palliative and end of life care: tackling variations, eradicating inequalities
TRANSCRIPT
Tackling Inequalities in Commissioning for EOLC
Dr Catherine Millington-Sanders
RCGP /Marie Curie National End of Life Care Clinical [email protected]
9nd February 2017
NHS fundingNHS net expenditure - increased from £75.822bn in 2005/06 to £117.229bn in 2015/16.
Planned expenditure for 2016/17 is £120.611bn.
Health expenditure per capita in England has risen from £1,868 in 2010/11 to £2,057 in 2014/15.
The NHS net deficit for the 2015/16 financial year was £1.851 billion.
Providers and commissioners of NHS services
209 CCGs7,674 GP practices137 acute non-specialist trusts17 acute specialist trusts 55 mental health trusts 34 community providers 853 for-profit and not-for-profit independent sector organisations10 ambulance trusts
Professionals
Between 2009 and 2015 the number of professionally qualified clinical staff within the NHS has risen by 3.9 per cent, includes:
increase doctors of 8.9% increase nurses of 0.7% 6.8% more qualified ambulance staff.
Medical school intake rose from 1997-2013 by 67.0%.
Patient Experience2015 - CQC inpatient satisfaction survey 84% per cent rated overall experience as 7+/10
2016 FFT, 95% inpatients treated by NHS trusts and 98% inpatients treated by independents would recommend their provider
84.9% felt their GP was good at treating them with care and concern. VOICES – pain and symptom control in community
73.3% rated overall experience making an appointment - good
67.0% stated their overall experience of out-of-hours GP services was good.
Population
7.7 million people500,000 deaths per annum (to increase by 17% by 2030)
500,000 carer prevalence for EOLC (c 10%)
Total EOLC spend c25% of total expenditure £3,000 per emergency admission (average 2-3 in the last year of life)
Cost: £3-4.5bn (c4% of total expenditure)
Commissioning complexitiesPatientsCarersFamiliesWorkforce skills
Providers:• GP providers•OOH service + NHS 111 and •Community Nursing•Acutes•SPC: Hospice, Acute, Home Care•Pharmacy: Access to PC drugs•Nursing and Residential homes•Continuing Care•Equipment•Bereavement services•Additional nurses e.g. Marie Curie, dementia nurses, COPD/heart failure nurses•Ambulance Services•Voluntary Sector •EPaCCS /IT•Training providers•Social Care•Spiritual Care providers
Modeling Care - LTC/Dementia/Frailty/EOLC
Risk:DementiaLTCsFrailtyEoLCNo of AdmissionsSocial Care needsPolypharmacySupporteg, Mental HealthCN ModelSocial Prescribing Carer etc
Top 20% takes=80% cost of total
Top 5% takes= 65% cost of total VHR Very High Risk
- Patients/YR
0.5%
4.5%
20%
HR High Risk – Patients/YR
Community Services
(a) Proactive – risk stratified population + clinical judgment
(b) Reactive - clinical judgment
Modeling Care
STRATEGIC OUTCOME PRIORITES
• Facilitation of discharge from the acute setting
• Rapid response services during periods out of hospital
• Centralised co-ordination of care provision in the community
• Guaranteeing 24/7 nursing care• 24/7 Access to SPC
CQC EOLC Thematic Review – Barriers to Care
people with conditions other than cancer older people people with dementia people from Black and minority ethnic (BME)lesbian, gay, bisexual and transgender people people with a learning disabilitypeople with a mental health conditionpeople who are homeless people who are in secure or detained setting Gypsies and Travellers.
Patient Goalssurvival is not the only objective
Why do we need to do something different?
Insanity
Defined as doing the same thing again and again and expecting a different result each
time.
Reframing palliative care
If we were designing palliative care now, from the beginning, would we do the same again?
Compassionate Cities
Serious personal crises of illness, dying, death and loss may visit any us, at any time during the normal course our lives. A compassionate city is a community that squarely recognises and addresses this social fact.
Death, dying and loss
Not the domain of professionalsEnormous inequality, only one quarter access specialist palliative care because of an historical anachronismIncludes all experiences relating to death, dying, loss, chronic severe disease, aging, suicide, sudden death, childhood death, stillbirths, murder etc
Policy
Service delivery, professional care
Community
Outer network
Inner Network
Person with
illness
Compassionate Community Networks
Imagine…
THE COMPASSIONATE CITY CHARTER
Compassionate Cities are communities that recognise that all natural cycles of sickness and health, birth and death, and love and loss occur everyday within the orbits of its institutions and regular activities. A compassionate city is a community that recognizes that care for one another at times of crisis and loss is not simply a task solely for health and social services but is everyone’s responsibility.
Author: Professor Allan Kellehear
Local implementation
Senior leadership to endorse implementation of the Compassionate City Charter
• City Level: e.g. Mayoral • CCG/ LA Level: e.g. Health and Wellbeing Board.
To offer leadership on the Compassionate Cities Board
50% home death rate by 2026 through role out of compassionate city and community charter
Communities exist wherever there are peopleWe need a new partnership between communities and professional services, e.g. Frome ModelWe have a responsibility to build compassionate communities, because this is the right thing to do. This needs to be part of our culture to be handed on to other community members, passed on through generations.
RCGP / Marie Curie GP EOLC Quality Improvement – Excellence Mark
GP robust identification and personalised care + support planning for EOLC is a crucial vehicleExcellence Mark designFree, self-directed resource for practicesPilot implementation – 2017Step-wedge implementation 2017/18Robust evaluation Please get in touch if you’d like to know more
Dr Catherine Millington-SandersRCGP/ Marie Curie National Clinical End
of Life Care Champion
For more information:
Email [email protected]