The End of Life Care Strategy Tessa Ing Head of End of Life Care Department of Health 20 October 2009

End of Life CareStrategy Chapter 1 The challenges of end of life care Chapter 2 Death, dying and society Chapter 3 The end of life care pathway Chapter 4 Care in different settings Chapter 5 Support for carers and families Chapter 6 Workforce Chapter 7 Measurement and research Chapter 8 Making change happen

Meeting the challenges of end of life care l NHS Constitution l “The NHS …. is there to improve our health and well-being, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives” l The handbook l “The NHS commits to make the transition as smooth as possible when you are referred between services, and to include you in relevant discussions.” l “The NHS commits to work in partnership with you, your family, carers and representatives”

Meeting the challenges of end of life care l Operating Framework for 2009/10 – Exhorts PCTs to deliver extended and improved service provision with their partners l Vital Signs – Measures the number of home deaths as a proxy for delivering better choice l Next Stage Review – SHAs and PCTs are planning to improve end of life care as one of the eight NSR pathways

Meeting the challenges of end of life care

l We will set out new plans over the next year to offer more patients the choice of care in their own homes, such as palliative care or children’s cancer care. l …we will look closely at where we can go further to establish new rights … and whether we can create a right to choose to die at home as further progress is made in implementing the end of life care strategy.

Death, dying and society l National Council for Palliative Care is running the national coalition Dying Matters l 1,200+ members – hospices, schools, solicitors, the GMC l NatCen Survey, to set baseline for current awareness and attitudes

The end of life care pathway identifying people who are approaching the end of life

The end of life care pathway assessment and care planning

The end of life care pathway delivering high quality services

The end of life care pathway last days of life l Liverpool Care Pathway – second National Care of the Dying Audit – Hospitals (NCDAH) report l 51 more hospitals involved in round two – up to 155, from 114 Acute Trusts l Non-cancer patients up to 61% from 55% l The vast majority of LCP patients are reported to be comfortable l Communication (especially with patients and primary care) is still an issue l 50% missing data on care after death

The end of life care pathway care after death l NCDAH shows poor data returns l After Death Audit (for the Gold Standards Framework) should report in November l Bereavement is to be a new strand of work for the End of Life Care Policy Team

Care in different settings Enhancing the Healing Environment l The King’s Fund programme, with DH funding, has supported 19 end of life care projects l These cover a wide range: – acute, – mental health, – primary care, – a prison

Care in different settings Enhancing the Healing Environment l Palliative Care Suite, United Bristol Healthcare NHS Trust before development

Care in different settings - Enhancing the Healing Environment l Palliative Care Suite United Bristol Healthcare NHS Trust after development

Care in different settings l Hospice capital grants l Two year £40 million programme launched in September 2006 l One year £40 million programme for 2010/11 l To be run, as before, by Help the Hospices

The end of life care workforce l Skills for Care and Skills for Health – core competencies and principles launched June 2009, implementation to March 2010 l E-learning for healthcare –developing suite of e-learning modules to be ready January 2010 – free access for health and social care staff l Pilots to review communications skill needs and provision at basic, intermediate and advanced level, to report December 2010 l MPET levy – 2009/10 indicative £12.8 million for end of life care education and training l GMC – Tomorrow’s Doctors

Measurement and research l Intelligence network – to be established by March 2010 l National Cancer Research Institute – rapid review of research in end of life care l National Institute for Health Research – four new projects on generalist services for people at the end of life l VOICES – surveys of bereaved relatives: pilot to run to January 2011

Making change happen l Raising the profile – Dying Matters l Next Stage Review – continuing impetus l Commissioning – world class commissioning l Benchmarking – Quality Markers l Investment – new money for 2009/10 and 2010/11, to be monitored

Next steps l Bereavement – Priority for year 2 l Spirituality – To meet the needs of those approaching the end of life, their carers and families l Triggers – ?when should the end of life care pathway start for people with progressive disease? l Communications – National Programme for End of Life Care to focus on different elements of the strategy over the next year.