The purpose of this briefing is to help you to identify the immediate priority actions to commission effective end of life care.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Guidance for commissioners of drug and alcohol servicesJCP MH
This guide has been written to provide practical advice on developing and delivering local plans and strategies to commission the most effective and efficient drug and alcohol services for adults.
Based upon clinical best practice guidance and drawing upon the range of available evidence, it describes what should be expected of a modern drug and alcohol service in terms of effectiveness, outcomes and value for money.
Guidance for commissioners of services for people with medically unexplained ...JCP MH
This guide is about the commissioning of comprehensive MUS services across the healthcare system. In developing this guide, we recognise that ‘medically unexplained symptoms’ is an unsatisfactory term for a complex range of conditions.
MUS refers to persistent bodily complaints for which adequate examination does not reveal suf ciently explanatory structural or other specified pathology. The term MUS is commonly used to describe people presenting with pain, discomfort, fatigue and a variety of other symptoms in general practice and specialist care. Whilst recognising that the phrase ‘medically unexplained symptoms’ can be problematic, it is nonetheless widely used, and an appropriate term to use in this guide.
This guide aims to: describe MUS and the associated outcomes: outline current service provision for MUS and detail the components of a high quality comprehensive MUS service, and highlight the importance of commissioning comprehensive MUS services.
Guidance for commissioning public mental health servicesJCP MH
Public mental health services (updated August 2013)
This is the second version of the public mental health guide. It has been revised and updated to include new sources of data and information.
The guide is about the commissioning of public mental health interventions to reduce the burden of mental disorder, enhance mental wellbeing, and support the delivery of a broad range of outcomes relating to health, education and employment.
Guidance for commissioners of dementia servicesJCP MH
This guide describes what a good quality, modern dementia service looks like. It has primarily been written for Clinical Commissioning Groups, local authorities, and Health and Wellbeing Boards. It will also be of interest to patients, carers and voluntary sector and provider organisations.
Guidance for commissioners of financially, environmentally, and socially sust...JCP MH
This guide supports commissioners, local health authorities and providers to think broadly, but practically, about building sustainable, resilient communities that have the potential, over time, to reduce mental ill health.
Sustainable commissioning involves making sure services make the most effective use of financial, environmental and social resources. This includes commissioning services that support secondary (reducing relapse) and tertiary (improving rehabilitation) prevention. It is these aspects, rather than primary preventative measures, that are the focus for this guide. The issue of primary prevention is discussed in the Guidance for commissioning public mental health services.
This guide has been written by a group of experts in mental health and sustainability, in consultation with service users and patients, and strengthened by input from a local government and public health perspective. The content is primarily evidence-based but ideas deemed to be best practice by expert consensus have also been included.
By the end of this guide, readers should:
- understand the concept of sustainability in mental health care, and how using this commissioning framework can create sustainable services
- be aware of the legislation relating to sustainability that the NHS is required to meet
- understand what sustainable commissioning looks like in practice
- understand how and why improving the sustainability of mental health interventions will contribute to achieving the aims of both the mental health, public health, NHS, and social care strategies, as well as improving quality and productivity
- be able to commission sustainable mental health services and interventions.
Find out more and download all the guides published by the Joint Commissioning Panel for Mental Health at http://www.jcpmh.info.
Guidance for commissioners of mental health services for people from black an...JCP MH
This guide describes what ‘good’ mental health services for people from Black and Minority Ethnic (BME) communities look like.
While all of the JCP-MH commissioning guides apply to all communities, there are good reasons (see P9) why additional guidance is required on commissioning mental health services for people from BME communities.
This guide focuses on services for working age adults. However, it could also be interpreted for commissioning specialist mental health services, such as CAMHS, secure psychiatric care, and services for older adults.
Guidance for commissioners of drug and alcohol servicesJCP MH
This guide has been written to provide practical advice on developing and delivering local plans and strategies to commission the most effective and efficient drug and alcohol services for adults.
Based upon clinical best practice guidance and drawing upon the range of available evidence, it describes what should be expected of a modern drug and alcohol service in terms of effectiveness, outcomes and value for money.
Guidance for commissioners of services for people with medically unexplained ...JCP MH
This guide is about the commissioning of comprehensive MUS services across the healthcare system. In developing this guide, we recognise that ‘medically unexplained symptoms’ is an unsatisfactory term for a complex range of conditions.
MUS refers to persistent bodily complaints for which adequate examination does not reveal suf ciently explanatory structural or other specified pathology. The term MUS is commonly used to describe people presenting with pain, discomfort, fatigue and a variety of other symptoms in general practice and specialist care. Whilst recognising that the phrase ‘medically unexplained symptoms’ can be problematic, it is nonetheless widely used, and an appropriate term to use in this guide.
This guide aims to: describe MUS and the associated outcomes: outline current service provision for MUS and detail the components of a high quality comprehensive MUS service, and highlight the importance of commissioning comprehensive MUS services.
Guidance for commissioning public mental health servicesJCP MH
Public mental health services (updated August 2013)
This is the second version of the public mental health guide. It has been revised and updated to include new sources of data and information.
The guide is about the commissioning of public mental health interventions to reduce the burden of mental disorder, enhance mental wellbeing, and support the delivery of a broad range of outcomes relating to health, education and employment.
Guidance for commissioners of dementia servicesJCP MH
This guide describes what a good quality, modern dementia service looks like. It has primarily been written for Clinical Commissioning Groups, local authorities, and Health and Wellbeing Boards. It will also be of interest to patients, carers and voluntary sector and provider organisations.
Guidance for commissioners of financially, environmentally, and socially sust...JCP MH
This guide supports commissioners, local health authorities and providers to think broadly, but practically, about building sustainable, resilient communities that have the potential, over time, to reduce mental ill health.
Sustainable commissioning involves making sure services make the most effective use of financial, environmental and social resources. This includes commissioning services that support secondary (reducing relapse) and tertiary (improving rehabilitation) prevention. It is these aspects, rather than primary preventative measures, that are the focus for this guide. The issue of primary prevention is discussed in the Guidance for commissioning public mental health services.
This guide has been written by a group of experts in mental health and sustainability, in consultation with service users and patients, and strengthened by input from a local government and public health perspective. The content is primarily evidence-based but ideas deemed to be best practice by expert consensus have also been included.
By the end of this guide, readers should:
- understand the concept of sustainability in mental health care, and how using this commissioning framework can create sustainable services
- be aware of the legislation relating to sustainability that the NHS is required to meet
- understand what sustainable commissioning looks like in practice
- understand how and why improving the sustainability of mental health interventions will contribute to achieving the aims of both the mental health, public health, NHS, and social care strategies, as well as improving quality and productivity
- be able to commission sustainable mental health services and interventions.
Find out more and download all the guides published by the Joint Commissioning Panel for Mental Health at http://www.jcpmh.info.
Guidance for commissioners of mental health services for people from black an...JCP MH
This guide describes what ‘good’ mental health services for people from Black and Minority Ethnic (BME) communities look like.
While all of the JCP-MH commissioning guides apply to all communities, there are good reasons (see P9) why additional guidance is required on commissioning mental health services for people from BME communities.
This guide focuses on services for working age adults. However, it could also be interpreted for commissioning specialist mental health services, such as CAMHS, secure psychiatric care, and services for older adults.
Guidance for commissioners of acute care – inpatient and crisis home treatmentJCP MH
This guide is about commissioning services for people with acute mental health needs. It explains the purpose, characteristics and components of acute care so that commissioners can commission good quality services that are therapeutic, safe and support recovery.
Guidance for commissioners of child and adolescent mental health servicesJCP MH
This guide describes what ‘good looks like’ for a modern child and adolescent mental health service (CAMHS). It should be of value to Clinical Commissioning Groups (CCGs) and NHS England.
By the end of this guide, readers should be more familiar with the concept of CAMHS and better equipped to understand:
what a good quality, modern, service looks like
why a good CAMHS delivers the mental health strategy and the Quality Innovation Productivity and Prevention initiative – not only in itself but also by enabling changes in other parts of the system
the benefits of CAMHS to children, young people, their families and carers, and
why CAMHS are important for commissioners.
Guidance for commissioners of mental health services for people with learning...JCP MH
This guide is about the commissioning of mental health services for people with learning disabilities, enabling them to live full and rewarding lives as part of their local communities.
This guide is aimed at all commissioners responsible for mental health services for people with learning disabilities including young people in transition to adulthood. The guide will also be helpful for providers of mental health services and for family carers.
This guide describes what we know about mental health services for adults with learning disabilities, and what effective and accessible services look like based on current policy, the law and best practice.
While this guide does make reference to autistic spectrum disorders and ‘behaviours that challenge’ (which people with learning disabilities who have mental health problems may also experience), the primary focus of this guide is on people with learning disabilities who have mental health problems.
Guidance for commissioners of rehabilitation servicesJCP MH
This guide is about the commissioning of good quality mental health interventions and services for people with complex and longer term problems to support them in their recovery.
Guidance for commissioners of primary mental health servicesJCP MH
This guide describes what good quality, modern, primary mental health care services look like. It has been written by a group of primary mental health care experts, in consultation with patients and carers. The content is primarily evidence-based but ideas deemed to be best practice by expert consensus have also been included.
Guidance for commissioners of community specialist mental health servicesJCP MH
This guide is about the commissioning of specialist community mental health services. It explores the role of Community Mental Health Teams (CMHTs), Assertive Outreach Teams and Early Intervention Teams among others.
Guidance for commissioners of older people’s mental health servicesJCP MH
This guide is about the commissioning of mental health services which can improve the mental health and wellbeing of older people.
This guide has been developed by a group of older people’s mental health professionals, people with mental health problems, and carers. The content is primarily evidence and literature-based, but ideas deemed to be best practice by expert consensus have also been included.
Joint Commissioning Panel for Mental Health briefingJCP MH
This briefing describes the Joint Commissioning Panel for Mental Health (JCP-MH), a collaborative co-chaired by the Royal College of Psychiatrists and the Royal College of General Practitioners. The collaboration includes seventeen leading organisations, inspiring commissioners to improve mental health and wellbeing, using a values based commissioning model. It brings together service users, carers, clinicians, commissioners, managers and others to deliver the best possible commissioning for mental health and wellbeing.
The JCP-MH publishes briefings on the key values for effective mental health commissioning. It also provides practical guidance and a framework for mental health commissioning and supports commissioners in commissioning mental health care that delivers the best possible outcomes for health and well being
When a person dies: guidance for professionals on developing bereavement services
The National End of Life Care Programme has supported the Bereavement Services Association and Primary Care Commissioning in the production of 'When a person dies: guidance for professionals on developing bereavement services.'
The manner in which professionals and volunteers respond to those who are bereaved can have a long term impact on how they grieve, their health and their memories of the individual who has died.
The publication covers the principles of bereavement services, along with bereavement care in the days preceding death, at the time of death and in the days following death. It also includes guidance on workforce and education and the commissioning and quality outcomes of bereavement care.
NHS Trusts, community providers and commissioners will wish to consider the guidance when developing policies and services relating to bereavement.
Discussion paper
06 October 2010 - National End of Life Care Programme / Department of Health
This discussion paper focuses on the current context of practices and policies that impact on end of life, including those that need to be explored with people who have a personal health budget.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Sample Report on International Healthcare policy By Global Assignment HelpAmelia Jones
Sample Report on International Healthcare policy By Global Assignment Help.This report is prepared to analyze the formation of healthcare policy in an international context and discussed contemporary issues in International Healthcare policy.
Practical mental health commissioning explains the changing commissioning environment and how commissioners can make the most of available resources to improve the quality and outcomes of mental health and social care services in their area.
Thailand was the first country outside of China that reported COVID-19 infection in January 2020. At the peak of transmission during March-April 2020, it was reporting close to 200 new cases per day and yet it has been able to control the outbreak with no laboratory confirmed local transmission reported for over 100 days as of 2 September 2020.
This publication attempts to identify in a systematic way, various policies and steps that were put in place from the beginning of the outbreak to control COVID-19 transmission in the country.
The November 2020 update builds on the previous document by focusing on the challenges of balancing opening up the country and protecting the population from COVID-19 as well as preparing for the potential second wave.
Guidance for commissioners of mental health services for young people in tran...JCP MH
This guide describes good quality mental health transitions services for young people making the transition from child and adolescent to adult services.
It also describes the benefits of transitions services and explains why a transitions service is important for the commissioners of specialist mental health services.
This guide is for members of the public and explains advance care planning. It outlines the different options available to people when planning for their end of life care.
This publication is an Urdu translation of Planning for your future care, which was published in February 2012 in partnership with the University of Nottingham and the Dying Matters Coalition.
Guidance for commissioners of acute care – inpatient and crisis home treatmentJCP MH
This guide is about commissioning services for people with acute mental health needs. It explains the purpose, characteristics and components of acute care so that commissioners can commission good quality services that are therapeutic, safe and support recovery.
Guidance for commissioners of child and adolescent mental health servicesJCP MH
This guide describes what ‘good looks like’ for a modern child and adolescent mental health service (CAMHS). It should be of value to Clinical Commissioning Groups (CCGs) and NHS England.
By the end of this guide, readers should be more familiar with the concept of CAMHS and better equipped to understand:
what a good quality, modern, service looks like
why a good CAMHS delivers the mental health strategy and the Quality Innovation Productivity and Prevention initiative – not only in itself but also by enabling changes in other parts of the system
the benefits of CAMHS to children, young people, their families and carers, and
why CAMHS are important for commissioners.
Guidance for commissioners of mental health services for people with learning...JCP MH
This guide is about the commissioning of mental health services for people with learning disabilities, enabling them to live full and rewarding lives as part of their local communities.
This guide is aimed at all commissioners responsible for mental health services for people with learning disabilities including young people in transition to adulthood. The guide will also be helpful for providers of mental health services and for family carers.
This guide describes what we know about mental health services for adults with learning disabilities, and what effective and accessible services look like based on current policy, the law and best practice.
While this guide does make reference to autistic spectrum disorders and ‘behaviours that challenge’ (which people with learning disabilities who have mental health problems may also experience), the primary focus of this guide is on people with learning disabilities who have mental health problems.
Guidance for commissioners of rehabilitation servicesJCP MH
This guide is about the commissioning of good quality mental health interventions and services for people with complex and longer term problems to support them in their recovery.
Guidance for commissioners of primary mental health servicesJCP MH
This guide describes what good quality, modern, primary mental health care services look like. It has been written by a group of primary mental health care experts, in consultation with patients and carers. The content is primarily evidence-based but ideas deemed to be best practice by expert consensus have also been included.
Guidance for commissioners of community specialist mental health servicesJCP MH
This guide is about the commissioning of specialist community mental health services. It explores the role of Community Mental Health Teams (CMHTs), Assertive Outreach Teams and Early Intervention Teams among others.
Guidance for commissioners of older people’s mental health servicesJCP MH
This guide is about the commissioning of mental health services which can improve the mental health and wellbeing of older people.
This guide has been developed by a group of older people’s mental health professionals, people with mental health problems, and carers. The content is primarily evidence and literature-based, but ideas deemed to be best practice by expert consensus have also been included.
Joint Commissioning Panel for Mental Health briefingJCP MH
This briefing describes the Joint Commissioning Panel for Mental Health (JCP-MH), a collaborative co-chaired by the Royal College of Psychiatrists and the Royal College of General Practitioners. The collaboration includes seventeen leading organisations, inspiring commissioners to improve mental health and wellbeing, using a values based commissioning model. It brings together service users, carers, clinicians, commissioners, managers and others to deliver the best possible commissioning for mental health and wellbeing.
The JCP-MH publishes briefings on the key values for effective mental health commissioning. It also provides practical guidance and a framework for mental health commissioning and supports commissioners in commissioning mental health care that delivers the best possible outcomes for health and well being
When a person dies: guidance for professionals on developing bereavement services
The National End of Life Care Programme has supported the Bereavement Services Association and Primary Care Commissioning in the production of 'When a person dies: guidance for professionals on developing bereavement services.'
The manner in which professionals and volunteers respond to those who are bereaved can have a long term impact on how they grieve, their health and their memories of the individual who has died.
The publication covers the principles of bereavement services, along with bereavement care in the days preceding death, at the time of death and in the days following death. It also includes guidance on workforce and education and the commissioning and quality outcomes of bereavement care.
NHS Trusts, community providers and commissioners will wish to consider the guidance when developing policies and services relating to bereavement.
Discussion paper
06 October 2010 - National End of Life Care Programme / Department of Health
This discussion paper focuses on the current context of practices and policies that impact on end of life, including those that need to be explored with people who have a personal health budget.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Sample Report on International Healthcare policy By Global Assignment HelpAmelia Jones
Sample Report on International Healthcare policy By Global Assignment Help.This report is prepared to analyze the formation of healthcare policy in an international context and discussed contemporary issues in International Healthcare policy.
Practical mental health commissioning explains the changing commissioning environment and how commissioners can make the most of available resources to improve the quality and outcomes of mental health and social care services in their area.
Thailand was the first country outside of China that reported COVID-19 infection in January 2020. At the peak of transmission during March-April 2020, it was reporting close to 200 new cases per day and yet it has been able to control the outbreak with no laboratory confirmed local transmission reported for over 100 days as of 2 September 2020.
This publication attempts to identify in a systematic way, various policies and steps that were put in place from the beginning of the outbreak to control COVID-19 transmission in the country.
The November 2020 update builds on the previous document by focusing on the challenges of balancing opening up the country and protecting the population from COVID-19 as well as preparing for the potential second wave.
Guidance for commissioners of mental health services for young people in tran...JCP MH
This guide describes good quality mental health transitions services for young people making the transition from child and adolescent to adult services.
It also describes the benefits of transitions services and explains why a transitions service is important for the commissioners of specialist mental health services.
This guide is for members of the public and explains advance care planning. It outlines the different options available to people when planning for their end of life care.
This publication is an Urdu translation of Planning for your future care, which was published in February 2012 in partnership with the University of Nottingham and the Dying Matters Coalition.
Dying Matters: Feel the fear, and have the conversation anywayNHSRobBenson
Presentation on a short training project and supporting materials for GPs and other health professionals proven to boost confidence and improved end of life care. From Hilary Fisher and Lorna Potter from England's Dying Matters coalition as part of the Department of Health's QIPP end of life care workstream seminar series at Healthcare Innovation Expo 2011.
This 'how to' guide builds upon the overarching framework set out in The route to success in end of life care - achieving quality in acute hospitals, published in 2010. The route to success highlighted best practice models developed by acute hospital Trusts, providing a comprehensive framework to enable hospitals to deliver high quality care to people at the end of life.
This 'how to' guide aims to help clinicians, managers and directors implement The route to success more effectively, drawing on valuable learning from the NHS Institute for Innovation and Improvement's Productive Ward: Releasing time to care™ series.
This guide contains individual sections that can be worked on in any given order, dependent upon the individual hospital and its current end of life care provisions. These can be downloaded below:
Introduction
Section 1: prepare
Section 2: assess and diagnose
Section 3: plan
Section 4: treat
Section 5: evaluate
Section 6: sustain
Section 7: further resources
Cover
It places emphasis on existing 'enabling' tools and models, which support and follow a person-centred pathway. These are Advance Care Planning, Electronic Palliative Care Co-ordination Systems (EPaCCS), AMBER Care Bundle, Rapid Discharge Home to Die Pathway, and the Liverpool Care Pathway.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
23 September 2010 - National End of Life Care Programme
This guide is principally for professionals working in health and social care and allied professions. Its main aim is to provide links to information sources, resources and good practice in end of life care (EoLC) for people with dementia, particularly for those who work with people with dementia who are not EoLC experts and EoLC experts who are not particularly knowledgeable about dementia.
While the document is not principally written for patients and carers, some of the information will be relevant to them.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
The route to success in end of life care - achieving quality in prisons and for prisoners
13 September 2011 - National End of Life Care Programme
This practical guide aims to support prison, health and social care professionals in delivering high quality end of life care to prisoners.
The guide follows the six steps of the end of life care pathway, beginning with initiating discussions as end of life approaches and concluding with care after death.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
A care home 'is' someone's home, one day it could be yours too … best practice in end of life care in care homes. Presentation from Eleanor Sherwen, Elaine Owen and Caroline Flynn from England's National End of Life Care Programme as part of the Department of Health's QIPP end of life care workstream seminar series at Healthcare Innovation Expo 2011
Slides from the workshop 'A modern vision of integrated care and support' led by Dr Martin McShane, Dr Damian Riley (NHS England) and David Pearson (ADASS) - NHS Medical Leaders Conference 2014. - See more at: http://www.icase.org.uk/pg/cv_content/content/view/98680#sthash.45Xs2o9r.dpuf
End of Life Care in Advanced Kidney Disease:
A Framework for Implementation
Published by NHS Kidney Care,
This document is an important step in
ensuring that people with advanced kidney
disease receive the very best care in the last
years, months and days of their lives. This
framework complements and extends work
already underway at a national level. It builds
on the vision of High Quality for All1 which
requires all strategic health authorities to
produce end of life clinical pathways. This
informed the End of Life Care Strategy2,
which aims to ensure that all adults receive
high quality care at the end of life, regardless
of their age, condition, diagnosis and place
of care.
This paper presents analysis of a Kent ‘whole population’ dataset, linking wholepopulation demographics with activity and cost data for the population from acute, community, mental health and social care providers. The data helps commissioners to understand the impact of different selections methods for people with ‘very complex’ health and social care needs, particularly in relation to the development of a LTC year of care currency.
This document should be seen alongside the ‘Recovery, Rehabilitation and Reablement – step-by-step guide’ which describes how providers can carry out the audit in their own organisation. Other documents and learning materials This document is part of a suite of learning materials being produced by the LTC Year of Care Commissioning Programme to support the spread and adoption of capitated budgets for people with complex care needs.
Five priorities for care of the dying personMarie Curie
Dr Bill Noble, Medical Director of Marie Curie Cancer Care, speaks at the end of life sesion with Dr Adam Firth (RCGP Clinical Support Fellow for End of Life Care).
This session was chaired by Dr Peter Nightingale, Marie Curie and RCGP End of life lead at the RCGP Annual Conference, ACC Liverpool, 2-4 October, 2014.
For more information visit: mariecurie.org.uk/rcgp
Cure care and research in English dementia policyshibley
I set out to make current dementia policy in England open to the public. This is the final talk to be given by me, Dr Shibley Rahman, at BPP Law School this evening, on cure, care and research.
Exploring the potential for using predictive modelling in identifying end of life care needs - 15 February 2013 - National End of Life Care Programme / Whole Systems Partnership
This report, produced in partnership with Whole Systems Partnership, is based on a project which reviewed the literature on predictive modelling, canvassed views and engaged with interested parties to formulate an initial response to the opportunities presented by predictive modelling approaches in identifying people likely to be nearing the end of life.
Predictive modelling involves the interrogation of datasets to inform professional judgement about potential needs. It is hoped that the findings of this report will be used to enable commissioners and providers of services to better understand and meet people's end of life care preferences and wishes, supporting more people to live and die well in their preferred place.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
Jacquie White, Deputy Director of NHS England Long Term Conditions, Older People & End of Life Care and Claire Cordeaux SIMUL8 Executive Director for Health & Social Care were invited by Centers for Medicare & Medicaid Services to discuss how NHS England work in chronic disease.
BPS DCP SIGOPAC Good Practice Guidance in Demonstrating Quality and Outcomes ...Alex King
This report outlines a rigorous, multidimensional framework for evaluating quality and outcomes in psycho-oncology services, which can be flexibly adapted to local needs and priorities.
It aims to challenge psycho-oncology services to develop and standardise procedures that address the clinical and operational aspects of quality, while maintaining a firm focus on the experiential.
The proposed framework focuses on six key domains of service quality:
- Is this service safe?
- Is this service equitable, while also focused on those most in need?
- Is this service timely and responsive?
- Is this service respectful, collaborative and patient-centred?
- Is this service offering effective interventions?
- Is this service contributing to efficient multidisciplinary care?
To address these domains, psycho-oncology services need to draw on multiple, convergent sources of data, including key performance indicators, activity levels, patient self-report measures, feedback from professional colleagues, etc.
This Guide for Executives is aimed at senior healthcare leaders. It provides 31 practical tips for leaders
who want to contribute positively to the culture for innovation in their organisations and systems.
A more in-depth practitioners guide, Creating the Culture for Innovation, provides much more
detailed advice and guidance, a host of additional examples, and information about an online staff
survey that can be used to assess, benchmark and understand the culture for innovation.
The Sustainability Model is a diagnostic tool that will identify strengths and
weaknesses in your implementation plan and predict the likelihood of sustainability
for your improvement initiative.
The Sustainability Guide provides practical advice on how you might increase the
likelihood of sustainability for your improvement initiative.
Pathways to Success: a self-improvement toolkit Focus on normal birth and reducing Caesarean section rates
Caesarean section (CS) has an important role in ensuring safe maternity care. How can we make
sure that every Caesarean is appropriate, effective and efficient?
The NHS Institute for Innovation and Improvement is working with NHS clinical staff to promote best practice in achieving low CS rates while maintaining safe outcomes for mothers and babies.
This toolkit is designed to help maternity services review and assess their current practice in promoting normal birth and reducing CS rates. The toolkit also provides practical techniques to support sustainable changes in maternity services.
A practical, introductory guide to thinking differently. It is not a comprehensive blueprint nor is it designed to make you an expert in thinking. But it will get you started on
a journey of thinking differently, and therefore doing things differently, that we hope continues well into
your future.
We have selected concepts and thinking tools that have proven their value, ease, and applicability in a
variety of industries and in over five years of experience with front line teams in various NHS organisations.
We’ll provide you with just enough background theory to help you see why the various thinking tools ask
you to do certain things that might seem a bit odd at first. But the emphasis here is not on dry theory or
abstract concepts. Rather, it is on developing new thinking that leads to new ways of doing.
If you are involved in treating patients, managing and/or improving health services or
managing or training those that do, you will understand the importance of providing the
best care possible for all our patients.
Great progress has been made in improving service standards and access and in reducing
waiting times, but there is still some way to go to ensure consistently high standards of
patient care across the NHS.
It is clear that we need to ensure we are getting it right first time, which means better care
and better value through the reduction of waste and errors and the prioritisation of effective
treatments. Quality, innovation, productivity and prevention (QIPP) is the mechanism through
which we can achieve this.
QIPP is about creating an environment in which change and improvement can flourish; it
is about leading differently and in a way that fosters a culture of innovation; and it is
about providing staff with the tools, techniques and support that will enable them to take
ownership of improving quality of care.
The Handbook of Quality and Service Improvement Tools from the NHS Institute brings
together a collection of proven tools, theories and techniques to help NHS staff design and
implement quality improvement projects that do not compromise on the quality and safety of
patient care but rather enhance the patient experience.
The ebd approach (experience based design) is a method of designing better experiences for patients, carers and staff. The approach captures the experiences of those involved in healthcare services. It involves looking at the care journey
and in addition the emotional journey people
experience when they come into contact with a particular pathway or part of the service. Staff work together with patients and carers to firstly understand these experiences and then to improve them.
This guide is an introduction to the ebd approach (experience based design).
This guide and toolkit has been produced as
a result of work that the NHS Institute for
Innovation and Improvement has undertaken in collaboration with NHS organisations and external agencies, using the experience of patients, carers and staff to design better
healthcare services.
This document is one of a series of documents that was produced by the NHS Institute for Innovation and Improvement as part of the High Volume Care programme.
Produced by the Delivering Quality and Value Team, the aim of the Focus on series was to help local health communities and organisations improve the quality
and value of the care they deliver
Support Sheet 18: PPC
This support sheet provides a description of Preferred Priorities for Care, a tool for the discussion and recording of end of life care wishes and preferences.
Support Sheet 15: Enhancing the Healing Environment
This support sheet outlines key design principles for end of life care environments and provides tips for managing an environmental improvement project
Support Sheet 14: Using the NHS Continuing Health Care Fast Track Pathway Tool
This support sheet provides answers to frequently asked questions about the NHS Continuing Health Care Fast Track Pathway Tool.
Support Sheet 13: Decisions made in a person's 'Best Interests'
This support sheet outlines the process for making decisions on behalf of someone who lacks capacity.
Support Sheet 12: Mental Capacity Act (2005)
This support sheet outlines the main provisions of the Mental Capacity Act the four tests essential for assessing capacity
Support Sheet 11: Quality Markers for Acute Hospitals
This support sheet outlines the quality markers by which acute hospitals can measure the standard of end of life care they provide.
Support Sheet 7: Models/Tools of Delivery
This support sheet outlines the key elements of
Advance Care Planning (ACP)
Gold Standards Framework (GSF)
Liverpool Care Pathway (LCP)
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...
Act early to avoid A&E
1. Commissioning End of Life Care
to avoid
June 2011
initial actions for
new commissioners
2. Contents
4
Introduction
Who, What, Why?
ac t&
e ar l y
6
7
7
8
Assessment
& Measurement
Communication
& Co-ordination
Transitions
Who else?
8
9
9
10
10
Education
Acute care
Realigning
resources
Life choices
Your checklist
of resources
12
Acknowledgements
and support
3. About…
The National Council for Palliative Care
The National Council for Palliative Care (NCPC) is the umbrella charity for all
those who are involved in providing, commissioning and using palliative care
and hospice services in England, Wales & Northern Ireland. NCPC promotes
the extension and improvement of palliative care services for all people with
life threatening and life-limiting conditions. NCPC promotes palliative care
in health and social care settings across all sectors to government, national
and local policy makers. For further information or to subscribe to NCPC to
receive publications free of charge and reduced rates at conferences visit
www.ncpc.org.uk
Dying Matters
Dying Matters is a broad based and inclusive national coalition set up by
the National Council for Palliative Care and is supported by the Department
of Health. It aims to engage thousands of organisations across a range of
sectors, generating, leading and supporting collective action to promote
public awareness and debate on issues of death, dying and bereavement in
England.
The National End of Life Care Programme
The National End of Life Care Programme works with the health and social
care workforce across all sectors in England to improve end of life care for
adults, supporting the implementation of the Department of Health’s End of
Life Care Strategy.
The National End of Life Care Programme aims to:
Promote high quality, person-centred care for all adults at the end of
life in all care settings
Enable more people nearing the end of life to choose where they
live and die.
The National End of Life Care Intelligence Network
The National End of Life Care Intelligence Network which is part of the
The National End of Life Care Programme aims to improve the collection
and analysis of information about end of life care services provided by the
NHS, social services and the third sector. Areas of research include quality,
volume and costs of care provided to adults approaching the end of life. This
intelligence will help drive improvements in the quality and productivity of
services.
3
4. Introduction: why act&early
Who?
What?
For the purposes of this guidance people are
‘approaching the end of life’ when they are likely to die
within the next 12 months.
A Working Definition of End of Life Care
This includes people whose death is imminent
(expected within a few hours or days) and
those with:
(a) advanced, progressive, incurable conditions
(b) general frailty and co-existing conditions that mean
they are expected to die within 12 months
(c) existing conditions if they are at risk of dying from a
sudden acute crisis in their condition
(d) life-threatening acute conditions caused by
sudden catastrophic events.
End of life care is care that:
Helps all those with advanced, progressive, incurable
illness to live as well as possible until they die. It enables
the supportive and palliative care needs of both patient
and family to be identified and met throughout the
last phase of life and into bereavement. It includes
management of pain and other symptoms and
provision of psychological, social, spiritual and practical
support.
Source: National Council for Palliative Care 2006
The End of Life Care Strategy 2008
For some people the appropriate start for end of life care
might be at the time of diagnosis of a condition which
usually carries a poor prognosis, for example motor
neurone disease or advanced liver disease.
Adapted from Treatment and care towards the end of life:
good practice in decision making, the General Medical Council 2010
to avoid
4
1
2
3
4
5
http://www.endoflifecareforadults.nhs.uk/publications/eolc-strategy
http://www.demos.co.uk/publications/dyingforchange/
http://www.nao.org.uk/publications/0708/end_of_life_care.aspx
http://www.nao.org.uk/publications/0708/end_of_life_care.aspx
http://www.kingsfund.org.uk/multimedia/ten_priorities.html
5. Why?
The next two years provide a unique opportunity
for new commissioning organisations to position
themselves in the best clinical and financial position
before they begin business as legal entities, for some
at least as early as April 2013. By targeting end of life
care, emergent commissioners can place themselves in
a strong position for one of the major required areas of
improving quality and safety of care; improving patient
and carer experience and making care more cost/
resource efficient.
Tackling end of life care early can offer a number of
significant ‘quick wins’ in improving the quality of care
in your locality. People should be supported to be
cared for and to die in their preferred place of care,
which is usually their home End of Life Care Strategy
20081. It may also include other community
based settings such as a care home or sheltered
housing. This means commissioners should ensure
there is planned 24/7 provision of community support,
including care co-ordination, nursing and symptom
control. In contrast, poor end of life care is rushed
and unplanned often resulting in unnecessary, and
expensive trips to Accident and Emergency with crisis
admissions to hospital. These are distressing not only to
individuals but can have a detrimental effect on those
who have been bereaved.
End of life care accounts for a high proportion
of NHS spending. The Demos2 think tank has
estimated it as at least a fifth of NHS costs and a
total of about £20 billion
The National Audit Office3 (NAO) found that 40% of
end of life care patients had no medical need to be
in hospital
In the same report, the NAO found wide variations
in end of life care provision across England.
Spending by PCTs varied from £154 to over £1,600
per person
There is considerable scope for improvement using
interventions such as early identification triggers,
advance care planning, co-ordination of care and
effective multi disciplinary team (MDT) working
End of life care is a national priority, following the End
of Life Care Strategy1. It is one of the DH’s Quality
Innovation Productivity & Prevention (QIPP) priority
areas and is included in the NHS Operating Framework
for 2011/12. There has been some excellent progress
made at local level over recent years but considerable
variation in quality and efficiency remains across the
country.
Aspects of end of life care are provided across the
health and social care economy. District nurses, GPs and
care assistants are fundamental to generalist palliative
and end of life care needed by the majority of people
at some stage. People may also receive elements of
end of life care from their specialist community and
secondary care teams, such as symptom management.
A smaller proportion of people will need direct access
to specialist palliative care teams. These might be based
in a hospital, a hospice or the community. The majority
of specialist palliative care services are managed by
voluntary sector organisations, not the NHS, and their
commissioning arrangements with the NHS have
traditionally varied substantially. Hospices and other
specialist palliative care providers, however, are vital not
only to the care of people with complex needs but also
to training and developing the wider workforce and
providing access to specialist advice and support to
other professionals.
The purpose of this briefing is to help you
to identify the immediate priority actions to
commission effective end of life care, focusing
on steps which we believe will make the most
difference initially and can be seen as ‘quick wins’.
The King’s Fund4 has identified improving primary
care management of end of life care as one of the
top 10 priorities for commissioners
5
6. Key actions for act&early
A
ssessment
& measurement
Assessment and measurement for end of life care
commissioning must reflect the whole population’s
needs across the end of life care pathway.
Commissioning services to meet people’s end of life
care needs will require linking with planning for areas
such as long term conditions care, care of the elderly,
dementia care and carers support.
On average, 1% of people (20 people) on a GP’s list, will
die each year. Every practice should be encouraged
to have an up to date and reviewed End of Life Care
register. However, not everyone needing end of life
care will be on an end of life care register. End of life
care should be a significant aspect of the local Joint
Strategic Needs Assessment (JSNA) process and
population needs assessment should draw on data
from health, social care, public health and housing,
including the National End of Life Care Intelligence
Network1.
Monitoring for quality outcomes will be core
to measuring service delivery. As part of the
commissioning cycle, assessment and measurement
should be combined with audit and review, including
information gathered in organisations’ Quality
Accounts.
The NHS Outcomes Framework2 for 2011/12 identifies
improving the experience of care for people at the end
of their lives as an improvement area, using surveys of
bereaved relatives (VOICES) as a measure. NICE will be
publishing a quality standard for end of life care3 in
2011/12
1 http://www.endoflifecare-intelligence.org.uk/home.
aspx
2 http://www.dh.gov.uk/prod_consum_dh/groups/
dh_digitalassets/@dh/@en/@ps/documents/
digitalasset/dh_123138.pdf
3 http://www.nice.org.uk/guidance/qualitystandards/
indevelopment/endoflifecare.jsp
6
Early recommendations
for new commissioners:
Ensure that each GP practice has a mechanism4
to identify people approaching the end of life
and holds a register for all those identified as
approaching the end of life. This needs to be
in place to ensure the other commissioning
steps can be implemented, for example
communication and co-ordination of care
All people on the end of life care register should
receive a holistic assessment5 of their care and
support needs, which includes their carers’ needs
assessment where appropriate
Understand the implications of local population
data on end of life care needs such as that
available from the ISNA6 process, National End
of Life Care Intelligence Network1, Hospital
Episode Statistics (HES), QOF and Care Quality
Commission (CQC)
Agree quality outcome markers for measuring
provision of EoLC by different organisations,
and ensure those are written into local service
specifications and contracts. The national End
of Life Care Strategy Quality Markers and
Measures for End of Life Care7 and the End of
Life Care Quality Assessment tool (ELQUA8) are
available now to support quality benchmarking.
The NHS Outcomes Framework and the NICE
quality standard will also be able to support this.
Monitor the reporting of end of life care
complaints, such as collected by PALs, and
reporting of serious untoward incidents to
inform future service design and commissioning
arrangements.
4 http://www.goldstandardsframework.
nhs.uk/OneStopCMS/Core/CrawlerResourceServer.
aspx?resource=68FE53BA-A79B-4DBD-A32A-E76B40B
C7828&mode=link&guid=9d9423c7b38d49c9b74c02c
dc95f1aa2
5 http://www.endoflifecareforadults.nhs.uk/
publications/holisticcommonassessment
6 http://www.networks.nhs.uk/networks/news/jointstrategic-needs-assessment-toolkit-for-shadowhealth-and-wellbeing-boards
7 http://www.endoflifecareforadults.nhs.uk/
publications/qualitymarkers
8 http://www.elcqua.nhs.uk/faq.php
7. C
T
Communication and co-ordination are fundamental
to good end of life care both at a strategic level and at
an individual care level. They require clinical leadership
at both a cluster level and within individual shadow
consortia.
Transitions occur throughout the end of life care
pathway, between providers and across sectors, and
at both a formal and informal level. End of life care
should be commissioned from a pathway approach
which incorporates management of transitions and
co-ordination between pathways including mental
health, dementia14 care, children and young adults15
long term conditions16 and carers17.
ommunication
& co-ordination
Early recommendations
for new commissioners:
Ensure professionals know how to initiate
conversations9 about end of life care and carry
out advance care planning10, including DNACPR
decisions, and that there are mechanisms to share
the information with other services
Ensure that people on the end of life care register
have access to an identified care co-ordinator11,
linking across all services including social care
and voluntary sector providers. Case studies
can be found at the National End of Life Care
programme12 website. Local experience of GP
triage systems may assist
Develop and implement local systems to share
information across providers, particularly out of
hours services
ransitions
Early recommendations
for new commissioners:
Learn from the Map of Medicine18 to develop and
roll out local pathways for end of life care service
arrangements
Implement robust handover processes between
primary and secondary care and with OOH and
ambulance services
Monitor implementation of above by auditing
what proportion of patients on GP practice end
of life care registers have had an OOH/ambulance
handover form completed.
Develop/support implementation of a local
unified policy for DNACPR. The South Central
SHA13 unified DNACPR policy is a useful example
to consider.
9 http://www.endoflifecareforadults.nhs.uk/educationand-training/communication-skills
10 http://www.endoflifecareforadults.nhs.uk/news/
all/neolcp-publishes-updated-guide-to-advance-careplanning
11 http://www.eastmidlandscancernetwork.
nhs.uk/_HealthProfessionals-ServiceImprovementSupportiveandPalliativeCare-KeyWorker.aspx
12 http://www.endoflifecareforadults.nhs.uk/
13 http://www.southcentral.nhs.uk/what-we-are-doing/
end-of-life-care/
14 http://www.endoflifecareforadults.nhs.uk/
commissioning/commissioning-for-people-withspecific-conditions/dementia
15 http://www.act.org.uk/landing.asp?section=97&
sectionTitle=Care+pathways+for+babies%2C+
children+and +young+people
16 http://www.endoflifecareforadults.nhs.uk/
commissioning/commissioning-for-people-withspecific-conditions/neurological-conditions
17 http://www.dh.gov.uk/en/Publicationsandstatistics/
Publications/PublicationsPolicyAndGuidance/
DH_122077
18 http://eng.mapofmedicine.com/evidence/map/end_
of_life_care_in_adults1.html
7
8. &
Who else?
There are many important contributors to end
of life care and part of the role for new cliniciancommissioners will be to provide the clinical leadership
needed to pull the strands into a coherent and efficient
service for patients and carers. Local authorities have
a fundamental role given their oversight of the JSNA
process, the management of social care services and
of the emerging Health and Wellbeing Boards. The
voluntary sector provides a wide range of services
across the end of life care pathway from specialist
hospice care to very local befriending support to
patients and carers. Many of these will have strong
understanding of patients and carers’ preferences and
needs, making them a very valuable resource for user
involvement.
User involvement must be central. There are
emerging statutory requirements on commissioners
to work collaboratively and to incorporate user
involvement in their planning; Health and Wellbeing
Boards will be crucial to this. Involving people in
planning end of life care will need creative thought to
ensure the views of the different groups within a local
population are included. NCPC’s publication Getting
Started can support this.
Early recommendations
for new commissioners:
Appoint a clinical commissioning board member
to lead on end of life care
Build early links with Local Authorities to identify
opportunities for greater joint commissioning to
improve efficiencies and quality of care
Build an understanding of the current range
of local voluntary sector providers as part of
mapping processes
Work with voluntary sector organisations and
the emerging Health and Wellbeing Boards to
develop user involvement which reflects the
range of people using eolc services locally
Build links with local care homes and communitybased supported housing to ensure the needs of
people living there are identified and met.
8
E
ducation
There are three levels of education to consider:
1
Public health and population level on death
and dying will help increase local communities’
resilience and knowledge which will help people
feel more confident at identifying and discussing
their wishes and preferences.
2
Individuals - provision of information and training
to enable people to make informed choices early
in their end of life care planning. See for example,
NHS Choices end of life care information1
3
Workforce education. While the arrangements
for this are still in an early stage of development,
shadow consortia will need to work with providers
to identify gaps in current workforce training
which need to be addressed in order to deliver the
locally agreed eolc priorities. Commissioners will
need to recognise the role of specialist palliative
care staff in providing education and support for
their non-specialist colleagues.
Early recommendations
for new commissioners:
Work with providers of end of life care education
to ensure education and development is available
across the local workforce. Local hospices are likely
to be key providers of local education and training
and their role must be reflected in local plans and
in their funding
Clusters of consortia may wish to develop local
End of Life Care Charters as part of public health
education, learning from work by NHS North East2,
and consider the charter’s role as a mechanism for
kitemarking services
Implement local action to raise public awareness
of dying, death and bereavement and link to the
national work being led by the Dying Matters3
coalition
Begin to build links with new workforce network
structures4 to ensure local education priorities
reflect EoLC needs
Access e- learning for end of life care5. About 135
sessions are currently free to access on this site for
health and social care staff.
9. A
R
A significant proportion of people will still die in
hospitals and more will need acute care during their
end of life phase. Arrangements with acute sector6
providers should therefore not just focus on enabling
discharge processes but also on improving the quality
of experience for people dying in hospital and their
carers. Commissioners should support services to be
compliant with the NICE Guidance for Supportive
and Palliative Care7 and the Improving Outcomes
Guidance for cancer, building in quality markers and
measures into service contracts and supporting Routes
to Success in Acute Care8
Realigning resources away from unplanned acute care
to planned community support will improve quality
of care, meet patient choice and provide value for
money. The Palliative Care Funding Reviews11 interim
report advised that a ‘relatively small investment in
community services now will enable commissioners
to deliver improved outcomes for patients, as well
as ensuring services are delivered in the most cost
effective way’. This should include assessment,
care co-ordination and 24/7 access to nursing and
symptom control. Consortia should consider the good
practice examples12 collected for the end of life care
QIPP pathway and by the National End of Life Care
Programme. Commissioners should encourage models
of integration between primary and acute services,
working with their local voluntary sector providers.
See, for example, Transforming End of Life Care6 from
the Transforming Community Services series. Pooled
budgets are vital to enabling more flexible services
working across care domains.
cute care
Early recommendations
for new commissioners:
Ensure that acute sector providers have
a systematic approach to supporting the
identification of people approaching the end of
life, and providing a holistic needs assessment
For those people in hospital who are identified
as dying, ensuring they are placed on an EoLC
pathway such as the Liverpool Care Pathway9
Requiring hospitals to ensure their staff have
received education and training in end of life care
where necessary
Ensure effective discharge planning10 and ensure
access to fast track continuing healthcare where
needed.
ealigning resources
Early recommendations
for new commissioners:
Agree local priorities for end of life care service
improvement
Ensure there is local monitoring of end of
life care spend and an agreed end of life care
budget
Work with Local Authorities to develop use of
pooled budgets to encourage integrated and
flexible care.
1 http://www.nhs.uk/Planners/end-of-life-care/Pages/
End-of-life-care.aspx
2 http://www.agooddeath.co.uk/
3 http://www.dyingmatters.org/
4 http://www.cfwi.org.uk/about
5 http://www.e-lfh.org.uk/projects/e-elca/index.html
6 http://www.endoflifecareforadults.nhs.uk/publications/
transformingendoflifecare
7 http://www.nice.org.uk/guidance/index.
jsp?action=byID&r=true&o=10893
8 http://www.endoflifecareforadults.nhs.uk/
publications/route-to-success-acute-hospitals
9 http://www.mcpcil.org.uk/liverpool-care-pathway/
index.htm
10 http://www.endoflifecareforadults.nhs.uk/
publications/rtssupportsheet14
11 http://palliativecarefunding.org.uk/
12 http://www.evidence.nhs.uk/qipp
9
10. L
ife choices
People’s choices are at the heart of good end of life
care. Taking an Act + Early approach to end of life care
will improve individuals’ and carers’ quality of care and
their experiences. The end of life care pathway includes
holistic care, spiritual care, bereavement care and carers’
support and these may well be priorities for individuals
and their families. Getting these right may improve
people’s experiences of end of life care and so reduce
negative long term impact and number of complaints.
Capacity building and education within the community
and the provider market is needed to encourage
service development responsive to people’s choices.
Early recommendations
for new commissioners:
With Local Authorities, identify a process to
develop capacity within the provider market to
support wider choices of services in line with
people’s preferences and the personalisation
agenda.
Y
our checklist of resources
National policy guidance
http://www.dh.gov.uk/en/
Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_122944
The Outcomes Framework for the NHS 2011/12
http://www.dh.gov.uk/
The Operating Framework for the NHS in England
2011/12
http://www.endoflifecareforadults.nhs.uk/
The National End of Life Care Strategy and annual
progress reports
http://www.nao.org.uk/publications/0708/end_
of_life_care.aspx
End of Life Care, National Audit Office, 2008
http://www.endoflifecareforadults.nhs.uk/
publications/qualitymarkers
End of Life Care Strategy Quality Markers and
Measures for End of Life Care
http://www.nice.org.uk/guidance/index.jsp?
action=byID&r=true&o=10893
Improving Supportive and Palliative Care for adults
with cancer, NICE, 2004
http://www.dh.gov.uk/en/
Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_085345
Carer’s strategy
http://www.dh.gov.uk/en/Aboutus/Features/
DH_125045
Dementia strategy
Commissioning and costing EoLC
http://www.improvement.nhs.uk
NHS Improvement QIPP resources
http://www.kingsfund.org.uk/topics/endoflife_
care/index.html
Implementing the End of Life Care Strategy: lessons
from good practice, the King’s Fund, 2010
10
http://www.nuffieldtrust.org.uk/publications/
Social care and hospital use at the end of life,
The Nuffield Trust, 2010
11. act &
early
A&E
Commissioning and costing EoLC (continued)
Data and measurement
http://www.palliativecarefunding.org.uk/
Palliative Care Funding Review
http://www.endoflifecare-intelligence.org.uk/
home.aspx
National End of Life Care Intelligence Network
http://www.endoflifecareforadults.nhs.uk/
publications/transformingendoflifecare
Transforming Community Services:
Ambition, Action and Achievement Transforming End of Life Care, DH,
NEoLCP, Housing 21, 2009
http://www.endoflifecareforadults.nhs.uk/
Information for Commissioning end of life care,
NEoLCP, 2008
http://www.ncpc.org.uk/
Focus on Commissioning: End of Life Care a commissioning perspective, NCPC, 2007
NICE Commissioning toolkits
http://www.endoflifecareforadults.nhs.uk/
publications/eolc-for-people-with-dementiacommissioning-guide
Dementia
Working with the whole community
http://www.crusebereavementcare.org.uk
Cruse bereavement pathways project
http://www.dyingmatters.org/
Dying Matters online resources
http://www.nhs.uk/Planners/end-of-life-care/
Pages/End-of-life-care.aspx
End of Life Care, NHS Choices
http://www.ncpc.org.uk
Getting started: involving people with personal
experience, NCPC, 2010
http://www.helpthehospices.org.uk/abouthospice-care/find-a-hospice/uk-hospice-andpalliative-care-services/
Hospice and Palliative Care Directory, United
Kingdom and Ireland, Help the Hospices
http://www.ncpc.org.uk/
Population Based Needs Assessment for Palliative
and End of Life Care, NCPC, 2008
http://www.vodg.org.uk/JSNA-Resources.html
Joint Strategic Needs Assessment, DH Strategic
Partners Programme online resource
http://www.ncpc.org.uk/
10 questions to ask if you are scrutinising end of life
care, NCPC & Centre for Public Scrutiny
Developing services and workforce
http://www.endoflifecareforadults.nhs.uk/
publications
Routes to Success series, NEoLCP
http://www.endoflifecareforadults.nhs.uk/
publications/corecompetencesguide
Common Core Competences and Principles:
A guide for health and social care workers working
with adults at the end of life
http://www.e-lfh.org.uk/projects/e-elca/index.
html
End of Life Care for all e-learning resources,
e-learning for health care, Association for Palliative
Medicine, NEoLCP
http://www.endoflifecareforadults.nhs.uk/
education-and-training/communication-skills
Communications skills online resource, NEoLCP
http://www.mapofmedicine.com/
newsandevents/news/2010/endoflife
Map of Medicine for End of Life Care
11
12. Acknowledgements
This document was written by the following members of the National Council for Palliative Care
and the National End of Life Care Programme:
Emily Sam, Deputy Director of Policy & Parliamentary Affairs, NCPC
Simon Chapman, Director of Policy & Parliamentary Affairs, NCPC
Anita Hayes, Deputy Director, The National End of Life Care Programme
Tes Smith, Social Care Lead, The National End of Life Care Programme
Particular thanks are also due to the following for their advice & comments:
Professor Mayur Lakhani, CBE FRCGP, Chair of NCPC & Dying Matters and practising GP
Eve Richardson, Chief Executive, NCPC & Dying Matters
Claire Henry, Director National End of Life Care Programme
Lorna Potter, Community Development Advisor, NCPC & Dying Matters
John Hughes, Director of Clinical Strategy (Medical Director) Hampshire Community Health Care
The contents are endorsed and supported by the following national charities working in end of life
care, who also commented on the draft version of this document. Further information about the
services that they provide can be found via their websites:
Help the Hospices
www.helpthehospices.org.uk
Macmillan Cancer Support
www.macmillan.org.uk
Marie Curie Cancer Care
www.mariecurie.org.uk
Sue Ryder
www.suerydercare.org
This publication is available as a web-based resource and also as a download
from the NCPC and National End of Life Care Programme websites:
www.ncpc.org.uk www.endoflifecareforadults.nhs.uk