London EOL CCG Engagement Event Dr Catherine Millington-Sanders - - PowerPoint PPT Presentation

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London EOL CCG Engagement Event Dr Catherine Millington-Sanders - - PowerPoint PPT Presentation

Jan 13, 2024 221 likes •883 views

London End of Life Care Clinical Network London EOL CCG Engagement Event Dr Catherine Millington-Sanders & Dr Katie Urch Co-Clinical directors, London End of Life Care Date Clinical Network (London region) 21 April 2015 Welcome Fire

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London End of Life Care Clinical Network Date

London EOL CCG Engagement Event

Dr Catherine Millington-Sanders & Dr Katie Urch Co-Clinical directors, London End of Life Care Clinical Network (London region)

21 April 2015

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Welcome

  • Fire alarm
  • Emergency exits
  • Mobile phones
  • Wi-Fi Access – free / no password needed
  • Presentations to be made available post event
  • Twitter - @NHSLondonSCN
  • Hashtag - #EOLCLDN
  • Join in the dialogue!
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Background & History

  • Autumn 2013 – Co-clinical directors appointed
  • Winter 2013/14 – Series of local roadshows held

mapping priority areas for London

  • Winter 2014 – Recruitment of members for EOLC

London clinical leadership group

  • Spring 2014 – Clinical leadership group meets for

the first time. Four Working groups identified

  • Community
  • Workforce and training
  • Good care, good death, good bereavement
  • Engagement and social strategy
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Partners working together

Pan London EoL Alliance NHS London EofL CLG 3rd sector ADAS social care Patients/ carers/ lay London Health partners LAS LCA PalE8

London regional hospice Group

CCG RCGP Education H&E / LETB CEPN Skills for care research AHSN CLAHRC NHS Eng Pal care Eof L

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CCG Engagement

  • Pan London CCG EOLC clinical leads meeting

chair by Dr Catherine Millington-Sanders

  • During Winter 14/15 the EOLC clinical network

team began a series of local visits to CCGs to highlight the work clinical network and to identify local concerns. Visits to-date include

  • City & Hackney CCG
  • BHR CCG
  • Harrow CCG
  • Brent CCG
  • Hillingdon CCG
  • Merton CCG
  • to request a visit contact paul.trevatt@nhs.net
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www.england.nhs.uk

London CCG Engagement Event: National perspective for palliative and end

  • f life care

Dr Bee Wee NCD for End of Life Care NHS England

21st April 2015

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www.england.nhs.uk

Identification and assessment

QS1 Identification QS2 Communication and information QS3 Assessment, care planning and review

Holistic support

QS4 Physical and psychological QS5 Social, practical and emotional QS6 Spiritual and religious QS7 Families and carers

Access to services

QS8 Coordinated care QS9 Urgent care QS10 Specialist palliative care

Care in the last days of life

QS11 Care in the last days of life

Care after death

QS12 Care of the body QS13 Verification and certification QS14 Bereavement support

Workforce

QS15 Training QS16 Planning

NICE Quality Standard: End of Life Care for Adults

Building on 2008 Strategy

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www.england.nhs.uk

NHS England’s

  • bjective is to pursue

the long-term aim of the NHS being recognised globally as having the highest standards of caring, particularly for older people and at the end of people’s lives.

NHS England direction of travel

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“ Improving the experience of care for people at the end of their lives”

‘LTCs, older people and End of Life care’

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www.england.nhs.uk

Wider context: key developments

Integrated pioneers Better Care Fund Personal health budgets Integrated Personalised Commissioning……

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www.england.nhs.uk

27/04/ 2015

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www.england.nhs.uk

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www.england.nhs.uk

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www.england.nhs.uk

Leadership Alliance for the Care of Dying People

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www.england.nhs.uk

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www.england.nhs.uk

Priorities for Care

Standards and audit Regulation Education and training Research

Commissioners and service providers

Embedding into daily practice

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www.england.nhs.uk

NICE Quality Standard 2008 National Strategy ‘legacy’

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www.england.nhs.uk

Engaged, involved and compassionate communities

House of Care framework – for End of Life Care

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www.england.nhs.uk

Engaged informed individuals and carers

Information Carers

VOICES-SF

PfC – secure and detained settings Inequalities

Engaged, involved and compassionate communities

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www.england.nhs.uk Health and care professionals committed to partnership working

Engaged, involved and compassionate communities

Communities

  • f practice

Transform ing EoLC in acute hospitals Guidance personalised care planning Data and intelligence know-how Priorities for Care of Dying Person Other professional now-how

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www.england.nhs.uk

Organisational and supporting processes

Knowledge hub NICE guidance CQC’s thematic review

One Chance to Get it Right – Priorities for Care

National audit Care coordination

  • EPaCCS

Engaged, involved and compassionate communities

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www.england.nhs.uk

Engaged, involved and compassionate communities

Commissioning

Metrics to support commissioning – insights, indicators National development currencies Commissioning Toolkit Input to Seven Day Services programme NHS Standard Contract Specialist palliative care service specification Incorporating EoLC into service specs for specific groups Individual- level palliative care clinical dataset

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www.england.nhs.uk

How do any of these fit together?

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www.england.nhs.uk

One example…..

Clinical Data Set

Currenci es

Improving experience,

  • utcomes

and commission ing

Service specifica tion

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www.england.nhs.uk

Another example….

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www.england.nhs.uk

Levels of insight

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www.england.nhs.uk

Focus on

  • Metrics
  • clinical outcomes
  • experience
  • Levers for improving quality and quality indicators
  • Supporting commissioning
  • generic end of life care
  • specialist palliative care
  • Developing Ambitions for End of Life Care: system-wide
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www.england.nhs.uk

Engaged, involved and compassionate communities

House of Care framework – for End of Life Care

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www.england.nhs.uk

Headline ambitions

  • Getting care as good as it can be wherever the person is -

at all stages

  • Care that matches the person’s preferences as closely as

possible and meets needs as far as possible

  • Staff who have confidence to bring these skills into other

parts of care – i.e. further upstream and laterally

  • Reducing the inequality gap
  • Everybody feels responsible for playing a positive part in

end of life care

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www.england.nhs.uk

What can we/I do to help you?

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London End of Life Care Clinical Network Date

End of Life Care Documentation: A London wide approach

Caroline Stirling, EOLC Lead for UCLPartners Rob George, Professor Palliative Care, Cicely Saunders Institute, KCL

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Outline

  • Background
  • Potential solutions
  • National picture
  • Project to date
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London

  • 8 million people – 50% from diverse backgrounds
  • Population likely to rise to 10.1 million by 2041
  • 65+ will rise from 0.9m to >1.5m (2011 – 2041)
  • 32 CCGs
  • 29 acute trusts (>60 hospital sites)
  • 12 mental health / community trusts
  • >5000 GPs
  • 27 hospices
  • ’00s other care environments - care / residential

homes / hostels / wet houses / prisons etc

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Priorities towards the end of life

Choice in end of life care – DoH Feb 2015 ‘Every moment counts’ – National Voices, March 2015

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Priorities for care in the last days of life

One chance to get it right, DoH, June 2014

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Preferred and actual place of death – national / London data

Place of death (2010)

Preferred - National (n=1351) Actual - National (461,016) Actual - London (n=48,297)

Hospital 3% 53% 59% Home 63% 21% 20% Care Home 3% 18% 13% Hospice 29% 5% 5% Other 2% 3% 3% Local preferences and place of death Gomes et al August 2011

33%

75% = ‘expected’

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Stakeholders meeting – October 2014

  • Acute / community Trusts
  • CCGs
  • Primary care – in and out of hours
  • Third sector / Social care / NH
  • LAS / 111
  • AHSN
  • Palliative Care – acute, community, hospice
  • Paediatrics
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Stakeholders meeting – October 2014

  • Is unified approach to DNACPR documentation

relevant and possible?

  • DNACPR or suite of documents?
  • Enablers / barriers?
  • Implementation steps?
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Unified DNA CPR policies

฀ ฀ ฀ ฀ ฀ ฀ ฀ ฀

Scotland Wales - draft

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UFTO outcomes

Fritz et al, PLOS ONE, 8;9 e70977, 2013

  • Reduction in harm:
  • frequency
  • Severity, including harm contributing to death
  • Themes from interviews
  • Interdisciplinary communication
  • Clarity and consistency
  • Patient dignity and respect
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Deciding Right

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Deciding Right

www.nescn.nhs.uk/deciding-right/

  • Shared decision making
  • Recording of mental capacity / best interest

decision making

  • DNACPR form
  • Emergency Health Care Plan
  • Advance decision to refuse treatment
  • Supporting ‘App’
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EPaCCS

  • Economic evaluation:
  • Extra 90 deaths in usual place of residence /200,000
  • i.e. 3,600 deaths across London
  • Cost savings - £324,000 – £535.3m
  • CMC data:
  • ~21,000 records made to date (since April 2010)
  • ~8,400 deaths (6,400 location recorded)
  • ~17% died in hospital, 37% at home, 28% in care

home, 17% in hospice

Economic evaluation of EPaCCS NHSIQ, February 2013 CMC data – to 1.4.15

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Is unified approach relevant and possible within current climate?

  • Unanimous agreement - a unified approach is needed

in London

  • The right time to do this is now due to London

structure and overview

  • This unified approach extends beyond the EOL CLG

It’s everyone’s business

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Which approach – DNACPR or suite of documents?

  • A unified DNACPR policy is an initial “quick win”

particularly for the LAS and patients

  • A suite of documents would suit GPs and primary care

more

  • Could do both in a phased roll out
  • On balance, a suite of documents is the best approach

A suite of documents

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Enablers?

Other organisations

  • CQC
  • Voluntary sector
  • AHSNs
  • EOL alliance

Financial levers

  • CQUINs
  • QIPP

Education

  • Toolkits
  • Training packages

Information technology

  • CMC
  • EPR
  • Social media
  • Apps

Stakeholders

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Barriers?

Perceptions

  • Public
  • Health & Social care

professionals

Litigation

  • Information governance
  • Paper vs. electronic record

Culture

  • Inexperience in holding difficult

discussions

  • Inexperience in decision making

Variation

  • Different service provision across

boroughs

  • Different priorities across CCGs

Financial support

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Implementation needs

  • Wider stakeholder support:
  • 18/32 CCGs, 7/27 acute trusts supportive,

awaiting responses from hospices, community trusts, social services etc

  • Further discussion/engagement about project

detail

  • Expert ambassadors
  • Information Governance and legal support
  • Education
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Summary National and local initiatives support the development of unified EOLC documentation The concept and culture of early shared decision making as patients approach the end of life are vital for success.

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London End of Life Care Clinical Network

End of Life Care Clinical Network

Hilary Shanahan Chair, Education and Training Working Group

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Clinical Networks

EOLC Clinical Leadership Group Working Groups Education and training Community Good care: good death: good bereavement Engagement and social Strategy

Hosted by NHS England, clinical networks are in areas of major healthcare challenges where a whole system, integrated approach is needed to achieve a real change in quality and outcomes of care for patients.

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Education and training : All London health and social care staff to be skilled in compassionate care at the end of life

This is to reflect that different levels of training need to be tiered for staff depending on their role, to include explicitly social care and to be specific about end of life care.

Aim

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Education and training

Key principles for education and training

  • Support commissioners and providers to know what good

looks like Case study directory

  • Share and spread effective examples
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Key principles

  • To support commissioners and providers, both of care and

training, to understand why a focus on end of life care is important

  • Covers the key principles that drive how such training can be

delivered effectively and the key elements it is likely to contain

  • For all staff, working in health and social care settings
  • Relevant for staff whether they are in a clinical, professional or
  • ther roles
  • Amount and type of training will vary according to the role they

have and contact with individuals requiring end of life care

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Key principles: how to deliver training

A mandatory basic level for all A process of continuous learning Include all staff, not just clinical staff Have a variety of approaches to meet different learning styles Leadership to drive improvements in care and changes in practice Tailor your training to the location and context of where care is delivered Evaluate the effectiveness of your training

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Key principles: elements of training

Communication skills Documentation – relevant and of high quality Assessment and treatment of physical, social and psychological needs Recognising deterioration Choice of place of care and death Advance care plans Support of carers Support of professionals/self- care Compassion in care Coordination of care, across the whole pathway Maintaining knowledge of safety and safeguarding, and of legal rights and responsibilities

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Case studies

We are collecting examples of good practice in training to share and inspire others

Please let us know if you are willing to share your work

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Conclusion Next steps:

  • Communications and engagement
  • Discussions to follow with LETBs and Skills for Care and

Skills for Health

  • Future work plan under discussion – carers, supporting
  • ther groups, specialist workforce recruitment and

retention, support for staff?

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Thank you!

For further information or to discuss: http://www.londonscn.nhs.uk/networks/others/end-of-life-care/ Email project lead: helen.o’kelly@nhs.net

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London End of Life Care Clinical Network Date

Developing an EOLC checklist for commissioners

Brian Andrews

21 April 2015 London End of Life Clinical Network

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Good care, good death, good bereavement working group Chair – Luke Howard and Brian Andrews Good care Good death Good bereavement Persuade Understand Define End of Life CLG Chairs – Catherine Millington Sanders & Katie Urch

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Commissioners Checklist

Aims:

  • Ensure needs of people at end of life are considered in both health and social

care

  • Useful to all settings
  • Help to achieve excellent quality care
  • Used throughout the commissioning cycle
  • Includes requirements that services are safe, effective, caring, responsive and

well-led

  • Available to support service providers and Health and Wellbeing boards
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Subsections 1. Identification 2. Planning 3. Living with the diagnosis 4. Implementation 5. Coordination 6. Improving quality of care 7. Bereavement

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Our questions for you

  • Would a checklist like this be useful?
  • Have we covered the main priorities?
  • Is this the best format?
  • How should we engage with you?

Send your comments to Ruth.Evans9@nhs.net