Making Connections Living and Dying Well Shifting the - - PowerPoint PPT Presentation

Making Connections

Living and Dying Well Shifting the Balance of Care Elizabeth Ireland

National Clinical Lead

Palliative and End of Life Care Patient experience programme

Scottish Government Health Department

Improving Experience

EXPERI ENCE EVI DENCE BASED PRACTI CE MODELS of CARE Working in Partnership I mproving Outcomes

• SHIFTING FOCUS
• SHIFTING WHO

DELIVERS CARE

• SHIFTING

LOCATION of CARE

Maximise flexible and responsive care at home, with support for carers Integrate health and social care and support for people in need and at risk Reduce avoidable unscheduled attendances and admissions to acute hospitals Improve capacity & flow for scheduled care Extend scope of services provided by non-medical practitioners outside acute hospital Improve access to care for remote and rural populations Improve palliative and end of life care (EOL) Improve joint use of resources (capital and revenue)

Reduced inequalities in time and geography Decreased institutional beddays Prevent adverse events by earlier interventions Better use of medical and non medical professionals Reduced overall infrastructure costs and minimise carbon footprints Use existing technology as fully as possible Improved individual experience

hifting the Balance of Care links to Health & Wellbeing Outcomes

mprovement areas shifts/impact

Single

• utcome

agreements HEAT targets

Increased independence and personal choice National

Performance

Framework

Policy and Strategies etc- Palliative Care in Scotland

Public Audit Committee

National consistent and accurate data

collection

Robust commissioning arrangements Single National DNAR policy across

Scotland

LIVING and DYING WELL

Palliative Care for whom?

• diagnosis of a progressive or

life-limiting illness

• critical events or significant

deterioration during the disease trajectory indicating the need for a change in care and management

• significant changes in patient or

carer ability to ‘cope’ indicating the need for additional support

• the ‘surprise question’

(clinicians would not be surprised if the patient were to die within the next 12 months)

• nset of the end of life phase –

‘diagnosing dying’

Number of comorbidities by age

6.4 4.6 21.1 13.6 8.8 22.5 19.2 15 18.4 20.1 16.9 12.7 12.5 16.4 16.1 12.8 24.3 38.6 55-64 65-74 75+ Age Percentage 1 2 3 4 5

From ISD

Place of death. Scotland 1981 to 2006

Source GRO Scotland

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 1 9 8 1 1 9 8 2 1 9 8 3 1 9 8 4 1 9 8 5 1 9 8 6 1 9 8 7 1 9 8 8 1 9 8 9 1 9 9 1 9 9 1 1 9 9 2 1 9 9 3 1 9 9 4 1 9 9 5 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 2 1 2 2 2 3 2 4 2 5 2 6

Home Nursing Homes etc. Hospital

Actual and Projected deaths 1974-2030

Gomes and Higginson. Palliative Medicine 2008

So by 2030… if current trends continue

home deaths will reduce by 42.3% Less than one in 10 (9.6%) will die at

home

increase in institutional deaths of

20.3%.

Patient Journey Emergency admissions

Mean number of emergency admissions per year (denominator = number of deaths 2006)

0.0 0.5 1.0 1.5 2.0 2.5 0-1 1-2 2-3 3-4 4-5 Years of life left Mean number of emergency admissions per year

Cancer Heart disease Other disorders of the circulatory system Other diseases of the respiratory system COPD

Patient Journey Length of Stay

Bed days in the last 5 years of life For persons who died in 2006

200,000 400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 1,600,000 1 2 3 4 5 Years of life left B ed d ays

Emergencies Transfers Electives

and the costs…

Living and Dying Well

LIVING and DYING WELL

• Assessment and Review of palliative and

end of life care needs

• Planning and delivery of care for patients

with palliative and end of life care needs

• Communication and Coordination
• Education, training and workforce

development

• Implementation and future developments

Activities from Living and Dying Well

Board Delivery Plans

Identification and

Assessment tools

Palliative Care Registers Anticipatory Prescribing Service Information

Directories

DNAR Community Nursing Equipment Education champions

Activities from Living and Dying Well

Education eHealth

ePCS

Palliative Care Dataset

Captured within GP system – some

already pre-populated:

Palliative care register flag (Read code)

consent

Carer details and key professionals Diagnosis and current treatment Preferred place of care Current care arrangements Patients and Carers Awareness of

Conditions

Advice for OOH care

Including DNAR

Activities from Living and Dying Well

Education eHealth

ePCS Voluntary sector SCI

Care Commission

Care standards Education

Palliative Care

Standards

Implementation of Living and Dying Well

For Discussion

Composite measures?

Preferred place of care? Palliative Care Register? LCP? DNAR?