Commissioning integrated end of life care

• The Marie Curie experience

Dr Jane CollinsFollow us on Twitter: @mariecuriepa

@docjanecollins

Demand for End of Life care is set to increase

• Total number of deaths per year to increase by 17%

• Particularly rapid increase in over 85s; Number of deaths in those aged 85 years+ to increase by 48%

• People accumulate long term conditions as they age; by 65, most people have multiple conditions

• The more conditions people have, the more hospital care they consume in the last 12 months of life

End of Life care is often not well integrated

• The VOICES national survey of bereaved people found the level of integration varied depending on the location of the care provided

Co-ordination at home and hospital

A number of services are provided at home at the end of life

Poor integration impacts on outcomes

• Quality of care • Pain control at home• Place of death

Quality of care by location

Pain and symptom management

Nuffield Trust - Data linkage studyregarding place of death

Source: Nuffield Trust: The impact of the Marie Curie Nursing Service on place of death and hospital use at the end of life

Place of death for Marie Curie patients and matched controls

Integrated services can make a difference to outcomes

• Somerset Delivering Choice Programme evaluation

• Greenwich Care Partnership experience

Aims of Somerset DCP

• High quality, equitable and cost-effective care that supports the needs of all patients with a terminal illness, regardless of their diagnosis

• Increase patient’s choice to reduce deaths in hospital

• Build on existing and establish new partnerships to improve coordination of care

• Build on existing good practice

42%

19%

45%

61%

44%

15%

19%

48%

Evaluation of Somerset DCP – Home and Hospital death rates

Source: Improving choice at end of life (King’s Fund, 2008)Source: University of Bristol Independent evaluation of DCP Somerset

Greenwich Care Partnership experience

• Integrated end of life care model - established in May 2011

• Partnership between MCCC, Greenwich and Bexley Community Hospice and Oxleas NHS Foundation Trust

• Palliative care coordination centre

• 24/7 rapid response service

• Key worker role – main point of contact

Moving the debate forward

• We must seize opportunities afforded to us and ensure that people at the end of life get the services they require.

• We have the evidence, what we need now is the determination and the will to affect fundamental changes which will ensure better quality care for dying people.

• We are keen to work with commissioners and others to improve end of life care services in all settings and to move the debate on.

Thank you