1. What next for End-of-Life Care?
Dr Fiona Hicks
Consultant in palliative medicine LTHT and clinical lead, Y&H palliative care network/HEYH

2. Outline 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

3. Influencing for change
Clinical leadership
CQC
Data and benchmarking (PHE)
Links with long-term conditions
Transition from adolescence
Dying Matters

4. 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
Background of financial austerity and need for efficiency
70+ Trusts in acute transform programme
Need conversations to provide individualised care. Barriers to conversations are not just about comms skills. Need to understand the barriers and work to overcome them.

5. New structures and their impact – Regional
NHS England Area Teams
Strategic Clinical Network
HEYH
End of life care network?
EoLC network being set up.
Priorities for work plan agreed and structures being defined. Links to NHS England and NCD.

6. New structures and their impact - Local
CCGs
Locality groups
HWBs
Providers……

7. 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

8. Integration of health and social care
Pilot sites
Not just around palliative and end of life care
Personal health budgets

9. 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.

10. EPaCCs

11. 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.

12. Implementation 2009 - 2012 Left – blue = pilot sites
Right – blue = under development, amber= partial implementation, green = full implementation

13. Future Hospice Commission
Challenge to hospices to look at their role in palliative and end of life care
Emphasis on developing services in the community, embracing generalist palliative care, education and research

14. 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
……..
All depends on honest conversations

15. Education and training
Underpins everything…….
Starting the conversation
Involving patients/carers
Shared decision-making
Role of HEYH
Role of HEIs
Role of employers

16. Influencing for change……..

17. Clinical leadership Need to engage…. Use structures Use data
Be tenacious
Share good practice
Develop ideas
Leadership training

18. 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
Chief exec bulletin etc

19. Data and benchmarking (PHE)
Data is important
Information is essential
Clinicians may need to interpret data
Involve public health colleagues
NEoLCIN – VOICES survey, data on DiUPR
Are we measuring the right things?

20. Links with long-term conditions
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)

21. Transition from adolescence
Links to long term conditions
Overlap with paediatric palliative care

22. Dying Matters

23. The road ahead…….