Advance Care Planning (Adults) in Shropshire, Telford & Wrekin

Severn Hospice’s website is hosting this advance care planning resource for healthcare professionals on behalf of the Shropshire, Telford & Wrekin Sustainability and Transformation Partnership (STP).

Shropshire, Telford & Wrekin’s STP brings together health and care organisations across the county to work more closely together to improve outcomes and care for local people, reduce pressures on services and make best use of financial resources.

An Advance Care Plan Task and Finish Group was established under the framework of the STP to develop a whole-system approach to advance care planning, bringing together guidance, good practice and training resources.

As a local health and care system in Shropshire, Telford and Wrekin the partnership has a duty to protect the safety and dignity needs and choices of patients and their families. This includes giving people the opportunity to discuss and be involved in planning their future care and support.

Advance Care Planning (ACP) is part of normal health and care practice and enables individuals, their families and those who care for them, to talk about what matters to them.  It is then documented in a plan which anticipates their future preferences and health priorities should they become unwell or no longer have the capacity to tell others what they would like. 

It is up to every individual to decide whether they want an ACP and these conversations can be started and supported by anyone working in our health and care system.  Some individuals will choose not to have an ACP however if someone changes their mind in the future it can always be reviewed.

Anyone can have an ACP but these conversations and plans should ideally be in place ahead of any deterioration in health.  This sort of planning is really important with more people living longer and more long term illnesses.

Whilst Covid-19 has brought ACP into sharper focus as the NHS tries to understand and manage a new and potentially life-threatening illness, as a local health and care system, we have been having these conversations with individual patients, when required, for a while.

To support the people of Shropshire, Telford and Wrekin and anyone who care for them, if an ACP is asked for or required, we have brought together a framework and toolkit for practitioners, referencing evidence and guidelines, training and practical tips. 

Framework

We appreciate that Advance Care Planning is an important and often sensitive subject and therefore have developed this guidance to support the development and review of advance care plans for people within the Shropshire, Telford and Wrekin Sustainability and Transformation Partnership (STP) area.

This guidance provides a framework for a system-wide (STP) approach and is supported by a suite of documents including clinician background information.

We thank everyone who has contributed with evidence, experience and concern for patient safety and dignity.

ACP Framework 

Toolkit

This toolkit has been created to support the Advance Care Planning Framework which references evidence and guidelines, training and practical tips, to support the people of Shropshire, Telford and Wrekin and anyone who cares for them, if ACP is asked for or required.

This toolkit should be used alongside the framework.  The framework will be reviewed and updated regularly so it is important to make sure you are referring to the most recent version.

ACP Toolkit 

Further Resources

We have pulled together a list of useful information and resources below:

 Advance Care Planning:

COVID-19 related:

  • Advance Care Planning guidance in context of Covid-19 for primary care: Guidance
  • The RCP – Ethical dimensions of Covid-19 for front-line staff, 31 Mar 2020: Guidance
  • Guidance on social distancing for vulnerable people: Guidance
  • Guidance on shielding and protecting people defined on medical grounds as extremely vulnerable from Covid-19: Guidance
  • Responding to Covid-19: The ethical framework for adult social care: Ethical Framework
  • Covid-19: BGS statement on research for older people durin the Covid-19 pandemic: Statement

Anticipatory care Planning:

ReSPECT:

End of Life:

Severn Hospice resources:

Severn Hospice ReSPECT presentation

Severn Hospice – Advance Care Planning

 CPR:

Resources for people with learning difficulties:

Bereavement:

Other:

FAQs

Frequently asked questions about Advance Care Planning: FAQs

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