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Transforming End of Life Care in Acute Hospitals PM Workshop 6: Working together - Building on the best


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Transforming End of Life Care in Acute Hospitals PM Workshop 6: Working together - Building on the best by Professor Bee Wee, NHS England, Adrienne Betteley, Macmillan Cancer Support, Anita Hayes, The National Council for Palliative Care

Published in: Healthcare

Transforming End of Life Care in Acute Hospitals PM Workshop 6: Working together - Building on the best

  1. 1. Improving the quality of end of  life care in acute hospitals Building on the Best Adrienne Betteley Anita Hayes Chris Sutcliffe
  2. 2. Macmillan’s current activities are focussed on four  core areas Existing assets and people Advance Care Planning Partnerships and Innovation Influencing • Buildings including palliative day care (20),  palliative inpatient (59), Oncology (40) and  Information Centres (104) • 551 palliative care beds • Approx. 1,700 posts  • L&D offer including face to face courses, e‐ learning and grants • To ensure people approaching the end of life  receive support to die in the place they  choose Pushing for a commitment to  implement free social care at the end  of life (England) Improving healthcare support/services  for people approaching the end of life,  e.g. 24/7 community nursing 
  3. 3. What is NCPC? • The umbrella charity for palliative and end of life care • Influences government policy • Supports all sectors involved in providing, commissioning and people using services • Promotes equity of access to palliative care and good end of life care for all • Key priority-models to support more people people with multiple conditions& dementia • Dying Matters Coalition
  4. 4. The Dying Matters Coalition Dying Matters was set up by the National Council for Palliative Care, the umbrella charity for all those involved in palliative care, to support the 2008 End of Life Care Strategy Our aim is to raise public awareness about the importance of talking more openly about dying, death and bereavement and of making your wishes known Dying Matters has over 32,000 members ranging from health and care organisations, funeral directors, legal and financial organisations and thousands of individual members
  5. 5. Partnership Initiative • NCPC & Macmillan Cancer Support • NHSIQ, NHSE & TDA • Hospitals  • Aiming for; ‐ Continual Quality Improvement ‐ Building on the Best 
  6. 6. The challenge UK wide quality improvement within a two and a half year timeframe  learning from across four nations  flexibly across four nations  best use of all available resource develops service improvement capability  building on success of Transform
  7. 7. Opportunity for improvement
  8. 8. % people who die in hospital Percentage of people dying in  hospital 2010‐12  Marie Curie data atlas. 2010‐ 2012. Copyright Marie Curie. 
  9. 9. 82,060,422 outpatient appointments  in 1 year in England [5] 10% of these were attended by patients aged 80+ 36% of the Welsh population had an  outpatient appointment [6] Emergency readmissions within 30 days  are  high xx for patients who had a period of uncertainty during their  inpatient stay who died within 100 days of discharge.   33% of  around 10,000   incidents  related to  discharge in  2012/13 were  due to communication at  handover. England [9] One third of patients die during the one year  follow‐up period. 9.3% of all patients died in  the admission period. 25 Scottish Teaching Hospitals [2] Systematic review showed variation in  home preference estimates ranged  31% to 87% for patients (9 studies),  25% to 64% for caregivers (5 studies),  49% to 70% for the public (4 studies).  [3] Studies included in our efficacy  analysis of advance care planning  were all conducted in an outpatient  setting during scheduled visits. [4] How well pain was relieved during the last three months of life, England, 2013 [7] Around half of the 570,000 people who  die in the UK each year, die in hospital [1] 25% patients who receive ICU / HDU  care are near end of their lives . Around 30k  patients admitted to ICU/HDU in Scotland. Around  16% receive last days of life care in the unit. A further  9% die in a general ward/ post discharge. [8] On average there were  xx  emergency readmissions per  acute hospital in 2011. 
  10. 10. "Those with experience of relatives dying in hospitals report the medical support is not as good as expected, while personal support is poor, but as expected." Sue Ryder, a time and a place[12] 69% of bereaved people whose relative or friend died in a  hospital, rated care as outstanding, excellent or good.  Significantly  lower than hospice (83%), care home (82%) or at home (79%). England,  VOICES‐SF survey 33% reported that the hospital services did not  work well together with GP and other services outside the  hospital. England VOICES‐SF survey  [7] some aspects of the dying  environment as being more  important than physical  location.  [11] Choice  report  More than 73% respondents felt  hospital was the right place for their  friend or relative to die, despite only 3%  of all respondents stating patients  wanted to die in hospital. [7] “Sometimes, it's  the little things that matter, and  that is what you remember.” Expert with lived experience.  [10] While the majority said choice is important, many  said an important consideration was quality. [11] Themes from ombudsman report [13] •Not recognising people are dying, not responding to  need •Poor symptom control  •Poor communication  •Poor care planning (hospitals and GPs liaise) •Delays in diagnosis   Hospital staff received  the lowest proportion always  showing dignity and  respect (58% for  hospital doctors and 51%  for hospital nurses).  [7] Most bereaved people did not  talk to anyone from any support  services since the death, most.  18% said they had not, but  would have liked to. VOICES‐SF 
  11. 11. What should the priorities be?  Patient focused outcomes Clinicians/Funders/ User & Carer  engagement Logic Modelling approach Long List of Priorities to Short List
  12. 12. ‘A logic model’ and shared  learning and insights
  13. 13. Aim: 2 stones  lighter! Energy Out Energy In Walk daily commute Stairs not  lift Exercise Reduce  alcohol  intake Eat Less Pedometer Gym work out 3 days Squash  weekends No pub  weekdays Take packed lunch Low fat  meals Driver Diagrams ‐ weight loss 
  14. 14. Transforming End of Life Care in  Acute Hospitals: driver diagram 
  15. 15. Long List Priorities  • Hospital outpatients: advance care planning,  anticipatory planning and co‐ordination • Emergency care: facilitating the best place of  care for patients • Communication on handover to GP and  services in the community 
  16. 16. Continued......... • Shared decision making on treatment options  • Improve pain and symptom management  • Bereavement and post death care • Sustainability ward and system capability to  sustain improvement
  17. 17. Short List to date • OPD – opportunity for ACP etc • Communication on handovers to GP /  Community • Pain & Symptom Management • Shared Decision making – Patient / family /  clinician 
  18. 18. Your Contribution • Give us your feedback on Priorities • Share your learning what works / what  doesn’t • Any resources you have found helpful • Solutions to barriers • Good Practice examples / case studies