Transcript Network End of Life Care Home Link Nurse

Elaine Horgan - End of Life Care, Care Home Coordinator – Greater Manchester and
Cheshire Cancer Network (GMCCN)
End of Life Care is care that:
“Helps all those with advanced, progressive
incurable illness to live as well as possible
until they die. It enables the supportive and
palliative care needs of both patient and
family to be identified and met throughout
the last phase of life and into bereavement.
It includes management of pain and other
symptoms and provision of psychological,
social, spiritual and practical support”
National and Regional Developments in End of
Life Care
National End of Life Care Programme
www.endoflifecareforadults.nhs.uk
•
Healthier Horizons – NHS North West (2008)
•
End of Life Care Strategy - DOH (2008)
•
End of Life Care Quality Markers - DOH (2009)
•
End of Life Care Strategy Review – 2nd Annual Report – DOH (2010)
•
Routes to Success in End of Life Care Achieving Quality in Care Homes –
NEoLCP (2010)
•
End of Life Care Standards - NICE (currently Draft 2011)
The End of Life Care Strategy:
Scope
The Strategy
•
Covers all conditions
•
•
Covers all care settings (e.g. home, hospital,
hospice, care home, community hospital, prison
etc.)
Has been developed within the current legal
framework
The End of Life Care Strategy:
Rationale (1)
• Around 500,000 people die in England each year. This
will rise to around 530,000 by 2030
• Before 2008, DH did not have a comprehensive strategy
on end of life care
• Some patients receive excellent care, others do not
– 54% of complaints in acute hospitals relate to care of the
dying/bereavement care (Healthcare Commission 2007)
• Hospices have set a gold standard for care, but only deal
with a minority of all patients at the end of their lives
The End of Life Care Strategy:
Rationale (2)
• There is a major mismatch between people’s
preferences for where they should die and their
actual place of death
– Most would probably like to die at home
– Only around 18% do so with a further 17% in care
homes
– Acute hospitals accounting for 58% of all deaths
– Around 4% in hospices
• Only around one third of general public have
discussed death and dying with anyone
End of Life Care Strategy 2008
4.39
“Good PCT’s working with local authorities will wish to commission services from care
homes which:
•
Residents approaching the end of life are on an end of life care register
•
Each resident is offered a care plan, which clearly identifies their needs and
preferences for care
•
Staff receive the training and support they need to provide end of life care
•
There is a appropriate access to GP, District nursing and specialist palliative care
advice”
DOH, 2008, End of Life Care Strategy p95
The End of Life Care Pathway
(Chapter 3)
The End of Life Care Pathway
Step 1
Discussions as
end of life
approaches
•
•
Open, honest
communication
Identifying triggers
for discussion
Step 2
Assessment, care
planning and
review
•
•
Agreed care plan
and regular review
of needs and
preferences
Assessing needs of
carers
Step 3
Step 4
Step 5
Coordination of
care
Delivery of high
quality services
Care in the last
days of life
•
•
•
•
•
Strategic
coordination
Coordination of
individual patient
care
Rapid response
services
•
•
High quality care
provision in all
settings
Hospitals,
community, care
homes, hospices,
community
hospitals, prisons,
secure hospitals
and hostels
Ambulance
services
Support for carers and families
Information for patients and carers
Spiritual care services
•
•
•
Identification of the •
dying phase
Review of needs
and preferences
for place of death •
Support for both
patient and carer
Recognition of
wishes regarding •
resuscitation and
organ donation
Step 6
Care after death
Recognition that
end of life care
does not stop at
the point of death.
Timely verification
and certification of
death or referral to
coroner
Care and support
of carer and
family, including
emotional and
practical
bereavement
support
The Workforce
• Within health and social care there are:
• Approximately 2.5 million staff
• Segmented into 3 broad groups:
• A: Staff working in Specialist Palliative Care
• B: Staff who frequently deal with end of life care
• C: Staff who infrequently deal with end of life care
• Of these only 5500 staff work in Specialist Palliative
Care Services
• It is recognised that a cultural shift in attitude and behaviour related
to end of life care must be achieved within the workforce
• Workforce development is key to the overall success of the end of
life care strategy
• Four areas have been identified as core common requirements:•
•
•
•
Communication skills training; basic, intermediate, advanced
Assessment of needs and preferences
Advance Care Planning
Symptom Control
Brief update on the End of Life Care Strategy
Second Annual Report:
• Published August 2010:
• –
“Much good work across England” (Tom HughesHallett)
• –
“Challenge of finding ways to do more for less”
(T. H-H)
• –
“Some areas of the NHS are investing and some
aren’t.” (T. H-H)
• –
“Real sense that momentum is building” (Mike Richards)
Healthier Horizons
Northwest NHS Next Stage Review
(Lord Ara Darzi)
Achieve a 10% reduction in hospital deaths
through enhanced community services by
2012
Would you be surprised if your patient was in the last year of life?
‘Gold Standards Framework’ (GSF) / Six Steps to Success
Advance Care Planning
‘Preferred Priorities for Care’
‘Rapid
Discharge
Pathway’
(RDP)
‘Liverpool Care Pathway for the
Dying’ (LCP)
2
1
Advancing
disease
1 year
Increasing
decline
6 months
3
4
Last Days of
Life
First Days
after Death
Death
The North West End of Life Care Model
Adapted from NHS Salford
5
Bereavement
1 year
How will the resident &
family/commissioner/care home know it has
worked
•
Residents receive their wishes and preferences at end of life
•
Family feel supported
•
Use of Liverpool Care pathway/Six Steps to Success programme demonstrates
quality care given
•
Fewer complaints relating to end of life care
•
Reduction in inappropriate hospital admissions
•
Staff are trained and competent to deliver the care
•
Equity and equal access to quality end of life care to all
Contact:
Elaine Horgan - End of Life Care, Care Home Coordinator
Greater Manchester and Cheshire Cancer Network
[email protected]