End of Life Care- Finding your 1% Julie Foster End of Life Care Lead Cumbria and Lancashire EoL Network

Who is going to die?

What is end of life? When does it begin?

Who is involved in end of life care?

National End of Life Care Strategy

Raising the profile of end of life care Strategic commissioning Identifying people approaching the end of life Care planning Coordination of care Rapid access to care Delivery of high quality services in all locations Last days of life and care after death Involving and supporting carers Education and training Measurement and research Funding

Key Performance Indicators 1.Increase in % of deaths in usual place of residence 2.Reduction in the number of hospital admissions of 8 days or more which end in death 3.Reduction in unplanned admissions in last year of life

How can we achieve the KPIs? End of life care is everybody’s business Identifying people likely to die in the next 12 months and communication are the keys to success No single professional group can do it on its own!

The Workforce Within health and social care there are: Approximately 2.5 million staff (only 5500 SpPC) Segmented into 3 broad groups: A: Staff working in Specialist Palliative Care B: Staff who frequently deal with end of life care C: Staff who infrequently deal with end of life care

It is recognised that a cultural shift in attitude and behaviour related to end of life care must be achieved within the workforce Workforce development is key to the overall success of the end of life care strategy Four areas have been identified as core common requirements:- Communication skills training; basic, intermediate, advanced Assessment of needs and preferences Advance Care Planning Symptom Control

GMC GMC Guidance for Doctors: ‘Patients must be able to trust Doctors with their lives and health’

Mental Capacity Act 2005-Statutory Principles A person must be assumed to have capacity unless it is established that they lack capacity A person is not to be treated as unable to make a decision unless all practicable steps to help them have been taken without success A person is not to be treated as unable to make a decision merely because he makes an unwise decision

Mental Capacity Act 2005-Statutory Principles continued….. An Act done, or decision made, under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as affectively achieved in a way that is less restrictive of the persons rights and freedom of action

MCA Assume Capacity – LD alone is not a determination of lack of capacity 2 Stage Test – Diagnostic – Functional Enable Capacity – How do we give meaningful information? The Language we use Who might be able to help with this process? Unwise decisions – PWLD with capacity refusing fluid thickening agents Best Interests – EoL decision making for people without capacity Least restrictive – Where should PWLD be cared for – Who should be looking after them

Cumbria & Lancashire Priorities Working to increase GP and primary care awareness of ‘Find your 1%’ campaign Supporting people to die in their usual place of residence: – investment in care home organisational change programme – Aiming for 3% increase per year from 2011 baseline Supporting improvement in end of life care in Acute Hospitals enabling reduction in hospital deaths: – Routes to success for acute hospitals, learning from renal project, rapid discharge

Cumbria & Lancashire Priorities Advance care planning: – Investment in communication skills training at all levels – Education programmes for all levels of health & social care staff and staff from independent and voluntary sectors Developing leadership skills in end of life care – Care home managers, social work teams, ward senior nursing staff Supporting training around spirituality Improving bereavement support