end of life strategy melanie wright macmillan clinical nurse specialist n.
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END OF LIFE STRATEGY MELANIE WRIGHT MACMILLAN CLINICAL NURSE SPECIALIST. PROVIDER FORUM 10 th June 2009. END OF LIFE STRATEGY July 2008 Preceded by NHS END OF LIFE CARE PROGRAMME 2004 - 2007. CONTEXT 500,000 Deaths per year two-thirds over 75 year age group

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slide2
END OF LIFE STRATEGY July 2008

Preceded by NHS END OF LIFE CARE PROGRAMME 2004 - 2007

slide3
CONTEXT

500,000 Deaths per year

two-thirds over 75 year age group

large majority of deaths following chronic illnesses i.e. heart disease, cancer, stroke, respiratory disease, neurological disease, dementia

slide4
Why a need for an End of Life Strategy?

Over 90% of the final year of a persons life is spent in the community.

Only 35% of people die in community settings despite 90% requesting home as preferred priority of care.

slide5
LOCATION OF DEATH:-
  • 58% Hospital
  • 18% Home
  • 17% Care Homes
  • 4% Hospices
  • 3% Elsewhere
slide6
s

STRATEGY AIM

  • Promoting high levels of care for all adults at end of life
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OBJECTIVES OF THE STRATEGY
  • To promote more choice about where they would like to live and die
  • Encompasses all adults with a progressive illness
  • Encompasses all care settings
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MAIN AREAS OF THE STRATEGY
  • Raise the profile of death and dying in the general population
  • Identify patients approaching end of life
  • Opportunity to discuss and document priority choices so that all services involved can work towards these choices
  • Co-ordinated care and support using a system or pathway
  • Rapid Specialist advice and clinical assessment and access to care
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M

MAIN AREAS OF THE STUDY cont…

  • High quality care and support throughout the last phase of life, promoting dignity and respect pre and post death in all locations
  • Involvement and support of carers during the illness and after the death (specific child support)
  • Appropriate commissioning of services
  • Measurement and research
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FUNDING

Main areas of expenditure in end of life care are:-

Hospital admissions

Hospices and Specialist Palliative Care Services

Community Nursing Services

Care Homes

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Government Manifesto Commitment for Increased Resources to Implement the

End of Life Strategy

£88m in 2009/2010

£198m in 2010/2011

slide14
Gold Standard Framework

Delivering Choice Programme

Advanced Decision to Refuse Treatment

E.M.A.S forms on DNAR

Advanced Care Planning

Mental Capacity Act

Development of Registration of Power of Attorney medical and financial

Preferred Priorities of Care

Out of Hours Green Card

Unified IT Systems Systmone

Continuing Care Funding

Commissioning of Appropriate Services:- Co-ordination Centres, 24/7 Specialist Care and Generalist Care Provision, Home Care Services

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GOLD STANDARDS FRAMEWORK

Provides the Primary Health Care team with tools to improve the planning of palliative care in association with the multidisciplinary team/agencies

Identifies the group likely to be in the last year/few months of life

Promotes use of best of hospice care advances in the community setting

Promotes numerous good practice occurring in Practices, Nursing Homes and associated community services, encourages sharing of good practice

Impacts on the effective use of resources, reducing hospital admissions and improving user satisfaction

slide16
GOLD STANDARDS FRAMEWORK

Palliative Register

Communication meetings - multidisciplinary

Anticipation of crises and medication requirements

Case Review

slide17
GOLD STANDARD FRAMEWORK 7 C’S

A programme of community palliative care centred around 7 components of care provision:-

*Communication *Continued Learning

*Co-ordination *Carer support

*Control of Symptoms *Care of the Dying

*Continuity

Liverpool Care Pathway

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:

LIVERPOOL CARE PATHWAY FOR END OF LIFE

  • Diagnosing dying/last 48 hours
  • Anticipate/control symptoms and issues – concentrating on main physical symptoms:- nausea/vomiting, pain, agitation, secretions, breathlessness
  • Planning around patients preferred priority of death
  • One record/documentation promoting ongoing assessment
  • Stopping non essential medication/futile treatments and cares appropriately
  • Carer support
  • Bereavement planning
  • Gives professionals the opportunity to review after the patients death
slide19
WHAT DOES THE END OF LIFE CARE STRATEGY AND GOLD STANDARD FRAMEWORK CHANGES MEAN FOR CARE HOMES, SUPPORT WORKERS AND OTHER SERVICES?
slide20
Unified programme of working
  • Facilitates multidisciplinary communication
  • Recording of patient and carer priorities
  • Reduces the number of crises, out of hours calls and unnecessary hospital admissions
  • Allows assessment of patients care
  • Liverpool Care Pathway ensures all involved have same aim in last days of life
  • Better educated, prepared and more knowledgeable staff
  • Encourages achievement of best practice in palliative care for all patients in community settings
slide21
COMMISSIONING IMPLICATIONS?

Nursing Homes may be required by Continuing Care to identify that they have acquired GSF registration to provide End of Life Care

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Macmillan Gold Standards Framework Facilitator for Care Homes

Lynne Goodliff – 01775 652257