end of life

1. NHS England and NHS Improvement
National End of Life Care Update
Prof Bee Wee
National Clinical Director for End of Life Care, NHS England
2nd May 2019

2. 2 |
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• NHS Long Term Plan
• Personalised approach
• New service models – older people, children and
young people
• GP Quality and Outcomes Framework
• Priorities and approach for 2019/20
• Responding to challenges
National update
Presentation title

3. 3 |
NHS Long Term Plan: Para 1.42
Para 1.42. With patients, families,
local authorities and our voluntary
sector partners at both national and
local level, including specialist hospices,
the NHS will personalised care,
to improve end of life care.
By rolling out training to help staff identify
and support relevant patients, we will
introduce proactive and personalised care
planning for everyone identified as being
in their last year of life……..

4. 4 |
NHS Long Term Plan: Para 3.41
Children’s palliative and end of life care –
…increase contribution by match-funding
CCGs who commit to increase their
Investment in local children’s palliative
and end of life care services
including children’s hospices – up to a
combined total of £25 million/year by
2023/24.

5. 5 |
Investment and Reform:
5 year framework for GP Contract Reform:
QOF reforms
Aims - improvement in:
1. Early identification and support for people with advanced
progressive illness who might die within the next 12 months
2. Well-planned and coordinated care that is responsive to the
person’s changing needs with the aim of improving the
experience of care
3. Identification and support for family/informal caregivers,
both as part of the core care team around the patient and as
individuals facing impending bereavement

6. 6 |
Investment and Reform:
5 year framework for GP Contract Reform:
QOF reforms
Practices need to:
• Evaluate current quality of their end of life care and
identify areas for quality improvement – e.g. retrospective
death audit
• Identify quality improvement activities and set
improvement goals
• Implement the improvement plan
• Participate in a minimum of 2 GP network peer review
meetings
• Complete QI monitoring template in relation to this module

7. 7 |
Investment and Reform:
5 year framework for GP Contract Reform:
Focus on: contractor engagement, participation in quality improvement
activity in own practice and shared learning across network

8. 8 |
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Comprehensive Model for Personalised Care
All age, whole population approach to Personalised Care
People with long
term physical
and mental health
conditions
30%
People
with
complex
needs
5%
Supporting people to stay well and
building community resilience,
enabling people to make informed
decisions and choices when their
health changes.
Supporting people to
build knowledge, skills
and confidence and to live
well with their health
conditions.
Empowering people,
integrating care and
reducing unplanned
service use.
Specialist
Integrated Personal Commissioning, including
proactive case finding, and personalised care and
support planning through multidisciplinary teams,
personal health budgets and
integrated personal budgets.
Targeted
Proactive case finding and personalised care and
support planning through General Practice.
Support to self manage by increasing
patient activation through access to health coaching,
peer support and self management education.
Universal
Shared Decision Making.
Enabling choice (e.g. in maternity, elective
and end of life care).
Social prescribing and link worker roles.
Community-based support.
Plus Universal and Targeted interventions
Plus Universal interventions
Whole population
100%
INTERVENTIONS OUTCOMES
TARGET POPULATIONS

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Shared decision making
Social prescribing &
community-based
support
In 2017/18 SDM was embedded into:
• Musculoskeletal elective care
pathways across 13 CCGs
• Respiratory elective care pathways in
8 CCGs
• 68,977 referrals in 2017/18
• 331 link workers employed in
local areas
Personalised care and
support planning
• 142,904 people had a personalised
care and support plan between April
2017 and September 2018
• Over 204,000 people supported by
integrated, personalised approaches
Supported self
management
Enabling choice
• 97% of CCGs have now completed
Choice Planning and Improvement
self-assessment
• Of these, 85% report compliance with
at least 5 (of 9) choice standards
• 32,341 PHBs by September 2018
• Up 110% year-on -year in 2018 (to end
Q2)
• 23% jointly funded with social care
• 55,511 Personal Maternity Care Budgets
delivered by September 2018 across 36
CCGs
Personal health
budgets & integrated
personal budgets
• 101,637 patient activation
assessments by September 2018
• Over 44,093 people referred to
community-based support
• Over 59,545 people referred to self-
management education or health
coaching
Significant delivery of Personalised Care

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Other high level commitments from 2019/20
Maternity
• 52% of women will receive a
personalised care plan by March
2020 (32% by March 2019)
End of Life Care
• Increase the percentage of people who
have died who had been offered the
opportunity for personalised care and
support planning, from 39.6% to 75% in 10
years

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Core Objectives
DH
Mandate
Increase the percentage of people identified as likely to be in
their last year of life, so that their End of Life Care can be
improved by personalising it according to their needs and
preferences.
UPC Target Increase the percentage of people who have died who had been
offered the opportunity for personalised care and support
planning, from 39.6% to 75% in 10 years.
Long Term
Plan (1.42)
Roll out training to help staff identify and support relevant
patients, we will introduce proactive and personalised care
planning for everyone identified as being in their last year of life.

13. Deliverables
Implementation of QOF
QI
The Quality and Outcomes Framework - Quality Improvement
(QOF QI) aims to improve; early identification and support for
people, well-planned and coordinated care and identification and
support for family/informal caregivers.
Improved outcomes and
experience in EoLC
Survey of Bereaved People (VOICES-SF). Collaboratively
working with the Insight and Feedback team to focus on local
options to gain feedback on the Quality of care delivered in the
last 3 months of life for adults who died.
NHSI Getting to Good
Programme
As part of an ICS or place based project this aims to reduce the
number of trusts rated as inadequate or requires improvement by
the CQC.
Early identification tools
within electronic systems
using read codes
The project will look to commence a wider testing of the screening
tools (test sites) as well as translating the toolkit from EMIS to
SystmOne.
CHC SIP • Using a place-based approach properly test the hypothesis that
improved identification, and personalised EoLC will reduce the
use of CHC Fast track.
• Build and continue to develop a joint narrative with CHC
SIP/ADASS/EoL

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Regional offer for NHSE/I teams
System offer for ICS/STPs
Place offer for CCGs
Neighbourhood offer for Primary Care Networks
Evidence
National Support offer
Delivery
Innovation
(formerly Testing)
Programme
Demonstrator
Programme
Champion and
Mentor Programme
Workforce
Professional
Wider
Community
Patients and
Carers
Enablers (LE,
FCC etc)
Policy and
Infrastructure

15. National Support offer- available to all
Sharing good practice, signposting, peer
support
Hospice UK –
Awareness
Raising
(Commitments)
NHS England has commissioned Hospice UK to work with a limited
number of hospices to explore mechanisms for raising awareness and
expectations about the governments 6-point commitment amongst
patients, their families and the wider community – case studies will be
available in 19/20 Q2.
RSA Student
Design Awards
NHS England has sponsored a Moving Pictures Brief to raise awareness
about the importance of talking about death and dying, planning for the
future, and thinking and talking about a time when you are going to be less
well, including when you are dying. The winning animation will be
announced in 19/20 Q1.
Hospice UK -
Holistic
NHS England has commissioned Hospice UK to identify the critical
components of hospice-led interventions and service models that are
effective in preventing avoidable admission to hospital, or supporting early
discharge and transfer from hospital for people approaching the end of life.
The report is due 19/20 Q1 and will provide an evidence-base for end of life
care service re-design.

16. National Support offer- cont’d
Commissioning
Models for
PEoLC for CYP
A group of stakeholders have developed a service specification &
commissioning model which is to be tested in 2 regions over the next 12
months. This draft model will be published in 19/20 to share best practice
commissioning for C&YP.
Generic Mailbox The EoLC mailbox is single point of access, the team will respond or
signpost as appropriate.
ENGLAND.endoflifecare@nhs.net
Collaboration
Platform
The Personalised Care Group NHSFuture Collaboration platform will
signpost to the knowledge hub on the Ambitions website and our
resources page.
Webinar Series Webinars provide support to professionals by raising awareness of
subjects, they also share good practice. Webinar recordings are available
on the NHS England website, slides are available upon request.

17. National Support offer- cont’d
Ambitions
Partnership
The Ambitions website contains published best practice, case studies,
implementation guidance and lessons learnt, the National EoL Programme
Board papers are also available.
National
EoLC
Practitioners
network
To share good practice, develop best practice, peer support, collaborative
working, getting to outstanding in EoLC, sharing the national agenda and the
LTP, support the CNO and NCD in ensuring EoLC continues to improve,
share the outputs and support service improvement requirements of the
NACEL
Palliative and
End of Life
Care Clinical
Leaders
To provide a focus for strategic clinical leadership for palliative and end of
life care reaching across every STP/ICS and maximising potential for
effective communication and shared learning
Support/Ment
oring (PCG
demonstrator
site leads)
End of Life Care Team can provide support and signposting for site leads.

18. Place offer
Place based
project in
each of 7
regions
Supports delivery of the core objectives and one or more of the proposed
deliverables for 19/20
Project assurance provided by the National EoL Team

19. Neighbourhood offer - available to Primary Care
Networks
Support for
QOF Quality
Improvement
Work with our partners to develop and deliver a support offer for GP
practices and Primary Care Networks to demonstrate continuous quality
improvement focused on end of life care

20. 20 |
EoL Programme: how it all fits
together
6 point commitment
• Honest conversations
• Informed decisions
• Developing personalized care plan
• Sharing plan with professionals
• Involving family to the extent wishes
• Know who to contact

21. 21 |
21 |
• NHS Long Term Plan
• Personalised approach
• New service models – older people, children and
young people
• GP Quality and Outcomes Framework
• Priorities and approach for 2019/20
• Responding to challenges
National update
Presentation title

22. 22 |
22 |
• More demand
• Less workforce
• More expectations
• Know more about less
• Struggle with acknowledging limits
• Diminished respect for authority, expertise
• Speed of communication
Complex challenging world
Presentation title
https://www.bluehomepm.com/common-myths-
investing-in-florida-real-estate-from-canada/complex/

23. 23 |
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• Crosses biomedical, social and societal boundaries
• Approach that integrates art and science
• Attracts public, media and political interest
• Dying and death happens to everybody
• Hugely emotive – personal stories
• Managing boundaries
• Palliative care leaders:
• driving forward the specialty
• supporting colleagues at generalist level
• managing expectations
• seeing wood for trees
Palliative care: specific features
Presentation title

24. 24 |
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Of 1.4 million people who work in the NHS in England:
• > 50% unable to meet all the conflicting demands at
work
• Nearly 40% - unwell as a result of stress in the past
year
• Around 50% more debilitating levels of work stress
compared with general working population
• 44% only - able to make improvements in their area of
work
Burning platform…..
Presentation title Source: West M, King’s Fund 2017

25. 25 |
25 |
• Link between quality of patient care and staff
wellbeing
• Low staff engagement – leads to:
• Lower patient experience
• Lower productivity
• Increased risk of workplace accidents
• Higher levels of staff turnover
• Higher rates of burnout
Staff wellbeing
Presentation title

26. 26 |
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How leaders think: shift in mental model
Volume
Patient
satisfaction
Increase
revenue
Organised
through large
hospitals
Quality
departments
and experts
Value
Patient as
partner
Decrease per
unit cost and
waste
Redesign
delivery of
care
QI in daily
work for all
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge,
MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.

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1. Person-centredness
2. Front line engagement
3. Relentless focus – on vision and strategy
4. Transparency – results, progress, aims, defects
5. Across boundaries
How leaders behave
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs.
Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.or

28. 28 |
28 |
IHI high impact leadership framework:
where leaders focus effort
Presentation title
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce
Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.