Kim Stewart Director, Office of the Chief Health Officer NSW Ministry of Health June 2015 End of Life policy and resources for health professionals

Outline 1.Advance Planning for Quality Care at End of Life: Action Plan Achievements to date 3.Legacy policy products 4.Future deliverables

1. Advance Planning for Quality Care at End of Life: Action Plan Released June 2013 Strategic approach for NSW Health system Actions assigned to MoH, Pillars, LHDs/SHNs & other government agencies

Context of the Action Plan

Each outcomes is divided into actions. Eg; Outcome 4 - Patients’ preferences about where they want to die are respected and appropriate support and resources are available to provide this

2. Achievements to date Examples provided are MoH lead projects. There have also been a number of important projects completed by ACI and CEC to date.

End of Life Decisions, the Law & Clinical Practice online resource Released September 2014 Focus The website provides information for health professionals as to who legally in NSW can make end of life decisions and advice on how they should be made. Target audience Primary: JMOs, early registrars, senior nurses, social workers. Secondary: Health service managers, policy makers, GPs, aged care professionals, lawyers

Specific issues addressed in resource Identifying the Person Responsible Scope of powers of the Person Responsible Advance Care Directives Distinguishing competent refusal of life-sustaining treatment from physician assisted suicide Disequilibrium between right to refuse and right to demand treatment Resolving disputes and seeking legal advice

Statewide Resuscitation Plans PD2014_030 released September 2014 Resuscitation plans replaced ‘No CPR’ form. Benefits of a standardised (statewide) form –Improve recognition and familiarity for (mobile) clinicians –Better transferability of decision outcomes between institutions –Assist expanding their reach beyond acute care

NSW Health Adult Resuscitation Plan

Implementation steps Integrate with concurrent programs about identifying/managing the deteriorating patient Track utilisation trends in aggregate (state) death audit data Integration into NSW Health electronic medical record Consult with aged and primary care re uptake of Resuscitation Plans into community settings

3. Legacy Policy Products GL2005_056 Using Advance Care Directives (NSW) –This guide aims to assist health professionals in discussing advance care planning with patients, and to clarify how to use an advance care directive as part of that process. GL2005_057 End-of-Life Care and Decision-Making – Guidelines –These guidelines set out a process for reaching end- of-life decisions which promotes communication among the treating team and with patients and families, compassionate and appropriate treatment decisions. Both are still current and are under review

4. Future MoH deliverables Revised Policy Directive to address verification and medical certification of death (to be accompanied by supporting eLearning modules) Advance Care Planning in Mental Health Settings web information resource Review of Advance Care Directives (ACD) – Promotion of a single ACD template recommended by NSW Health End of Life Conversations Skills Training – Framework developed and HETI commissioned to develop an eLearning Module and Advance Skills workshop resources.

Thank you