West Kent End of Life Care Strategy July 2013

Vision and Values 06/06/2016 Slide 2 A safe sustainable and affordable patient focused healthcare service that provides quality patient experience and improves outcomes for local people Delivered with a focus on: Clinical leadership; Quality and Safety; Focus on Benefits; Working in Partnership; Openness and transparency; Evidence based decisions; Individuals; Courage; Trust; The team When diagnosed with a life-long illness, individuals, carers and their families will be offered the opportunity to discuss the type of care they would like to receive for the individual, and where the individual would like to treated. Individuals will also be supported to have conversations regarding where they would like to die and what is important to them and their family in the last days of their life such as discussions about pain relief, family issues, spiritual guidance. Please contact if you require further information or require a copy of the more detailed West Kent EOLC

End of Life Care - Pathway 06/06/2016 Slide 3 Purpose : End of Life Care (EOLC) should support people to remain independent where possible, allowing the final stages of life to be as comfortable as possible

Setting the context  Political, Clinical and Strategic Drivers  End of life care strategy (DH 2008):- Delivering co-ordinated care and support ensuring that individuals’ needs are met irrespective of who is delivering the service.  Transforming our health care system: Ten priorities for commissioners (The Kings fund – October 2011); Improving primary care management of EOLC.  NHS Mandate (April 2013-March 2015): improving standards of care and not just treatment, especially for older people and those at the end of their lives.  NHS Outcomes framework Domain 4.; Improving the experience of care for people at the end of their lives; Bereaved carers’ views on the quality of care in the last 3 months of life.  Health and wellbeing strategy (Kent ) – Improving End of Life care (outcomes 3 and 5 – reference to long term conditions and dementia)  Find your 1% mobilisation campaign (Dying Matters): engaging GPs in identifying the individuals who would benefit from a discussion on choices etc  Economic and Financial Factors  Variation on spending by PCTs on palliative care from £154 to over £1600 per individual (National Audit office 2008)  Palliative care funding review (July 2011) : seeking to create a fair and transparent funding system for palliative care 06/06/2016 Slide 4

Setting the context  Social & Demographic Features  More than 5 thousand people die every year in West Kent of which two thirds are over 75 and the large majority follow a period of chronic illness (WK CCG Urgent care strategy 2013).  Annual number of deaths expected to rise by 17% from with many more expected to die at an older age with multiple co-morbidities with average age of death set to increase (e.g. those over 86 to rise from 32 to 44 percent).  Two thirds of people would prefer to die at home but in practice only one third do (Higginson 2003)  Bereaved people rated the quality of care in the last three months of life as outstanding or excellent by 43%, good by 33% fair by 14% and poor by 10% - with greatest satisfaction in hospices or at home and lowest satisfaction in hospital. (National VOICES survey).  Only 10-20% of specialist palliative care are made available to non-cancer patients. (National Council Palliative Care 2012)  Technology Drivers  Use of risk stratification systems to identify individuals who would benefit from the EOLC pathway and reduce unnecessary use of acute hospital care.  Expansion of assistive technology to support people at home. 06/06/2016 Slide 5

Setting the context – West Kent  Strengths  In line with national data trends showing a decline in the number of deaths in hospital and an increase in hospice care.  Established whole system planning structure in place and active engagement by hospices  Weaknesses  Benchmarking data shows a poorer than average performance in supporting people to die in their own homes and for those over 85 a significantly higher percentage of terminal admissions as emergencies.  A significantly lower % of care homes achieving the Gold Standard Framework than the English average.  Threats  Rising number of frail older people with multiple co-morbidity and in need of complex care requiring more intensive support and greater capacity in health and social care.  Opportunities  Hospice in the Weald have been funded by the National End of Life Care Programme for a project to develop, deliver and evaluate a 6 Steps to Success Programme for Community Hospitals with a view to this being the programme will then roll out countywide  National commitment to developing a per-patient funding system for palliative care piloted by Heart of Kent Hospice delivering better quality data on individuals to help identify range of needs 06/06/2016 Slide 6

Mapping the Ambitions 06/06/2016 Slide 7 WK CCG Strategic Aims i.A thriving local NHS provider landscape for the West Kent population which delivers safe and high quality urgent and non- urgent care. ii.Improved patient and carer experience for End of Life Care. iii.Improved and integrated health and social care packages for the older population. iv.Support and enhance healthcare provided by General Practice. v.Engaged and empowered patients who are able to manage their own health and make informed decisions. Strategic Ambitions for End of Life Care  Increase the percentage of deaths in usual place of residence.  Reduce inequalities in access to end of life care.  Secure the provision of effective high quality care.  Develop a whole system approach to improving end of life care. NHS Outcomes  Enhancing quality of life for people with long- term conditions.  Ensuring that people have a positive experience of care.  Treating and caring for people in a safe environment and protecting them from avoidable harm.

Strategic Ambitions –EOL care 06/06/2016 Slide 8 Increase in the percentage of deaths in usual place of residence Strategic Focus  Proactive identification and risk management e.g. risk stratification, early advance care planning for all individuals, MDTs  Community alternative to crisis hospital care preventing admission and supporting fast track discharge e.g. Rapid response home treatment services, out of hours services, virtual wards, anticipatory prescribing, equipment, key worker roles Outcome Measures  Reduction by 15% in the number of people at the end of their lives being inappropriately admitted as emergencies to hospital by April 2016;  Reduction in the number of individuals inappropriately dying in hospital by 15% by April 2016;  Increase by 15% in the number of individuals dying in their normal place of residence by April 2016;  Reduction by 15% in care home admissions for individuals who are at the end of their life and who can be appropriately supported in their own home environment by April 2016; Links to Domain 2,4 and 5

Strategic Ambitions –EOL care 06/06/2016 Slide 9 Reduced inequalities in access to end of life care Strategic Focus  Securing effective and equitable coverage offered by specialist palliative care and EOLC based on need e.g. pathway to support those with organ failure, links with dementia strategy  Increasing awareness and reducing taboo around EOLC e.g. media campaigns, engagement events, dying matters. Outcome Measures  EOL experience improved for people with organ failure accessing specialist palliative care.  Increase in the number of people with advance care plans, particularly with dementia  Identify approximately 1% of a practice population who are at the end of their life across all diseases Links to Domain 2 & 4

Strategic Ambitions –EOL care 06/06/2016 Slide 10 Secure provision of effective high quality community services Strategic Focus  Workforce training, development and support e.g. protected learning time for GPs and hospital consultants, six step programme, GPs in care homes  Use of assistive technology in line with strategies for Long term conditions e.g. pilot use and evaluate impact  Audit programmes e.g. systematic review of patient experience including VOICES survey  Shared health diagnostic and social care information e.g. electronic supportive care register Outcome Measures  Reduction by 15% in care home admissions for individuals who are at the end of their life and who can be appropriately supported in their own home environment by April 2016;  Improvement in quality of care in the last three months of life (VOICES)  Greater multi agency coordination of care  Improved information, signposting, co- ordination, decision making, communication, preferences and choice Links to Domain 2 and 5

Strategic Ambitions –EOL care 06/06/2016 Slide 11 Develop a whole system approach to improving End of Life Care Strategic Focus  Compassionate communities and strategies to reduce isolation e.g. links across housing, health and social care.  Whole system planning and monitoring of EOLC e.g. data set and monitoring framework, engagement strategy. Outcome Measures  Housing Planning framework in place to support people as they age  EOLC identified as a key element of the Health and Well-being Strategy.  Evidence of active and well supported engagement processes.  Agreed performance framework with tools to deliver data in a timely and accurate way Links to Domain 2,4 and 5

Partnerships and whole system engagement 06/06/2016 Slide 12 Local Authorities (KCC and District Councils)  Kent Health and wellbeing strategy Outcome 3  Housing - supporting compassionate communities  Electronic Palliative Care Co-ordination System record  Supporting care homes Public Health  Joint Strategic Needs Assessment  Prioritisation  Service improvement and commissioning plans  Public health Intelligence and evidence based information Public and Patients  Health Network  Healthwatch  Patient Participation groups  Carers Voluntary sector  Heart of Kent Hospice  Hospice in the Weald  Community groups  National groups e.g. Macmillan  Domiciliary services (e.g. Care at home)  NHS England  National EOLC strategy leadership  Primary care commissioning NHS Providers  Maidstone and Tunbridge Wells NHS Trust (Macmillan Palliative Care team)  Kent Community Health  Kent and Medway Partnership Trust  Primary Care (GPs, Pharmacists)  OOH providers  SECAmb Other West Kent Strategy groups  Long term conditions pathways including Dementia  Cancer Network (Supportive and Palliative care)  Urgent care whole system group / Network  Health and social care integration  Dementia (KMCS)  Practice engagement (Practice Focused committee) End of Life Care Strategic Implementation Group Management team incl: KMCS  Contracting and Procurement  Finance  Quality and safety

Programme governance (Proposed) 06/06/2016 Slide 13 Clinical Strategy Committee Governing Body Integrated Care Programmes for Older People Practice Focused Committee KCC Health and Wellbeing Board (Strategy) Quality & SafetyFinance & Performance West Kent Health and Wellbeing Board H&SC integration (joint with KCC) Dementia (supported by KMCS) End of Life care (WK strategy implementation group) Carers (joint with KCC) Urgent Care Programmes Healthy & Wellbeing (Localities & Public Health) Medicine Management Direct Accountability Partnerships Planned Care Programmes Falls (to be led across Kent) Mental Health Programmes Urgent Care Integrated Care Programmes for Older People Dementia (supported by KMCS) Integrated Care Programmes for Older People H&SC integration (joint with KCC) Dementia (supported by KMCS) Integrated Care Programmes for Older People Carers (joint with KCC) H&SC integration (joint with KCC) Dementia (supported by KMCS) Falls (to be led across Kent) Carers (joint with KCC) H&SC integration (joint with KCC) – Task force group Dementia (supported by KMCS)

Summary  West Kent clinical commissioning group and Kent County Council are committed to working in partnership across health and social care as well as the voluntary and private sector in improving the end of life experience of local people.  This strategy identifies four interrelated strategic ambitions to ensure that people at the end of their lives and their families and carers receive seamless, safe and integrated Health and Social care services, and that they have access to care to help prevent a crisis and are able to die in their place of preference.  Achievement of these ambitions will be regularly monitored, evaluated and reported using national and local quantitative and qualitative information. Responsibility will sit with the Integrated care programme reporting to the West Kent CCG Clinical Strategy Committee. 06/06/2016 Slide 14