© NHS Institute for Innovation and Improvement, 2010

Improving End of Life Care

Dr. Sakthi Karunanithi, Locum Consultant in Public HealthMr. Mike Leaf, Director of Public Health (Acting)

Acknowledgements: Dr. Mark Spencer and Dr. Gillian Au

The Quality Challenge People are not receiving the best possible

end of life care Gap between scientific know how and reality Unwanted clinical variation Avoidable costs National and Local priority

Aim: Improve the percentage of people dying in their preferred place of care by 10% in one year

Patient & Carer

Care Homes

GP

HospiceHospital

Community Services

NWASPCT

People and Changes Being Introduced

Education

Pathways

Team mobilisation

Funding

Gold Standards Framework

McMillan GP

Paradigm Shift: Moving beyond a QI project to a large scale change

Run chart of number and percent of deaths occuring at homeJan 2009- present: North Lancashire resident population

0%

10%

20%

30%

40%

50%

60%

2009 2010 2011

No.

dea

ths

% of Home Deaths

Baseline - 2009 Median – 37%

Impact so far

Impact of Vanguard on us

Insight into various dimensions of large scale change

Enhanced understanding of methods to match the large scale change

Ability to mobilise the right people with narratives Mindset to blend QI with organisational development

and social mobilisation Already applying the learning into other areas of

work!

Spread so far and next steps From one practice in Fleetwood towards a

EoL care programme across the local health economy

Linking with level 3 QIPP priorities

Next steps Link with regional work stream Spread through end of life care network Scope new financial models