South West Public Health Observatory South West Regional Public Health Group Trends in End of Life Care in the South West Mark Dancox, Andy Pring, Roy Maxwell, Sean McPhail and Julia Verne

South West Public Health Observatory South West Regional Public Health Group A good death The NHS End of Life Care strategy (DH, 2007) defines a good death as: –Being treated as an individual, with dignity and respect –Being without pain and other symptoms –Being in familiar surroundings –Being in the company of close family and/or friends

South West Public Health Observatory South West Regional Public Health Group Targets from the Next Stage Review Reduce deaths in acute hospitals by 10% per year (from 2007/08 baseline) for each of the next three years Reduce unplanned admissions to hospital from nursing homes in the last 12 months of life by 10% per annum (from the 2007/08 baseline) for each of the next three years. Ensure that patients can access the “basic building blocks of care” as described in the South West End of Life Pathway group report 24 hours a day, seven days a week.

South West Public Health Observatory South West Regional Public Health Group Numbers of cancers are still increasing, 33% increase expected by 2020 from a 2001 baseline (1.5% per year) Demographic change

South West Public Health Observatory South West Regional Public Health Group Changes by PCT ‘Urban’ PCTs ‘Rural’ PCTs

South West Public Health Observatory South West Regional Public Health Group Possible future mortality in the South West

South West Public Health Observatory South West Regional Public Health Group Possible future mortality in the South West

South West Public Health Observatory South West Regional Public Health Group Place of death by place- All causes

South West Public Health Observatory South West Regional Public Health Group Place of death by place- Circulatory Disease

South West Public Health Observatory South West Regional Public Health Group Place of death by place- Emphysema and COPD

South West Public Health Observatory South West Regional Public Health Group Place of death by place- Neoplasms

South West Public Health Observatory South West Regional Public Health Group Place of death by place- Respiratory disease

South West Public Health Observatory South West Regional Public Health Group Roy and Andy

South West Public Health Observatory South West Regional Public Health Group Preliminary analyses of patients and their end of life care using Hospital Episode Statistics (HES), South West, 2006/7 Roy Maxwell

South West Public Health Observatory South West Regional Public Health Group Emergency admissions of patients to hospital in the last year of life anonymised electronic records of patients who died in hospital in the period 1 st April, 2006 to 31 st March, 2007 who had a primary diagnosis of one of the following conditions, Dementia, Motor neuron disease, Multiple sclerosis, Heart failure, Renal failure, COPD plus any previous emergency admission in the last 365 days.

South West Public Health Observatory South West Regional Public Health Group Sex and age of patients at death Source: HES, NHS Information Centre

South West Public Health Observatory South West Regional Public Health Group Where the patient was immediately prior to their last admission to hospital Source: HES, NHS Information Centre

South West Public Health Observatory South West Regional Public Health Group Number of emergency admissions in the last year of life Source: HES, NHS Information Centre

South West Public Health Observatory South West Regional Public Health Group Length of all emergency admissions to hospital in last year of life, by primary diagnosis of final admission Source: HES, NHS Information Centre

South West Public Health Observatory South West Regional Public Health Group Length of final admission to hospital, by primary diagnosis (selected diagnoses) Source: HES, NHS Information Centre

South West Public Health Observatory South West Regional Public Health Group Month in which final admission took place, by primary diagnosis Source: HES, NHS Information Centre

South West Public Health Observatory South West Regional Public Health Group Patterns of Hospital Care among people who will die from cancer Andy Pring Julia Verne

South West Public Health Observatory South West Regional Public Health Group Place of Death

South West Public Health Observatory South West Regional Public Health Group Hospital Episode Statistics Cancer Register People who die from bladder, breast, colorectal, lung, prostate cancer ( ) HES All episodes between 1998 and 2006 Link NHS No DOB Postcode Sex 85%

South West Public Health Observatory South West Regional Public Health Group Included patients Bladder2098 Prostate4800 Breast5201 Colorectal6695 Lung10546

South West Public Health Observatory South West Regional Public Health Group Episodes

South West Public Health Observatory South West Regional Public Health Group Time spent in hospital – bed-days Cancer siteDays Bladder32.6 Breast22.9 Colorectal26.2 Lung22.5 Prostate27.3 Cancer siteMonths Bladder7 Breast8 Colorectal9 Lung4 Prostate7 Average bed-days in last 6 months Half the total bed-days

South West Public Health Observatory South West Regional Public Health Group Elective day cases

South West Public Health Observatory South West Regional Public Health Group Following emergency admission

South West Public Health Observatory South West Regional Public Health Group Treatment

South West Public Health Observatory South West Regional Public Health Group Treatment

South West Public Health Observatory South West Regional Public Health Group Treatment

South West Public Health Observatory South West Regional Public Health Group Treatment

South West Public Health Observatory South West Regional Public Health Group Treatment

South West Public Health Observatory South West Regional Public Health Group Treatment

South West Public Health Observatory South West Regional Public Health Group Treatment

South West Public Health Observatory South West Regional Public Health Group Treatment

South West Public Health Observatory South West Regional Public Health Group Treatment

South West Public Health Observatory South West Regional Public Health Group Is there a difference between those who die in hospital or elsewhere ?

South West Public Health Observatory South West Regional Public Health Group Is there a difference between those who die in hospital or elsewhere ?

South West Public Health Observatory South West Regional Public Health Group To conclude

South West Public Health Observatory South West Regional Public Health Group Risk of death in relation to hospital admission Collaborative work between SWPHO and the National Cancer Surveillance and Analysis Team Cancer, COPD, Heart Failure, Dementia, renal failure Multi-variate analysis of national HES dataset Examine interacting influence of age, diagnosis, admission type, co-morbidity, deprivation and other factors

South West Public Health Observatory South West Regional Public Health Group Information and communication on the End of Life Care Pathway – Stakeholder Survey As a first step: review current situation Aim to explore gaps in information and provision of services, experience of frontline staff across a range of disciplines 45 responses to survey, plus face-to-face discussions

South West Public Health Observatory South West Regional Public Health Group

South West Public Health Observatory South West Regional Public Health Group Hospital Trusts Communication Problems with other services Cultural issues of having the discussion about death and putting patient on care plan

South West Public Health Observatory South West Regional Public Health Group Primary Care/Community Nursing Better integration of systems needed Multi-disciplinary approach to GSF needed, which engages care homes Need better guidance for GPs, and more incentives to encourage their active involvement

South West Public Health Observatory South West Regional Public Health Group Hospices How much does good End of Life Care cost? There needs to be greater coordination in the delivery of patient care across providers There needs to be sharing of patient information throughout care pathway Needs to be more sharing of ideas and knowledge between Paediatric and Adult services across the region

South West Public Health Observatory South West Regional Public Health Group Care Homes Needs to be consideration of the multicultural makeup the workforce in care homes Better communication is needed with partners to be able to function effectively as part of the End of Life Care pathway Care homes need to be supported to develop required skills and confidence in staff

South West Public Health Observatory South West Regional Public Health Group PCT – Comissioners/PEC There is a lack of detailed information available to guide action and resource allocation Better information is needed on the implementation of End of Life Care tools/frameworks Problems with various systems that do not interact

South West Public Health Observatory South West Regional Public Health Group Out of Hours Service Better communication and patient information sharing is needed between out-of-hours services and other providers Needs to be a system in place to identify patients who are on an End of Life Care plan, and what their wishes are

South West Public Health Observatory South West Regional Public Health Group

South West Public Health Observatory South West Regional Public Health Group Further developments (for comment...) Addressing issues raised in stakeholder survey: –Liaison with regional stakeholders –Improving dataflow in the region National work : risk of death in relation to hospital admission Your suggestions...

South West Public Health Observatory South West Regional Public Health Group Risk of death in relation to hospital admission Collaborative work between SWPHO and the National Cancer Surveillance and Analysis Team Cancer, COPD, Heart Failure, Dementia, renal failure Multi-variate analysis of national HES dataset Examine interacting influence of age, diagnosis, admission type, co-morbidity, deprivation and other factors