Review Progress

Proposed themes - Setting the context; Stakeholder engagement; Innovation; Community palliative care; Findings and funding opportunities; SMH and the wider community; workforce/investing in volunteers; conclusions and options; overall conclusions; consultation and implementation plans.

Panel Meeting 9: 9th September 2016

Presentations by Public Health (SCC), PwC on 'Fit for Future' report highlights and Joy Milliken (SMH) on Camilla Wilson's journey (patient)

Somerset's PH vision is that people live healthy and independent lives, supported by thriving and connected communities, with timely and easy access to high quality and efficient public services when they need them

Resulting in a good birth, a good life and a good death. 

The strategy has three aims;-


  • 1) People, families and communities take responsibility for their own health and wellbeing
  • 2) Families and communities are thriving and resilient
  • 3) Somerset people are able to live independently

The three current priorities are;-

  • 1) To build strong, resilient and healthy communities
  • 2) A joint leadership for prevention and
  • 3) A new, integrated and sustainable model of care

Mental and Social Capital will result in that stronger community that is positively connected, inclusive, resilient, mutually supportive and informed

There is a high risk factor of loneliness due to the number of one person households. The population in terms of those aged 65 or over is growing. Currently there is an inequality in who is dying and why

There is a significant role for SMH in palliative care

Early intervention is best practise. Like water money flows downstream so early intervention is PREVENTION

There are three types of prevention; Primary, Secondary and Tertiary

There is also a lot that SMH can do about primary prevention i.e. wills, talking about dying

Prevention opportunities are present at all levels from Specialised/acute need, complex needs, low level of need and independent living in communities and neighbourhoods

SMH fits across all levels

Forward planning, humanity of the journey and collaboration between the acute and voluntary sector are critical.

PwC 'Fit for Future' report highlights

  • Six key challenges
  • The age of the population is growing
  • STP's
  • Accessibility and equality
  • Maintaining and developing the workforce
  • The impact of immigration as both part solution and part problem 

Indispensable services:

  • CRC and 24 hour advice and support line
  • Home and community care
  • Educations and research and
  • IPU services

Camilla Wilson's journey: the patient face of 'Fit for Future'

Described through a series of blogs and interviews. Ultimately tha family felt let down by the system. For example:

  • A difference of opinion by health professionals was confusing
  • Care was not coordinated
  • There were issues with equipment
  • The family did not know what to expect at the end of life

Key message was that expectations need to be managed in a sensitive and open manner by all professions to help patients deal with their progressing illness

Option criteria - break-out sessions

The Review Panel suggested that four criteria were equally critical

  • Fit with charitable mission and vision
  • Ability to address the six key challenges
  • Alignment with changes in the external environment
  • Alignment with SMH's objective of increasing reach

The Review Panel felt that remaining criteria wold be easier to address if the critical four criteria were prioritised. In order of importance, the Review Panel ranked the remaining criteria as

  • Implications on fundraising
  • Promotion of coordination of specialist palliative care
  • Workforce capability and capacity
  • Ease of implementation

REPUTATION management was seen as critical when considering all options

Summary of key themes

  • A Public Health approach to strenghten and build strong communities
  • Reputation of SMH moving forward


Panel Meeting 8: 22nd July 2016

Presentation by PwC on proposed service model options

A review of the 'Foreword' with proposed amendments

Putting patients first; Reaching the harder to reach; Embracing new technologies; Promoting a caring network; Making caring a career; Valuing our volunteers; Growing our reputation in Somerset; Keeping up with the times; Maintaining a high quality

Six key challenges and connecting complex community care

Implications for models: connectivity; video conferencing; tele-health & tele-monitoring; Skype; whiteboards; patient and professional portal

Systematic high quality care; Targeted; Coordinated; Access to specialist expertise; Patient engagement; Improved resource management; System improvement and learning

Exploration of potential service delivery options; Buildings; Increased access; Workforce implications; Branding implications; Risks to consider

Education and multiagency hubs; Shift more care to community; Beds nearer to home; Fluid and flexible workforce; Technology and new ways of working

Demand assumptions; Change management; Marketing and communication; Stepped transitions; Collaboration

Compassionate communities; Strengthening and giving power to communities to support palliative and end of life care

Panel report and conclusions

Summary of key themes

  • 6 key challenges
  • Recommendations and 'Foreword'
  • Digital technology and innovation are key to potential service model options
  • Coordinated and targeted access to care
  • Patient engagement
  • Utilisation of resources
  • Exploration of models, implications including workforce, branding and risks to consider
  • Education
  • Shifting care to the community and closer to home
  • Strengthening communities
  • Marketing, collaboration and communication
  • Panel report and conclusions

Panel Meeting 7: 24th June 2016

Workforce - Career Pathways and Investing in Volunteers

Six key challenges (listed in April 2016 session)

The Foreword (Chapeau)

Volunteering matters - value them and give recognition

Listen to what people feel they can offer - 'Best Bit Benefit'

Target and market

Give taster session/signpost

Be brave in our approach

Embrace innovative solutions and be less risk averse

Volunteers don't replace jobs... but they augment care

Develop volunteer pathways into: work/student placement/lifelong vocations

Be volunteer ready - policy/procedures/recruitment/education/support

Don't discriminate between volunteers and employed staff

Increase productivity through operational efficiency

Develop career pathways - integrate with other providers

Shift from industrial to digital age healthcare - shift mind-sets

Co-create and empower patients and family to be 'experts' with professionals as facilitators

Develop roles that are not professionally based - competency based, apprenticeships, tailored

Develop leadership skills for managing change

Summary of key themes

  • Six key challenges and 'foreword' as central to thinking
  • Be brave and less risk averse
  • We should be volunteer ready
  • Value and recognise what volunteers can bring
  • Develop high impact volunteer led solutions to our care delivery challenge
  • Career pathways and succession planning for all staff
  • Embrace innovative solutions and support staff in a cultural shift
  • Be more productive and improve operational efficiency
  • Co-create - patients as partners, creating organizational and professional hubs
  • Equip people with leadership and change management skills

Panel Meeting 6: 20th May 2016

SMH and the Wider Community

Six key challenges (listed in April 2016 session)

The Chapeau

Patients first/embrace technology/caring network/career pathways/valuing volunteers/reputation/adapting to change

Sharing responsibilities

The power of commmunities

Homecare challenges

Funding obstacles

Micro providers increasing choice

Help local people use gifts/talents

Tailored care


Using parish councils to create connections/parish nurse

Get to know local community and support networks better

Spiritual support and holistic care

Directory of information

Compassionate communities

Increased support for patients/carers from our own networks

Reduced isolation and increased connections

Utilise a range of local solutions. Small solutions can create a mass to help solve bigger problems

Summary of key themes

  • Six key challenges central to thinking
  • Power of communities
  • Increased choice
  • Tapping into resources
  • New opportunities to stimulate the market
  • Micro providers
  • Holistic tailored care to need
  • Know local communities and networks, use parish councils to help
  • Sustainability of options


Panel Meeting 5: 15th April 2016

Findings and Funding Opportunities (PwC presentation on stakeholder engagement findings in stage 1)

Needs led

Key stakeholder feedback

Socio-economic landscape and funding and finance opportunities

6 main challenges

Tightening funding and finances. Competition/forecasting costs/identifying new funding

Meeting rising demand - aging population - new ways of working

Maintaining quality - keep what works well, don't fill gaps outside of expertise

Fractured services and need for integration - interconnectivity challenge

SMH could be central enabler and coordinator of a caring network

Accessibility and equity - engaging with representative groups

Rurality challenge supported with blended approach using digital technology

Maintaining and growing workforce - building capacity, capability and volunteer base/branding/community responsibility

What to keep doing and add? 24 hour advice line, IPU, Community Team, and Education - but delivered differently

Stop CHC beds, outsource e.g. Physio/OT. Charge for complimentary therapies. Develop Bereavement service as offering to other organisations.

Cost benefit analysis of any change with test pilots and impact assessments

Whole system approach through collaboration

Summary of key themes

  • Needs led focus
  • Funding opportunites
  • New ways of working
  • Understand costs and benefits
  • Build on what works well
  • Be brave about what needs to go
  • Whole system approach
  • Collaborate and establish vision
  • SMH as central enabler and coordinator of a caring network


Panel Meeting 4: 26th February 2016

Community Palliative Care

Community models


Patient expectation

Sharing knowledge/skill huddles

Early access


Needs led


Symptom control

Co-ordination - overlaying models



Infrastructure gaps

Whole system approach


Summary of key themes

  • Needs led focus
  • Education/training/sharing expertise
  • Build on successful models and adapt
  • Realistic expectations/timescale
  • Early and timely referral
  • Multi-agency collaboration critical


Panel Meeting 3: 15 January 2016


Stakeholder engagement

Plenary *Session Themes


Technical innovation to improve long term conditions in palliative care

Telementoring and education

Reaching out to rural areas

Sharing knowledge and skill

Monitoring improvements

Telemedicine - connecting with people at any time

Enhancing EOL care

Challenge of interoperable IT systems and broadband coverage

Summary of key themes

  • Need to embrace technology to enhance quality of care for patients and staff
  • Address capacity and ability
  • Use technology in a blended approach as another 'tool'
  • Technology is as much about people - building on good relationships
  • Opportunities to build on existing practises 


Panel Meeting 2: 27 November 2015

Stakeholder Engagement

Strategic approach to stakeholder engagement and consultation across Somerset

Agreed process

A vision of palliative care

Effective models for end of life care

Meeting the challenges

Providing innovative services

Funding now and in the future

Summary of key themes

  • What is St. Margaret's Hospice about?
  • Education to empower
  • Collaboration and partnership working
  • Workforce re-design
  • Innovative thinking and technology
  • Clever funding models
  • Effective communication and co-ordination
  • Promoting the website


Panel Meeting 1: 30 October 2015

Setting the Context

The 'Fit for Future' review of palliative care underway

Engaging across the community

Setting the context and drivers for change

Socio-economic and demographic challenges

How does it feel and what does good look like?

Communications strategy

Summary of key themes: 

  • Providing innovative services
  • Funding now and in the future
  • Collaboration and partnership
  • Workforce (including volunteers)
  • Boundaries and barriers
  • Innovation