Thames Valley: National perspective for palliative and end of life care – challenges and priorities Professor Bee Wee NCD for End of Life Care NHS England 7 th May 2015 www.england.nhs.uk
Distribution of adults in need of palliative care at the end of life by age and disease groups Source: Global Atlas of Palliative Care, 2014 (WHO) www.england.nhs.uk
Distribution of children in need of palliative care at the end of life by disease groups Source: Global Atlas of Palliative Care, 2014 (WHO) www.england.nhs.uk
Hospital and social care costs Estimated average cost of care services in each of the last twelve months of life (n = 73,243) Source: Understanding patterns of health and social care at the end of life, Nuffield Trust, www.england.nhs.uk Oct 2012
Average hospital costs per day over final 90 days of life (n = 1.22 million) Source: Exploring the cost of care at the end of life: www.england.nhs.uk Georghiou and Bardsley, Nuffield Trust, Sept 2014
Multi-aspect challenge Demographi Sociologic c al Epidemiolog Scientific y Workforce Care capacity systems www.england.nhs.uk
Additional Challenges Sociologica Demographic l Ideology Epidemiolog Well-meant Scientific y assumptions Workforce Care capacity systems www.england.nhs.uk
Challenges for commissioning • End of life care needs to be all-pervasive • Need to commission across whole spectrum: from generic care to specialist palliative care – multiple providers • Plurality of providers: • health and social care (generalist) • NHS and voluntary sector (specialist) • Measurement of outcomes and experience are difficult: • intrinsically difficult because of subject • no suitable tools exist • Incentives and levers can go wrong very easily • Political, public and interest – funding does not always follow www.england.nhs.uk
Wider context: key developments Integrated pioneers Better Care Fund Personal health budgets Integrated Personalised Commissioning…… www.england.nhs.uk
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Leadership Alliance for the Care of Dying People www.england.nhs.uk
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Standards and audit Priorities Commissioners Regulation and service for Care providers Education and training Public attitude and understanding Research Embedding into daily practice www.england.nhs.uk
2008 National Strategy ‘legacy’ NICE Quality Standard 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
House of Care framework – for End of Life Care Engaged, involved and compassionate communities 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 Communities Information of practice Transform ing Carers EoLC in acute hospitals Priorities for Care of VOICES-SF Dying Person Guidance PfC – secure personalised and detained care settings planning Data and Inequalities intelligence know-how Specialist Incorporating palliative care Other Individual- EoLC into service professional level palliative service specs specification know-how care clinical for specific dataset Engaged, involved and compassionate communities Metrics to groups 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: specialist palliative care Clinical Data Set Improving experience, outcomes and commission ing Service Currenci specifica es tion www.england.nhs.uk
Another example: Capturing insights: different levels 5. National level 4. Locality 3. Organisation level 2. Clinical area 1. Individual-staff interaction www.england.nhs.uk
Mapping documents…. 23/06/ www.england.nhs.uk 2015
NCD focus: system leadership and support commissioning • Contributing to development of Ambitions for End of Life Care: system-wide • Metrics • clinical outcomes • experience • Levers for improving quality and quality indicators • Supporting commissioning • generic end of life care • specialist palliative care www.england.nhs.uk
Expectations • One Chance to Get it Right: Priorities for Care of the Dying Person • Electronic shared records system (EPaCCS) • Improving end of life care in acute hospitals • Inequities: condition, time of day/night, location of care, population groups www.england.nhs.uk
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