Transforming End of Life Care in Acute Hospitals AM Workshop 1: EPaCCS 2020 ‘Where we are and where we need to be’
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Transforming End of Life Care in Acute Hospitals AM Workshop 1: EPaCCS 2020 ‘Where we are and where we need to be’ presented by Jeri Hawkins, NHS England and Stephen Burrows, Greater Manchester, Lancashire and South Cumbria SCN & Cheshire and Merseyside SCN
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Transforming End of Life Care in Acute Hospitals AM Workshop 1: EPaCCS 2020 ‘Where we are and where we need to be’
- 1. www.england.nhs.uk Workshop EPaCCS 2020: Where we are and where we need to be 18 November 2015
- 2. www.england.nhs.uk Agenda 1. Welcome 2. North West EPaCCS - Past, Present & Future Stephen Burrows, North West EPaCCS Project Lead 3. EPaCCS 2020: Where we need to be Jeri Hawkins, Sustainable Improvement Team NHS England 4. Focused Discussion All
- 4. • records and shares people’s preferences and wishes about their end of life care, with everyone involved in their care • improves co‐ordination of care by making information available 24 hours a day • supports appropriate treatment decisions and interventions • allows more people to die in the place of their choice What is an EPaCCS?
- 7. • Use existing systems • Avoid / reduce duplication of existing EoLC recording • Replace / reduce other non-electronic EoLC communication • Quick and easy to use, avoiding over use of text • Ensure sustainability and make ‘future-proof’ North West requirements
- 8. Potential North West issues • Standardise (as much as possible) the processes and flow of information to NWAS from 34 CCGs • Use of other shared resources (e.g. hospices / other organisations that cross boundaries) • Patients that cross boundaries (e.g. 15% -20% of EoLC patients in one acute trust not from that locality) or move • Providing patient access • Reporting and monitoring of outcomes (measuring ‘like for like’)
- 9. • Identification of 22 EPaCCS ‘localities’ across the North West, and subsequent setting up of EPaCCS Task Groups to meet regularly and represent the range of stakeholders within a locality involved in End of Life Care (EoLC). • Creation of a common dataset – the North West EPaCCS dataset – a minimum implementation of which ensures ISB 1580 compliance, but which also includes other frequently used information commonly shared by end of life care services. Accepted by all localities in 2013, and continually updated to reflect changes to the standard. The North West EPaCCS – achievements so far ‐ 1
- 10. • System supplier created, nationally available, EPaCCS templates based upon the NW EPaCCS dataset available and in use in local systems – EMIS Web/LV/PCS (available since 2013), INPS Vision+ (available since 2014), TPP SystmOne (now available locally), iPM Lorenzo (Morecambe Bay), Graphnet (available since Nov 2014) etc. • Training materials for the national EPaCCS templates to support local rollout of their use, and provide resource for EoLC facilitators etc involved in supporting EPaCCS use. The North West EPaCCS – achievements so far – 2
- 11. • A North West template for an EPaCCS Information Sharing Agreement (ISA), shared with all localities for their adaptation and completion. • An ISB compliant End of Life View available in the MIG (Medical Interoperability Gateway) supplied by Healthcare Gateway. This is currently the only commercial solution allowing for the streaming of information recorded on GP systems to be shared with other organisations. The North West EPaCCS – achievements so far ‐ 3
- 13. • Regional support and networking provided through the creation of EPaCCS Network Implementation Groups (NIG) – for Cheshire & Merseyside, Greater Manchester, and Lancashire & Cumbria – that meet quarterly, and share best practice / developments via a Yammer network. • Targeting and support for locality EPaCCS implementation set through the Eight Key Areas document, RAGB‐rated on a quarterly basis, and fed back through SCNs and AHSNs to organisations. In GM this has been developed into an AHSN supported performance dashboard to be rolled out further. The North West EPaCCS – achievements so far – 4
- 14. Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 0.1 Project Plan R R R R R C C C C C R R R R R A G G G G 1 Scope and Census R R R R R G G G G G R R R R R A A A A A 2 EPaCCS Task Group A A A A G G C C C C C C R R R R R R C C C C C C 3 EPaCCS Recording R R R R R R A G G G G G R R R R R R G G G G G G 4 Information Governance R R R R R R A G G G G G R R R R R R C C C C C C 5 EPaCCS Sharing R R R R R R R G G G G G R R R R R R A A A A A A 6 GSF Meetings R R R R R R A A G G G G R R R R R R G G G G G G 7 EPaCCS Reporting R R R R R A A A A A R R R R R A A A A A 8 Electronic Documentation R R R R R R A A A A A A R R R R R R R R R R R R Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 0.1 Project Plan C C C C G G G G G R R R R G G 1 Scope and Census A A A A G G G G G R R R R G G 2 EPaCCS Task Group C C C C C R G G G G G R R R R A A G G 3 EPaCCS Recording A A A A A A A A A G G G G G G R R C C 4 Information Governance C C C C C A G G G G G G G G G A A G G 5 EPaCCS Sharing G G G G G R G G G G G A A A A R R G G 6 GSF Meetings A A A A A R G G G G G R R R R R R G G 7 EPaCCS Reporting R R R R A A A A A A A A R A A 8 Electronic Documentation R R R R R R G G G G G A A A A A A G G Comments No task group as yet - assumption of red status. No update received from Feb 2015. Have assumed no change. No task group set up yet - assumption of red status. Ref Area RAG Status / Plan RAG Status / Plan Area RAG Status / Plan RAG Status / Plan Trafford (PM - TBA) Wigan (Robert Walters) RAG Status / Plan RAG Status / Plan Bolton (PM - Gill Baker) Manchester (Mohamed Abas) EPaCCS RAG Status (Aug15) Stockport (PM was Jane Owens) Tameside & Glossop (Philippa Robinson) Comments Ref EPaCCS RAG Status (Aug15) North East Sector (PM - TBA) Salford (PM was Steve Gene) RAG Status / Plan RAG Status / Plan Status of EPaCCS Implementations across GM Conurbation
- 16. • Link into Lancashire Patient Record Exchange System (LPRES) and Datawell interoperability solutions for Lancashire & Greater Manchester. • Work begun on a ‘Why EPaCCS’ video to encourage and promote the use of EPaCCS by clinicians in all EoLC services. • Work ongoing to promote EPaCCS implementation through Transform agenda. The North West EPaCCS – achievements so far – 6
- 17. Transforming End of Life Care in the Community • About • Based on the Transforming End of Life in Acute Hospitals Programme • Commenced in March 2015 • Encompasses ACP, DNACPR, Communication and End of Life Care training for Primary Care as well as promoting the roll out of EPaCCS to the GP practices • Why • To reduce unnecessary hospital admissions / deaths • To increase the choice for patients to die in their UPR • Aims • Promote discussions about end of life care and translate into workable documents • To support patients to achieve their wishes and preferences at the end of life • To encourage GP’s to find their ‘1%’ • How • Delivering sustainable education programmes to Community practitioners • Initiating and maintaining cross-community communication • So far • Surgeries/District Nurses/Health centres • GSF Meetings • Future • Commencement of Transforming End of Life Care in Care Homes
- 18. Read only Read and write Via a third party (eg call centre, another team) GPs Lancs Nth Pennine Lancs Salford Manchester Tameside & Glossop South Cheshire, Vale Royal & Eastern Cheshire Blackpool, Fylde & Wyre West Cheshire Wigan Borough Liverpool South Sefton Stockport Cumbria Out of hours GP service Lancs Nth Pennine Lancs Salford Tameside & Glossop Wigan Borough Liverpool Cumbria Manchester Stockport District nursing service Pennine Lancs Cumbria Salford Manchester South Cheshire, Vale Royal & Eastern Cheshire Liverpool South Sefton Stockport Specialist palliative care - community services Pennine Lancs Wigan Borough Cumbria Lancs Nth Salford Manchester South Cheshire, Vale Royal & Eastern Cheshire Liverpool South Sefton Stockport Care homes with nursing Manchester Stockport Salford NHS IQ EPaCCS Baseline Questionnaire responses
- 19. Read only Read and write Via a third party (eg call centre, another team) Acute hospital community Lancs Nth Pennine Lancs Wigan Borough Salford Manchester Stockport Acute hospital specialist palliative care in patient Lancs Nth Pennine Lancs Tameside & Glossop South Cheshire, Vale Royal & Eastern Cheshire Wigan Borough Liverpool South Sefton Cumbria Salford Manchester Stockport Acute hospital A&E department / acute admissions Lancs Nth Tameside & Glossop South Cheshire, Vale Royal & Eastern Cheshire Wigan Borough Liverpool South Sefton Cumbria Salford Manchester Stockport Acute hospital - discharge teams / processes Lancs Nth Wigan Borough Salford Manchester Stockport Hospice Tameside & Glossop Wigan Borough Liverpool South Sefton Salford Manchester South Cheshire, Vale Royal & Eastern Cheshire Stockport Social care Salford The Christie Salford Tameside & Glossop Patient Cumbria
- 20. Challenges in progressing EPaCCS • Leadership • Clinical engagement • IT engagement • Finance
- 22. www.england.nhs.uk EPaCCS 2020: Where we need to be Jeri Hawkins Sustainable Improvement Team 18 November 2015
- 23. www.england.nhs.uk • Some Current Understandings (End of Life Care and EPaCCS) • National Ambitions • Current Priorities • Some Proposed National Support Agenda
- 24. www.england.nhs.uk Some Current Understandings End of Life Care & EPaCCS
- 25. www.england.nhs.uk End of Life Care, Some Current Understandings • Important information in What we know now 2014 (PHE, June 2015) An increasing proportion of people die at home or in care homes Patients with an Electronic Palliative Care Co- ordination System (EPaCCS) record are more likely to die in the place of their preference Two in five people with dementia die in hospital Factors most important to people at the end of their life were having pain and other symptoms managed effectively, being surrounded by loved ones and being treated with dignity More GPs are having conversations with people about their end of life care wishes but 25% still say they have never initiated such a conversation
- 26. www.england.nhs.uk EPaCCS, Some Current Understandings • Information from various evaluations and most recently the 2013 Survey • “68% of CCGs have a working EPaCCS” What does the statement mean? How is information shared? Who is connected and sharing? What are they sharing and for how many patients? When will everyone be sharing? What kind of help might they need?
- 27. National Ambitions National Palliative and End of Life Care Partnership
- 28. www.england.nhs.uk • 27 organisations; patients, voluntary sector, social care, colleges & councils, regulators, hospice, health education, NHS • Equal partners to provide a collective, collaborative, cooperative approach to create the change everyone wants in end of life care National Ambitions National Palliative and End of Life Care Partnership
- 29. www.england.nhs.uk National Ambitions National Palliative and End of Life Care Partnership
- 30. www.england.nhs.uk National Ambitions National Palliative and End of Life Care Partnership
- 31. www.england.nhs.uk National Ambitions National Palliative and End of Life Care Partnership
- 32. www.england.nhs.uk National Ambitions National Palliative and End of Life Care Partnership
- 33. www.england.nhs.uk National Ambitions National Information Board (NIB) & NHS England
- 34. www.england.nhs.uk • National Information Board (NIB) Membership includes CEOs of all major health & care organisations including Simon Stevens Progresses the ambitions of the Care Act 2014, the Government Digital Strategy (2013), the DH Digital Strategy: Leading the Culture Change in Health and Care (2012) and the proposals in the DH’s Power of Information (2012) • Personalised Health and Care 2020 Builds on the commitment to exploit information revolution outlined in the Five Year Forward View https://www.gov.uk/government/publications/personalised- health-and-care-2020 National Ambitions National Information Board & NHS England
- 35. www.england.nhs.uk • Align EPaCCS development with NIB work programme, ergo the Five Year Forward View and digital ambitions, e.g. a paper-free NHS by 2020 • 100% EPaCCS implementation throughout England by 2020, compliant with the core information standard SCCI 1580 • 100% compliance with EPaCCS Recommended IT Systems Requirements by 2020 National Ambitions National Information Board & NHS England
- 36. www.england.nhs.uk National Ambitions National Information Board & NHS England • What’s it all for? Joined up, safer care Patient / carer involvement Better informed and efficient care System interoperability • All of which go way beyond EPaCCS
- 37. www.england.nhs.uk National Ambitions National Information Board & NHS England • To meet the challenges of the 2020 digital agenda we need to get from here: • To here:
- 39. www.england.nhs.uk • Changes were made to the national information standard. These were published 25/09/15 http://www.endoflifecare-intelligence.org.uk/news/ Current Priorities
- 40. www.england.nhs.uk • Changes were also made to the supporting EPaCCS Recommended IT System Requirements and this document has also been published http://systems.hscic.gov.uk/qipp/library/epaccsreq.pdf Are you & your suppliers working with these documents? Current Priorities
- 41. www.england.nhs.uk Current Priorities • Personalised Health & Care 2020 (NIB) requires each and every CCG to produce: A footprint and governance template for 30 October 2015 A complete digital roadmap for 1 April 2016. http://www.england.nhs.uk/digitaltechnology/info- revolution/digital-roadmaps/ Is your organisation feeding into this process? • Establishing a new national understanding through delivery of a new baseline for EPaCCS Commissioned by NHS England and the NIB Deadline November 15 To help identify where CCGs are now so that a longer term work programme can be defined to support getting where everyone needs to be
- 42. www.england.nhs.uk Some Proposed National Support
- 43. www.england.nhs.uk • Transforming End of Life Care event today (Network!) • Quantitative & qualitative EPaCCS evaluation (end-February 16) • National EoLC Intelligence Network economics-based research project into the costs of EPaCCS (end-March 16) • A new community of practice A national forum for EPaCCS users Connecting with and learning from this community Showcase event(s) and Case Studies • Development of a practical longer term support plan • National EPaCCS conference(s) • Review and revamp support and guidance documents • Develop a national compendium of best practice resources Some Proposed National Support
- 45. www.england.nhs.uk Questions for you • Are your EPaCCS going to meet the ambitions for 2020? • What do you see as the major barriers to meeting the ambitions for 2020? • How can the national team help you to meet the ambitions for 2020?