Presentation on theme: "What next for End-of-Life Care?"— Presentation transcript:
1What next for End-of-Life Care? Dr Fiona HicksConsultant in palliative medicine LTHT and clinical lead, Y&H palliative care network/HEYH
2Outline New Structures and their impact Refreshing the End of Life Care StrategyIntegration of health and social careEPaCCsFuture Hospice CommissionLearning from the LCPEducation and training
3Influencing for change Clinical leadershipCQCData and benchmarking (PHE)Links with long-term conditionsTransition from adolescenceDying Matters
4New structures and their impact - National National clinical directorNHSIQ – EPaCCs, transform programme (acute hospitals)Leadership Alliance – good care in the last days of life, project on terminology, NICE guidelines 2016Background of financial austerity and need for efficiency70+ Trusts in acute transform programmeNeed conversations to provide individualised care. Barriers to conversations are not just about comms skills. Need to understand the barriers and work to overcome them.
5New structures and their impact – Regional NHS England Area TeamsStrategic Clinical NetworkHEYHEnd of life care network?EoLC network being set up.Priorities for work plan agreed and structures being defined. Links to NHS England and NCD.
6New structures and their impact - Local CCGsLocality groupsHWBsProviders……
7Refreshing 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
8Integration of health and social care Pilot sitesNot just around palliative and end of life carePersonal health budgets
9EPaCCS 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 peopleSource: Economic Evaluation of the Electronic Palliative Care Coordination System (EPaCCS) Early Implementer Sites. NHS Improving Quality. May 2013.
11EPaCCS 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.
12Implementation 2009 - 2012 Left – blue = pilot sites Right – blue = under development, amber= partial implementation, green = full implementation
13Future Hospice Commission Challenge to hospices to look at their role in palliative and end of life careEmphasis on developing services in the community, embracing generalist palliative care, education and research
14Learning from the LCPClinical advisory group - what good care in the last days of life should look likeTerminology – what palliative care and end of life care mean to people (SCIE)NICE guidance 2016National Voices developing a narrative on person-centred care at end of life……..All depends on honest conversations
15Education and training Underpins everything…….Starting the conversationInvolving patients/carersShared decision-makingRole of HEYHRole of HEIsRole of employers
17Clinical leadership Need to engage…. Use structures Use data Be tenaciousShare good practiceDevelop ideasLeadership training
18CQC Changed practice around inspections End of life care is one of eight priority areasOpportunity to influence Trust Boards and raise the profile of EoLCLearning from othersChief exec bulletin etc
19Data and benchmarking (PHE) Data is importantInformation is essentialClinicians may need to interpret dataInvolve public health colleaguesNEoLCIN – VOICES survey, data on DiUPRAre we measuring the right things?
20Links with long-term conditions End of life care is needed in all LTCsLink in with other work in your localityLinks with the Strategic Clinical NetworkCardiovascular and renalCancerMental health, dementia and neurologyWomen’s and children’s (transition)
21Transition from adolescence Links to long term conditionsOverlap with paediatric palliative care