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) 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 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’ 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 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?