On 20 January, 2017 Joanne Stradling, Divisional General Manager at Marie Curie, spoke at Transforming end of life care in acute hospitals.
Joanne spoke on different models for end of life care, benefits to patients, cost effectiveness of home care and the lessons from integrated systems.
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Alternative end-of-life care models from the third sector
1. An Alternative Perspective from the third sector
Jo Stradling
Divisional General Manager, Central & Eastern England
2. An Alternative Perspective from the third sector
2
• Different models for end of life care
• Cost effectiveness of home care
• Benefits to Patients
• Lessons from Integrated Systems
3. Current Position
3
47% of deaths
take place in
hospital
30% of bed
occupancy in
last year of life
Number of
deaths due to
rise 17% by
2030
Basic demand
pressures will
not change
demography and
morbidity… but
we can change
the supply
factorsBest systems in UK
4. International Perspective…
4
% of deaths taking place in hospital:
New
Zealand
28.1%
Context:
• System
• Funding mechanisms
• Societies attitude to death
• Qualified workforce
• Palliative care is free
• Universal access
• Low percentage of deaths
taking place in hospital
Netherlands
24.6%
5. Kinds Fund Study on the Sustainability of Social
Care Services
5
Key findings from: Social Care and Older People – The Home Truths
• Social Care system in its current form is struggling to meet the needs of
older people
• Huge pressures on the social care market
• Access to care depends increasingly on what people can afford- and where
they live – rather than on what they need
• There is a widening gap between needs and resources set to reach at least
£2.8 billion by 2019
Three major strategic challenges:
• Achieving more with less
• A different offer
• Long-term reform
https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/Social_care_older_people_Kings_Fund_Sep_2016.pdf
6. Deaths in hospitals are an unnecessary burden on our
struggling healthcare system Huffington Post article by Dr Jane Collins
http://www.huffingtonpost.co.uk/dr-jane-collins/nhs-crisis-marie-curie_b_14145006.html
Care and support needs of those who are dying in UK, are being
fundamentally neglected
Care packages are not put in place in time for hospital discharge
Need to recognise the role of social care at end of life
Ironically, these failures in terms of transferring care often mean that
the NHS will spend more money on costly hospital treatment.
Also, more cost effective to die at home and mostly personal
preferences
6
8. Exploring the cost of care at the end of life
Nuffield trust research report 2014
http://www.nuffieldtrust.org.uk/sites/files/nuffield/publication/end_of_life_care.pdf8
Two thirds of
patients saw their
GP at least once
during last three
months of life
40-50 minutes of
district nurse time
per day in last few
days of life.
Just over a quarter
of people used local
authority funded
social care in final
year of life
Hospice costs est
£550 per person
Hospital cost for
final three months of
life = £4500 per
person
Hospital
costs are
highest
10. Benefits to patients through successful commissioning
Personalised
care planning
Coordinated
care and
support
including
information
Rapid access
to specialist
advice
Services that
treat people as
individuals,
and with
dignity and
respect
Services that
acknowledge
patient and
carers as part
of the care
team
Equality of
access
Experience of
services of a
consistent high
quality
PATIENT CHOICE
11. Exploring the cost of care at the end of life
Nuffield trust research report 2014 continued…
People who received care from our Marie Curie Nursing
service…
….had a lower
average
hospital costs
of £1140 per
person.
…spent two
and half fewer
days in
hospital during
last 90 days of
life.
…were less
likely to need
emergency
hospital care
(12% vs. 35%)
… were less
likely to die in
hospital (8%
vs. 42%)
11
12. Community Nursing – rethought
12
Overnight Service
Rapid Response
Companionship
Helper
New Zealand & the Netherlands: both have excellent facilities, qualified workforce, access to palliative care is free and universal. Good system = low % of deaths taking place in hospital
https://www.eiseverywhere.com/file_uploads/37856d137d4a0aae37c05ec7ddfb1282_Plenary1.pdf
https://www.eiuperspectives.economist.com/sites/default/files/images/2015%20Quality%20of%20Death%20Index%20Country%20Profiles_Oct%206%20FINAL.pdf
Differences in EOL care internationally, in the UK we need to find a sustainable model that suits our population.
Info
GP visits: Average 4-5 GP visits per person in last 3 months of life (rates much higher for cancer patients)
District nurses 1/3 patients had contact with a district nurse in their last 90 days- average cost per person was not high £278- A clear increase in activity in final days of life. Most intensive 10% of users average 40-50 minutes of district nurse time per day in last few days of life.
Local Authority Just over ¼ of people used local authority funded social care in final year of life. Average cost over last three months = over £1000 for nursing and residential care + higher costs for older age groups
Hospice: Average total inpatient hospice cost £400 (Based on £400 per day x 14 day stay = £5600, averaged over all people who have died)
Hospital cost is largest- care in final three months =£4500 per person- bulk due to emergency hospital admissions.
Hospital costs are largest costs involved in EOL care. Hospital costs increase for each condition a person has, while the same is not true of social care costs
Potential savings from reduced hospital care for people who are able to access community care services.
Using Marie Curie nursing service as an example- estimated if hospital activity and costs at the EOL were likely to be offset by increased care costs in other health and social care sectors. – care costs very likely to be lower at about £500 per person even allowed for the commissioning costs of home based nursing support at the EOL.