London End of Life Care Clinical Network London EOL CCG Engagement Event Dr Catherine Millington-Sanders & Dr Katie Urch Co-Clinical directors, London End of Life Care Date Clinical Network (London region) 21 April 2015
Welcome • Fire alarm • Emergency exits • Mobile phones • Wi-Fi Access – free / no password needed • Presentations to be made available post event • Twitter - @NHSLondonSCN • Hashtag - #EOLCLDN • Join in the dialogue!
Background & History • Autumn 2013 – Co-clinical directors appointed • Winter 2013/14 – Series of local roadshows held mapping priority areas for London • Winter 2014 – Recruitment of members for EOLC London clinical leadership group • Spring 2014 – Clinical leadership group meets for the first time. Four Working groups identified • Community • Workforce and training • Good care, good death, good bereavement • Engagement and social strategy
Partners working together NHS London EoL Alliance London Health Pan London 3 rd sector EofL CLG partners Patients/ ADAS social LAS carers/ lay care NHS Eng London Pal care PalE8 LCA regional Eof L hospice Group CCG Skills research Education for care AHSN CLAHRC RCGP H&E / CEPN LETB
CCG Engagement • Pan London CCG EOLC clinical leads meeting chair by Dr Catherine Millington-Sanders • During Winter 14/15 the EOLC clinical network team began a series of local visits to CCGs to highlight the work clinical network and to identify local concerns. Visits to-date include • City & Hackney CCG • BHR CCG • Harrow CCG • Brent CCG • Hillingdon CCG • Merton CCG • to request a visit contact paul.trevatt@nhs.net
London CCG Engagement Event: National perspective for palliative and end of life care Dr Bee Wee NCD for End of Life Care NHS England 21 st April 2015 www.england.nhs.uk
Building on 2008 Strategy NICE Quality Standard: End of Life Care for Adults Identification Access to Care in the last Care after and Holistic support Workforce services days of life death assessment QS4 Physical QS8 QS11 Care in QS1 QS12 Care of and Coordinated the last days of QS15 Training Identification the body psychological care life QS2 QS5 Social, QS13 QS9 Urgent Communication practical and Verification and QS16 Planning care and information emotional certification QS3 QS14 Assessment, QS6 Spiritual QS10 Specialist Bereavement care planning and religious palliative care support and review QS7 Families and carers www.england.nhs.uk
NHS England direction of travel NHS England’s objective is to pursue the long-term aim of the NHS being “ Improving the ‘ LTCs, older people and End of Life care’ recognised globally experience of care as having the highest for people at the standards of caring, end of their lives” particularly for older people and at the end of people’s lives . www.england.nhs.uk 8
Wider context: key developments Integrated pioneers Better Care Fund Personal health budgets Integrated Personalised Commissioning…… www.england.nhs.uk
27/04/ www.england.nhs.uk 2015
www.england.nhs.uk
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Leadership Alliance for the Care of Dying People www.england.nhs.uk
www.england.nhs.uk
Standards and audit Priorities Commissioners Regulation and service for Care providers Education and training Research Embedding into daily practice www.england.nhs.uk
2008 National Strategy ‘legacy’ NICE Quality Standard www.england.nhs.uk
House of Care framework – for End of Life Care Engaged, involved and compassionate communities www.england.nhs.uk
Information Carers VOICES-SF Engaged informed individuals PfC – secure and carers and detained settings Inequalities Engaged, involved and compassionate communities www.england.nhs.uk
Communities of practice Transform ing EoLC in acute hospitals Health and Priorities for Care of care professionals Dying Person committed to partnership Guidance working personalised care planning Data and intelligence know-how Other Engaged, involved and compassionate communities professional now-how www.england.nhs.uk
One Chance to CQC’s Care Get it Right – Knowledge NICE National thematic coordination hub guidance Priorities for audit review - EPaCCS Care Organisational and supporting processes Engaged, involved and compassionate communities www.england.nhs.uk
Individual- level palliative care clinical dataset Incorporating Specialist EoLC into Commissioning palliative care service specs service for specific specification groups Engaged, involved and compassionate communities Metrics to National Input to Seven support NHS Standard Commissioning development Day Services commissioning Contract Toolkit currencies – insights, programme www.england.nhs.uk indicators
How do any of these fit together? www.england.nhs.uk
One example….. Clinical Data Set Improving experience, outcomes and commission ing Service Currenci specifica es tion www.england.nhs.uk
Another example…. www.england.nhs.uk
Levels of insight www.england.nhs.uk
Focus on • Metrics • clinical outcomes • experience • Levers for improving quality and quality indicators • Supporting commissioning • generic end of life care • specialist palliative care • Developing Ambitions for End of Life Care: system-wide www.england.nhs.uk
House of Care framework – for End of Life Care Engaged, involved and compassionate communities www.england.nhs.uk
Headline ambitions • Getting care as good as it can be wherever the person is - at all stages • Care that matches the person’s preferences as closely as possible and meets needs as far as possible • Staff who have confidence to bring these skills into other parts of care – i.e. further upstream and laterally • Reducing the inequality gap • Everybody feels responsible for playing a positive part in end of life care www.england.nhs.uk
What can we/I do to help you? www.england.nhs.uk
London End of Life Care Clinical Network End of Life Care Documentation: A London wide approach Caroline Stirling, EOLC Lead for UCLPartners Date Rob George, Professor Palliative Care, Cicely Saunders Institute, KCL
Outline • Background • Potential solutions • National picture • Project to date
London • 8 million people – 50% from diverse backgrounds • Population likely to rise to 10.1 million by 2041 • 65+ will rise from 0.9m to >1.5m (2011 – 2041) • 32 CCGs • 29 acute trusts (>60 hospital sites) • 12 mental health / community trusts • >5000 GPs • 27 hospices • ’ 00s other care environments - care / residential homes / hostels / wet houses / prisons etc
Priorities towards the end of life Choice in end of life care – DoH Feb 2015 ‘Every moment counts’ – National Voices, March 2015
Priorities for care in the last days of life One chance to get it right, DoH, June 2014
Preferred and actual place of death – national / London data 75% = Preferred - Actual - Actual - ‘expected’ Place of death National National London (2010) (n=1351) (461,016) (n=48,297) Hospital 3% 53% 59% Home 63% 21% 20% 33% Care Home 3% 18% 13% Hospice 29% 5% 5% Other 2% 3% 3% Local preferences and place of death Gomes et al August 2011
Stakeholders meeting – October 2014 • Acute / community Trusts • CCGs • Primary care – in and out of hours • Third sector / Social care / NH • LAS / 111 • AHSN • Palliative Care – acute, community, hospice • Paediatrics
Stakeholders meeting – October 2014 • Is unified approach to DNACPR documentation relevant and possible? • DNACPR or suite of documents? • Enablers / barriers? • Implementation steps?
Unified DNA CPR policies Scotland Wales - draft
UFTO outcomes • Reduction in harm: • frequency • Severity, including harm contributing to death • Themes from interviews • Interdisciplinary communication • Clarity and consistency • Patient dignity and respect Fritz et al, PLOS ONE, 8;9 e70977, 2013
Deciding Right
Deciding Right • Shared decision making • Recording of mental capacity / best interest decision making • DNACPR form • Emergency Health Care Plan • Advance decision to refuse treatment • Supporting ‘App’ www.nescn.nhs.uk/deciding-right/
EPaCCS • Economic evaluation: • Extra 90 deaths in usual place of residence /200,000 • i.e. 3,600 deaths across London • Cost savings - £324,000 – £535.3m • CMC data: • ~21,000 records made to date (since April 2010) • ~8,400 deaths (6,400 location recorded) • ~17% died in hospital, 37% at home, 28% in care home, 17% in hospice Economic evaluation of EPaCCS NHSIQ, February 2013 CMC data – to 1.4.15
Is unified approach relevant and possible within current climate? It’s everyone’s business • Unanimous agreement - a unified approach is needed in London • The right time to do this is now due to London structure and overview • This unified approach extends beyond the EOL CLG
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