Policy responses and statements
Background: The Scottish Government invites people to consider and comment on the draft guidance on developing bereavement care in the NHS in Scotland, “Shaping Bereavement Care - a framework for action for Bereavement Care in NHS Scotland”. The purpose of the guidance is to develop a recognition of the need for support of those who have been bereaved by the death of someone close, and to encourage health boards to clarify planning in this area. The guidance will provide a framework for health boards to reassess their local policy and procedures around the time of, and following, the death of a patient and to do so in the context of the impact of such policies and procedures on the grief of those who have been bereaved. The guidance also provides an opportunity to examine the training and support available to all NHS staff whose work involves contact with the dying and the bereaved. COMMENTS ON
|
| a) Immediately after the death? | Yes |
| b) Through the early days of grief (say first week?) | Yes |
| c) Until the bereaved person feels ready to move on? | Yes |
Comments:
This question did not ask for specific comments, but the College believes it is important to consider this question holistically. The consultation as written concerns only in-patient deaths in acute hospitals. Deaths occurring at home and the role of the GP and primary care team are not mentioned. The roles of hospices and palliative care teams are presumed but not incorporated. The NHS as a whole has responsibility for all of these elements. In reality, while the staff of acute hospital wards has an immediate role in supporting relatives and ensuring that the necessary practical arrangements following a death are sensitive and appropriate, much of the support to the bereaved in the days following their loss is, and should be, provided by their own primary care team. A bereaved person may not be “ready to move on” for a considerable period of time. Their support lies well beyond any reasonable expectation of assistance by the staff of the acute hospital ward, whose focus was primarily the terminal care of the deceased. Research in Lothian has suggested that, after death, bereaved carers frequently have existential or spiritual issues that have caused them considerable grief for a number of months. The distress encompasses spiritual, social and psychological domains and often a degree of physical ill health. Multi-dimensional support for the bereaved extends well beyond the hospital where their loved one died. Where the deceased and the relatives do not share the same primary care team, communication and organisation of support will be even more difficult.
- Do you feel that implementing the Shaping
Bereavement Care Framework will help ensure that:
- Boards are more aware of how good planning of the relatives'/carers' experience around the time of death and can contribute to better outcomes in their grief;
- Staff are better equipped to support bereaved people and will be better supported themselves in their responses to death and grief; and
- Bereaved people will feel more supported at, during and following a death and that their wishes, and the wishes of the person who has died, have been taken into consideration.
Yes, to some extent.
Comments:
There is a role for locally agreed policies to set consistent standards for quality of care around the time of death and to make it clear what is expected of all members of the health care team. However, sensitive empathic interaction with bereaved relatives is a fundamental part of the work of every clinician, which is already practised routinely, and should be included in training programmes for medical students and postgraduates. These essential skills are tested routinely in the postgraduate MRCP(UK) PACES examination run by the Royal Colleges of Physicians.
The strategy as described appears to be top-heavy and prescriptive, despite cautioning against adoption of such an approach. The concept of a bereavement co-ordinator being available to manage the processes around the time of death has its attractions, but at a time when resources are limited, it is hard to justify the creation of a new post to fulfil this role. The job would be valuable if it could be carried out effectively within existing resources. An alternative strategy might be to boost and develop existing disciplines without the need for a whole new structure. Trained and committed patient champions, such as experienced staff nurses, could be available for specific or difficult cases. The ward manager may be the key person here in terms of providing overall leadership and inspiration, although some may be better suited and more interested in this role than others.
- Do you agree with the recommendations set out in the Shaping Bereavement Care Framework document (pages 4-6)?
Yes in part.
Please provide comments if you disagree with the recommendations or feel that there are some missing.
Comments:
The College supports the creation of local policies in relation to death and bereavement. As noted above, the appointment of a specific bereavement co-ordinator may be difficult to justify in the current financial climate. Resources may be better spent on direct clinical care. Communication skills are taught to medical and nursing undergraduates and are a core part of daily professional work; the additional value from specialised bereavement training may not justify the loss of clinical time or the appointment of a full-time educator. The College is definitely not convinced of any requirement for a Board Executive and a Senior Manager to have specific responsibility in this area. This is like saying that a designated executive and a manager are required for any area that cuts across disciplines. Managing death and bereavement is part of daily life in the NHS; while it is important to set standards for good quality care, it should not be seen as something separate from other aspects of clinical care. Likewise, it is the responsibility of all clinical staff and should not be regarded as a job assigned to one individual.
- Do you think that it is important that spiritual, religious and cultural issues are taken into consideration in the delivery of Bereavement Care Services?
- To what extent do you think this currently happens?
- Please provide any additional comments/views you wish to share on the principles and content of the overall document.
Yes.
Comments:
Anecdotal evidence from our Fellows suggests this can be done well when relatives make such needs known. However, the College is unaware of any other specific evidence in this area.
Comments:
The principles of bereavement care in the document are important and are supported by the College. The approach to implementation, however, seems heavy handed and over- idealistic, with some impracticalities and a failure to consider the wider support mechanisms available to the bereaved. A simpler approach in hospital and real involvement from primary care would better address these concerns. The principles underlying the care and support of the dying and bereaved should remain at the core of all good medical, nursing, and NHS staff training and education, and the College will continue to play its part to achieve these aims.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[30 November 2010]