National Standards

for Specialist
Palliative Care
Cancer Services
2005
G/356/04-05 January Typeset in 12pt
ISBN 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. 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

1
 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. INTRODUCTION TO SPECIALIST PALLIATIVE
CARE STANDARDS

4.1 All services caring for patients with progressive life-threatening disease have a
responsibility to provide care with a palliative approach.These skills should be a core
competency of every health care professional. Standards covering communication
and information with respect to the needs of patients and professionals are
incorporated 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 from
diagnosis to terminal phase, including bereavement support. It is informed by a
knowledge and practice of palliative care principles and supported by specialist
palliative care.The goal of palliative care is the best possible quality of life for patients
and families.

4.3 These standards are the core requirement for specialist palliative care. They
are 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 of
local 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 team
who have undergone recognised specialist palliative care training.The support
provided is holistic, encompassing physical, psychological, social and spiritual support,
and will involve practitioners with a broad mix of skills including medical and nursing
care, social work, pastoral/spiritual care, physiotherapy, occupational therapy and
pharmacy. 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 other
professional staff and develops education, audit and research activities with the focus
on patients with progressive disease.

4.7 It is recognised that extensive palliative care, extending beyond that for cancer
patients, is provided in primary care and standards will need to be developed that
link to these specific standards for specialist palliative care and are in-line with
national guidance2,3.The standards for Specialist Palliative Care Teams detailed in this
document support a generic standard for palliative care that is incorporated in all
the cancer site specific standards.

2 Improving Outcomes: Supportive and Palliative Care, NICE, 2004

3 Improving Health in Wales. A Strategic Direction for Palliative Care Services in Wales. Cardiff:Welsh Assembly
Government. February 2003.
4
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 in

Wales. Cardiff:Welsh Assembly Government. [February 2003].

• Improving Health in Wales. A plan for the NHS with its partners. Cardiff:Welsh
Assembly 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 public
enquiry 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 Group

chaired 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.

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

6
STANDARD MONITORING CRITERIA

1.1 Network management arrangements and 1.1 The establishment agreement

accountability should be documented. detailing Network management
accountability to be held by the
Regional Office.

1.2 Agreements on clinical governance lines of 1.2 Documentation detailing

accountability for clinical teams providing care in agreements on lines of accountability
more than one organisation should be clearly for clinical governance.
documented.

1.3 The Network should produce a SDP, which 1.3

takes account of local and the all Wales priorities a. The Network SDP, approved by
and policy and is updated annually. the Network Board, is available
for external peer review.
b. The Network to report to the
Regional Office on
implementation of service plans.

1.4 Commissioners and providers as 1.4 Regional Offices to monitor

stakeholders of the Cancer Network should implementation of Network
work with the Network team to identify priorities.
priorities, taking account of all Wales Cancer
Standards, NICE and other national guidance and
agree an appropriate programme for
implementation.

7
 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
STANDARD MONITORING CRITERIA

2.1 Each Trust should have an identified
Cancer Management Team that reflects the
manner in which cancer is treated across the
management structures. Each team should
include at a minimum
2.1 Documentation detailing names and
designation and a description of how the
management team relate to internal
management structures.

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.

2.2 The TCLC should be appointed by the 2.2 Job plan to detail role, sessional
Trust Chief Executive and have recognised time and management support for TCLC.
dedicated sessional time with administrative
and senior management support.

2.3 The TCLC should attend both Trust 2.3 Detailed in Job Plan.
and Network cancer meetings as
appropriate.

2.4 The SPCT lead clinician should be 2.4 Network documentation.

confirmed by the Cancer Network Board in
consultation with their respective TCLC and
Medical Director or Executive lead.

2.5 The lead clinician for each voluntary 2.5 Network documentation.
sector SPCT should be a formal appointment
by that organisation’s Chief Executive and
confirmed by the Cancer Network Board.

2.6 The SPCT lead clinician should
a. Have overall responsibility for team
working, the team meeting, clinical audit.
b. Provide clinical advice and co-ordinate
any modernisation projects that are
associated with working of the MDT.
c. Have dedicated administrative and
secretarial assistance to support the
functioning of the MDT.
d. Attend both Trust and Network cancer
meetings as appropriate.
2.6 Responsibility detailed in job plan
with evidence provided of
a. Regular team meetings with
attendance register.
b. Clinical audit undertaken.
c. Service modernisation e.g. process
mapping and capacity/demand studies.
d. Dedicated administrative and
secretarial support.
e. Attendance at Trust and Network
meetings

9
 STANDARD MONITORING CRITERIA

2.7 Each Trust or voluntary sector organisation 2.7

providing specialist palliative care services should adopt
a process, involving representatives from the Cancer a. Outline of process for annual
Network5, by which the organisation or the Trust assessment.
Cancer Management Team report to their Board at b. Minutes of Board meeting
least annually on compliance with the cancer standards. covering report on
compliance to standards.

2.8 An analysis of the reasons for non-compliance 2.8 Trusts/voluntary sector

with standards should be undertaken with action plans, organisations to provide
agreed by the Cancer Network, drawn up as a result. documentation of agreed action
plans.

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

10
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.

6 National Service Framework No 1. NHS Cancer Care in England and Wales, Commission for Health
Improvement, 2001
12
STANDARD MONITORING CRITERIA

3.1 The SPCT should agree a communication 3.1 Detail of SPCT communication
policy regarding policy to include
a. Communication between members of the a. Evidence of communication skills
team. assessment.
b. Communication between the team members b. Evidence that the MDT has
and the patient and their carers. considered the views of its
c. Communication skills training for team patients or carers regarding the
members with direct patient contact appropriateness of
especially those involved in breaking bad communication.
news.
d. Adequate time for patients to consider
treatment opt

3.2 Written information should be offered to 3.2 Copies of documentation

each patient or carer accessing the SPCT.The provided to patients/carers.
information should be in a language and format
appropriate to the patient or carer and should
cover

a. General background information about

specific symptoms or interventions.
b. Detail of treatment options, specific local
arrangements including information about
the SPCT and support services and whom
the patient should contact if necessary.
c. Details of local self-help/support groups and
other appropriate organisations.

3.3 The SPCT should nominate a person to be 3.3 Name of responsible person
responsible for ensuring written information is and detail of provision of written
offered to all new patients. information within the
communication policy.

3.4 A designated person/s should be 3.4 Name of responsible person/s.

responsible for ensuring that written
information is generally available in appropriate
wards/outpatient areas and is checked and
replenished when necessary.

3.5 Providers of specialist palliative care 3.5 Detail audit of provider

should ensure all communication with patients communication policy.
with special needs in relation to language,
culture and physical or learning disabilities is
addressed.

13
 STANDARD MONITORING CRITERIA

3.6 There should be access to a private room or area 3.6 Details should be provided
where patients and or their carers can discuss the of facilities available.
treatment options and care plans in conditions of
adequate privacy with the appropriate member of the
SPCT.

3.7 Patients found to have significant levels of anxiety 3.7 Detail access
and or depression7 should be offered prompt access to arrangements.
specialist psychological or psychiatric care capable of
providing level 3 and level 4 psychological interventions
as defined in the NICE Supportive and Palliative Care
Guidance.

3.8 Cancer Networks should facilitate a Network 3.8 Networks to detail access
wide approach to psychological support services as arrangements.
recommended in the NICE Supportive and Palliative
Care Guidance.

7 Supportive and Palliative Care Guidance for Adults with Cancer, NICE 2004
14
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
STANDARD
4.1 The SPCT should include the
following:
a. Palliative medicine consultant who is on
the specialist register, with at least one
other doctor with a postgraduate
qualification in Palliative Care in support.
b. Palliative care nurse specialists.
c. Social worker or other staff member
with specialist training in providing
psychological and social support and
advice on benefits, with designated time
for working with palliative care patients.
d. SPCT coordinator/secretary.
4.2 The SPCT should be sufficiently
staffed to allow direct assessment of patients
with life-threatening illness in all care
settings during normal working hours, as
agreed with the Network, seven days a
week.
4.3 The SPCT should make arrangements
for direct patient assessment by core team
members in exceptional circumstances
outside normal working hours.
MONITORING CRITERIA
4.1
a. Detail names of designated SPCT and
details of post-registration
qualifications appropriate to their
professional role.
b. Designated time for palliative care
work.
c. Detail arrangements for co-ordination
and secretarial support.
4.2 Detail of,
a. Categories of staff who will provide
the service.
b. Categories of patients and carers who
may access the service.
c. Types of assessment and intervention
provided by the service.
d. Safe visiting protocol.
e. The geographical area and service
units covered by the service.
f. Information to users on how to
access the service.
g. Named person responsible for
producing and maintaining the on-call
rota.
h. The contribution of the SPCT to the
on-call rota.
4.3 Detail access arrangements
covering outside normal working hours.
17
 STANDARD MONITORING CRITERIA

4.4 The SPCT should, in agreement with 4.4 Detail of,

the Network, ensure access to specialist
palliative care telephone advice 24 hours a
day 7 days a week.
a. Categories of staff who will provide
the service.
b. Categories of staff to whom the
service is available.
c. Availability of the service to patients
and carers.
d. The geographical area and service
units covered by the service.
e. Information to users on how to access
the service.
f. Named person responsible for
producing and maintaining the on-call
rota.
g. The contribution by the SPCT to the
on-call rota.

4.5 If not already core team members, the 4.5 Job plans to include,
SPCT should have access to:
a. Names of the specialists designated to
a. An occupational therapist and work with/advise the SPCT.
physiotherapist, with specialist training as
defined by the NICE guidance on b. Details of post-registration
Supportive and Palliative Care and qualifications appropriate to their
designated time to assess and provide professional role.
palliative rehabilitation. c. Details of designated time.
b. Appropriate mental health specialist to d. Arrangements for cover.
provide specialist psychological and/or
e. Access arrangements to these support
psychiatric intervention at level 3 and
services.
level 4 as defined by the NICE Guidance
on Supportive and Palliative Care.
c. A suitably qualified spiritual care
provider, such as an authorized
healthcare chaplain, to provide support
and liaise with local faith leaders.
d. Input from site-specific cancer MDTs.
e. A named pharmacist with a special
interest in Palliative Care.
f. Other appropriate Allied Health
Professionals: Dietician and Speech and
Language therapist.

18
STANDARD
4.6 The Cancer Network/s and their
SPCTs should work together to ensure
adequate sharing of specialist resources
between SPCTs to meet patient need.
4.7 Nurses and allied health and social care
professionals working as part of the specialist
team should have a post registration
qualification in palliative care appropriate to
their professional role.
4.8 Each SPCT within a Cancer Network
should have access to specialist palliative care
inpatient facilities capable of addressing
complex symptom or other needs not readily
met in other settings.
4.9 Specialist inpatient units should have
sufficient core staff to provide 24 hour
medical cover.
4.10 All cancer patients referred to the 4.10 Audit of case notes.
SPCT should be discussed by the team at the
first available meeting.
4.11 The SPCT should agree mechanisms for 4.11 % completion of Welsh Palliative
collection of the Welsh Palliative Care Care Minimum Dataset.
Minimum Dataset on each of its patients.
4.12 The SPCT should participate in all
Wales clinical audits as specified by the
CSCG All Wales Palliative Care Cancer
Steering Group.
4.13 The SPCT should participate in
Network-wide clinical audit as specified by
the Network Palliative Cancer Advisory
Group.
MONITORING CRITERIA
4.6 Detail arrangements by which the
development of shared resources may
be coordinated across different core
services and localities to meet patient
need.
4.7 Details of qualifications [e.g.
certificate in palliative medicine and
other courses as developed] and
profession-specific competencies.
4.8 Cancer Network details of
accessible specialist palliative care beds;
capacity defined against national
standards such as those of National
Council for Hospice and Specialist
Palliative Care, Association of Palliative
Medicine of GB and Ireland.
4.9 Details of employment of palliative
medicine consultants supported by
experienced medical staff, sufficient to
comply with employment directives.
Where necessary, details of formal
arrangements between providers to
ensure adequate cover of neighbouring
units.
4.12 Reports of All Wales Palliative
Care Cancer Steering Group.
4.13 Network annual report to detail
Network-wide audit programmes and
resulting action plans.
19
 TOPIC: INITIAL ASSESSMENT AND PALLIATIVE
TREATMENT

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
STANDARD MONITORING CRITERIA

5.1 SPCTs within each Cancer Network 5.1

and their referring clinicians should agree
referral criteria, and where appropriate
discharge criteria, for core palliative care
services [inpatient care, outpatient clinics, day
care facilities and community-based care] in
line with the recommendations of the NICE
guidance.There should be, within each
Network, a service directory clarifying the
contact points for, and types of service
provided by, NHS and voluntary palliative care
services.
a. Documentation confirming that the
Network Manager,Trusts and all
local GPs in the area have a copy of
referral guidelines.
b. Evidence that a copy of the service
directory is available to health and
social care professionals, patients and
carers.

5.2 The agreed referral pathway must 5.2 Documented in agreed care
provide explicit information on how to access pathways.
services not directly provided by the SPCT
including psychological support services,
spiritual care, family and carer support
services and complimentary therapy services.

5.3 The Network should ensure that 5.3 Networks to provide evidence of
referral pathways are adhered to particularly review of agreed referral pathways.
where pathways cross Trust or Network
boundaries.

5.4 Patients referred to the SPCT for 5.4 Audit of patient records.
urgent review of uncontrolled symptoms
should be assessed within 2 days of referral.

5.5 The Network should agree with its 5.5

SPCTs time limits for initial and follow up a. Written policy agreed with the
assessment, treatment and care of patients Network, detailing arrangements.
and carers referred for non-urgent evaluation.
b. SPCT audit of waiting times.

21
 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
STANDARD MONITORING CRITERIA

6.1 Written, locally agreed, clinical and service 6.1 Network Manager to have
guidelines should be provided by the Network a copy of the agreed clinical
palliative care advisory group for use by Network policies and clinical standards
SPCTs. These should incorporate the NICE guidance and guidelines.
on Supportive and Palliative Care and be consistent
with the clinical guidelines recommended by the All
Wales Palliative Medicine Consultants Group.These
clinical and service guidelines will need to take
account of new NICE and other national guidance
publications when issued.

6.2 The SPCT should work to guidelines, agreed 6.2 Written Network
with the Network, for patient assessment in relation guidelines as agreed by the
to the following potential needs: palliative care advisory group.

a. Symptom control.
b. Functional.
c. Psychological.
d. Social.
e. Spiritual.
f. Those of the carer.

6.3 The SPCT should work to guidelines, agreed 6.3 Written Network
with the Network, for management of palliative care guidelines as agreed by the
needs in at least the following situations: palliative care advisory group.

a. Control of specific symptoms.

b. Common palliative emergencies.
c. End of life care8, to include families and carers.

6.4 The SPCT should support research into models 6.4 Patient recruitment into
or types of intervention and measurement of approved research studies.
outcomes important to patients and carers.

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

23
 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
STANDARD
7.1 The SPCT should have rapid access to
current clinical information on individual
patients.
7.2 There should be clear co-ordination
between agencies, across statutory and
voluntary sectors, responsible for meeting
palliative and supportive care needs.
7.3 The SPCT should be adequately staffed
to provide education to other professional
colleagues including care homes and primary
care teams.
MONITORING CRITERIA
7.1 Audit of critical events.
7.2 Evidence of formal links such as:
a. Multiprofessional meetings on
individual patient care with
representatives from different
organisations.
b. Joint or parallel clinics.
c. Participation in site-specific MDT
meetings.
7.3 Details of SPCT contribution to
educational programmes on general
palliative care.
25
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

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