National perspective for palliative and end of life care - - PowerPoint PPT Presentation

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National perspective for palliative and end of life care - - PowerPoint PPT Presentation

Jan 23, 2023 238 likes •480 views

Thames Valley: National perspective for palliative and end of life care challenges and priorities Professor Bee Wee NCD for End of Life Care NHS England 7 th May 2015 www.england.nhs.uk Distribution of adults in need of palliative care

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www.england.nhs.uk

Thames Valley: National perspective for palliative and end

  • f life care –

challenges and priorities

Professor Bee Wee NCD for End of Life Care NHS England

7th May 2015

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www.england.nhs.uk

Distribution of adults in need of palliative care at the end of life by age and disease groups Source: Global Atlas of Palliative Care, 2014 (WHO)

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Distribution of children in need of palliative care at the end of life by disease groups Source: Global Atlas of Palliative Care, 2014 (WHO)

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Hospital and social care costs

Estimated average cost of care services in each of the last twelve months of life (n = 73,243)

Source: Understanding patterns of health and social care at the end of life, Nuffield Trust, Oct 2012

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www.england.nhs.uk

Average hospital costs per day over final 90 days of life (n = 1.22 million)

Source: Exploring the cost of care at the end of life: Georghiou and Bardsley, Nuffield Trust, Sept 2014

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Multi-aspect challenge

Sociologic al Demographi c Epidemiolog y Scientific Workforce capacity Care systems

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Additional Challenges

Sociologica l Demographic Epidemiolog y Scientific Workforce capacity Care systems

Ideology

Well-meant assumptions

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Challenges for commissioning

  • End of life care needs to be all-pervasive
  • Need to commission across whole spectrum: from generic care to

specialist palliative care – multiple providers

  • Plurality of providers:
  • health and social care (generalist)
  • NHS and voluntary sector (specialist)
  • Measurement of outcomes and experience are difficult:
  • intrinsically difficult because of subject
  • no suitable tools exist
  • Incentives and levers can go wrong very easily
  • Political, public and interest – funding does not always follow
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Wider context: key developments

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

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Leadership Alliance for the Care of Dying People

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Priorities for Care

Standards and audit Regulation Education and training Research

Commissioners and service providers

Embedding into daily practice Public attitude and understanding

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NICE Quality Standard 2008 National Strategy ‘legacy’

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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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Engaged, involved and compassionate communities

House of Care framework – for End of Life Care

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Engaged, involved and compassionate communities

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 Individual- level palliative care clinical dataset Incorporating EoLC into service specs for specific groups Knowledge hub NICE guidance CQC’s thematic review

One Chance to Get it Right – Priorities for Care

National audit Care coordination

  • EPaCCS

Communities

  • f practice

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

VOICES-SF

PfC – secure and detained settings Inequalities

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How do any of these fit together?

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One example: specialist palliative care

Clinical Data Set

Currenci es

Improving experience,

  • utcomes

and commission ing

Service specifica tion

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Another example: Capturing insights: different levels

  • 5. National

level

  • 4. Locality
  • 3. Organisation level
  • 2. Clinical area
  • 1. Individual-staff interaction
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Mapping documents….

23/06/ 2015

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NCD focus: system leadership and support commissioning

  • Contributing to development of Ambitions for End of Life Care:

system-wide

  • Metrics
  • clinical outcomes
  • experience
  • Levers for improving quality and quality indicators
  • Supporting commissioning
  • generic end of life care
  • specialist palliative care
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Expectations

  • One Chance to Get it Right: Priorities for Care of the

Dying Person

  • Electronic shared records system (EPaCCS)
  • Improving end of life care in acute hospitals
  • Inequities: condition, time of day/night, location of

care, population groups