Ashgate Hospicecare are leading the way in ReSPECTing patient’s wishes for emergency care

“You can only die once and you can only get it right once”. This is the way that the two End of Life Care Development Facilitators from Ashgate Hospicecare in Chesterfield open their ReSPECT training sessions. The ReSPECT forms (Recommended Summary Plan for Emergency Care and Treatment) are a summary of somebody’s wishes for how they would like to be treated in an emergency.

As well as starting to use the ReSPECT process within the Hospice, Ashgate Hospicecare have been delivering ReSPECT information and training sessions to GPs, district nurses, community nurses and nursing homes across North Derbyshire to try to encourage more conversations between patients and their families about a patient’s future and how they would like to be cared for.

The new ReSPECT forms are for everybody, but they are particularly important for those with a life-limiting illness. They help people to think and talk about their priorities in terms of life-sustaining treatments versus dignity and comfort.

The ReSPECT process is a national campaign, however the forms are only being used in a few counties at the moment, including North and South Derbyshire, with the hope that neighbouring counties will come on board in 2019. The process was developed by a working group of more than 30 representatives of the public and of professional organisations from a range of care and clinical settings. The aim is to replace the current DNACPR forms (Do Not Attempt CardioPulmonary Resuscitation) which have been criticised for being confusing, with too many different versions around, and for not being detailed enough about the care and treatments patients would like to receive in an emergency.

Dr Sarah Parnacott, a consultant from Ashgate Hospicecare, said; “It’s really important that everybody gets behind the ReSPECT process. I know of many cases where patients haven’t had those important conversations with their doctors or their families about what could happen in the future and about how they would like to be treated. Having one clear form across the country that summarises a patient’s wishes for care is imperative.

I know of one really sad case where a patient, who was admitted to hospital in an emergency, was not treated for an infection because they carried the DNACPR form. The healthcare professionals at the hospital had confused a patient’s wishes not to be resuscitated with a wish not to be treated at all and unfortunately the patient died as a result.”

The ReSPECT process is endorsed by a number of medical organisations, including Resusitation Council (UK), NHS, Care Quality Commission and Macmillan Cancer Support. It is hoped that the new ReSPECT process will eventually be recognised and used nationwide. Patients and families won’t be able to request a ReSPECT form until it has been

established in their locality and until the healthcare professionals have received adequate training in filling out the forms and in Advanced Care Planning.

Diana Gibson, one of the two End of Life Care Development Facilitators at Ashgate Hospicecare has been in post since April 2017. Her colleague, Jill Davies has been in post since March 2018. Their role consists of delivering ReSPECT information sessions, End of Life care education, training and support to colleagues in primary and tertiary care, information sessions to patients, carers and relatives about thinking and planning ahead and raising awareness in the general public by speaking at colleges, universities and public events.

Diana said, “We’ve got a big job on our hands in raising awareness about end of life care issues and in bringing ReSPECT to the whole of North Derbyshire.” Jill added, “We need to get the message across that thinking and planning for the end of life and communicating individual wishes doesn’t mean that death will imminently follow. We can only get things right if we know what people want, i.e. where they want to be cared for, what treatments they would and wouldn’t want to have, funeral wishes and so on.”

Jill and Diana are really excited about a a new video conferencing system called Project Echo, which will support health and social care professionals, particularly in harder to reach places such as the High Peak area, by offering remote education and training.

To find out more about ReSPECT, go to https://www.respectprocess.org.uk. To understand more about the work that Ashgate Hospicecare do, please go to https://www.ashgatehospicecare.org.uk/.

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