1. © NHS Institute for Innovation and Improvement, 2010 Improving End of Life Care Dr. Sakthi Karunanithi, Locum Consultant in Public Health Mr. Mike Leaf, Director of Public Health (Acting) Acknowledgements: Dr. Mark Spencer and Dr. Gillian Au

2. The Quality Challenge People are not receiving the best possible end of life care Gap between scientific know how and reality Unwanted clinical variation Avoidable costs National and Local priority Aim: Improve the percentage of people dying in their preferred place of care by 10% in one year

3. Patient & Carer Care Homes GP Hospice Hospital Community Services NWAS PCT People and Changes Being Introduced Education Pathways Team mobilisation Funding Gold Standards Framework McMillan GP Paradigm Shift: Moving beyond a QI project to a large scale change

4. Baseline - 2009 Median – 37% Impact so far

5. Impact of Vanguard on us Insight into various dimensions of large scale change Enhanced understanding of methods to match the large scale change Ability to mobilise the right people with narratives Mindset to blend QI with organisational development and social mobilisation Already applying the learning into other areas of work!

6. Spread so far and next steps From one practice in Fleetwood towards a EoL care programme across the local health economy Linking with level 3 QIPP priorities Next steps Link with regional work stream Spread through end of life care network Scope new financial models