Assessment throughout the unit have been identified.
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Health and Safety
In accordance with trust and employee responsibilities; Adhering to the two most
important statutory requirements are The Health and Safety at Work etc Act 1974, and
the Management of Health and Safety at Work Regulations 1999.
Catering Services
Meals are provided from the Dr Grays site.
Meals are plated in the kitchen before serving. Only lunch and snacks are provided.
This kitchen is accessed by staff and volunteers only.
Facilities are available to heat food.
Refrigeration facilities to store, for example, ice cream and yoghurts is also available.
Dietetic advice is sought in planning catering services.
Pharmacy Service
Policies and protocols regarding drug issues are decided on consultation between the
Nurse Manager, medical staff, and pharmacist. Existing policies and protocols within
NHS Grampian Trust are used.
Wherever possible, patients are responsible for the safe-keeping, provision and
administration of their own routine medication.
If, for any reason this is not possible, then the medications are taken into safekeeping, and administered by a trained member of the nursing staff.
A small stock of medication is kept for prn administration, in a locked cupboard
situated in the nurses treatment room.
Domestic Services
Are discussed, reviewed and co-ordinated by Domestic Service Manager and Centre
Manager.
Secretarial Services and IT Systems
The Day Unit accommodates the secretary to the Macmillan nursing team who also
provides secretarial support for the unit.
Links with IT systems within Dr. Gray’s Hospital – the Unit is linked to the GHRIN
system.
Gardening
Maintenance of garden areas are part of the service provided to the grounds at Dr.
Gray’s Hospital. Volunteers or patients, in a therapeutic context augment this service,
in certain areas.
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