End of Life Care in Leeds Health Needs Assessment for Adults Dr Fiona Hicks Ms Kathryn Ingold

High level context 0.8% of the population of Leeds die each year 75% of people who die need palliative care If people are given choices they chose less intervention Specialist palliative care in the tip of the iceberg 20% of people using LTHT services are in the last year of their life 20% of the NHS budget is spend on the last year of life

What people value The target is DIUPR (death in usual place of residence) or PPD (preferred place of death) Need to separate “the where from the want” What people value is: ◦Being free of pain and discomfort ◦Being surrounded by loved ones ◦Privacy and dignity ◦Being in familiar surroundings

In Leeds 48% of people who die in Leeds died in hospital Leeds is in the top 20% nationally for: ◦Dignity and respect shown by nurses all the time in the last two days ◦Pain management: reported relief of pain in the last two days Leeds is in the bottom 20% nationally for: ◦Patient involved in decisions about care as much as they wanted ◦Preferred priorities: expressed a preference for where they would like to die

What we did Epidemiological HNA ◦Review of the evidence ◦Analysis of local statistics Corporate HNA ◦Service providers ◦People using end of life care services, the bereaved and their carers ◦Over 100 interviews and 200 survey responses Comparative HNA ◦How does Leeds compare with other areas?

Results Patients who receive early palliative care survive longer with better quality of life 84% of people using Leeds hospices have a cancer diagnosis only 28% of people aged 65 and over die of cancer People living in affluent areas of Leeds are more likely to die in a hospice or care home. More people living in deprived areas die in hospital. The death rate in Leeds is 0.8% and only 0.14% of patients are on palliative care registers High level of personal motivation and skill amongst most staff Concerns around capacity in terms of staff numbers and facilities in community and hospital Leeds compares well with four comparators, other two have lots of care homes. Similar issues.

High impact actions Improve EoLC discharges from LTHT Deliver a seven day service Improve access to medicines Increase district nurse capacity Improve coordination of care Ensure meaningful patient choice Improve support for carers Change culture around discussing death and dying Improve performance management of the impact of EoLC services Ensure equity of access across the city to EoLC.

Next steps HNA sign off Approve direction of travel Approve investment of time to develop models

Contacts Dr Fiona Hicks ◦t: Kathryn Ingold ◦t: