and End of Life Care Services Launch Event 15 th January 2019 What - - PowerPoint PPT Presentation

Transforming Warrington’s Palliative and End of Life Care Services

Launch Event 15th January 2019

What is End of Life?

NW EOLC Model

Ambitions for Palliative and End of Life Care:

A national framework for local action 2015-2020

VISION

“I can make the last stage of my life as good as possible because everyone works together confidently, honestly and consistently to help me and the people who are important to me, including my carer(s)”

Ambitions for Palliative and End of Life Care:

A national framework for local action 2015-2020

National Key Outcomes

Professor Bee Wee National Clinical Director for End of Life care, NHS England

➢

Increased percentage of people who die that have been offered the opportunity for personalised care planning in their last year of life:

• Nationally 39.6% (currently on GP palliative care

register) increase to 75% in 10 years. ➢ Over 80% of people achieving their preferred place of death (nationally currently 59%) ➢ Improve experience of care reported by patients, carers and bereaved families, from current baseline, year on year

Intervention: 3 components

Professor Bee Wee National Clinical Director for End of Life care, NHS England

• 1. Identification: people who are deteriorating from

their condition(s) and likely to die within next 12 months

• 2. Better, proactive conversations: shared

decision making, personalised care and support planning

• 3. Appropriate sharing of key information

1 2 3 4 5

The Local Story

Inequity for patients being put on on the GSF register GSF meetings within primary care vary widely Lack of system wide coordination

• f care

Only 17% of deaths had advanced care planning in place Not identifying 1% practice popn on GSF register (approx. 0.25%) Inequity patients in last 12 months life experiencing higher number emergency admissions & increased LOS

Deaths in usual place of residence: Warrington, the case for change

Patients and families

In 2015 only 43% people died in usual place of residence 54% of all deaths for 75-84 years were in hospital In 2016 50% deaths were in a hospital setting 75% deaths were ‘predictable deaths’ (Hospice UK 2016) Opportunity to improve outcomes for patients, workforce and achieve financial sustainability

Warrington Response to date:

➢ Facilitated system-wide workshops: undertook ‘Ambitions’ self assessment, some gaps identified and lack care coordination ➢ CCG successful in Macmillan funding bid: team appointed, attended NHSE Large Scale Change masterclass with key stakeholders ➢ Steering group: established Nov 18 ➢ CCG Logic Model: developed from previous driver diagram ➢ Warrington-wide Advanced Care Planning (ACP) document: launched Nov 18 ➢ Best Interests at End of Life: co-design work commenced Nov 18 ➢ System-wide Data Sharing Agreement for (EPaCCs): formally launched Dec 18 ➢ Community Ceiling of Clinical Treatment: used within Care Homes now rolled out ➢ Networking: learning from best practice examples ➢ Community engagement: commenced

Warrington CCG Prevention and Risk Earlier Recognition & Planning Self care and Maintenance Exacerbation care Comprehensive reablement

End of life Standards and care

Using data to strengthen a Health and Social Care Model

➢ Prevention & Risk e.g. Influenza vaccination? ➢ Earlier Recognition & Planning e.g. Risk Stratification and Care Planning? ➢ Self Care & Maintenance e.g. Lifestyle choices? ➢ Exacerbation Care e.g. Rapid response? ➢ Comprehensive Reablement e.g. Community OT/Physio? ➢ End of Life Standards & Care e.g. Early planning & support?

Frailty Storyboard

Warrington’s most similar CCGs

Warrington CCG is compared to the 10 most demographically similar CCGs in order to identify realistic opportunities to improve health and healthcare for the population. Warrington’s most similar CCGs are: ➢ Barnsley ➢ Cannock Chase ➢ Chorley & South Ribble ➢ Hartlepool & Stockton-on-Tees ➢ Redditch & Bromsgrove ➢ South Cheshire ➢ South East Staffs & Seisdon Peninsular ➢ Telford & Wrekin ➢ Wigan Borough

Cancer deaths: Below average percentage in usual place of residence

Circulatory diseases: Lowest quintile for percentage of deaths in usual place of residence

Respiratory diseases: Lowest quintile for percentage of deaths in usual place of residence

Dementia: Lowest quintile for percentage

• f deaths in usual place of residence,

patients aged 65+

Cancer: Lowest quintile and in peers for number of ordinary hospital admissions during last year of life 2013-2015

Circulatory: High number of ordinary hospital admissions during last year of life 2013-2015

Respiratory: Highest quintile for number of

• rdinary hospital admissions in last year of

life 2013-2015

Dementia: High number of ordinary hospital admissions in last year of life 2013-2015

Cancer: Low number of days (nights) in

• rdinary hospital admissions during last year
• f life 2013-2015

Circulatory: Above average number of days (nights) of ordinary hospital admissions during last year of life 2013- 2015

Respiratory: High number of days (nights)

• rdinary hospital admissions during last

year of life 2013-2015

Dementia: Average number of days (nights) spent in ordinary hospital admissions in last year of life 2013-2015

Cancer: Lowest quintile for percentage of Emergency hospital admissions during last year of life 2013-2015

Circulatory: Highest quintile for percentage

• f patients with an emergency hospital

admission during their last year of life 2013-2015

Respiratory: Highest quintile for percentage of patients with an emergency hospital admission during last year of life 2013-2015

Dementia: High percentage of patients with emergency hospital admissions in last year of life 2013-2015

Cancer: Average number of days (nights) spent in emergency hospital admissions during last year of life 2013-2015

Circulatory: Highest quintile for number of days (nights) in emergency hospital admissions in last year of life 2013-2015

Respiratory: Highest quintile for number of days (nights) spent in emergency hospital admissions during last year of life 2013- 2015

Dementia: Higher number of days (nights) emergency hospital admissions in last year of life 2013-2015

Cancer: Lowest in peers in number of emergency hospital admissions during last year of life 2013-2015

Circulatory: Highest quintile for number of emergency hospital admissions during last year of life 2013-2015

Respiratory: Highest quintile for number of emergency hospital admissions during last year of life 2013-2015

Dementia: Higher number of emergency hospital admissions in last year of life 2013-2015

Priorities and Policy

Local Interdependencies

➢ Primary care: Gold Standards Framework (GSF) ➢ Warrington Together: Frailty workstream ➢ WHHFT: Serious Illness Care Programme (Respiratory/Cardiology) ➢ Clinical workstreams: dementia, respiratory, cardiovascular and cancer ➢ Strategic Partnership: End of Life Programme Board and End of Life Care North West Strategic Coast Clinical Network

What good looks like

3 2 1 4 5

WBC/CCG Commissioning Prospectus supports EOL care Co-designed Integrated Palliative and EOL Care service Reduction in hospital admissions & LOS Increase in deaths in preferred place of care Equitable early identification & monitoring using GSF/Primary Care Data sharing/Care Co-ordination using EPaCCS

Better outcomes patients and carers

Any questions?

Primary Care Gold Standard Framework Proje ject

• Inconsistent use of traffic coding of

patients and understanding of the coding.

• Inconsistent attendance at the meeting,

however most well attended. GP’s have feedback previous meetings have not been so well attended.

• All GSF meetings have very low number
• f non-cancer patient discussed at the

meeting and there appears to be confusion in one practice if people with frailty should be on a GSF register.

• All had prepared list of patients’ to be

discussed, some practices sent out list prior to meeting.

• All take practice’s take minutes of the

meeting

Introductory Practice Visits to Observe GSF Meetings

Development of tools and Promotion of End of Life Tools

• Electronic Palliative Care Coordination System (EPaCCS)
• Consistent approach of recording and sharing an individual’s end of

life care preferences, decisions and plans within and across

• rganisations.
• Proactive Identification Guidance (PIG)
• To support earlier identification of all patients nearing end of life
• Gold Standard Framework Register Templates
• To assist with identifying patients in the correct coding and ensuring

EOL key Performance Indicators are achieved i.e. ACP’s

• To encourage consistent approach to GSF meetings
• Optimal GSF Process
• Guidance on planning and holding GSF meeting
• Advanced Care Plan

Progress to Date

• Attended 17 GSF meetings with a

further 4 planned

• Attended 10 Practice meetings
• 11 Practices agreed to participate in

the Project – Combine population 117,873

• First baseline audit completed
• 3 further baseline audits underway

Future Plans

To use audits findings to inform improvements Address inconsistency in GSF Meeting Increase number of Practices participating in project Identify Educational Gaps Develop Training and Education Re-audit Patient and Family

Patient Story

Patient 3 had long term respiratory condition, not identified in their last 12 months of life, therefore not on the GSF register. In the first half of their last year of life they had 5 admissions to Accident and Emergency and 4 emergency hospital admissions. On their last admission they were referred to the Community Matron who then went on to refer them to the vitality unit at the hospice and DNCRP was completed. The remainder last year of life, the patient had no further admissions and died in the hospice.

Any questions?

Experience Based Design – Our Approach

Katie Horan – Engagement Manager

Experience based co-design is an approach that enables staff, patients, carers and Third Sector partners to co-design services and pathways together in partnership. The approach was designed for and within the NHS to develop simple solutions that offer patients a better experience of treatment and care. Experience Based Design allows us to gather insight into how services are experienced based on the person’s emotional response to the

• interaction. It helps individuals and teams to challenge assumptions

and perceptions about what we think the patient or family member feels and needs. https://www.youtube.com/watch?v=uim_Uzv_a30

What is Experience Based Design

Our Approach

12 month programme of engagement January 2019 – December 2019 A range of engagement and communication activity that will involve patients, carers, families, Third Sector organisations, staff from partners and providers including primary care

January – February 2019

• Launch event
• Identify organisations to be involved and how

to engage with them

• Identify patients/ carers/ families to be involved

in interviews

• Identify staff/ volunteers to be involved in the

interview process

• Training to be undertaken by staff and

volunteers on EBD and interview techniques

• Support pack to be produced including tools

and tips for the interviews and consent forms

March – July 2019

• Engagement activity to take place over 12 weeks
• Throughout the engagement interested patient/

carer representatives to be identified to be involved in the co-design element

• Training to be received by MacMillan on being a

patient representative

• All feedback, interviews etc. to be analysed and

themed based on the 6 ambitions that have been discussed earlier

• Workshop/ event to feedback these themes, an
• pportunity to add any more experiences and

discuss the way forward

August – October 2019

• Stakeholder meetings, including patient and carer

representatives, to discuss the themes and draft the new model of care

• Equality Impact Assessment to be undertaken to ensure we

pay regard to the Public Sector Duty and the Equality Act

• To draw up the draft model in a visual to easily explain and

communicate

• To consider if any potential changes to services that have

been discussed need a formal consultation due to substantial changes

• 12 week engagement or consultation on the proposed new

model to ensure it is fit for purpose and will address the issues that were raised during the experience based design approach

Any questions?