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End of Life Care


End of Life Care Gordon J Pownall Community Commissioning Manager Commissioning Lead for End of Life and Palliative Care NHS Hertfordshire Usual place of residence ... – PowerPoint PPT presentation

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Title: End of Life Care

End of Life Care
  • Gordon J Pownall
  • Community Commissioning ManagerCommissioning
    Lead for End of Life and Palliative Care
  • NHS Hertfordshire

Usual place of residence
  • The latest figures from the Care Quality
    Commission show there are over 460,000 residents
    living in 17,740 nursing and residential homes
    across England.
  • Latest statistics indicate that 18 of people
    died in care homes between 2008 2010 compared
    with 29 of those on an Electronic Palliative
    Care Co-ordination System (EPaCCS) who say they
    would prefer to die in their care home setting.
  • Meanwhile 16 of care home residents are still
    admitted to hospital within the last week of
    their life and die there 1.
  • 1. What we know now that we didnt know a year
    ago New intelligence on end of life care in
    England. NEoLCIN, May 2012.

Integrated Care for End of Life
Place of death 2011/12
What are the issues?
  • Care homes are often seen as the poor relation
    when it comes to end of life care training and
  • The rapid turnover of the workforce combined with
    heavy workload demands can make it particularly
    challenging to organise training and embed the
  • Homes are often isolated from each other and
    often the rest of health and social care services
    this serves to exacerbates the issue of poor
  • Perception of additional pressures (financial and
    human) on smaller organisations / services taking
    staff away from primary roles in service
  • Lack of understanding what is being asked of you
    and more importantlyWHY!

Actions we have
  • Implementation of AMBER in East and North Herts
  • Hospice opening 24/7 Pilot in West Herts
  • Extension of Hospice at Home to cover the gap in
    St Albans and Harpenden
  • Extension of funding to education in care and
    nursing homes
  • Planned implementation of cAMBER pilot in West

Additional investment for 2012/13 on pilot
initiatives - 500,000
So what is the current picture?
  • A recent NEoLCP survey of 56 end of life care
    facilitators, representing 5,693 care homes,
    showed significant increases in the
    implementation of -
  • Gold Standard Framework
  • ACP
  • Liverpool Care Pathway between 2010 and 2011.
  • A more in-depth survey of 12 of these
    facilitators, representing 1,768 homes, indicates
    that the uptake is still quite low.
  • Just over 20 of homes were making use of ACP
    while use of tools such as GSF, LCP, PPC and
    local approaches were significantly below this.
  • Even in the nursing home sector, uptake of each
    of these approaches was below 50.

Making adjustments and supporting initiatives
  • It is also crucial to have the support of the
    care home manager and to have people working on
    the ground as (end of life) care champions,
    ensuring the individual is always at the centre
    of the care planning process.

What challenges can we overcome?
  • Invest in activities that promote advance care
    planning (to reduce hospital admissions, AE
    attendances, unnecessary use of ambulances)
  • Invest in services that support people to remain
    where they wish (to encourage and promote respect
    for an individual to choose to die in their
    preferred place whether you are staff, relative
    or other professional)
  • To understand the impact on the wider community
    where we react rather than respond (to promote
    and make best use of the limited resources we
    have available and ensure the right care is
    always available)

We need your support to -
  • Record your activity evidence the work
  • Dont tell me show me!
  • Admissions to Hospital
  • Advance Care Planning
  • DNACPR decisions
  • How you support service users through care
    planning and involve them in the decision making
  • Show how you ensure service users are active
    participants, not passive recipients
  • Without this evidence, we cannot promote and
    influence the changes you know are needed

Actions we will
  • Encourage GPs to identify their 1
  • Continue to work closely with social care
  • Benchmark all health commissioned providers
    against the NICE Quality Standards for End of
    Life Care for Adults - 2011
  • Respond to the scrutiny recommendations

Email - gordon.pownall_at_hertfordshire.nhs.uk Tel
- 01707 369777
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