Rachael Addicott on commissioning end-of-life care


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Rachael Addicott, senior fellow at The King's Fund, presents early findings from her ongoing research into effective commissioning of services at the end of life, along with case studies of innovation and best practice.

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Rachael Addicott on commissioning end-of-life care

  1. 1. COMMISSIONING END-OF-LIFE CARE<br />Rachael Addicott<br />r.addicott@kingsfund.org.uk<br />
  2. 2. Overview<br />Introduction and background<br />commissioning in the current context<br />commissioning end-of-life care<br />Early examples of good practice<br />Ongoing challenges in commissioning<br />Conclusions and next steps<br />
  3. 3. Introduction and background<br />Financial crisis<br />Nature of provision<br />Demographic changes<br />Commissioning for outcomes<br />QIPP<br />World class commissioning priority area <br />‘…we will introduce a new per-patient funding system for all hospices and providers of palliative care’<br />(The Coalition: Our Programme for Government , 2010: p. 26)<br />
  4. 4. Outcomes of successful commissioning for patients at the end of life<br />Personalised care planning<br />Co-ordinated care and support<br />Access to specialist support and care – in the preferred place of care<br />Dignity and respect<br />Patients and carers involved in decision making<br />Equality of access<br />Consistently high quality of care<br />Effective processes for care after death<br />(Leeds Castle Summit – 2009)<br />
  5. 5. Early examples of commissioning EOLC<br />Integrated care organisation pilots<br />Personal health budgets<br />Practice-based commissioning<br />Pooled budgets between health and social care<br />Devolved budgets to a network of practices<br />
  6. 6. Examples of good practice: common themes<br />Integration across providers and professional groups<br />Commissioning for (joint) outcomes and objectives<br />Personalised and enable choice<br />Support patients and their carers<br />
  7. 7. Ongoing challenges (1)<br />How much does end-of-life care cost?<br />measurement of £ and activity<br />defining end of life<br />diversity of provision<br />Tariffs and other currencies<br />range of spending<br />difficulties calculating costs<br />perverse incentives?<br />Creating a silo (eg: long-term conditions)<br />
  8. 8. Ongoing challenges (2)<br />Collaboration – communication and joint budgets<br />Forecasting demand<br />Block contracts<br />difficult to incentivise quality<br />Who should fund EOLC? (Palliative Care Funding Review)<br />
  9. 9. Conclusions and next steps<br />Keeping EOLC on the national agenda<br />Quality improvement needed despite financial pressures and policy environment<br />Learning from examples of good practice<br />