Transcript TItle

END OF LIFE
The Commissioner’s Perspective
Amanda Sullivan
Teresa Cope
Executive Leadership Council 16 April 2013
Overview
National context
 Local context
 Key challenges
 Plans for the future
 Progress so far
 Making a difference

National context

NICE quality standards
 Identification
& assessment
 Holistic support
 Access to services
 Care in last days of life
 Care after death
 Workforce

NHS CCG Outcomes Indicators
 ‘Improving
the experience of care for people at
the end of their lives’
Nottinghamshire picture
Place of death by cause of death (ONS)
All causes
Cancer
CVD
Respiratory
Disease
Home
1897
729
584
192
Care Home
1713
368
452
224
Hospital
4890
1229
1414
745
Hospice
141
134
2
2
Total
8641
2460 (28%) 2452 (28%) 1163 (13%)
What are the challenges?

‘Nearly two-thirds of us would prefer to die at
home’ (Dying Matters)
 BUT
57% of deaths occurring in hospital in
Nottinghamshire
 People with diagnosis of cancer more likely to
die at home than any other condition
 QOF data shows only around one-fifth of
patients expected to die were on practice End
of Life registers in 11/12

What are the challenges?

60% of GPs ‘not confident’ in talking about End of
Life care with their patients (National Council for Palliative
Care)

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RCP research shows confidence higher in
secondary care BUT few patients placed on
registers following acute spell
Liverpool Care Pathway
adverse media coverage
CCGs have ambitious plans to improve
the picture
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Early identification and continual intervention
Ongoing support for patients and carers
Support at home and integration of services
More choice of where to die
Dying well – focusing on dignity
Information to inform care planning
Support for health care professionals to improve
communication and identification.
Care co-ordination approach
The ‘how’
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Increasing End of Life registers in General Practice through
education and support
Rapid response service out of hours for palliative care
support and advice
Implementation of Electronic Palliative Care Co-ordination
System (EPaCCs) across County and City
Improved communications training for HCPs
Respite services to support end of life patients and their
carers
Dedicated non-cancer palliative care nurse specialists
Crisis response services to include end of life care and
support
Engaging citizens to ‘talk about dying well’
The ‘now’
Increased End of Life registers above the
reported levels in 2011/12 (Some CCGs
reporting over 30%)
 Specialist palliative nurse services piloted
 Sustained programme of education across the
County & City
 Funding secured for EPaCCs
 Integrated Care rolling out or being planned
across County and City

Making a difference
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89 year old gentleman living at home with partner (who
had previously nursed husband in his dying phase)
Query tumour due to prolonged abnominal pain; refused
hospital investigation
End of Life plan discussed and agreed with GP; support
provided for him and partner via local hospice as wanted
to remain at home
Following rapid deterioration of condition, partner
expressed fears of not being able to cope with another
death and feeling unable to keep him at home
Palliative care nurses and carers were mobilised to look
after him at home so that his partner could stay with her
daughter for support
He died peacefully at home that night according to his
wishes
Thank you
Any questions?