Breakout 4.4 Meet Marjorie - Les Storey Consultant Respiratory Physician, Whittington Health & NHS Islington Part of a set of presentations from NHS Improvement event: Better value, better outcomes held on Thursday 21 February 2013, Guoman Tower Hotel, London How to deliver quality and value in chronic care:sharing the learning from the respiratory programme

1. Meet Marjorie
• Marjorie lived in her own home and was able to
care for herself and make all of her own decisions.
She has a son and daughter who are both married
and they have their own grown up children and
they all live locally. Marjorie visits her surgery once
a month to see the practice nurse for a respiratory
screening and blood tests due to her breathing
problems.
• Q. What could be introduced to Marjorie at this time.
•
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2. • Marjorie became unwell and was admitted to
hospital having had been unwell. Prior to her
discharge an assessment was completed and Marjorie
made the decision to move into Leafy Green Care
Home(N) because she wouldn’t be able to manage at
home and she didn’t want to be on her own anymore,
her son and daughter both worked full-time.
• Q. While Marjorie was in hospital what other
documents could be considered.
•
• Marjorie lived in Leafy Green Care Home for three years, she
enjoyed the company of the other residents and she had
taken an active part in the life of the home, being chair of
the residents committee for the last year.
• She had told the home manager and her GP in the previous
year that if she had problems breathing or swallowing she
did not want to have any feeding tubes as she loved her food
and would not want to live without being able to eat and
drink normally.
• Q. What documents should be in place for Marjorie at this
point in time, and what documents should have been sent
into hospital with her.
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3. • Marjorie has become worse and is in
hospital. She is now steruggling to breathe
and isunable to swallow safely. The
consultant does not know whether she will
be able to regain her ability to swallow and
advises that she may die without artificial
hydration and nutrition.
• Q. What assessment/document should be
completed at this stage.
• Marjorie doesn’t appear to be able to
understand and is unable to communicate her
needs and wishes with her family or the staff.
• Her daughter is very upset and wants the
consultant to put in a feeding tube. Her son
isn’t certain whether this is the right thing to do.
• Q. Is Marjorie’s daughter able to make this
decision.
• Q. What documents should be
discussed/completed to assist in the decision
making process.
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4. • Marjorie had not given her son or daughter
power to consent or refuse treatments with a
PWLPA.
• Marjorie had never had any conversations
with her family about what she would want if
anything like this happened to her.
• Q. Should the care home/GP have discussed
their conversation about artificial hydration
and nutrition.
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