Reflections on the National Summary of Patient Activity Data for Adult Specialist Palliative Care Services in Ireland
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IHF reflections on MDS data in relation to specialist palliative care services. Reflections offered on SPC beds, access to SPC services. This presentation highlights inequities that exist.
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Reflections on the National Summary of Patient Activity Data for Adult Specialist Palliative Care Services in Ireland
- 1. Reflections on the National Summary of Patient Activity Data for Adult Specialist Pallative Care Services in Ireland September 2018 Sharon Foley, Deirdre Shanagher, Stephen Toft
- 2. Acknowledgements: Authors Dr John Weafer, Researcher Stephen Toft, Palliative Care Programme Officer, HSE Co-chair committee Sharon Foley, CEO, Irish Hospice Foundation Sheilagh Reaper Reynolds, National Lead Palliative Care, HSE, Author Sharon Foley, CEO, Irish Hospice Foundation
- 3. Who we are Our Vision: No-one will face death or bereavement without the care and support they need. Our Mission: To strive for the best care at end of life and in bereavement, for all. Our Values: Change Care Together
- 4. Bereavement Healthcare Education & Research Advocacy & Public Engagemen t What we do
- 5. Today: 1. National summary of patient activity data for adult specialist palliative care services (2012-2015) 2. IHF Reflections on the report 3. Questions
- 6. Background: • Minimum Data Set (MDS) Data is being collected since 2012 from community specialist palliative care (SPC) settings and inpatient SPC units. • In 2015, a report was commissioned to: o Plot trends in MDS Data o Identify gaps in SPC services o Identify areas where planning & improvement could improve SPC services
- 7. MDS Key Findings: • Increase in number of new patients • Increase in access to SPC services • Place of Care Prior to admission: Home • Increase in admissions to & discharges from SPC inpatient units • Increase in bed availability and occupancy • The provision of care to non-cancer patients • Improvement in wait times for SPC inpatient care & community care • SPC in the community & place of death
- 8. IHF Reflections: The Data Says:
- 9. IHF Reflections: The Data Says:
- 10. IHF Reflections: The Data Says:
- 12. IHF Recommendations: • Eliminate funding deficits and regional disparity in access to inpatient units • Eliminate staffing deficits: staffing ratios, originally set in 2001, require updating as part of the Department of Health commitment to update national policy, including workforce planning. • Update national policy on access to SPC, to include required number of beds and other services per region. • Deal with inequities in the length of time referred patients have to wait for SPC services.
- 13. IHF Recommendations: • Resolve disparities in access to SPC for people who do not have cancer. • Recognise officially the role of SPC inpatient and community services on relieving pressure on acute services • Improve the end of life experience of those who die in hospitals through reporting on the Minimum Dataset and establishing key performance indicators for this setting.
- 14. Limitations: • Unique Health Identifiers – likelihood of duplication • Data from acute hospital services not included • Those referred but didn’t receive the service not included • Half year data included for 2016
Editor's Notes
- MDS Report was prepared in partnership with the HSE and a project steering group. Reflections Report based on MDS report as well as HIPE (Hospital Intake Enquiry data) and HSE financial data
- CHANGE: - We drive change through education, innovation, advocacy, practice and mindset, research and communication. -We make a difference in the availability of best care and how it is delivered to the dying and bereaved every minute of every day across all settings. - We nurture a better understanding of how planning ahead for end of life enables us to live better now. CARE: - Through programmes like Nurses for Night Care, Hospice Care for Children, Design and Dignity and Think Ahead we are providing best care for the dying and bereaved nationwide. - The need for the best end of life care is at the heart of everything we do so everyone can experience dignity, comfort and compassion at end of life. TOGETHER We cannot do our work alone. Dying is everyone’s business. We work for and with you for a better end-of life. We co-ordinate and co-operate with individuals, communities, hospices, hospitals and organisations so the principles at the heart of hospice care touch you and your loved ones when needed. Together we make a real difference for people and their families at end of life.
- Data collected: individual basic pt info, referral info, t/f & d/c info, activity in SPC in inpt units, day care, community & hospital settings & SPC activity in bereavement support Collection of MDS data for SPC services 1st proposed 2004 Not implemented & collected in an adhoc manner 2008 National Steering gp for Pall Care set up to examine implementation of collection 2008 consultancy commissioned to examine the fitness for purpose of MDS = good, need updating and based on UK MDS for SPC
- More people are receiving SPC so more resources for SPC services is required
- Unequal access to specialist inpatient palliative care services persists The National Palliative Care Policy (2001) recommended a ratio of 10 inpatient unit beds per 100,000 population. According to the MDS data, no region has achieved this target. Between 2012 and 2015, over half of new patients to inpatient units came from their usual place of residence (own home or nursing home). Encouragingly, at over 2,600 in 2015, the rate of admittance from an acute hospital rose to 47% (from 44% in 2012). This is in stark contrast to the UK, where only 28% of people admitted to inpatient units come from acute hospitals. The high rate of referral from acute hospitals demonstrates the importance of inpatient units in meeting patient preferences, as well as alleviating the pressures faced by the hospital sector. AT THE TIME OF THE REFLECTIONS REPORT: CHO 8 (Midlands) accurately reported ‘Not Applicable’ due to the absence of inpatient unit beds in this region. However, the 100% achievement of all patients being seen in the inpatient unit in CHO 5 (South East region) and 98% in CHO 1 (North West region), relates to two SPC inpatient beds in CHO 5, and eight in Sligo, eight in Donegal, but none in Cavan / Monaghan or in Leitrim. This report also highlighted Cork Donegal, Dublin Galway Limerick and Sligo as being well developed Kerry Kildare, Mayo Waterford and Wicklow as under developed No IPU in Cavan, Monaghan, Carlow, Kilkenny, Tipperary, Wexford, Laois, Offaly, Longford, Westmeath, Louth, Meath Leitrim, Roscommon and CLare However, there are plans to open units in 2019 in Wicklow (to serve hinterland including possibly parts of Carlow) Waterford (to initially serve Waterford, Wexford, Carlow, Kilkenny, South Tipperary) Mayo (to serve Roscommon as well). There are also plans underway to open units in Cavan and in Louth in 2021. Clare and North Tipperary are currently served by Milford. The only remaining ‘black spot’ is the Midland counties of Laois, Offaly , Longford and Westmeath. There are still no inpatient beds in CHO 8 (Midlands and North East),
- Big improvement has occurred in wait time and access to SPC in the community Staffing ratios, set in 2001, require updating The shift in emphasis towards community necessitates a change in service provision. staffing ratios outlined in the 2001 policy need to be updated, enabling more care to be delivered through SPC in the community. The HSE three-year development framework for palliative care services, makes this recommendation.
- The proportion of new non-cancer patients receiving SPC inpatient care rose from 11% to 14% from 2012 to 2015. Reassuring to see non-cancer patients gain access to inpatient units in a similar proportion to the UK. The level of access, however, to inpatient units for those with diseases other than cancer varies throughout Ireland, demonstrating differences in referral patterns and inequity in provision. Greater equity is needed since people, no matter what their diagnoses, should be able to expect equal access to SPC, no matter where they live. HSE introduced referral metrics to try and found out if there was an issue re. preference being shown for cancer over non-cancer patients. Found referrals have equal access regardless of diagnosis and that the issue would appear to be based on who is being referred i.e. the referral rates for both sets of patients. This may point to us / the sector needing to do a lot of awareness raising with both the public and clinical professionals about the benefits of palliative care for non-cancer patients.
- 1. In line with the new HSE Palliative Care Services, Three Year Development Framework, 2017-2019
- Acute hospital data only being collected since 2016 – need for KPIs to be developed. Though Acute data has recently become usable. There are nearly a full set of returns each month, with the exception of one hospital. After a while if this continues the HSE will be able to repost stats on these too) Those referred but didn’t receive the service not included (referral metrics have been rolled out by the HSE – not usable at the moment but are closely monitored) Half year data included for 2016 but has recently been rectified Report only measures quantity not quality We need national standardised information on the impact that palliative care services have on patients & on the health improvements that result from receiving the service.