Transcript End of Life Care in Cumbria and Lancashire

End of Life Care- Finding your 1%
Julie Foster
End of Life Care Lead
Cumbria and Lancashire EoL Network
Who is going to
die?
What is end of life?
When does it begin?
Who is involved in end
of life care?
National End of Life Care Strategy
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Raising the profile of end of life care
Strategic commissioning
Identifying people approaching the end of life
Care planning
Coordination of care
Rapid access to care
Delivery of high quality services in all locations
Last days of life and care after death
Involving and supporting carers
Education and training
Measurement and research
Funding
Key Performance Indicators
1. Increase in % of deaths in usual place of
residence
2. Reduction in the number of hospital
admissions of 8 days or more which end in
death
3. Reduction in unplanned admissions in last
year of life
How can we achieve the KPIs?
• End of life care is everybody’s business
• Identifying people likely to die in the next 12
months and communication are the keys to
success
• No single professional group can do it on its
own!
The Workforce
Within health and social care there are:
• Approximately 2.5 million staff (only 5500 SpPC)
• 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
• 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:•
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Communication skills training; basic, intermediate, advanced
Assessment of needs and preferences
Advance Care Planning
Symptom Control
GMC
GMC Guidance for
Doctors:
‘Patients must be able
to trust Doctors with
their lives and health’
Mental Capacity Act 2005-Statutory
Principles
• A person must be assumed to have capacity
unless it is established that they lack capacity
• A person is not to be treated as unable to
make a decision unless all practicable steps to
help them have been taken without success
• A person is not to be treated as unable to
make a decision merely because he makes an
unwise decision
Mental Capacity Act 2005-Statutory
Principles continued…..
• An Act done, or decision made, under this Act for or
on behalf of a person who lacks capacity must be
done, or made, in his best interests
• Before the act is done, or the decision is made,
regard must be had to whether the purpose for
which it is needed can be as affectively achieved in a
way that is less restrictive of the persons rights and
freedom of action
MCA
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Assume Capacity
– LD alone is not a determination of lack of capacity
• 2 Stage Test
– Diagnostic
– Functional
Enable Capacity
– How do we give meaningful information?
• The Language we use
• Who might be able to help with this process?
Unwise decisions
– PWLD with capacity refusing fluid thickening agents
Best Interests
– EoL decision making for people without capacity
Least restrictive
– Where should PWLD be cared for
– Who should be looking after them
Cumbria & Lancashire Priorities
• Working to increase GP and primary care awareness
of ‘Find your 1%’ campaign
• Supporting people to die in their usual place of
residence:
– investment in care home organisational change
programme
– Aiming for 3% increase per year from 2011 baseline
• Supporting improvement in end of life care in Acute
Hospitals enabling reduction in hospital deaths:
– Routes to success for acute hospitals, learning from renal
project, rapid discharge
Cumbria & Lancashire Priorities
• Advance care planning:
– Investment in communication skills training at all levels
– Education programmes for all levels of health & social care
staff and staff from independent and voluntary sectors
• Developing leadership skills in end of life care
– Care home managers, social work teams, ward senior
nursing staff
• Supporting training around spirituality
• Improving bereavement support
01772 647147
[email protected]
www.endoflifecumbriaandlancashire.org.uk