Transforming Warrington’s Palliative and End of Life Care Services Launch Event 15 th 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
The Local Story GSF meetings within primary care vary widely Only 17% of deaths Inequity for had advanced care patients being planning in place put on on the GSF register 3 2 4 Lack of Inequity patients Not identifying system wide in last 12 months 1% practice coordination life experiencing popn on 5 1 of care higher number GSF register emergency (approx. 0.25%) admissions & increased LOS
Deaths in usual place of residence: Warrington, the case for change Opportunity to improve outcomes Patients 75% deaths were and families for patients, ‘predictable deaths’ workforce and (Hospice UK 2016) achieve financial sustainability In 2015 only 43% 54% of all deaths people died in usual for 75-84 years place of residence were in hospital In 2016 50% deaths were in a hospital setting
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
Using data to strengthen a Health and Social Care Model ➢ Prevention & Risk e.g. Influenza vaccination? ➢ Earlier Recognition & Planning e.g. Risk Prevention and Stratification and Care Planning? Risk ➢ Self Care & Maintenance e.g. Lifestyle choices? End of life Earlier ➢ Exacerbation Care e.g. Rapid response? Standards Recognition & Planning and care ➢ Comprehensive Reablement e.g. Community OT/Physio? Warrington CCG ➢ End of Life Standards & Care e.g. Early planning & support? Comprehensive Self care and reablement Maintenance Exacerbation care 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 of 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 ordinary 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 ordinary hospital admissions during last year of 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) ordinary 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 of 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 Data sharing/Care 3 4 Co-ordination using EPaCCS Co-designed Integrated Equitable early Palliative and EOL Care 2 identification & service monitoring using GSF/Primary Care 5 1 Reduction in hospital admissions & LOS Better outcomes Increase in deaths in WBC/CCG preferred place of care patients and Commissioning Prospectus carers supports EOL care
Any questions?
Primary Care Gold Standard Framework Proje ject
Introductory Practice Visits to Observe GSF Meetings • 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 of 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
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 organisations. • 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
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