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Newsletter
April 2022
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The importance of delivering on patients' wishes
In a few days’ time, it will be Dying Matters Week 2022 – a moment to encourage all communities to start talking about what is a sensitive subject for many people.
This year’s theme is about being #InAGoodPlace when you die and the importance of having a health and social care system which can deliver on the wishes of a dying patient.
In this month’s newsletter, you will read about the work of our Palliative and End of Life Care Network, which has launched an electronic method of communication which will allow staff at different organisations to access information about patients, increasing the chances of people across Greater Manchester (GM) spending their final days the way they chose.
We also have news on an updated guideline for asthma management for adults, a Q&A on our maternity Equity and Equality Action Plan, as well as stories about videos to promote the Healthier You NHS Diabetes Prevention Programme to our diverse communities, World Asthma Day 2022 and clinical lead and staff updates.
We hope you enjoy reading about this important work.
Best wishes
Julie Cheetham - Director
Dr Peter Elton - Clinical director
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The Palliative and End of Life Care Network has launched a shared electronic method of communication which will allow staff from different organisations to work on individuals’ end of life care plans.
The introduction of a Greater Manchester Care Record (GMCR) provided a perfect opportunity for the initiative to be accelerated and has seen the incorporation of the Electronic Palliative Care Coordinating System (EPaCCS) Summary Care record template into the GMCR.
With consent, this allows palliative and end of life care information to be shared between in and out of hours services, reducing the risk of unnecessary hospital admissions at end of life.
The Network leads an EPaCCS implementation group which brings together digital and clinical leads from each of the localities within the network. The group has a shared vision to support the use of EPaCCS on the GMCR.
Recently the group has developed an implementation roadmap, which is hosted on the GMEC End of Life Care NHS Future Platform. The roadmap embraces change management methodology and resources to support training and sustainability of using EPaCCS.
The Network Implementation Group is collating the benefits of implementing an EPaCCS and has recently published the EPaCCS Benefits Summary document. A total of 31 current articles were reviewed to draw out the professional and system benefits alongside some of the challenges and opportunities identified from across the country in implementing an EPaCCS.
Read more about the benefits of EPaCCS.
The Greater Manchester and Eastern Cheshire SCN Palliative and End of Life Care Advisory Group, with GM Cancer and GM Hospices, have launched a guide to clearly describe the services across the network and their role in providing palliative and end of life care.
It is hoped this document will support health care professionals identifying the services available to them and encourage appropriate referrals to support people receiving timely palliative and end of life care.
Read the guide.
Dying Matters Awareness Week 2022 is a chance to open the conversation around death, dying and grief, remove the stigma that surrounds it, and call for meaningful change so that everyone gets the high quality end of life care they deserve.
The week starts on 2 May and many localities are planning events.
There is a new Dying Matters Awareness Week resource pack - filled with messaging, graphics and images, social media headers and much more that people can use in the run up to and during the week.
Dying Matters Awareness Week resource pack and events pages can be found here!
A dad of two successfully completed his epic challenge to run 100 miles in four days to raise money for the area’s hospices.
We reported in our last newsletter how Martin Foster, 38, from Urmston, who works as a programme lead for GM Hospices, coordinating relationships between health and care organisations like the SCNs and the hospices, was preparing to run 100 miles in four days to raise money to help the hospices.
He has raised around £4,000, which will support the care of patients and families.
He said: “My four days running around Greater Manchester's hospices were simply unforgettable and, strange as it is to say, I've been genuinely sad it's all over!”
Martin started his challenge at Derian House Children’s Hospice, in Chorley, before ending his epic run at Piccadilly Place, where the SCNs’ offices are based, in Manchester city centre.
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An updated guideline for managing asthma in adults in GM has been published, which underlines the need to look at non-pharmacological options and lower carbon emissions.
You can read the guidelines here.
Dr Murugesan Raja (pictured right), the Respiratory Network’s clinical lead for respiratory disease in primary care, chaired the guideline’s working group and writes here about its importance:
“Did you know that inhalers make up 3% of all NHS carbon emissions?
The difference between inhalers is quite stark. For example, one year use of a metered dose inhaler (MDI) like Clenil is equivalent to driving 437 miles in an average car, compared to only driving 9 miles if a dry powder inhaler (DPI) like Easyhaler Budesonide is used instead.
Short acting beta agonists (SABA) MDI inhalers have an even larger environmental impact due to high prescribing and is a reflection of poor control.
There is now growing evidence that inhalers used correctly, including the ease of technique needed for most dry powder inhalers, helps to manage asthma better.
I am extremely pleased that the Greater Manchester Medicines Management Group Asthma Guideline for managing asthma in adults over 18 is published now.
This helps to re-emphasise the need to correctly diagnose, review and reinforce non-pharmacological options and also help to choose the right inhaler to minimise the carbon footprint and move up as needed to improve control.
It also advocates the consideration of using one inhaler for maintaining and relieving treatment (MART) when there is poor control as there is evidence that this reduces exacerbation frequency and also reduces the environmental impact by reducing the number of inhalers needed.
A total of 85% of patients and carers in an Asthma UK survey thought that asthma patients should be encouraged to use environmentally friendly inhalers. I am confident now that as clinicians, when we have shared decision making with our patients in managing asthma, we not only will reduce carbon emissions, but also optimise control of asthma for our patients.”
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 As part of our plan to engage better with our diverse communities, promotional videos have been produced which follow the journeys of patients Sunita and Tariq as they take part in the Healthier You NHS Diabetes Prevention Programme.
The films draw on the experience of service users who have completed the programme and successfully reduced their type 2 diabetes risk.
They have been co-produced with the Healthier You service provider Xyla and colleagues at the British Muslim Heritage Centre, who have supported us with recording the voiceovers in community languages.
The programme includes education on healthy eating, including what to eat to help regulate blood glucose levels and the correct portion sizes for your food. It also supports people to incorporate activity into their lifestyle, along with other wellbeing strategies that have been proven to reduce the risk of developing type 2 diabetes.
Dr James Hider, diabetes prevention clinical lead for the SCNs, said “These videos are great and will hopefully help raise the profile of the Healthier You programme across all our communities.”
Research from the University of Manchester has shown someone completing the nine-month NHS scheme reduces their chances of getting diabetes by more than a third.
The videos are available in English, Urdu, Punjabi and Bengali and can be accessed at the Healthier You Vimeo page.
They will be shared on social media by the SCNs and our partners in local authorities and CCGs as part of a coordinated campaign to raise the profile of the programme with our diverse communities and to let them know how to join the programme.
For more information and support promoting Healthier You with your patients please contact the team.
Our clinical lead midwife, Eileen Stringer (pictured left), is part of the team producing the maternity Equity and Equality Action Plan.
She explains here in a Q&A what the work involves and how it will improve services for women and their families.
Q: What is the Equity and Equality Action Plan?
The Greater Manchester and Eastern Cheshire Local Maternity System (LMS) is working with women, families and others to develop an Equity and Equality Action Plan. It will address the poorer outcomes for women and their babies from Black, Asian and Mixed ethnic backgrounds and those living in deprived areas. The plan will describe the steps we need to take over the next 5 years to ensure all women and babies receive the best maternity care and outcomes in our area. What happens during pregnancy, birth and the first days of a child’s life has a significant impact on how well a child develops and thrives so we need to create the best beginnings for all children and families. Importantly, we will also look at how staff from ethnic minority backgrounds are represented within our workforce and ensure they have the same opportunities and experience as others.
Q: Why are we producing one in Greater Manchester and Eastern Cheshire?
The LMS received a directive from the national maternity team to understand our local population and describe their outcomes in maternity care. This helped us to identify characteristics of the people we look after, determine main issues relating to maternity care, such as recognising where gaps in care/provision occur, and compare this to where disparity in outcomes exist. Within Greater Manchester and Eastern Cheshire we have a diverse population, including a wide range of ethnicities. Socio-economic status and quality of life varies widely across boroughs with a high number of individuals living in deprived areas and in poverty. People from these groups have some of the worst maternity outcomes and we are determined to improve that. It is therefore important that we work together with all partners, and the parents we look after, in order to create a plan for maternity care that is effective, accessible, personalised and effective.
Q: What work has taken place so far? Has it revealed anything about the situation in our area?
So far, we have completed data gathering and analysis of our population. This highlighted some interesting factors that our action plan will address. For instance, more than 40% of our women/birthing people from a Black, Asian or Mixed background book for maternity care after 10 weeks of pregnancy. So, later than others and later than what we want. The earlier maternity care is accessed, the better the outcome. We will therefore address this in the plan to achieve greater equity of care. We can then carry out screening tests earlier on in pregnancy. Some of these tests, such as the identification of sickle cell anaemia, are highly prevalent in the black community.
Q: What are the next steps?
We are working in partnership with service users, communities, voluntary and faith groups as well as others to jointly produce a meaningful action plan for the next 5 years. The plan will support and interlink with others in Greater Manchester that look to tackle health inequalities. Our task and finish group has members from many different sectors, including service users who are engaged and committed to jointly producing this. When drafted, we will share the plan widely. The final plan will be submitted to the national maternity transformation team in September this year.
Q: How will this work make a difference to the care mothers and their families receive?
The plan will improve outcomes for women and their babies who are from Black, Asian and Mixed backgrounds and those who live in deprived areas. By taking action we will help to reduce health inequalities and improve the life chances of all children born in Greater Manchester and Eastern Cheshire. We also intend to diversify our workforce to include staff from these backgrounds, reduce disparity and improve staff experience.
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Look out for our World Asthma Day 2022 tweets on May 3 and help us spread the word!
We will be using the hashtag #WorldAsthmaDayGM with our posts, which will use photos and video to promote services which are available in GM to help children and young people manage and understand their condition.
World Asthma Day is organised by the Global Initiative for Asthma, (GINA) a World Health Organisation collaborative organisation founded in 1993. The day is held each May to raise awareness of asthma worldwide.
GINA has chosen ‘Closing Gaps is Asthma Care’ as the theme for the 2022.
The team is delighted to welcome Dr Aseem Mishra (pictured left), who has been appointed as the clinical lead for cardiovascular disease prevention for the Cardiovascular Network and the GM Neurorehabilitation and Integrated Stroke Network.
He will be supporting the development of a comprehensive and effective prevention strategy for GM.
Aseem is in his third year of the National Institute for Health and Care Research (NIHR) Academic Clinical Fellowship Programme in Primary Care and has led the Stockport BPM@Home NHSE programme, which sees monitors loaned to patients with high blood pressure, so they can check their condition when convenient.
Initially propelled by curiosity, Aseem has always been fascinated with technology and how we develop and use it to help us with the problems we face each day.
His time as a doctor has made him passionate about holistic person-centred care, the values of the NHS and the overall well-being of people.
A natural systems thinker and serious about QI, Aseem is a strong proponent of whole-system working to facilitate and implement positive real-world change, aiming to improve the system for all.
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The Palliative and End of Life Care Network welcomes Laura Linford, who will be offering business support to the team.
Laura has worked in private air freight charter and, before that, exports for the HMRC. Both roles were complex and fast-paced.
During lockdown, she was part of the NHS test and trace programme, dealing with mainly non-digital members of the public who would otherwise struggle to order, register and book tests.
Laura said “I'm really looking forward to supporting such a great team with their ongoing projects.
“When the opportunity to join the team came about, it made me remember how much I valued my time and the work I did within NHS during the worst of the Covid-19 pandemic, and I can see how the work of the Network can bring about valued change to those approaching or within their final stages of life.”
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