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The End of Life Care Programme Adrienne Betteley End of Life Care Programme Lead Merseyside and Cheshire Cancer Network

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Title: The End of Life Care Programme Adrienne Betteley End of Life Care Programme Lead Merseyside and Cheshire Cancer Network


1
The End of Life Care ProgrammeAdrienne
BetteleyEnd of Life Care Programme
LeadMerseyside and Cheshire Cancer Network
2
Most people would prefer to die at home
3
The majority die in an acute setting.
4
It helps to have some foundations to build upon!
5
End of Life Care Strategy Context
  • First ever national strategy on end of life care
  • Developed in parallel with the Next Stage Review

6
End of Life Care Strategy
  • The Strategy
  • covers all conditions
  • covers all care settings (eg home, hospital,
    hospice, care home, community hospital, prison
    etc)
  • has been developed within the current legal
    framework

7
End of Life Care Strategy
  • Aims
  • To bring about a step change in quality of care
    for people approaching the end of life
  • To enhance choice at the end of life
  • To deliver the Governments manifesto commitment
    to double investment in palliative care

8
(No Transcript)
9
Spiritual care services
Support for carers and families
Information for patients and carers
10
Summary
  • The strategy sets out a vision to transform end
    of life care in this country over the coming
    years
  • Action is now be taken by a very large number of
    people and organisations who contribute to
    commissioning, delivery of care, education and
    research

11
The Political Map !
Review Life Cycle (8 groups)
End of Life Care Strategy
End of Life Clinical Working Group
Extended to other 9 SHAs
Framework
?
US !
12
Healthier Horizons for the North West
13
  • 11 recommendations

14
MCCN Programme 2009-2012
  • Programme devolved to the Cancer Network
  • In line with the 11 recommendations from
    Healthier Horizons
  • http//www.northwest.nhs.uk/healthierhorizons/

15
Key issues End of Life
  • Establishing advance care planning
    systematically
  • Enabling patients who wish to die at home to do
    so
  • Establishing a supportive palliative care
    register across settings
  • Development of joint commissioning/funding
  • Establishing integrated information systems
  • Equity of access for bereaved relatives for
    support

16
Patient Pathway
1 year
1 year
Advancing disease
GSF/PPC
LCP
Preferred Priorities for Care (PPC) Gold
Standards Framework (GSF) Liverpool Care Pathway
(LCP)
17
NHS - End of Life ToolsEnd of Life Care Strategy
1 2 3
18
Preferred Priorities for Care
19
  • www.endoflifecare.nhs.uk
  • www.endoflifecareforadults.nhs.uk

20
Advance Care Planning
21
Process
  • the process is voluntary
  • the content of any discussion should be
    determined by the individual concerned

22
Competency framework
23
Preferred Priorities for Care (formerly known as
Preferred Place of Care) (PPC)
  • What is it?
  • An advance care plan for people with a life
    limiting illness who wish to have their choices
    and preferences recorded in relation to their
    care and ultimate place of death
  • A patient held record which should go with the
    patient if they are transferred to a different
    care setting

24
Background to the PPC
  • Originated in Lancashire South Cumbria Cancer
    Services Network 2003
  • Recommended by Department of Health End of Life
    Care Programme
  • Used in variety of settings for patients with
    life-limiting conditions

25
Positives of Implementing
  • Empowering for patients
  • Opens up vital discussions
  • Promotes choice
  • Excellent way of lobbying for further resources
  • Helps prevent inappropriate transfer to another
    setting.
  • Builds staff confidence and encourages difficult
    conversations

26
The new PPC document
  • Change from Preferred Place of Care to Preferred
    Priorities for Care
  • Patient-held advance care plan
  • Only to be used for those who have mental
    capacity
  • Allows patients to consider, discuss and document
    their preferences and priorities for care as they
    approach the end of life

27
Support
  • Not everyone finds it easy to have conversations
    about death and dying
  • Staff may need additional support through
    communication skills training or through mentor
    or peer support may be a Specialist Palliative
    Care Nurse

28
Gold Standards framework
  • http//www.goldstandardsframework.nhs.uk

29
Aim of GSF
  • Aim is to develop a practice-based system to
    improve the organisation and quality of care of
    patients in the last year of life in the community

30
Gold Standards Framework
  • Better organisation of care for some of the most
    needy patients
  • Better teamwork and practice morale
  • Fewer crisis calls and admissions with more
    proactive care
  • Better quality of care for patients in the last
    year of life at home
  • More patients enabled to die well in their place
    of choice

31
The Key Tasks or 7 Cs
  • Communication
  • Co-ordination
  • Control of symptoms
  • Continuity out of hours
  • Continued learning
  • Carer support
  • Care of the dying

32
GSF is About
  • Planning ahead
  • Anticipatory care helps avoid crisis and can
    enable
  • Improved support for families and nursing teams
  • Reduction in hospital admissions
  • Achievement of preferred place of care

33
Liverpool Care Pathway
34
Care of the Dying Audit
  • NATIONAL AUDIT SHOWS DYING PATIENTS RECEIVE HIGH
    QUALITY CARE SUPPORTED BY THE LIVERPOOL CARE
    PATHWAY FOR THE DYING PATIENT (LCP). The second
    National Care of the Dying Audit of Hospitals
    (NCDAH) published 14th September 2009, shows that
    patients on the Liverpool Care Pathway for the
    Dying Patient (LCP) are receiving high quality
    care in the last hours and days of life. The
    audit covers the use of the LCP in 155 hospitals,
    looking at the records of almost 4000 patients.

35
New Version
  • Version 12 LCP will be launched at the LCP
    Conference 25th November 2009 at the Royal
    Society of Medicine - London.
  • www.lcp-mariecurie.org.uk

36
How we measure the uptake of the EOLC tools in
MCCN
  • Data collection tools used across sectors
  • Level Descriptors
  • Death data (ONS)
  • Quality Markers

37
Example of data collection tool
38
Level Descriptors
Level 0 The organisation has not implemented the specific EOLC tool
Level 1 The organisation has plans in place for the implementation of the specific EOLC tool
Level 2 The organisation is in the early phase of implementation of the specific EOLC tool
Level 3 The organisation is able to demonstrate implementation of the specific EOLC tool
Level 4 The organisation has embedded and sustained the specific EOLC tool.
39
MCCN Targets
40
Quality Markers as a way of measuring for the
future
DRAFT
41
Dying Matters
  • to support changing knowledge, attitudes and
    behaviours towards death dying and bereavement,
    and through this to make living and dying well
    the norm.

42
MCCN Dying Matters Campaign
43
Promoting healthier attitudes to the end-of-life
makes sense
44
  • Contact details
  • 0151 201 4150
  • Adrienne.Betteley_at_mccn.nhs.uk
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