Harrow Planning and caring together 2016-2018

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The Harrow PACT Project grew from the knowledge and relationships built from the Challenges in End of Life Care Project (read more here). The lack of effective collaborative advance care planning which is a process where the hopes and goals of people for their care is understood and documented, was evident despite the skills being taught to the multi-professional work force. This was particularly noticeable for those in care homes who are often in their last phase of life. Despite social care who are assessed by the Care Quality Commission on their advance care planning, the recent primary care initiatives to focus on advance care planning for care home residents lacks a collaborative approach and causes duplication of efforts. Our model recognised the benefits of combining efforts into one digital accessible platform (Coordinate My Care [CMC]). Our hope was to ensure that people have more choice and control about what happens to them in their last phase of life.

With the vast majority of people preferring to die at home and not in hospital, this was clearly an important area to focus on.  With a large proportion of older adults within Harrow, a large number of which being in nursing and residential homes, the Harrow PACT Project was born. 

The model involved designing a multi-professional 5 day last phase of life programme for care home workers on advance care planning in collaboration with St Luke's hospice care home support service nurses Sarah Brown, Beverly Clement and Lorraine Fitzgerald with PACT nurses Sulekha Ali and Marco Suadoni. The programme curriculum included:

- Prognostication (predicting how long someone might have to live using tools)

- creation of supportive care records 

- The fundamentals of advance care planning including legal and ethical aspects and in particular, newly developed simulation training (read more here).

- Recognising and acting in signs of deterioration

- Recognising death and dying 

- Care for the bereaved including reflective debrief for staff. 

-Knowledge, skills and confidence evaluation.

It culminated in a training model of staff being able to co-create CMC Records. This work was presented as a seminar at the 2019 Royal College of General Practitioners Conference in Glasgow. Contact us to learn more about the model.

The model also incorporated the first Northwest London pilot for the Sutton Homes of Care Vanguard hospital transfer 'Red Bag Scheme'.

This model enabled:

- 482 multi-professional attendees were trained in 67 well evaluated educational events in 233 hours of teaching between January 2017 and July 2018. 

- A 196% increase in CMC records created in Harrow because the model demonstrated the utility of the platform which is accessible to primary and secondary care providers, as well as the London Ambulance Service. As the project lead then moved to Hillingdon, this CCG then took the lead in 2019 as highest creator of CMC records.

- The first published demonstrated used of simulation training using actors for advance care planning for care home workers. 

Publications include: 

- British Geriatric Society Age and Ageing Journal (read more here)

- Simulation training Dementia jo publication (here)

The team included: Dr Asha Katwa (GP), Sulekha Ali (Nurse), Robin Christy (Nurse), Marco Suadoni (Palliative Care Nurse) and Dipti Khatri (Project administrator). Dr Chris Jenner and Diana Carne (SQA Officer at Harrow Council) provided mentorship.

The steering group included experts from primary, secondary care, paramedics, local hospice leads, Harrow council and care home managers.