Minimum Data Set Project

Section 5 Specialist Palliative Care Bereavement Service

When completing the form, please refer to the accompanying Guide.

Please answer for the period 1 April2013to 31 March 2014

Dataset number If you do not know your MDS dataset number please
tel 020 7697 1520 or email giving your postcode for identification
Name of organisation
Who manages your service? Answer NHS or IND (independent).
Your answer should be irrespective of who funds you. / NHSIND
5.1 / All service users
5.1a / New service users - number of service users who received bereavement support from you for the first time ever during the year
5.1b / Continuing service users - number of service users who were first seen by you before 1 April 2013were still being seen by you after this date
5.1c / Re-accessing users - number of service users who had been discharged before 1April 2013 but who re-accessedthe service during the year
5.1d / Total service users – found by adding the three numbers given above
5.2 / Re-accesswithin the same year
Number of times a service user, who had been discharged from your service since April 2013,is seen again during the year. Count each time a re-access occurs (one patient may re-access more than once).
5.3a / Service user analysis – age and gender
New Service users
Analysis of service users given in 5.1a / Total Service users
Analysis of service users given in 5.1d
Female / Male / All / Female / Male / All
Under 16 years
16 to 18 years
19 to 24 years
25 to 64 years
65 to 74 years
75 to 84 years
85 years and over
Not recorded
Totals
5.3b / Service user analysis - ethnicity
New Service users
Analysis of service users given in 5.1a / Total Service users
Analysis of service users given in 5.1d
White British
White Irish
Other white
Mixed white/black Caribbean
Mixed white/black African
Mixed white/Asian
Other mixed
Indian
Pakistani
Bangladeshi
Other Asian
Black Caribbean
Black African
Other black
Chinese
Other
Not stated
Total
5.4a / Contacts with service users

Only include contacts relating to service users who have been referred
Only include contacts with professionals or fully trained and supervised volunteers
For telephone calls only include those where an actual contact is made
For groups, count the number of service users e.g. a group with 6 service users would count as 6 contacts, regardless of the number of staff present

Number of contacts
Telephone contact lasting less than 10 minutes
Telephone supportlasting more than 10 minutes
Face to face – group work (mutual support group/not facilitated)
Face to face – group work (facilitated)
Face to face – individual support (by trained and supervised person)
Face to face – individual counselling (by trained and professionally accredited person)
Face to face – complex intervention by mental health specialist
Other (e.g. internet/email – please specify)
5.4b / External Referrals
External referrals for complex intervention by mental health specialist
5.5 /

Outcome

5.5a / Give the number of service users who were discharged or whose formal support ended during the year
Count as discharged if the client no longer requires the service, or where there has
been no contact for 12 months.
5.5b / Number of continuing service users at the end of the year
The total of 5.5a and 5.5b should be equal to or greater than 5.1d -please check
5.6 / Length of support
5.6a / Give the number of completed periods of support (adding up to 5.5a above) divided according to the length of time between the date of first contact and the date of last contact before discharge
Single session only / 6-12 months
Less than 3 months / Over one year
3-6 months / Total
Total should equal the number given at 5.5a
5.6b / Average (mean) length of period of support, defined as the average
duration in days from date of first contact to date of last contact before discharge
This can be calculated by adding together each service user’s length of support in days and dividing by the number of service users
5.7 / Diagnosis of the deceased relative or friend of the service user
New Service users
Analysis of service users given in 5.1a / Total Service users
Analysis of service users given in 5.1d
Cancer/malignant diagnosis
Other diagnosis
Not recorded
Total

Totals should equal numbers given in 5.1a and 5.1d

Any comments
Contact name
Email / Telephone

Please tell us which IT system you use for patient data

Please return byFriday30thMay2014 to

The National Council for Palliative Care
The Fitzpatrick Building,

188-194 York Way,

London

N7 9AS

Tel: 020 7697 1520 Fax: 020 7697 1530

Keeping a copy of your completed forms is highly recommended

Any enquiries, contact Adrian Jones Tel: 020 7697 1520 or Email: