Merseyside & Cheshire
End of Life and Palliative Care
Clinical Network Group
2010 JOINT ANNUAL CONFERENCE
Merseyside & Cheshire Cancer Network
and
The National Council for Palliative Care
“Preparing the Workforce
for
End of Life Care”
Merseyside & Cheshire
End of Life and Palliative Care
Clinical Network Group
WELCOME AND
INTRODUCTION TO THE DAY
JULIE GORRY
(Chief Executive, St John’s Hospice Wirral
NCPC NW Area Representative)
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:
•
Individual level: Integrated service delivery based around
a care pathway
•
Infrastructure:
Actions to raise awareness of death and
dying and to change attitudes
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 Markers
Public 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 SHAs
e.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
National End of Life Care Programme workstreams
Pre pathway
Step 1
Discussions
as the end
of life
approaches
Raising
Awareness
• Supporting NCPC
Commissioned
literature review
National Coalition
Dying Matters
• Member of Dying
Matters
• National
Awareness
raising week
• Communications
skills (introductory,
intermediate,
advanced) 12
pilots
• Clinical triggers kidney, dementia
Heart cancer
neurological
• Transition services
from children to
adult services
Step 2
Step 3
Assessment,
care planning
and review
Coordination
of care
• Advance care
planning - patient
and professional
information –
planning for your
future care
(evaluation)
• PPC
• ADRT information
for patients
• Assessment
framework/ pilot
(EoE)
• Locality wide
registers pilots
(8 sites)
• DH initiatives
Transforming
community
services
integrated care
pilots
Personal budgets
Step 4
Step 5 & 6
Delivery of
high quality
services in
different
settings
Care in the
last days
of life and
care after death
• Acute
Hospitals
• Primary care –
GSF/ADA
• “Route to Success”
• Care homes
(volunteers)
• Extra care housing
• Prisons
• Hostels
• QIPP
• LCP neurological
/hospital Audit
• Environments of
care - King’s Fund
• Last offices
• Bereavement
Social care
Measurement - Intelligence network ,quality markers , VOICES
Spirituality, User involvement, Information/support for patients and carers
Workforce – competences, E-learning, methods of delivery, facilitators network
Commissioning, currency and pricing, provider development, service improvement
Cross boundary working/sharing good practice, communications strategy, events ,website
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 care
Locality 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
Integrated OOHs
Care
Integrated Service Model
(16.00-9.00 Mon-Fri; and
24hr cover weekends)
Triage calls
Patients, Family
Provide advice
Provide crisis hands on
care
Core team in Community
Coordination Centre
•Arrange packages of care for
community professionals and
discharge
•End of life Register
•Information and sign posting for
services
Supportive Care Pathway
Role-key worker
• To direct and manage the
care; GSF Register; care
plan; MDT practice
meetings
Advanced care plans
Integrated Hospital
Discharge Team
Case manager
OT, ward nurse,
social care worker
•Website for palliative care
•Coordination of training and
education
•Management information
Short notice planned care, planned care
(health & social care providers)
Professionals
Commissioners (arranging and managing contracts)
Step 4: Delivering high quality services
THE ROUTE TO SUCCESS
IN END OF LIFE CARE - ACHIEVING
QUALITY 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
SETTING THE SCENE
Eve Richardson
Chief Executive
www.ncpc.org.uk
ABOUT NCPC
• 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)
www.ncpc.org.uk
5 DH PRIORITIES
• A patient-led service culture - “nothing about us without
us”
• Focus on better health outcomes - aligning patientreported 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
www.ncpc.org.uk
3 CHALLENGES FOR
THIS PARLIAMENT
• “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
www.ncpc.org.uk
Merseyside & Cheshire
End of Life and Palliative Care
Clinical Network Group
DISCUSSION