Improving end of life care in hospital

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1 Improving end of life care in hospital 10 February 2014 Dr Martin McShane Director- Improving quality of life for people with LTCs

2 Context 2 NHS Improving End of Life Care in hospitals

3 What s the job? Our Mission is: High Quality Care for Allnow and for future generations What do we mean by high quality care? Clinically Effective Good Patient Experience Safe How will we measure success? What will my care look and feel like? I will feel supported to keep healthy and spot any problems at an early stage Reducing premature mortality My care and treatment will be organised around me as a person Enhancing quality of life for people with long term conditions I will feel in control of managing my own condition(s) Helping people to recover from episodes of ill Health or following injury I will get the best possible treatment in the most appropriate setting and be fully supported to recover Ensuring people have a positive experience of treatment and care I will always be treated with compassion, dignity and respect Treating people in a safe environment & protecting them from avoidable harm I will feel my safety is everyone s paramount concern, but if things do go wrong people will be honest with me My preferences will be listened to and the feedback I provide will be acted upon

4 Nationally, we have identified key areas for action for each domain to support our mission Preventing people from dying prematurely Enhancing the quality of life for people with long term conditions Helping people to recover from episodes of ill health or following recovery Maximising the contribution that the NHS can make to preventing disease Finding the missing millions and diagnosing earlier and more accurately Treating people in an appropriate and timely way Addressing unwarranted variation in mortality and survival rates Reducing deaths in babies and young children Helping patients take charge of their care Enabling good primary care Ensuring continuity of care Ensuring a parity of esteem for mental health Keeping people out of hospital when appropriate Effective interfaces between primary, secondary and community care High quality, efficient care for people in hospital Co-ordinated care and support for people following discharge from hospital 4 5 Ensuring that people have a positive experience of care Treating and caring for people in a safe environment and protecting from avoidable 4 harm Improving our understanding of the patient experience Reduce inequality in patient experience Enabling commissioners and providers to create a culture that puts good patient experience and positive staff experience at the heart of services Establishing clear lines of accountability for patient experience in the NHS Increase our understanding of the problem Create the conditions for patient safety Build capacity for safe care Create a whole system response Address our key patient safety concerns

5 NHS England can use the tools and levers of the Quality Framework to support these actions CCG Outcomes Indicator Set NHS England 5

6 The House of Care Organisational & clinical processes Plan Do Engaged, informed individuals & carers Personcentred, coordinated care Health & care professionals committed to partnership working Act Study Commissioning

7 The House supports: Informational continuity: people, carers and professionals will have the right information needed to provide the right care at the right time (e.g. medical care in hospital and social care at home) Management continuity: care and support along recommended pathways will be available as and when needed by people, without undue difficulty in transferring between agencies and settings Relational continuity: people will know where and to whom to turn for assistance in managing their conditions 7

8 The House of Care - Person centred, coordinated care at three levels: National: What can national organisations and policy makers can do to enable construction of the House of Care at the next two levels. Local: How local health economies ensure that the House of Care involves a whole system approach, including more than medicine offers Personal: How the House of Care gives professionals on the front line a framework for what they need to do for patients and ask local commissioners to secure for them

9 Long Term Conditions Community Carers Professions Person 9

10 Some challenging information.. 10 NHS Improving End of Life Care in hospitals

11 British Social Attitudes Survey (DM) 79% confident about planning support/care 45% discussed own wishes if not long to live 5% have living will/advance care plan 85% would like to be told if terminally ill 12% would prefer not to know 67% would prefer to die at home 60% of these would change their mind if doing so without support 11 NHS Improving End of Life Care in hospitals

12 National bereavement survey Overall quality of care: 23% rate as fair/poor Coordination of care: Community services - 14% did not work well together Hospital/community 31% did not work well together Relief of pain and suffering at home 51% partially/not at all 12 NHS Improving End of Life Care in hospitals

13 Inequity Confidential enquiry learning disability BAME Homeless population 13 NHS Improving End of Life Care in hospitals

14 14 NHS Improving End of Life Care in hospitals

15 Seize the Opportunity To empower individuals and their carers by delivering excellence in person centred end of life care Enable collaboration so that the team works together to deliver best care Deliver professional partnerships across interdisciplinary and organisational boundaries Add value to the whole system by engaging in continuous service improvement which is outcomes focussed and driven by on-going measurement 15 NHS Improving End of Life Care in hospitals

16 Currently over 50% people die in acute hospitals We need to ensure that we provide excellent end of life care for all who need it and support individual choices/ preferences for care and place of death National media coverage regarding care of the dying creates challenges and opportunities 16 NHS Improving End of Life Care in hospitals

17 Key drivers for excellence in end of life care 17 NHS Improving End of Life Care in hospitals

18 National drivers for future improvement NHS Mandate Draft NHS Constitution NHS Outcomes Framework- VOICES National LCP review Palliative Care Funding ( Tariff Development) National Care of the Dying Hospital Audit ELQUCa ( End of Life Care Quality Assessment Tool) EPaCCs roll out (Improve Care coordination) 18 NHS Improving End of Life Care in hospitals

19 Culture devours strategy What we see and attempt to address Individual behaviours Mindsets and beliefs What we don t see and don t know how to address Values Needs (met or unmet) SOURCE: Scott Keller and Colin Price, Performance and Health: An evidence-based approach to transforming your organisation, 2010.

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