Delivering excellent person centred end of life care for allAmanda RollandNational End of Life Care Programme

East Midlands EoLC Summit 22 November 2012

Recent history – where were we?

• Nearly 60% of people died in hospital• Projections suggested that by 2030 less than 10%

of people would die at home• Palliative and end of life care focussed mainly on

cancer patients and hospices• Mortality data was the only routine source of

information for EoLC

• As a result of the UK’s aging population, the number of deaths per year is expected to rise by 17% between 2012 and 2030

• Many more people will be dying at an older age and therefore more likely to have complex needs and multiple co-morbidities as they near the end of their lives.

• To deliver quality care effectively requires a shared vision for end of life care to encourage commissioners and providers to work together.

The facts

Num

ber

of d

eath

s (T

hous

ands

)

Office for National Statistics:

Projected number of deaths in England

600

500

400

300

200

100

0

2005 2010 2015 2020 2025 2030 2035

Year

1% of the population die each year

450,000 deaths 1 death per min

The impact on services of the demographic time bomb needs to be addressed as a priority:

4whose business is it?

End of Life Care Strategy

A step change in the quality of care for people approaching the end of life

To enhance choice at the end of life

To reduce inequalities (e.g. geographical and cancer vs. non-cancer)

To prepare for the future demographic challenge: increasing numbers of deaths, particularly amongst people over 85 years

To raise the profile of end of life care amongst health and social care staff and the public

National Improvement

charts on DIUPR- from: End of Life Care Strategy: fourth annual report. DH. October 2012

Regional Improvement

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charts on DIUPR- from: End of Life Care Strategy: fourth annual report. DH. October 2012

Person centred /family care1. Engage individuals and families as active partners in care2. Open transparent communication that is respectful of preferred priorities for care and preferred place of death3. Involve families in the physical care of their relatives4. Involve families in improvement teams5. Facilitate user feedback within service improvement6. Care after death

Leadership1. Leadership explicit with organisation’s agenda2. Part of senior management objectives3. Clinical and social care champions for end of life care as well as facilitators networks4. Competent trained staff – partnerships between hospital palliative care teams/hospices with long term conditions, primary care, OOHs, social care/domiciliary and care home staff e.g. e-ELCA5. Change of culture towards eolc by staff caring for individuals approaching end of life

Effective Teamwork1. Agreed standards for effective communication with individual and family2. Effective identification and development of management/care plans across sectors3. Discharge liaison/Community/GPs/Ambulance/OOH/Social Care4. Adopt common end of life care Pathway language – e.g. use of RtS and other eolc resources

Safe, effective, reliable systems1. Implement end of life care good practice models – productive series, advancing quality, clinical audit, ELCQuA, NEoLCIN profiles, Social care TEST2. Use of agreed prognostic indicator guidance3. AMBER Care Bundle in use across Acute Trust4. Advance care planning, Preferred Priorities for Care, Do Not Attempt Cardio-Pulmonary Resuscitation, Liverpool Care Pathway, GSF, Disease specific frameworks, RtS, etc5. Electronic palliative care co-ordination system (EPaCCS), rapid discharge home to die pathway6. Symptom management

Measurement1. Safe and effective care with regular review of Serious Untoward Incidents, complaints etc2. PROMS3. National bereavement survey (VOICES)4. The route to success acute dashboard – each trust to develop own utilising ‘how to’ guide metrics for wards and boards5. Real Time Survey results

Delivering excellence in EoLCOur drivers, outcomes and enablers

Care that is compassionate, equitable, reliable, improves the care experience, makes the best use of resources

Full compliance with national policy , Outcomes Framework, NICE Quality Standard and COF, CQC regulations

Reduction of harm

Policy – Existing and New• EoLC Strategy – 6 years to run• Operating Framework

2011/2012, 2012/2013• Our NHS Care Objective – draft

mandate (2012 focus on interdependent health care outcomes through integrated care

• Caring for our future WP 2012 – Palliative Care Funding Review

NICE EoLC Quality Standards and Commissioning Outcomes Framework

VOICES survey 2012 - in relation to overall quality of eolc in the last three months of life a difference of nearly 20% was observed between the highest and lowest PCT cluster (51% to 32%) - differences between patient groups and between care settings were also evident . A traffic light system used for benchmarking highest and lowest 20% will be used to measure progress on improving eolc at national and local levels.

Drivers

Outcomes

Enablers

VOICES• First ever national survey of bereaved

relatives• 22,292 questionnaires returned• 46% return rate• Data valid to PCT cluster level• Published July 2012• Second survey commissioned• Data to support an Indicator in the NHS

Outcomes Framework

VOICES• Overall quality of care in the last three months of

life was rated as − Outstanding or excellent 43% − Good 33% − Fair 14% − Poor 10%

• “It is good some of these questions are being asked.”

• “I am really passionate that lessons are learnt.”

VOICES

PCT Cluster benchmarking

End of life care strategy 2008

Key elements: Raising awareness of death and dying

Integrated service delivery

Workforce, measurement, research, funding, national support. policy

Societal level

Individual level

Infrastructure

Supporting people to live an die well is everybody’s business

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Be confident be brave, initiate a conversation

EPaCCS Strategic Benefits

Partnership working – making it happen

End of life care - Passing on the baton… • The new Improvement

Body• Health and Well-being

Boards• CCGs/LAs• Public Health England • NHS Commissioning Board,

EoLC within Domain 2 under Martin McShane

And finally……Remember….. its about real people

Contact us:

Website: www.endoflifecareforadults.nhs.ukEmail: information@eolc.nhs.ukTelephone: 0116 222 5103

National End of Life Care Intelligence Networkwww.endoflifecare-intelligence.org.ukNEoLC Programme newsletter