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
O documento discute a Portaria no 106/2000 que institui os Serviços Residenciais Terapêuticos no Brasil com o objetivo de promover a desinstitucionalização e reinserção social de pacientes psiquiátricos. A portaria define residências terapêuticas como moradias na comunidade para pacientes sem suporte familiar que facilitam a reabilitação psicossocial.
O documento descreve a implantação de um sistema de monitoramento e avaliação da Estratégia Saúde da Família no município de São Paulo, Brasil. O sistema monitora 17 indicadores agrupados em 6 eixos, incluindo cobertura vacinal, acompanhamento de gestantes e doenças crônicas. O sistema foi implementado através de parcerias com instituições e modificações nos termos de convênio para incluir o monitoramento.
O documento discute conceitos e modelos relacionados à promoção, prevenção e reabilitação em saúde. Aborda a evolução histórica destes conceitos, os diferentes níveis de prevenção, as ações de promoção da saúde e os modelos de intervenção em saúde, incluindo o modelo do senso comum e como as experiências passadas influenciam as crenças e ações das pessoas em relação à saúde.
Health Care Delivery System India for CCCHKailash Nagar
The health care delivery system in India operates at national, state, district, and local levels. At the local level, primary health care is provided through a network of sub-centers, primary health centers (PHCs), and community health centers (CHCs). PHCs are staffed by doctors and serve a population of 30,000, while CHCs serve 80,000-120,000 people. The system aims to provide universal and affordable basic health services with a focus on maternal and child health, immunization, disease prevention and health promotion.
O documento descreve o diagnóstico multidimensional de saúde mental de um paciente, incluindo: esquizofrenia paranoide, personalidade psicótica, problemas médicos associados, experiências traumáticas sob a ditadura militar no Brasil, dependência de serviços sociais, isolamento social e delírios de defesa.
Este documento apresenta uma introdução à psicopatologia geral, discutindo seus limites e conceitos-chave. Aborda tópicos como a definição de normalidade e doença, a hierarquia dos sintomas e o diagnóstico como um processo.
O documento discute a Portaria no 106/2000 que institui os Serviços Residenciais Terapêuticos no Brasil com o objetivo de promover a desinstitucionalização e reinserção social de pacientes psiquiátricos. A portaria define residências terapêuticas como moradias na comunidade para pacientes sem suporte familiar que facilitam a reabilitação psicossocial.
O documento descreve a implantação de um sistema de monitoramento e avaliação da Estratégia Saúde da Família no município de São Paulo, Brasil. O sistema monitora 17 indicadores agrupados em 6 eixos, incluindo cobertura vacinal, acompanhamento de gestantes e doenças crônicas. O sistema foi implementado através de parcerias com instituições e modificações nos termos de convênio para incluir o monitoramento.
O documento discute conceitos e modelos relacionados à promoção, prevenção e reabilitação em saúde. Aborda a evolução histórica destes conceitos, os diferentes níveis de prevenção, as ações de promoção da saúde e os modelos de intervenção em saúde, incluindo o modelo do senso comum e como as experiências passadas influenciam as crenças e ações das pessoas em relação à saúde.
Health Care Delivery System India for CCCHKailash Nagar
The health care delivery system in India operates at national, state, district, and local levels. At the local level, primary health care is provided through a network of sub-centers, primary health centers (PHCs), and community health centers (CHCs). PHCs are staffed by doctors and serve a population of 30,000, while CHCs serve 80,000-120,000 people. The system aims to provide universal and affordable basic health services with a focus on maternal and child health, immunization, disease prevention and health promotion.
O documento descreve o diagnóstico multidimensional de saúde mental de um paciente, incluindo: esquizofrenia paranoide, personalidade psicótica, problemas médicos associados, experiências traumáticas sob a ditadura militar no Brasil, dependência de serviços sociais, isolamento social e delírios de defesa.
Este documento apresenta uma introdução à psicopatologia geral, discutindo seus limites e conceitos-chave. Aborda tópicos como a definição de normalidade e doença, a hierarquia dos sintomas e o diagnóstico como um processo.
▪ O documento discute a vigilância epidemiológica e o sistema de informação SINAN, apresentando a evolução histórica da vigilância em saúde, as principais fontes de dados e desafios atuais. O documento também fornece um cronograma de atividades para uma aula sobre o tema.
O documento discute a visita domiciliar como uma estratégia de atenção à saúde que ocorre na casa dos pacientes. Ela permite que profissionais de saúde avaliem as condições de vida dos pacientes e forneçam assistência, educação e monitoramento de saúde no ambiente doméstico. A visita domiciliar promove a integralidade da assistência à saúde e uma melhor comunicação entre pacientes, famílias e equipes de saúde.
O documento descreve o Sistema Único de Saúde (SUS) no Brasil. O SUS foi criado pela Constituição de 1988 para fornecer assistência médica universal e gratuita à população brasileira. Ele é financiado por impostos e coordenado em três níveis - federal, estadual e municipal. O SUS visa promover equidade no acesso à saúde, priorizando ações preventivas e democratizando informações sobre direitos e riscos à saúde.
O documento discute a história e os princípios do Sistema Único de Saúde brasileiro (SUS). Ele explica que o SUS foi criado para universalizar o acesso à saúde e fornecer atendimento integral e equitativo a todos os cidadãos brasileiros de forma descentralizada e com participação da população. O documento também descreve os objetivos, princípios e mecanismos de financiamento e gestão do SUS.
O documento discute as políticas públicas de saúde mental no Brasil, desde a Reforma Psiquiátrica até a atual Lei 10.216/01, que assegura os direitos dos portadores de transtornos mentais. Também aborda os principais serviços oferecidos como CAPS, SRT e hospitais psiquiátricos, além de programas de formação de recursos humanos e supervisão clínica.
1) O documento descreve a evolução do conceito de atenção primária à saúde e promoção da saúde desde as décadas de 1960 e 1970, influenciado por experiências na China e no Canadá;
2) A Declaração de Alma-Ata de 1978 estabeleceu os princípios da atenção primária à saúde, incluindo a participação comunitária e abordagens multissetoriais;
3) Posteriormente, relatórios canadenses enfatizaram os determinantes sociais e ambientais da saúde, fazendo a
O documento discute Terapia Nutricional, abordando Nutrição Enteral e Nutrição Parenteral. A Nutrição Enteral é preferida pois apresenta vantagens fisiológicas, enquanto a Nutrição Parenteral é indicada quando não há possibilidade de alimentação oral ou enteral. O texto descreve equipas multidisciplinares, histórico, métodos, cuidados e complicações relacionadas a ambos os tipos de terapia nutricional.
O documento discute as redes de atenção à saúde no Brasil. Apresenta o conceito e organização das redes, incluindo os diferentes níveis de atenção e sistemas de apoio. Também aborda a situação histórica e atual das redes no SUS, com foco na rede da região sudeste. Por fim, discute perspectivas futuras como a consolidação das redes para melhorar resultados sanitários e eficiência dos sistemas de saúde.
PSICOPATOLOGIA II: Aula 01 (introdução à CID-10)Alexandre Simoes
O documento descreve a Classificação Internacional de Doenças (CID-10), um sistema de classificação de transtornos mentais e problemas relacionados à saúde desenvolvido pela Organização Mundial da Saúde. Apresenta as origens e desenvolvimento da CID-10, seus conceitos ordenadores e categorias de transtornos mentais, incluindo esquizofrenia, transtornos de humor, transtornos neuróticos e outros. O professor Alexandre Simões dará detalhes dessas famílias de transtornos mentais nas próximas
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
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.
A guide to workforce development to support social care and health workers to apply the common core principles and competences for end of life care
23 February 2012 - National End of Life Care Programme / Skills for Care / Skills for Health
The National End of Life Care Programme has worked alongside Skills for Health and Skills for Care to ensure that workers involved in supporting someone who is at the end of their life are properly trained to be able to undertake their work effectively and appropriately.
Each section gives an explanation of the area of work and includes important links to further information and resources. There is also a 'practice scenario' to show how the competences are connected and how they can be used to help in developing services and ensuring that workers are appropriately trained and skilled.
This guide completely replaces the 2010 A framework of National Occupational Standards to support common core principles for health and social care workers working with adults at the end of life and should be read alongside the Common Core Competences and Principles: A guide for health and social care workers working with adults at the end of life.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
This document provides a blueprint for implementing interprofessional care in Ontario. It outlines the context, including demands on the healthcare system that necessitate new collaborative models of care. The blueprint was developed through extensive consultation with healthcare and education leaders. It presents 4 key recommendations to advance interprofessional care through actions like preparing current and future caregivers via interprofessional education, and supporting organizational structures, regulations, and policies that enable collaborative team-based care. The goal is to provide guidance to transform the healthcare system through system-wide adoption of interprofessional care.
Angela Coulter and Beverley Matthews presented a webinar on why care planning is not happening widely in the NHS. They discussed how care planning can help patients better manage their long-term conditions through shared goal setting and action planning. However, surveys show that less than 10% of patients with long-term conditions have a written care plan. Barriers to effective care planning included a lack of time and resources, inflexible systems, and a clinical culture that does not prioritize self-management support and partnership with patients. The webinar argued that improving care planning requires addressing attitudes, skills, leadership and incentivizing planning through policies and performance measures.
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.
The document provides guidance for domiciliary care organizations and staff on delivering high quality end of life care for people in their own homes. It outlines six key steps in the end of life care pathway: 1) discussions as end of life approaches, 2) assessment, care planning and review, 3) coordination of care, 4) delivery of high quality care, 5) care in the last days of life, and 6) care after death. The guidance addresses important considerations for organizations and the roles of care workers at each step to help ensure people receive dignified and compassionate care at the end of life in their own homes.
An overview of the work carried out by NHS England and NHS Improving Quality's Long Term Conditions Sustainable Improvement Team. It puts the case for why person-centred care has to be at the heart of healthcare.
What offers more choice? Budgets or human rights?shibley
My talk on how best to deliver choice in English dementia strategy - through the market, e.g. personal budgets, or international law, e.g. human rights.
This document discusses community engagement for health improvement. It identifies four key roles for community engagement: 1) determining local needs and aspirations, 2) promoting health and reducing inequalities, 3) improving service design and quality of care, and 4) strengthening local accountability. The document reviews different approaches to community engagement in the UK, presents examples of relevant initiatives, and identifies characteristics of successful community engagement projects, including clarity of purpose, leadership, engagement strategies, and evaluation. The goal is to inform the Health Foundation's efforts to strengthen community engagement in health.
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
1) The document discusses establishing Wellness Clinics in India under the Ayushman Bharat program to deliver comprehensive primary health care services close to where people live.
2) It outlines plans to convert 150,000 sub-centers and primary health centers into Health and Wellness Centers (HWCs) by 2022 to provide services like screening for non-communicable diseases, reproductive health services, and treatment of minor ailments.
3) The HWCs will be staffed by mid-level health providers and ASHA workers who will receive additional training to handle the expanded services while ensuring continuity of care through referrals between different levels of facilities.
▪ O documento discute a vigilância epidemiológica e o sistema de informação SINAN, apresentando a evolução histórica da vigilância em saúde, as principais fontes de dados e desafios atuais. O documento também fornece um cronograma de atividades para uma aula sobre o tema.
O documento discute a visita domiciliar como uma estratégia de atenção à saúde que ocorre na casa dos pacientes. Ela permite que profissionais de saúde avaliem as condições de vida dos pacientes e forneçam assistência, educação e monitoramento de saúde no ambiente doméstico. A visita domiciliar promove a integralidade da assistência à saúde e uma melhor comunicação entre pacientes, famílias e equipes de saúde.
O documento descreve o Sistema Único de Saúde (SUS) no Brasil. O SUS foi criado pela Constituição de 1988 para fornecer assistência médica universal e gratuita à população brasileira. Ele é financiado por impostos e coordenado em três níveis - federal, estadual e municipal. O SUS visa promover equidade no acesso à saúde, priorizando ações preventivas e democratizando informações sobre direitos e riscos à saúde.
O documento discute a história e os princípios do Sistema Único de Saúde brasileiro (SUS). Ele explica que o SUS foi criado para universalizar o acesso à saúde e fornecer atendimento integral e equitativo a todos os cidadãos brasileiros de forma descentralizada e com participação da população. O documento também descreve os objetivos, princípios e mecanismos de financiamento e gestão do SUS.
O documento discute as políticas públicas de saúde mental no Brasil, desde a Reforma Psiquiátrica até a atual Lei 10.216/01, que assegura os direitos dos portadores de transtornos mentais. Também aborda os principais serviços oferecidos como CAPS, SRT e hospitais psiquiátricos, além de programas de formação de recursos humanos e supervisão clínica.
1) O documento descreve a evolução do conceito de atenção primária à saúde e promoção da saúde desde as décadas de 1960 e 1970, influenciado por experiências na China e no Canadá;
2) A Declaração de Alma-Ata de 1978 estabeleceu os princípios da atenção primária à saúde, incluindo a participação comunitária e abordagens multissetoriais;
3) Posteriormente, relatórios canadenses enfatizaram os determinantes sociais e ambientais da saúde, fazendo a
O documento discute Terapia Nutricional, abordando Nutrição Enteral e Nutrição Parenteral. A Nutrição Enteral é preferida pois apresenta vantagens fisiológicas, enquanto a Nutrição Parenteral é indicada quando não há possibilidade de alimentação oral ou enteral. O texto descreve equipas multidisciplinares, histórico, métodos, cuidados e complicações relacionadas a ambos os tipos de terapia nutricional.
O documento discute as redes de atenção à saúde no Brasil. Apresenta o conceito e organização das redes, incluindo os diferentes níveis de atenção e sistemas de apoio. Também aborda a situação histórica e atual das redes no SUS, com foco na rede da região sudeste. Por fim, discute perspectivas futuras como a consolidação das redes para melhorar resultados sanitários e eficiência dos sistemas de saúde.
PSICOPATOLOGIA II: Aula 01 (introdução à CID-10)Alexandre Simoes
O documento descreve a Classificação Internacional de Doenças (CID-10), um sistema de classificação de transtornos mentais e problemas relacionados à saúde desenvolvido pela Organização Mundial da Saúde. Apresenta as origens e desenvolvimento da CID-10, seus conceitos ordenadores e categorias de transtornos mentais, incluindo esquizofrenia, transtornos de humor, transtornos neuróticos e outros. O professor Alexandre Simões dará detalhes dessas famílias de transtornos mentais nas próximas
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
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.
A guide to workforce development to support social care and health workers to apply the common core principles and competences for end of life care
23 February 2012 - National End of Life Care Programme / Skills for Care / Skills for Health
The National End of Life Care Programme has worked alongside Skills for Health and Skills for Care to ensure that workers involved in supporting someone who is at the end of their life are properly trained to be able to undertake their work effectively and appropriately.
Each section gives an explanation of the area of work and includes important links to further information and resources. There is also a 'practice scenario' to show how the competences are connected and how they can be used to help in developing services and ensuring that workers are appropriately trained and skilled.
This guide completely replaces the 2010 A framework of National Occupational Standards to support common core principles for health and social care workers working with adults at the end of life and should be read alongside the Common Core Competences and Principles: A guide for health and social care workers working with adults at the end of life.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
This document provides a blueprint for implementing interprofessional care in Ontario. It outlines the context, including demands on the healthcare system that necessitate new collaborative models of care. The blueprint was developed through extensive consultation with healthcare and education leaders. It presents 4 key recommendations to advance interprofessional care through actions like preparing current and future caregivers via interprofessional education, and supporting organizational structures, regulations, and policies that enable collaborative team-based care. The goal is to provide guidance to transform the healthcare system through system-wide adoption of interprofessional care.
Angela Coulter and Beverley Matthews presented a webinar on why care planning is not happening widely in the NHS. They discussed how care planning can help patients better manage their long-term conditions through shared goal setting and action planning. However, surveys show that less than 10% of patients with long-term conditions have a written care plan. Barriers to effective care planning included a lack of time and resources, inflexible systems, and a clinical culture that does not prioritize self-management support and partnership with patients. The webinar argued that improving care planning requires addressing attitudes, skills, leadership and incentivizing planning through policies and performance measures.
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.
The document provides guidance for domiciliary care organizations and staff on delivering high quality end of life care for people in their own homes. It outlines six key steps in the end of life care pathway: 1) discussions as end of life approaches, 2) assessment, care planning and review, 3) coordination of care, 4) delivery of high quality care, 5) care in the last days of life, and 6) care after death. The guidance addresses important considerations for organizations and the roles of care workers at each step to help ensure people receive dignified and compassionate care at the end of life in their own homes.
An overview of the work carried out by NHS England and NHS Improving Quality's Long Term Conditions Sustainable Improvement Team. It puts the case for why person-centred care has to be at the heart of healthcare.
What offers more choice? Budgets or human rights?shibley
My talk on how best to deliver choice in English dementia strategy - through the market, e.g. personal budgets, or international law, e.g. human rights.
This document discusses community engagement for health improvement. It identifies four key roles for community engagement: 1) determining local needs and aspirations, 2) promoting health and reducing inequalities, 3) improving service design and quality of care, and 4) strengthening local accountability. The document reviews different approaches to community engagement in the UK, presents examples of relevant initiatives, and identifies characteristics of successful community engagement projects, including clarity of purpose, leadership, engagement strategies, and evaluation. The goal is to inform the Health Foundation's efforts to strengthen community engagement in health.
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
1) The document discusses establishing Wellness Clinics in India under the Ayushman Bharat program to deliver comprehensive primary health care services close to where people live.
2) It outlines plans to convert 150,000 sub-centers and primary health centers into Health and Wellness Centers (HWCs) by 2022 to provide services like screening for non-communicable diseases, reproductive health services, and treatment of minor ailments.
3) The HWCs will be staffed by mid-level health providers and ASHA workers who will receive additional training to handle the expanded services while ensuring continuity of care through referrals between different levels of facilities.
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
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.
John Gillies: Health and Social Care Integration in Scotland 2018STN IMPRO
The document discusses health and social care integration in Scotland. It provides background on the Scottish population and healthcare system. The key goals of integration are to support people living independently at home, provide positive experiences of care, and design services around individual needs rather than organizational structure. Integration partnerships aim to improve outcomes such as quality of life, reducing inequalities, and supporting carers through coordinated primary, community and social care services.
Prudent healthcare and patient activation (1)Andrew Rix
The document discusses patient activation, which refers to empowering patients to take greater control of their health. It finds that activated patients who are informed and able to make healthy choices tend to have better health outcomes and lower healthcare costs. Interventions like education programs and community support can increase patient activation levels. The Patient Activation Measure is presented as a tool to measure a patient's knowledge, skills, and confidence in managing their health across different conditions. The document argues that whole-system approaches are needed to successfully promote patient activation, and that further studies could explore applying activation principles to planned care services in Wales.
Holistic common assessment of supportive and palliative care needs for adults requiring end of life care - 17 March 2010 - National End of Life Care Programme
This document provides guidance for holistic common assessment of the supportive and palliative care needs of adults requiring end of life care. It highlights five core areas or domains for holistic common assessment and sets out the content within each of these, so that teams can benchmark their local processes and tools. It sets out the main features of the process - including the who, when, where and how - of holistic common assessment.
It also highlights a range of existing assessment and planning tools, guidance and relevant policy, signposting to other resources where appropriate.
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.
Similar to End of life care planning with people who have a personal health budget (20)
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.
The document provides information and guidance for patients on how to take an active role in their recovery process before and after a hospital operation or procedure. It emphasizes the importance of staying physically and mentally active before surgery, eating healthy foods, and making plans for support and transportation at home after being discharged from the hospital. Taking small, achievable steps each day toward recovery goals like walking, showering, and eating can help patients leave the hospital sooner and feel better faster.
This document discusses bringing social movement thinking to healthcare improvement by incorporating principles from successful social movements. It outlines five key principles for creating social movement dynamics within healthcare organizations: see change as a personal mission; frame issues to connect with core values; energize and mobilize individuals; organize for impact; and maintain forward momentum. The document argues that while traditional improvement approaches have had some success, social movement thinking can help deliver deeper, more sustainable changes to better serve patients. It provides several case studies of teams that have applied social movement ideas to spur healthcare improvements.
The 15 Steps Challenge provides a toolkit to help healthcare teams evaluate the quality of patient care from the patient's perspective. A 15 Steps Challenge team conducts ward walkarounds using the toolkit to assess four areas: Welcoming, Safe, Caring and Involving, and Well Organised and Calm. The team then provides feedback to the ward and trust sponsor to identify good practices and areas for improvement. Repeating the Challenge ensures continuous quality improvement by regularly incorporating the patient voice.
This document provides an overview of a toolkit aimed at helping NHS trusts reduce their Caesarean section rates. The toolkit was developed by the NHS Institute for Innovation and Improvement based on visits to maternity services with low C-section rates. It includes self-assessment tools covering key areas like first pregnancies, VBAC, and organizational characteristics. The goal is to help services evaluate their practices and develop action plans to promote normal birth and reduce C-section rates in a safe and sustainable way.
This document provides an introduction to thinking differently and why it is important, especially within the healthcare system. It discusses how thinking differently has led to innovations that have transformed various industries. Within healthcare, thinking differently created the NHS and has led to improvements like keyhole surgery. The document encourages readers to challenge traditional ways of doing things and consider new possibilities, like using interactive TV to book appointments. It argues that thinking differently is needed to achieve reforms and make significant gains in effectiveness and efficiency. Examples are given of projects that emerged from rethinking traditional models of service delivery.
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.
- Slit lamp examination (including fundus)
- Perform biometry and focimetry
- Decide appropriateness for surgery
- Perform auto-refraction
- Discuss desired post-operative refractive status
with the patient (including current type of
spectacle correction) to enable the choice of lens
implant
- Perform ECG and blood tests
- Identify 2nd eye surgery where appropriate
Benefits
- reduces duplication of tasks
- reduces waiting time for patients
- frees up nursing time for other duties
- ensures all key tasks are completed in one visit
- improves patient experience
- reduces overall time in clinic
09
The Preferred Priorities for Care (PPC) is a tool that:
1. Facilitates discussions about end of life care wishes and preferences which can then be recorded.
2. Enables communication across care providers for care planning and decisions.
3. Acts as an advance statement if the person loses capacity, allowing their previously expressed wishes to inform best interest decisions about their care.
The PPC records an individual's end of life care preferences but these may change, so current views should take precedence. It is a voluntary and non-binding document but informs best interest decisions if capacity is lost.
The document discusses key principles for designing end-of-life care environments. It notes that the physical environment can directly impact patient experience and the memories of family and caregivers. Design should facilitate privacy, dignity, and respect. Key principles include being fit for purpose, providing comfort and connection to nature, use of natural light and materials, clarity of wayfinding, and enabling patient control and privacy. Improving environmental design can enhance patient and family experience through intuitive wayfinding, access to nature, consideration of heightened senses, provision of informal spaces, and co-located bereavement services. An environmental improvement project requires forming a multidisciplinary team to review needs, develop a plan and budget, and implement high quality design standards.
The Fast Track Tool is used to gain immediate access to funding for individuals who need urgent care packages due to rapidly deteriorating health conditions that may be terminal. It can be completed by nurses or doctors familiar with the patient's needs. The tool must be used when urgent continuing healthcare is required and replaces the regular assessment process. Patient consent is required unless they lack capacity, in which case clinicians make a best interests decision. Evidence of a completed Fast Track Tool is sufficient for eligibility and PCTs must accept and immediately action properly completed tools.
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)
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
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Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
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Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
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5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
The Children are very vulnerable to get affected with respiratory disease.
In our country, the respiratory Disease conditions are consider as major cause for mortality and Morbidity in Child.
End of life care planning with people who have a personal health budget
1. End of life care planning with people who
have a personal health budget
Discussion paper September 2010
Produced by the Department of Health’s personal health budgets pilot
programme and the NHS National End of Life Care programme
2. DH INFORMATION READER BOX
Policy
HR / Workforce
Management
Planning /
Clinical
Estates
Commissioning
IM & T
Finance
Social Care / Partnership Working
Document Purpose
For information
Gateway Reference
14840
Title
End of life care planning with people who have a personal health budget
Author
The Department of Health personal health budgets pilot programme and the
NHS national end of life care programme
Publication Date
"September 2010"
Target Audience
Programme management leads
Circulation List
#VALUE!
Description
This 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.
Cross Ref
Superseded Docs
Action Required
N/A
N/A
N/A
Timing
N/A
Contact Details
Personal health budgets pilot programme
Delivery team
309 Wellington House
133-155 Waterloo Road
London, SE1 8UG
personalhealthbudgets@dh.gsi.gov.uk
www.dh.gov.uk/personalhealthbudgets
For Recipient's Use
3. Contents
1. Introduction ........................................................................................................................3
2. Background ........................................................................................................................4
3. Key elements of good planning at end of life ......................................................................9
4. Additional elements required for personal health budgets ................................................14
5. Further information ...........................................................................................................16
Appendix 1: Edna’s journey and person-centred thinking tools.............................................17
Appendix 2: An approach developed in two personal health budgets sites that supports
person-centred thinking and end of life care .........................................................................18
Appendix 1: End of life care pathway....................................................................................21
4. End of life care planning with people who have a personal health budget
1. Introduction
The Department of Health’s personal health budget pilot programme team commissioned
this discussion paper, which builds on the earlier discussion paper Key elements of
personalised care planning in long term conditions and personal health budgets1. The
paper was planned and delivered in partnership with the NHS National End of Life Care
programme team.
In June 2010, a group of people came together to discuss the issues described in this
paper2. This group included people who use services, family members, people from the
personal health budgets pilot sites, hospices, key partners from the health, social care
and voluntary sectors and the Department of Health.
The group explored the current context of practices and policies that impact on end of
life. They heard about existing good practice and identified key issues that need to be
explored in end of life care planning with people who have a personal health budget. The
term support plan is also used in some areas to describe a care plan, and for the
purposes of this document the terms will be used interchangeably.
This is not a DH policy document or a prescriptive guide to end of life care planning with
people who have a personal health budget, but it is intended to offer a summary of the
learning described and developed on the day with the aim to provide a useful framework
to pilot sites.
1
Department of Health, Key elements of personalised care planning in long term conditions and
personal health budgets, 2010
2
Jo Harvey and Helen Sanderson of Helen Sanderson Associates facilitated the day.
PHBDP005/Sep10
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5. End of life care planning with people who have a personal health budget
2. Background
Personal health budgets can be seen as part of a wider drive to personalise public
services, which dates back to the 1970s and the campaign by disability groups for people
to be allowed to control their own funding. A pilot involving around half the Primary Care
Trusts (PCTs) in England is currently underway, testing out personal health budgets in
the NHS. Twenty of these pilot sites have been selected for an in-depth study as part of a
wider evaluation exploring the potential of personal health budgets to benefit different
groups of people.
The key characteristics of a personal budget are:
•
a clear, upfront allocation of resources
•
encouraging and helping the person, with the people who know them best, to plan
their care and support in a way that suits their individual circumstances
•
the provision of more choice by a person as to how the budget is managed
•
greater flexibility over how money can be spent.
Allocation of
budget
Care/support
Planning
Plan agreed
Review
This paper will focus on the care planning path of the personal health budgets process. It
does not address other important issues such as funding or commissioning; further
discussion papers will be produced over the course of the pilot as learning develops.
At the heart of a personal health budget is a care plan, which is the agreement between
the PCT and the individual that sets out the person’s health needs, the amount of money
available to meet those needs and how this money will be spent. This paper recognises
that there are many contributions to good care planning with a person at the end of their
life. It also draws on the work of the National End of Life Care programme, support
planning techniques and person-centred approaches, specifically:
•
the End of Life Care pathway
•
holistic common assessment
•
advance care planning
•
person-centred thinking tools
•
an approach that has been developed in the personal health budgets pilot sites.
The aim is to identify the key elements of good practice that support personalised
care/support planning from all of the approaches and any additional elements that may
be required for a personal health budget.
PHBDP005/Sep10
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6. End of life care planning with people who have a personal health budget
This work has become even more relevant in light of the recent publication of the NHS
White Paper Equity and excellence: Liberating the NHS3, which sets out the
Government's long-term vision for the future of the NHS. Patients will be “put at the heart
of everything we do” so they will have more choice and control and be in charge of
making decisions about their care. Shared decision-making will become the norm, while
the Secretary of State for Health has set out proposals on how patients, locally elected
councillors, local authorities, public health experts and others will work side by side with
GP consortia to make health services meet the needs of people in local areas and
improve health outcomes.
2.1 The End of Life Care pathway
A suggested working definition for end of life care is “… care that helps all those with
advance, 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”4.
One way to think of end of life is through a pathway, which is shown here and at the end
of this document.
The End of Life Care Pathway
Step 1
Step 2
Discussions
as the end
of life
approaches
! Open, honest
communication
! Identifying
triggers for
discussion
Assessment,
care planning
and review
! Agreed care
plan and
regular review
of needs and
preferences
! Assessing
needs of carers
Step 3
Co-ordination
of care
! Strategic
co-ordination
! Co-ordination
of individual
patient care
! Rapid response
Services
! Communication
Step 4
Step 5
Step 6
Delivery of
high quality
services in
different
settings
Care in the
last days
of life
Care after
death
! High quality
care provision
in all settings
! Acute
hospitals,
community,
care homes,
Extra care
housing,
hospices,
community
hospitals,
prisons, secure
hospitals and
hostels
! Ambulance
Services
! Identification
of the dying
phase
! Review of
needs and
preferences for
place of death
! Support for
both patient
and carer
! Recognition of
wishes
regarding
resuscitation
and organ
donation
! Recognition
that end of life
care does not
stop at the
point of death.
! Timely
verification and
certification of
death or
referral
to Coroner
! Care and
support of carer
and family,
including
emotional and
practical
bereavement
support
3
4
Department of Health, Equity and excellence: Liberating the NHS, 2010
Department of Health, National End of Life Care Strategy, 2008
PHBDP005/Sep10
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7. End of life care planning with people who have a personal health budget
There is no simple way to define the start of the End of Life Care pathway. Some people may
be receiving palliative care. The World Health Organisation definition of palliative care
describes it as an approach that improves the quality of life of patients and their families
facing the problem associated with life-threatening illness. This is done through the
prevention and relief of suffering by means of early identification and impeccable assessment
and treatment of pain and other problems, physical, psychosocial and spiritual. A person
suffering long term conditions will be under continual review for deterioration of their
condition. Other people may be identified as approaching end of life through the ‘triggers’ for
discussion. For example, professionals could ask themselves the ‘surprise’ question:
“Would I be surprised if this patient died in the next six months?” 5
If the answer is no, then this would suggest that opening a discussion about the end of life
care and the person’s wishes and preferences may be appropriate (Step 1 of the pathway).
2.2 Holistic common assessment
The Department of Health’s National End of Life Care strategy stresses the importance of
a person having a holistic assessment of their end of life care needs. Assessment is seen
as a continual process, often beginning at Step 2 of the pathway. A holistic common
assessment should include the person’s physical, psychological, social, cultural,
environmental, spiritual and financial needs in the last phase of their life.
2.3 Advance care planning
Advance care planning6 is a process of discussion between an individual and their care
providers, irrespective of the profession or discipline. This can take place at any time, but
may occur as a result of a care planning assessment. It starts at steps 1 and 2 of the End
of Life Care pathway, but is continually reviewed all the way through the other steps.
The difference between advance care planning (ACP) and general planning is that the
purpose of ACP is to make clear the person’s preferences and wishes in the context of
their condition deteriorating and the likely loss of their capacity to make decisions or
communicate their wishes to others. It is advised that the results of ACP discussions are
documented and regularly reviewed, and with the person’s permission, are
communicated to everyone who may be involved their care.
“Advance care planning has been defined as a process of discussion between an
individual, their care providers and often those close to them, about future care. The
discussion may lead to:
•
an advance statement (a statement of wishes and preferences).
•
an advance decision to refuse treatment (ADRT –a specific refusal of treatment(s) in
a predefined potential future situation.)
•
the appointment of a personal welfare Lasting Power of Attorney (LPA).
5
Lynn J, Schuster JL, Kabcenell A. Improving Care for the End of Life: A Sourcebook for Health Care
Managers and Clinicians, New York: Oxford Univ Pr, 2000.
6
Royal College of Physicians, Advance Care Planning National Guideline, 2009
PHBDP005/Sep10
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8. End of life care planning with people who have a personal health budget
All or any of these can help inform care providers should the individual lose capacity.
These terms supersede previous phrases such as 'living wills' and 'advance directives’.”7
Preferred Priorities for Care8 is the national validated tool for advance care planning.
2.4 Person-centred planning, thinking and end of life care
Putting People First9 expects that person-centred planning is embedded across adult
social care.
Person-centred planning is a way of discovering what people want, the support they need
and how they can get it. It is evidence-based practice that assists people in leading an
independent and inclusive life; it’s both an empowering philosophy and a set of tools for
change at an individual, a team and an organisation level. It shifts power from professionals
to people who use services.
The guidance Delivering personalisation through person-centred [lanning10 states that:
“The foundation for person-centred planning is a range of simple, practical person-centred
thinking skills and tools. When person-centred planning is combined with an upfront
allocation of money (a personal budget), it is called support planning. Together, personcentred planning and support planning are practical ways to deliver personalised services
and self directed support.”
One example of a person-centred tool which can support someone approaching end of life is
Living well before you die, and planning for the end of your life11 - an approach that has been
developed in conjunction with Lancashire County Council and NHS Hull (a personal health
budgets pilot site). It includes information on how a person wants to be remembered after
death. Other materials include Dying Matters12 – a website with information that aims to help
start conversations around death and dying.
7
Royal College of Physicians, Advance Care Planning National Guideline, 2009
Lancashire & South Cumbria Cancer Network, Preferred Priorities for Care, 2004
www.endoflifecare.nhs.uk
9
Department of Health, Putting People First: a shared commitment to the Transformation of Adult
Social Care, 2007
10
Department of Health, Delivering Personalisation through Person-centred Planning, 2010
11
Sanderson H., Living well before you die, and planning for the end of your life (draft 1), 2010
12
Dying Matters www.dyingmatters.org.uk
8
PHBDP005/Sep10
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9. End of life care planning with people who have a personal health budget
Below is a brief description of how some of the person-centred thinking tools can be used in
end of life care. Appendix 1 shows a real example of how these and other tools have been
used to help improve Edna’s quality of life and care in the last phase of her life.
Tool
What it does
How this tool helps in end of life
care
Relationship
circle
Identifies who is important
to the person.
Knowing who the important people
are – that you might want to see,
visit or reconnect. Helps the person
think about who they want to play
what role at the end of their life.
For example, who they may want to
be with them at the very end, or
who they want to contribute to their
funeral.
Sorting
important to/for
Sorts what’s important TO
a person (what makes us
happy, content, fulfilled)
from what‘s important FOR
a person (health and
safety, being valued) while
working towards a good
balance.
Helps us to stay focused on what
matters to the person in the context
of medical issues and interventions.
Keeps the focus on who the person
is, not just the medical care that
they need. It helps to see the
person beyond the patient.
Sorting what’s
working/ not
working
Analyses an issue/
situation across different
perspectives.
Helps a person to clarify what they
want and what they don’t want now,
and to use this as a basis for action
planning. Using this tool from
different perspectives is a way to
ensure that family and carers views
are heard and can be discussed.
Can also be used to reflect on the
past, for example something that
has worked for the person in the
past that they would like to do
again. Also useful for planning for
the future – what a person both
wants and does not want at the end
of their life, and a way to get the
family’s perspective on this.
Provides a picture of how
things are right now, or can
be used to reflect on the
past or plan for the future.
A list of other person-centred thinking tools and how they are used in end of life care can be
found in Appendix 2.
PHBDP005/Sep10
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10. End of life care planning with people who have a personal health budget
3. Key elements of good planning at end of life
The following information builds on the work done as part of the Long Term Conditions
group13 and was further developed at the end of life care event in June 2010. This
information builds on the good practice in planning and end of life care that has been
described in this discussion paper.
This is not a prescriptive or exhaustive list but a broad framework of what we see as the
essential components of any personalised care planning conversation discussion or
consultation.
The following key elements have been developed:
•
timely and relevant information available beforehand
•
knowing who is involved
•
clear goals and outcomes
•
identification of services to be bought or commissioned that can meet the need
•
contingency and change planning and risk management
•
how and when the plan will be reviewed
•
planning for step 6 – after death.
In addition, for personal health budgets the care plan should record:
•
How the budget is going to be spent
•
How the budget is going to be managed.
3.1 Timely and relevant information available beforehand
There are a range of triggers that result in a person starting to think about planning for
the end of their life and they may look to websites like NHS Choices to find out more
information14. These triggers may include the ill health or death of a spouse, moving into
a care home, family history or a review of the patient and their care. Triggers may be
provided by the person themselves, consultant or professional. As stated earlier, one
such trigger is for professionals to ask themselves “Would I be surprised if my patient
died in the next 6 – 12 months?”
There are a wide range of possible triggers and disease specific clinical triggers as
specified by the national Gold Standards Framework prognostic indicators15.
To be fully involved and engaged in care planning at end of life, the person needs to have
information about their condition, about personal health budgets, the care planning
process and the options available to them. This should include clear information on
anything that their budget cannot be spent on. Stories and examples from other patients
can be very helpful in understanding what is possible in buying and using support and
services at the end of life.
13
Department of Health, Personalised Care Planning with People Who Have Long Term Conditions,
2009
14
NHS Choices Live Well http://www.nhs.uk/Livewell/Endoflifecare/Pages/Endoflifecarehome.aspx
15
NHS Gold Standards Framework http://www.goldstandardsframework.nhs.uk/
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11. End of life care planning with people who have a personal health budget
Learning from support planning in social care and person-centred thinking with a person
at the end of their life has shown that presenting them with information in a form and
manner that makes the most sense to them is crucial if they are to fully engage in
decision making within the planning process. There are some person-centred tools that
can support this. For example, Decision Making Profiles ask the person how they like
information presented to them, how they can be supported to understand that information
and the best and worst times to ask them to make decisions.
3.2 Knowing who is involved
The person clearly needs to be at the centre of their planning process and choose who
else to involve. This could include carers, family and friends as well as the relevant
professionals. The group created a long list of other individuals or organisations a person
may also choose to involve in their care plan at end of life. This included people from
faith communities and spiritual advisors, therapists, people from buddy groups or support
networks and possibly funeral directors.
Ideally, there would be one person who co-ordinates the person’s journey along the end
of life care pathway. One group suggested that there should be a ‘conductor’ appointed,
for example, a community matron, or a care coordinator or key worker. Another group
stressed the importance of the support a person may need to manage their finances
around a personal budget and the possible role of a financial manager.
3.3 Clear outcomes/goals and how people will achieve these
Once a person has the information they need and have decided who they want to involve,
the next step is to have conversations and make decisions about what the person wants
to happen as they near the end of their life. It is vital that all other plans and care plans
dovetail into one document, rather than having several care plans being used by different
professionals. This is particularly important if the person is also in receipt of a personal
budget and support plan, via social care. Without careful coordination of plans and
funding streams there is a risk of duplication in interventions and care provision. The
information should be accessible to all professionals and all who are dealing with the
person’s care with consent of the individual.
Any planning conversation needs to address what is important to and for a person, and
what is working and not working for them, as well as what they hope to achieve or how
they want to be supported. This may cover how to live well before death, maintain dignity
and respect, manage symptoms and pain and include family and friends. It should be
acknowledged that a person’s outcomes and choices may change as their condition and
journey progresses.
Learning from support planning and the use of person-centred thinking provides some
useful questions or areas to consider:
•
who is important in my life and what role might I ask them to play at the end of my
life? Who do I want to say goodbye to, and how?
•
what does/will a good day and a bad day look like for me? How can I have more good
days towards the end of my life?
•
what is working and not working in my life and what do I want to change?
•
‘if I could, I would…’ what would I still like to do or experience or achieve?
•
what do I want and do not want in the future around my treatment and care?
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12. End of life care planning with people who have a personal health budget
•
what is my history…my important memories and how would I like to be remembered?
•
what decisions need to be made and how must I be involved?
Appendix 2 has examples of different person-centred thinking tools that can be used to
help a person answer these questions.
These conversations can be used to support holistic care planning and advance care
planning, and lead to identifying clear outcomes and how the person wants to use their
personal health budget to achieve them. There should be a clear link between the
developments of specific outcomes to the assessed needs of the person. The care plan
must set out how the services to be bought should achieve these outcomes.
Being truly person-centred is about recognising a person within the full context of their
lives and how they live them, and not just focusing on their health condition and the end
of their life. Outcomes will need to be based on what is important to a person within these
contexts and specifically relate to them as individuals.
At this stage of the process/conversation, the person and the healthcare practitioner
should agree a set of action points, deciding who will be responsible for achieving each
of the actions and deciding how and when the actions will be reviewed. Actions are more
likely to be undertaken if they are detailed, specific and set out within a given timescale.
All plans should be regularly reviewed – both in general conversations and in prearranged review meetings. Healthcare professionals should be proactive in arranging
these review sessions.
3.4 Services to be bought or commissioned
A key part of the end of life care planning conversation is providing the person with the
opportunity to explore solutions and options to meet their agreed outcomes.
Consideration should be given to the impact it will have on the family. People need to
have information about the local options available, what they cost and how they can buy
these services or have them commissioned on their behalf. Of course, a person can
spend their money on more than just existing services, and can think - and be supported
to think - creatively about different ways that they can use their budget to achieve their
outcomes. It is also important to note that many of the services for people at the end of
life are free of charge, for example, the health and social services provided by a hospice.
One of the critical success factors for personal health budgets will be achieving an
optimum level of flexibility and room for innovation and creativity to unlock better
solutions for individuals than the current system provides. Therefore the care planning
process at end of life must provide opportunities to discuss these creative solutions. The
care plan then needs to record the services the person will be using.
It is expected that staff dealing with personal health budgets in the context of end of life
care should have training in how to deal with conversations around end of life issues.
They will need to be able to open up conversations about what matters to people and
deal sensitively with the response. They also need training in where to access
information, for example, about how to make a will.
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13. End of life care planning with people who have a personal health budget
3.5 Contingency or change planning and risk management
The end of life care plan must include plans for contingencies, as the person’s needs
increase. One approach to this is to describe in the plan what the triggers would be for
the plan to be reviewed. It should also be noted that there may not always be predictable
triggers, so flexibility remains important. The contingencies could include both changes to
the person’s health and changes to the person’s capacity to make decisions. Changes in
capacity for decision making would need to be assessed in the light of the Mental
Capacity Act.
There will also need to be a discussion about the management of risk within the care
planning process and exploration of whom or what this risk might be to. For example, are
there separate risks for the individual’s well-being, resources being used appropriately or
an impact on other people, such as the person’s carer? Being overly risk averse can
prevent a person from achieving their goals. Creative and innovative solutions should be
considered and discussed, for example, the use of assistive technology to support
independence.
Any discussion about risk should be realistic and aimed at enabling the person to make
the decisions that are right for them and their family. This may require balancing potential
risks and consequences with the benefits associated with any particular decision. There
is a delicate balance between empowerment and safeguarding, choice and risk.
3.6 Planning for after death
One of the significant differences between care planning with a person, and planning
where they are facing the end of their life, is step 6 on the end of life care pathway: care
after death.
A care plan can include what a person wants to happen in relation to purchases,
equipment and services bought through the personal health budget. Carers in the group
talked about the importance of sensitive communications around returning equipment and
how distressing this is when not handled well. A system needs to be in place for the
completion of services and how the organization, services and key people involved will
be notified.
3.7 How often and who will review the plan?
Reviews with people at the end of their life care will need to happen more frequently
(compared to other patient groups) with a clear process to trigger reviews. One
possibility, as indicated earlier, is that when the plan is agreed, decisions are made about
when and how a review could be called. This could include:
•
who the person would contact to get an urgent review
•
who else may need to be involved in the review, such as social care or care providers
•
who the family, carer or professionals would contact
•
what level of change in the person’s condition or capacity, of if the plan was not
meeting the person’s needs, would automatically suggest that a review was needed,
and who would make that judgment.
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14. End of life care planning with people who have a personal health budget
The review would need to consider what is working and not working from the person,
carer and professionals perspectives, and in the context of the outcomes that the person
wants to achieve (as described in their care plan). Reviewing should therefore be flexible,
proportionate and focused on reviewing outcomes. It will need to take into account
various factors including lasting powers of attorney and anticipatory prescription of ‘just in
case’ drugs.
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15. End of life care planning with people who have a personal health budget
4. Additional elements required for personal health
budgets
There will be some additional elements required for a person receiving a personal health
budget at the end of their life.
4.1 How the budget is going to be spent
Pilot sites will need to explore how they set the budget and be able to offer the person an
indication of the resources available before they begin the care planning process. It is
essential that in setting the indicative budget, that the costs of charitably provided
services are also factored in. It should not simply be a budget based on statutory service
expenditure.
The care plan for end of life care will also need to have a clear record of how the
personal health budget is going to be spent. This should include:
•
the amount of the personal health budget
•
clear costs for support either through employing personal assistants or services or
through organisations or agencies
•
if a person employs their own personal assistants, the costs related to insurance,
training and expenses
•
one off purchases for equipment, tele-healthcare or technology
•
contingency costs.
Information about what money can be spent on should be very clear. Any required
accounting or reporting systems should be easy to fill in and there should be a named
contact if a person is concerned or confused about how the budgets work or financial
management generally. Help should also be provided for filling in any forms.
4.2 How the budget is going to be managed
As part of the care planning process, the practitioner will have to discuss with the person
how they wish their allocated personal health budget to be managed. These are the
options proposed for managing personal health budgets that are being tested through the
pilots (either singularly or in a combination):
Notional budget – This is where an individual understands the amount of funding
available to them and decides how the budget is used. The PCT still commissions
services, manages contracts etc. Notional budgets could be an option for individuals who
want more choice and control over their healthcare but who do not feel able or willing to
manage a budget.
Real budget managed by a third party – This is where the individual knows how much
funding is available to them but a third party holds the funding. This maybe a budgetholding lead professional, a GP practice, a provider organisation, an NHS Trust or an
organisation like a community interest company.
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16. End of life care planning with people who have a personal health budget
Direct healthcare payment – This is where the individual receives the funding that is
available to them as a direct payment for them to manage themselves. This is only
available to authorised pilot sites. More information on specific requirements around
direct payments is available in the document Direct payments for health care: information
for pilot sites16.
We expect people to use personal health budgets to purchase a range of services; from
traditionally commissioned services to more personalised and individualised options.
Different options will give people different levels of choice and control.
16
Department of Health, Direct payments for health care: information for pilot sites, 2010
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17. End of life care planning with people who have a personal health budget
5. Further information
Further information can be found on these websites.
www.dh.gov.uk and www.dh.gov.uk/personalhealthbudgets
For all the Department of Health documents referenced in this discussion paper, and
other early learning from pilot sites.
www.endoflifecareforadults.nhs.uk
“Holistic common assessment of adults requiring end of life care”
“Advance care planning – A guide for health and social care staff”
“Advance decision to refuse treatment – A guide for health and social care professionals”
“Planning for your future care – A guide for patients” (currently being revised)
“Practical guidance for best interests: decision making and care planning at end of lif”
www.rcplondon.ac.uk
“Concise guidance to good practice – advance care planning”
www.gmc-uk.org/guidance/ethical_guidance/6858.asp
“Treatment and care towards the end of life: good practice in decision making, 2010”
www.resus.org.uk/pages/dnar.pdf
“Decisions relating to cardiopulmonary resuscitation“
www.ncpc.org.uk/publications
“The Mental Capacity Act in Practice”
“Good decision making – the Mental Capacity Act and end of life care”
www.dca.gov.uk/legal -policy/mental-capacity/publications.htm
Mental Capacity Act – Information booklets
www.publicguardian.gov.uk/mca/code-of-practice.htm
“Mental Capacity Act – Code of Practice”
www.dyingmatters.org.uk
“Dying Matters – a resource for end of life conversations and planning”
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18. Appendix 1: Edna’s journey and person-centred thinking
tools
Edna’s Journey
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19. End of life care planning with people who have a personal health budget
Appendix 2: An approach developed in two personal
health budgets sites that supports person-centred
thinking and end of life care
Tool
What it does
How this tools helps in end of
life care
Relationship circle
Identify who is important
to the person.
Sorting important
to/for
Sorts what’s important TO
a person (what makes us
happy, content, fulfilled)
from what‘s important
FOR a person (health and
safety, being valued)
while working towards a
good balance.
Knowing who the important people
are – that you might want to see,
visit or reconnect. Helps the person
think about who they want to play
what role at the end of their life, for
example who they may want to be
with them at the very end, or who
they want to contribute to their
funeral.
Helps us to stay focused on what
matters to the person in the context
of medical issues and
interventions.
Keeps the focus on who the person
is, not just the medical care that
they need. Seeing the person
beyond the patient.
Good days and
bad days
Helps a person reflect on
what makes a good day
and a bad day, to inform
action planning and
identify what is important
to the person and how
they want to be
supported.
Sorting what’s
working/ not
working
Analyses an issue/
situation across different
perspectives.
Provides a picture of how
things are right now, or
can be used to reflect on
the past or plan for the
future.
PHBDP005/Sep10
Identifies the elements of days that
are good and days that are bad, to
enable the person and their
supporters to work out what they
can do together to ensure that they
person has less bad days and
more good days. This also
provides information about what is
important to the person and how
they want to be supported.
Helps a person to clarify what they
want and what they don’t want now
and to use this as a basis for action
planning. Using this tool from
different perspectives is a way to
ensure that family and carers views
are heard and can be discussed.
Can also be used to reflect on the
past, for example something that
has worked for the person in the
past that they would like to do
again. Also useful for planning for
the future – what a person both
wants and does not want at the
end of their life, and a way to get
the families perspective on this.
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20. End of life care planning with people who have a personal health budget
Gives a person an
opportunity to think about
what they would still like
to do, achieve, or
experience.
Identifies specific
responsibilities- core
responsibilities, using
judgment and creativity,
not a paid responsibility.
Acknowledges that there may still
be things that the person wants to
do i.e. ‘The bucket list’ of what you
want to do before you die.
Histories/how I
want to be
remembered
A way to help a person
reflect on and record the
past. Helps a person to
begin to think about how
they want to be
remembered and their
legacy.
A way for the person and family to
capture their life and how the
person wants to be remembered.
Provides an opportunity for
achievements to be celebrated and
acknowledged. Offers a different
way of knowing the person and
informing their funeral and how
they are seen by future
generations.
Communication
charts
A quick snapshot of how
someone communicates.
A way of recording a
richness of information for
a person who uses words
to speak and particularly
for a person who doesn’t.
Helps us focus on a person’s
communication whether they use
words to speak or not, and
understand what we think they
mean and how we should respond.
Vital to inform any decision making
process.
Decision making
agreement
Helps us to think about
decision making and
increasing the number
and significance of
decisions a person
makes.
Enables a person to be in control
and make the decisions they want
to make at the end of their life. Can
inform best interest decision
making and advance decision
making.
Matching staff
A structure to look at both
what skill/supports and
what people
characteristics make for
good matches for staff or
volunteers.
Helps a person think about what
kind of person they want to support
them. This is important information
for recruiting personal assistants or
using with a provider agency. Can
form the basis of a person
specification and inform a job
description.
If I could, I would
The doughnut sort
PHBDP005/Sep10
It clarifies the roles of the different
professionals and agencies
supporting people and families. It
helps a person to be clear about
what they must do, and where they
can be creative.
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21. End of life care planning with people who have a personal health budget
Learning log
A way to record what
people are learning on a
day-to-day basis.
4 + 1 questions
Helps a person focus on
what they are learning
and what to do next.
Person-centred
reviews
A person-centred way to
meet, review progress
and agree actions.
PHBDP005/Sep10
Provides a way for people to
record ongoing learning (focused
on what worked well, what didn’t
work well) for any event or activity.
This can add to information about
what is important to the person and
how best to support them.
Can replace traditional progress
notes or records to help us focus
more clearly on critical information
about the person. Can be used to
focus on someone’s whole life or
specific areas of their life, e.g.
someone’s health.
A way to reflect on what has been
tried and the impact of this and
what could be tried next. Important
in areas such as medication and
keeping the person comfortable. A
way to explore what is being tried
and learned with the person,
family, carers and professionals to
review progress and at reviews.
A way to reflect on what is
important to the person, how they
want to be supported and what is
working and not working from their
perspective, the families/carers’
perspective and staff/professionals’
perspective. This review process
focuses on the whole of the
person’s life. The 4+1 tool is an
excellent way to focus on one area
of the person’s life.
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22. Appendix 3: End of life care pathway
The End of Life Care Pathway
Step 1
Discussions
as the end
of life
approaches
! Open, honest
communication
! Identifying
triggers for
discussion
Step 2
Assessment,
care planning
and review
! Agreed care
plan and
regular review
of needs and
preferences
! Assessing
needs of carers
Step 3
Co-ordination
of care
! Strategic
co-ordination
! Co-ordination
of individual
patient care
! Rapid response
Services
! Communication
Step 4
Step 5
Step 6
Delivery of
high quality
services in
different
settings
Care in the
last days
of life
Care after
death
! High quality
care provision
in all settings
! Acute
hospitals,
community,
care homes,
Extra care
housing,
hospices,
community
hospitals,
prisons, secure
hospitals and
hostels
! Ambulance
Services
! Identification
of the dying
phase
! Review of
needs and
preferences for
place of death
! Support for
both patient
and carer
! Recognition of
wishes
regarding
resuscitation
and organ
donation
! Recognition
that end of life
care does not
stop at the
point of death.
! Timely
verification and
certification of
death or
referral
to Coroner
! Care and
support of carer
and family,
including
emotional and
practical
bereavement
support