What next for End-of-Life Care?
Dr Fiona Hicks
Consultant in palliative medicine LTHT and clinical lead, Y&H
palliative care network/HEYH
Outline
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New Structures and their impact
Refreshing the End of Life Care Strategy
Integration of health and social care
EPaCCs
Future Hospice Commission
Learning from the LCP
Education and training
Influencing for change
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Clinical leadership
CQC
Data and benchmarking (PHE)
Links with long-term conditions
Transition from adolescence
Dying Matters
New structures and their impact National
• National clinical director
• NHSIQ – EPaCCs, transform programme
(acute hospitals)
• Leadership Alliance – good care in the last
days of life, project on terminology, NICE
guidelines 2016
New structures and their impact –
Regional
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NHS England Area Teams
Strategic Clinical Network
HEYH
End of life care network?
New structures and their impact Local
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CCGs
Locality groups
HWBs
Providers……
Refreshing the EoLC Strategy (2008)
“Ambition for high quality in end of life care”
• Due for publication this spring – five themes
- Community engagement
- Patients and carers feeling supported and able to cope
- Professionals feeling supported and able to learn and
provide care
- Addressing inequity and differences in practice
- Developing and improving systems that support efficient
and effective palliative and end of life care
Integration of health and social care
• Pilot sites
• Not just around palliative and end of life care
• Personal health budgets
EPaCCS
Electronic palliative care co-ordination systems
• Evidence from an independent economic evaluation of EPaCCS suggests
a correlation between EPaCCS implementation and the number of
people being able to die in the community in line with their wishes with:
- An additional 90 deaths occurring in a person’s usual place of residence
per 200,000 population each year, over and above the underlying increase in
rates being experienced across England.
- Can save at least £35,910 per 200,000 population each year
- Recurrent savings after four years will be over £100k pa and cumulative
net benefit over 4 years of c.£270k for a population of 200,000 people
Source: Economic Evaluation of the Electronic Palliative Care Coordination
System (EPaCCS) Early Implementer Sites. NHS Improving Quality. May 2013.
EPaCCs
EPaCCS
• Multi-professional workforce training is required to help:
- Identify the patients (and their carers).
- Have the conversations with patients, family and carers in
order establish their preferences for care and advance care
planning.
- Record them on EPaCCS in order to coordinate them
between professionals.
Implementation 2009 - 2012
Future Hospice Commission
• Challenge to hospices to look at their role in
palliative and end of life care
Learning from the LCP
• Clinical advisory group - what good care in the
last days of life should look like
• Terminology – what palliative care and end of
life care mean to people (SCIE)
• NICE guidance 2016
• National Voices developing a narrative on
person-centred care at end of life
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Education and training
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Underpins everything…….
Starting the conversation
Involving patients/carers
Shared decision-making
Role of HEYH
Role of HEIs
Role of employers
Influencing for change……..
Clinical leadership
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Need to engage….
Use structures
Use data
Be tenacious
Share good practice
Develop ideas
Leadership training
CQC
• Changed practice around inspections
• End of life care is one of eight priority areas
• Opportunity to influence Trust Boards and
raise the profile of EoLC
• Learning from others
Data and benchmarking (PHE)
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Data is important
Information is essential
Clinicians may need to interpret data
Involve public health colleagues
NEoLCIN – VOICES survey, data on DiUPR
Links with long-term conditions
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End of life care is needed in all LTCs
Link in with other work in your locality
Links with the Strategic Clinical Network
Cardiovascular and renal
Cancer
Mental health, dementia and neurology
Women’s and children’s (transition)
Transition from adolescence
• Links to long term conditions
• Overlap with paediatric palliative care
http://www.togetherforshortlives.org.uk/professionals
/projects/project_two
Dying Matters
The road ahead…….