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What next for End-of-Life Care?

What next for End-of-Life Care?. Dr Fiona Hicks Consultant in palliative medicine LTHT and clinical lead, Y&H palliative care network/HEYH. Outline. New Structures and their impact Refreshing the End of Life Care Strategy Integration of health and social care EPaCCs

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What next for End-of-Life Care?

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  1. What next for End-of-Life Care? Dr Fiona Hicks Consultant in palliative medicine LTHT and clinical lead, Y&H palliative care network/HEYH

  2. Outline • New Structures and their impact • Refreshing the End of Life Care Strategy • Integration of health and social care • EPaCCs • Future Hospice Commission • Learning from the LCP • Education and training

  3. Influencing for change • Clinical leadership • CQC • Data and benchmarking (PHE) • Links with long-term conditions • Transition from adolescence • Dying Matters

  4. New structures and their impact - National • National clinical director • NHSIQ – EPaCCs, transform programme (acute hospitals) • Leadership Alliance – good care in the last days of life, project on terminology, NICE guidelines 2016

  5. New structures and their impact – Regional • NHS England Area Teams • Strategic Clinical Network • HEYH • End of life care network?

  6. New structures and their impact - Local • CCGs • Locality groups • HWBs • Providers……

  7. Refreshing the EoLC Strategy (2008) “Ambition for high quality in end of life care” • Due for publication this spring – five themes - Community engagement - Patients and carers feeling supported and able to cope - Professionals feeling supported and able to learn and provide care - Addressing inequity and differences in practice - Developing and improving systems that support efficient and effective palliative and end of life care

  8. Integration of health and social care • Pilot sites • Not just around palliative and end of life care • Personal health budgets

  9. EPaCCS Electronic palliative care co-ordination systems • Evidence from an independent economic evaluation of EPaCCS suggests a correlation between EPaCCS implementation and the number of people being able to die in the community in line with their wishes with: - An additional 90 deaths occurring in a person’s usual place of residence per 200,000 population each year, over and above the underlying increase in rates being experienced across England. - Can save at least £35,910 per 200,000 population each year - Recurrent savings after four years will be over £100k pa and cumulative net benefit over 4 years of c.£270k for a population of 200,000 people Source: Economic Evaluation of the Electronic Palliative Care Coordination System (EPaCCS) Early Implementer Sites. NHS Improving Quality. May 2013.

  10. EPaCCs

  11. EPaCCS • Multi-professional workforce training is required to help: • Identify the patients (and their carers). • Have the conversations with patients, family and carers in order establish their preferences for care and advance care planning. - Record them on EPaCCS in order to coordinate them between professionals.

  12. Implementation 2009 - 2012

  13. Future Hospice Commission • Challenge to hospices to look at their role in palliative and end of life care

  14. Learning from the LCP • Clinical advisory group - what good care in the last days of life should look like • Terminology – what palliative care and end of life care mean to people (SCIE) • NICE guidance 2016 • National Voices developing a narrative on person-centred care at end of life • ……..

  15. Education and training • Underpins everything……. • Starting the conversation • Involving patients/carers • Shared decision-making • Role of HEYH • Role of HEIs • Role of employers

  16. Influencing for change……..

  17. Clinical leadership • Need to engage…. • Use structures • Use data • Be tenacious • Share good practice • Develop ideas • Leadership training

  18. CQC • Changed practice around inspections • End of life care is one of eight priority areas • Opportunity to influence Trust Boards and raise the profile of EoLC • Learning from others

  19. Data and benchmarking (PHE) • Data is important • Information is essential • Clinicians may need to interpret data • Involve public health colleagues • NEoLCIN – VOICES survey, data on DiUPR

  20. Links with long-term conditions • End of life care is needed in all LTCs • Link in with other work in your locality • Links with the Strategic Clinical Network • Cardiovascular and renal • Cancer • Mental health, dementia and neurology • Women’s and children’s (transition)

  21. Transition from adolescence • Links to long term conditions • Overlap with paediatric palliative care http://www.togetherforshortlives.org.uk/professionals/projects/project_two

  22. Dying Matters

  23. The road ahead…….

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