Transforming the quality of end of life care - a regional collaborative Dr Julian Abel Consultant in...
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Transforming the quality of end of life care - a regional collaborative
Dr Julian AbelConsultant in Palliative Care, Weston Super Mare, England
Clinical Lead, End of Life Care, Southwest Strategic Health Authority2008 - 2013
Our Health, Our Care, Our Say. Department of Health 2006.
‘Over 500,000 adults die in England each year. Although over 50 per cent of people say they would like to be cared for and die at home if they were terminally ill, at present only 20 per cent of people die at home.’
‘We will establish end-of-life care networks, building on the co-operative approach suggested by the new urgent care strategy.’
South West Strategic Health Authority End of Life Care Network, 2008 – 2013Population 5,289,00042,000 deaths per annum
Formation of South West SHA end of life care network• Invitation to all individual Primary Care Trusts• Lead commissioners for end of life care, lead clinicians and specialist
palliative care professionals• Ring fenced mulitprofessional education and training budget, £1
million for 2008 – 9 and 2009 -10.
The End of Life Care Pathway, National End of Life Strategy 2008 (Primary and secondary drivers)
Discussions as end of life approaches
Discussions as end of life approaches
Assessment, care planning and review
Assessment, care planning and review
Delivery of high
quality services
Delivery of high
quality services
Care in the last days of lifeCare in the last days of life
• Strategic coordination
• Coordination of individual patient care
• Rapid response services
• Identification of the dying phase
• Review of needs and preferences for place of death
• Support for both patient and carer
• Recognition of wishes regarding resuscitation and organ donation
• Recognition that end of life care does not stop at the point of death.
• Timely verification and certification of death or referral to coroner
• Care and support of carer and family, including emotional and practical bereavement support
Care after deathCare after deathCoordination of careCoordination of care
• High quality care provision in all settings
• Hospitals, community, care homes, hospices, community hospitals, prisons, secure hospitals and hostels
• Ambulance services
• Agreed care plan and regular review of needs and preferences
• Assessing needs of carers
Support for carers and families
Information for patients and carers
Spiritual care services
The End of Life Care Pathway
Step 1 Step 2 Step 3 Step 6Step 5Step 4
• Open, honest communication
• Identifying triggers for discussion
Micro, meso, macro
Micro Meso Macro• Hospices• GP practices• District Nursing Services• Community Matrons• Domiciliary Care
Agencies• Nursing Homes• Residential Homes• Out of hours GP
services
• Ambulance services• Primary Care Trusts• Acute Hospitals
• South West SHA• National meeting of
SHA with National Clinical Director for End of Life Care Mike Richards
• National End of Life Care Programme
3 year programme
Year 1 Year 2 Year 3• Adoption of EPaCCS• Advance care planning
(ACP)• Nursing Homes
• Education programmes building on year 1
• Use of EPaCCS• ACP• Residential and nursing
homes
• Transforming end of life care in Acute Hospitals national programme
Transforming End of Life Care in Acute Hospitals5 key enablers1. Use of electronic palliative care coordination systems2. Use of advance care planning3. Use of treatment escalation plan (eg Amber Care Bundle)4. Use of rapid discharge home to die pathway5. Use of Integrated Care Pathway for the dying (last 48 – 72
hours)
Where people with terminal illnesses choose to die
Impact of advance care planning on place of death
EPaCCS place of death data
ICD10 desc (source ONS)
Care home (nursing or residential)
Hospice Hospital (acute or community, not psychiatric)
Other Places
Other Residence or Road
Own Residence
Total
Neoplasms 386 439 230 15 22 930 2022 Percentage place of death 19 22 11 1 1 46 100
Non cancer diagnoses 498 48 87 15 8 329 985
Percentage place of death
50 5 9 2 1 33 100
Total data set 884 487 317 30 30 1259 3007
Percentage place of death
29 16 11 1 1 42 100
ONS Mortality place of death compared to EPaCCS place of death (3007 EPaCCS deaths)
ONS DEATHS EPPACS DEATHS
Total Total Total Total
Non cancer
Cancer Non cancer
Cancer
Hospital 45.9 32.8 Hospital 9 11
Care Home 34.2 18.1 Care Home
50 19
Home 18 31 Home 33 46
Hospice 0.8 16.8 Hospice 5 22
Elsewhere 1.1 1.3 Elsewhere 3 2
Percentage death in usual place of residence (DIUPR)Rolling three quarters 2010 to 2013
1 2 3 4 5 6 7 8 9 10 1135.037.039.041.043.045.047.049.051.053.0
Percentage DIUPR England Percentage DIUPR South West
South West SHA
First National Survey of Bereaved People 2012Benchmark Ratings for key 11 questions about quality of care.
Dame Cicely Saunders (1918 - 2005) founder of the modern hospice movement
How people die remains in the memory of those who live on