Quality Improvement Projects - a national update Paul Baughan General Practitioner National Clinical Lead Palliative and End of Life Care Living Well in Communities, iHub Healthcare Improvement Scotland

Vision: By 2021, everyone in Scotland who needs palliative care will have access to it. What’s the aim? Commitment 1: We will provide Health and Social Care Partnerships with expertise in testing and implementing improvements to identify those who can benefit from palliative and end of life care and in the co-ordination of their care.

(Zheng et al 2013) To illustrate these points, this study by Zheng in 2013 showed in general that people are placed on the palliative care register late but while 75% of those who died from cancer were placed on the register only 20% of those with non-cancer diagnosis were put on the register Worthwhile noting the differences of these disease durations 6 months for cancer compared to 6 years for long term conditions

Cancer 75% Frailty /Dementia 20% (Zheng et al 2013) Percentage of patients on the general practice palliative care register at death, according to illness trajectory and if on register number of weeks before death they were placed on the register. Cancer 75% Frailty /Dementia 20% To illustrate these points, this study by Zheng in 2013 showed in general that people are placed on the palliative care register late but while 75% of those who died from cancer were placed on the register only 20% of those with non-cancer diagnosis were put on the register Worthwhile noting the differences of these disease durations 6 months for cancer compared to 6 years for long term conditions (Zheng et al 2013)

6 Health and Social Care Test Sites

Dundee Change idea: Test the Advanced Dementia Practice Model in a care home setting Detail:   Identification of (advanced) Dementia using FAST Tool Consider how to reliably use PPS for review of needs Consider use of Palliative Care Register Using the Alzheimer’s Scotland ADPM to co-ordinate and provide care Establish the training needs of qualified nursing staff and design an appropriate education package as required. Education/support for service users to improve experience of service before and after test of change

East Ayrshire Change ideas: 1. COPD community model for palliative care; 2. Care home palliative bed Theory for Change: COPD Population accounts for top 3% admissions to hospital. Improved identification and more effective anticipatory care will allow health and social care professionals to plan prospective need and provide care in the right place. Utilise a care home bed for those with palliative needs as an alternative to acute admission. Using SPICT and ECOG tools

Perth & Kinross Change idea: Improve identification and co-ordination of care need in small rural community setting Detail:  Adapt the Enhanced Community Support (ECS) model to identify those who might benefit from palliative approach and 'wrap' a personalised team around the individual providing the care and support required (using ECS risk stratification tool). More effective multi-disciplinary working to support end of life care, ensuring that care and support is more holistic and responsive to patient need.

Glasgow City Change idea: Improve access to palliative care for residents of local authority care home Detail:   Training sessions in aspects of palliative care organised for staff within care home Test the use of a SPAR tool with PPS to identify those who would benefit from palliative approach and use of Anticipatory Care Questionnaire / national ACP documentation to co-ordinate care.

Fife Change ideas: Development of Primary Care based MDT meetings across different GP practices Detail:  The development of extended MDT palliative care meetings across 2 large GP practices in NE Fife serving 25000. Testing use of Anticipal and SPICT to identify those who would benefit from a palliative approach which will be co-ordinated by an extended weekly multidisciplinary team. A structured formal assessment and individualised care plan will follow.

Western Isles Change idea: Develop a wider commissioning strategy to support end of life care and its implementation

Identification Tools?

Summary Many advantages to identifying people early Currently not doing this very well in Scotland HIS ihub Palliative Care Identification Tools Comparator can help 6 Scottish test sites looking at different approaches Great things to come from Dundee!

@PaulBaughan paul.baughan@nhs.net Living Well in Communities, iHub Healthcare Improvement Scotland