Community development in end of life care

1. Community development in end of life care
Libby Sallnow and Julian Abel

2. Why has community development become the new
buzz word?
Drivers for change:
• Recognition of limitations of professional knowledge
• Communities possess answers
• Demographic and funding pressures
• Appreciation of the impact of social factors on health and
wellbeing
• Top-down approaches often do not lead to sustainable change
• Upstream interventions can have significant impact
• Health is everyone’s responsibility

3. The evidence base is now building
• Having a poor social network is as dangerous as smoking 15/day
– Social relationships and mortality risk: a meta-analytic review. Holt-Lunstad et al. (2010) PLoS
Med
• Having a strong social network in LTC results in significant cost
savings in formal care and improves mental and physical
wellbeing
– The contribution of social networks to the health and self management of patients with long-term
conditions. Reeve et al. (2014) PLOS One
• There is solid evidence that engaging communities has a positive
impact on health outcomes, behaviours, self-efficacy etc.
– Community engagement to reduce inequalities in health: a systematic review, meta-analysis and
economic analysis. O’Mara-Eves et al. (2013) Public Health Research

4. Community development and end of life care
• Kellehear first described the ‘public health approach to end of
life care’ (1999)
• Aligned the two apparently paradoxical disciplines of EOLC
and public health
Compassionate Communities are community development
initiatives that actively involve citizens in their own end-of-
life care
Build partnerships between services and communities to
build on the strengths and skills they possess, rather than
replacing them with professional care

5. Surge in interest in the UK

6. Severn Hospice Community Development Project
Reduced GP appointments. 44%
. Reduced A&E attendance. 30%
Reduce hospital admissions. 60%
Reduced Shropdoc calls. 30%
Reduced the cost associated with dependency. unquantified
Improved health and well-being for patients and carers, initial
evaluation
120%

7. Total Emergency Hospital admissions
0
2
4
6
8
10
12
14
16
18
6/12 prior how many emergency
admissions
6/12 post how many emergency
admissions
Series1
Total of Home visits
0
10
20
30
40
50
60
70
6/12 prior to coco how many home
visits?
6/12 post coco how many home visits?
Series1
Total A&E Attendances
0
1
2
3
4
5
6
7
8
9
6/12 prior to coco how many A&E
attendances
6/12 post coco how many A&E
attendances
Series1
Total visits to practice
105
110
115
120
125
130
135
6/12 prior to coco how many practices
visits?
6/12 post coco how many practices
visits?
Series1

8. What are the problems?
• Addiction to high cost professional services and failure to imagine
new ways of working
• Dying from a chronic illness, including frailty, is a speeded up form
of aging
• Main problems of people are loss of mobility, loss of a role, loss of
sense of meaning and value, with increasing social isolation
• These problems cannot be addressed using professional services
alone
• The solution lies in supporting, enabling, encouraging communities
to look after and value their elderly, frail, dying and those who are
bereaved.

9. THE COMPASSIONATE CITY
- CHARTER -
Compassionate Cities are communities that recognize that all
natural cycles of sickness and health, birth and death, and love
and loss occur everyday within the orbits of its institutions and
regular activities. A compassionate city is a community that
recognizes that care for one another at times of crisis and loss is
not simply a task solely for health and social services but is
everyone’s responsibility.

10. THE COMPASSIONATE CITY
- CHARTER -
Compassionate Cities are communities that publicly encourage,
facilitate, supports and celebrates care for one another during life’s
most testing moments and experiences, especially those pertaining to
life-threatening and life-limiting illness, chronic disability, frail ageing
and dementia, grief and bereavement, and the trials and burdens of
long term care are not the limits of our experience of fragility and
vulnerability. Though local government strives to maintain and
strengthen quality services for the most fragile and vulnerable in our
midst, serious personal crises of illness, dying, death and loss may
visit any us, at any time during the normal course our lives. A
compassionate city is a community that squarely recognizes and
addresses this social fact.

11. THE COMPASSIONATE CITY
- CHARTER -
 Our city will establish and review these targets and goals in the first two
years and thereafter will add one more sector annually to our action plans
for a compassionate city – e.g. hospitals, further & higher education,
charities, community & voluntary organizations, police & emergency
services, and so on.
This charter represents a commitment by the city to embrace a view of health and
wellbeing that embraces social empathy, reminding its inhabitants and all who
would view us from beyond its borders that ‘compassion’ means to embrace
mutual sharing. A city is not merely a place to work and access services but equally
a place to enjoy support in the safety and protection of each other’s company, even
to the end of our days.