Merseyside & Cheshire End of Life and Palliative Care Clinical Network Group
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Transcript of Merseyside & Cheshire End of Life and Palliative Care Clinical Network Group
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