Merseyside & CheshireEnd of Life and Palliative CareClinical Network Group

2010 JOINT ANNUAL CONFERENCE

Merseyside & Cheshire Cancer Network and

The National Council for Palliative Care

““Preparing the WorkforcePreparing the Workforceforfor

End of Life Care”End of Life Care”

WELCOME ANDINTRODUCTION TO THE DAY

JULIE GORRY(Chief Executive, St John’s Hospice Wirral

NCPC NW Area Representative)

Merseyside & CheshireEnd of Life and Palliative CareClinical Network Group

National Overview

Professor John Ellershaw

National Deputy End of Life Care Lead, Department of Health

Director, MCPCIL

Achieving excellence in end of life care: Overview

• Where have we come from on end of life care?

• Key aspects of the End of Life Care Strategy

• Early progress on implementation

• Next steps

National initiatives on end of life care

2000 NHS Cancer Plan - £50m pa for specialist palliative care services

2004 NICE guidance on supportive and palliative care (adults with cancer)

2004-7 National End of Life Care Programme (£4m x 3 years)- part of the ‘choice’ programme- roll out of GSF, LCP, PPC etc. by 28 SHAs

2005 Labour election manifesto commitment to increase choice at the end of life and double investment in palliative care

2006 Decision to develop a national strategy

2007/8 SHA ‘Darzi’ EOLC workstreams

2008 End of Life Care Strategy

End of Life Care Strategy

Aims:

• To bring about a step change in quality of care for people approaching the end of life

• To enhance choice at the end of life

• To deliver the government’s manifesto commitment to double investment in palliative care

End of Life Care Strategy

Key elements:

• Societal level: Actions to raise awareness of death and dying and to change attitudes

• Individual level: Integrated service delivery based around a care pathway

• Infrastructure: Workforce development, measurement, research, funding, national support etc.

Examples of SHA priority areas

NW: Aim for 10% reduction in hospital deaths

NE: 10 priority Quality MarkersPublic health approach – Charter on EOLC

Y&H: Social marketing work

SC: DNAR policy

EOE: Marie Curie Delivering Choice Programme

SW: EOLC registers

National support for implementation

• Coordination between SHAse.g. DH + SHA clinical/managerial leads

• Further policy initiatives

DH End of Life Care Policy Team (Tessa Ing)

• Support for the NHS, social care and third sector

National End of Life Care Programme (Claire Henry)

• Deputy National Clinical Directors

Professor John Ellershaw and Dr Teresa Tate

Death, dying and society

• National Council for Palliative Care is running the national coalition Dying Matters

• Around 7000 members – hospices, schools, solicitors, the GMC

• NatCen Survey, to set baseline for current awareness and attitudes

• Literature review (Professor Jane Seymour)

• Awareness week: March 2010

Step 2

Assessment,care planning

and review

•Advance care planning - patient and professional information –

planning for your future care

(evaluation)•PPC•ADRT

information for patients

•Assessment framework/ pilot

(EoE)

Step 3

Coordinationof care

•Locality wide registers pilots

(8 sites) •DH initiatives Transforming community

services integrated care pilots Personal budgets

Step 4

Delivery ofhigh qualityservices in

differentsettings

•AcuteHospitals• Primary care – GSF/ADA•“Route to Success”•Care homes

(volunteers)• Extra care housing•Prisons•Hostels•QIPP

Step 5 & 6

Care in thelast daysof life and

care after death

•LCP neurological /hospital Audit•Environments of care - King’s Fund•Last offices•Bereavement

Pre pathway

RaisingAwareness

•Supporting NCPC Commissioned literature review

National Coalition Dying Matters•Member of Dying Matters •National

Awareness raising week

Commissioning, currency and pricing, provider development, service improvement

Spirituality, User involvement, Information/support for patients and carers

Workforce – competences, E-learning, methods of delivery, facilitators network

Discussionsas the end

of lifeapproaches

•Communications skills (introductory, intermediate,

advanced) 12 pilots

•Clinical triggers - kidney, dementia Heart cancer neurological •Transition

services from children to adult services

Step 1

National End of Life Care Programme workstreams

Cross boundary working/sharing good practice, communications strategy, events ,website

Measurement - Intelligence network ,quality markers , VOICES

Social care

Step 1: Identifying people who are approaching the end of life

Step 2: Assessment and care planning

• Advance care Planning: A guide for health and social care staff

• Planning for Your Future Care

Step 3: Coordination of careLocality registers: 8 pilots

• Camden PCT Provider Services

• Royal Marsden NHS Trusts and Connecting for Health

• Sandwell PCT

• Salford PCT with Salford Royal NHS Foundation Trust

• Weston Area Health Trust

• NHS Brighton and Hove

• Leeds Teaching Hospital

• NHS Mid Essex

London: Hospital to Home project with IT support

Core team in Community

Patients, Family

Supportive Care Pathway

Role-key worker• To direct and manage the care; GSF Register; care plan; MDT practice meetings

Advanced care plans

Integrated OOHs Care

(16.00-9.00 Mon-Fri; and 24hr cover weekends)

Triage calls

Provide advice

Provide crisis hands on care

Integrated Hospital Discharge Team

Professionals

Short notice planned care, planned care(health & social care providers)

Coordination Centre

•Arrange packages of care for community professionals and discharge

•End of life Register

•Information and sign posting for services

•Website for palliative care

•Coordination of training and education

•Management information

Case manager

OT, ward nurse, social care worker

Commissioners (arranging and managing contracts)

Integrated Service Model

Step 4: Delivering high quality services

THE ROUTE TO SUCCESSIN END OF LIFE CARE - ACHIEVINGQUALITY IN ACUTE HOSPITALS

Step 5: Care in the last days of life

• Vast majority of clinicians believe that care of the dying has improved as a result of LCP

• Of course, LCP must be used properly Training Assessment that a patient is likely to be dying Documentation Review Audit

• 155 hospitals participated in the 2nd national audit

Step 6: Care after death

• NCDAH shows poor data returns

• After Death Audit (for the Gold Standards Framework)

• Bereavement is to be a new strand of work for the End of Life Care Policy Team

Workforce development

• Progress from SHA EoLC Workforce Leads using MPET funding

• E-learning for healthcare – modules launched 21 January – free access for health and social care staff

• Pilots to review communications skill needs and provision at basic, intermediate and advanced level, to report December 2010

Measurement

• Place of death (from death certification)

• National End of Life Care Intelligence Network will bring together different datasets e.g. HES, ONS, GPRD and social care

• VOICES – surveys of bereaved relatives will provide a proxy for quality of care given to patients at the end of life

• Other measures are being considered

Next steps

• The Coalition: our programme for government(May 2010)

“We will provide £10 million a year beyond 2011 from within the budget of the Department of Health to support children’s hospices in their vital work. And so that proper support for the most sick children and adults can continue in the setting of their choice, we will introduce a new per-patient funding system for all hospices and providers of palliative care.”

Summary

• We are now approaching two years since the publication of the End of Life Care Strategy

• Momentum continues to increase (National, Third Sector, SHAs and some PCTs)

• It is still too early to assess outputs/outcomes

• The financial climate is very challenging

Summary

• We are now approaching two years since the publication of the End of Life Care Strategy

• Momentum continues to increase (National, Third Sector, SHAs and some PCTs)

• It is still too early to assess outputs/outcomes

• The financial climate is very challenging

• Opportunity – to make a difference

www.ncpc.org.uk

Eve RichardsonChief Executive

SETTING THE SCENE

ABOUT NCPC

www.ncpc.org.uk

• The umbrella charity for palliative care

• Promotes palliative care for all

• Influences government policy

• Supports all sectors involved in providing, commissioning and using palliative and end of life care services

• Provides guidance on best practice (combining evidence with experience)

5 DH PRIORITIES

www.ncpc.org.uk

• A patient-led service culture - “nothing about us without us”

• Focus on better health outcomes - aligning patient-reported experiences with clinical outcomes

• Autonomy and accountability - empowering clinicians free from target-centred and bureaucratic systems

• Improving public health - promoting health, well-being and individual responsibility as part of the Big Society

• Reform of long term care - with better integration of health and social care

3 CHALLENGES FORTHIS PARLIAMENT

www.ncpc.org.uk

• “Ensuring a good death for everyone” should be a key quality outcome for all commissioners and providers across health and social care

• Access to co-ordinated 24/7 end of life care services to enable people to remain in home and community settings of their choice

• Empowering people to talk about dying, death and bereavement and to make plans for their the end of life care and support

Merseyside & CheshireEnd of Life and Palliative CareClinical Network Group

DISCUSSION