1. Darzi Review and The End of Life Care Strategy A summary and initial analysis Graham Elderfield Chief Executive Earl Mountbatten Hospice25.09.08

2. Chapter Headings 1.The challenges of end of life care 2.Death, dying and society 3.End of Life Care Pathway 4.Care in different settings

3. Chapter Headings 5.Support for carers and families 6.Workforce 7.Measurement and research 8.Making change happen

4. Summary No real surprises in strategy apart from new money £280m No move to PBR or quantification of Hospice funding Moves responsibility for Palliative Care leadership to PCTs from others eg. Hospices, MCCC

5. Initial Reflections EOLC becomes a priority Tasks PCTs with improving co-ordination of care All staff to be trained in communication skills Widespread adoption of LCP, GSF

6. Initial Reflections Improvements in verification of death, including by nurses Spiritual and cultural needs should be part of training Training is a key priority within the strategy PCTs to review progress annually

7. Initial Reflections PCTs to ensure 24hr availability, including rapid response OOH staff appropriately trained EOLC register Quality standards set for Care Homes, Hospices, Hospitals

8. Initial Reflections EOLC strategy sets out role for Ambulance services and support to Prisons Carers should get a Carers Care Plan Challenge for research and evidence base EOLC intelligence network

9. Making it Happen Additional money to be monitored by DOH PCTs/LAs to develop 3yr plans PCTs to work with the Third Sector New investment to be focused on rapid response co-ordination of care, SPC in Hospital, workforce

10. Making it Happen New role for Hospices SHAs to examine workforce needs National programme of bereavement surveys Public awareness campaigns led by NCPC

11. A VISION OF END OF LIFE CARE IN 2018

12. Nature of Need in 2018 Significant increase in proportion of population over 85 Increase in numbers of people with complex co- morbities By 2025 1 million people with Dementia, many in own homes Total numbers of deaths rising after period of decline

13. Nature of Commissioning in 2018 Implementation of world class commissioning in 2009/10 Guidance on commissioning from independent sector issued to NHS Greater use of competitive tendering Model contracts for commissioning services from non NHS providers Signals an end to ‘grant’ funding for Hospices

14. Demonstrating Outcomes New system of quality assurance under Care Quality Commission An end to commissioning for activity Services commissioned on basis of patient/service users outcome Providers expected to demonstrate qualitative outcomes as part of contract management

15. Funding Care in 2018 Tariffs for Palliative Care in voluntary sector since 2012 Personal budgets for NHS patients providing greater choice Users as consumers of Health and Social Services New Partnership model for paying for social care Patients able to ‘top up’ their state provided personal budget for health and social care needs

16. The Palliative Care ‘Market’ in 2018 Care Homes marketing themselves as ‘palliative care specialists’ Increasing NHS provision of palliative care within Acute and Community Hospitals (especially within Foundation Trusts) Widespread private sector provision encouraged by implementation of payment by results and personal budgets.

17. Society in 2018 ‘Live for ever’ culture disappears We discuss death as much as we discuss sex Patients direct the care they receive End of Life Care seen as important as Maternity Care

18. Thank you