These resources and forms are for the public and for health and social care professionals, with the aim of providing a One Wales sharing and involving approach towards Future Care Planning.
The documents have been peer reviewed by the Advance and Future Care Planning Strategy Group (AFCP) for Wales, which sits under the auspices of the NHS Wales End of Life Care Board and the Deputy Chief Medical Officer for Wales.
The decision making to inform these forms involved extensive patient and carer engagement. The AFCP Group has patient representation and is pan-Wales. It has also been informed by data collated during a National Future Care Planning Conference in Wales.
All of this information can only work well with the appropriate ‘scaffolding’, so where conversations have occurred in one setting, it is important that they are not ‘lost’ to other settings and teams. Appropriate local policies to share this information safely, set out by local health boards should be in place, and community settings, ambulance services and out-of-hours providers must not be left out.
Where there are local Advance and Future Care Plan schemes in place already, these can be continued and adhered to in line with LHB and Trust guidance. We suspect that gradually, however, teams and patients will start using the All Wales documents increasingly, as everyone becomes more accustomed to the forms.
The hospital/inpatient Treatment Escalation Plan (TEP) on this page was developed by Aneurin Bevan University Health Board in April 2020 in response to the pandemic. It has been reviewed by the AFCP Group and the Deputy CMO, and can be used in all inpatient settings in Wales. Again, this is merely a guide for practitioners to indicate what ceilings of treatment have been suggested and discussed previously and, importantly, it is a short-term document for one specific episode of care. Its recommendations may change daily if patient's health/frailty improves or worsens.