www.england.nhs.uk

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

7th May 2015

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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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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

Sociological

Demographic

Epidemiology

Scientific

Workforce capacity

Care systems

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Additional Challenges

Sociological

Demographic

Epidemiology

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

of 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

Currencies

Improving experience, outcomes

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