The Balance of Care Group

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Presentation transcript:

The Balance of Care Group Alternatives to hospital for end of life care Tom Bowen The Balance of Care Group www.balanceofcare.com NAO End of Life Care Conference, London, 17 June 2009

The Sheffield study for NAO Support and participation of Sheffield University Teaching Hospitals NHS Foundation Trust Sheffield PCT St Luke’s Hospice Sheffield City Council Anonymised retrospective survey of hospital casenotes of people who died in Sheffield in October 2007 Additional linked data sets

Three major themes Where did patients die? What were the characteristics of the patients who died? What can be done to change the patterns of care?

More died elsewhere missing as some will not have any recent contact with STH hence no recent notes. 200 out of 217 died in hospital (as inpatient) surveyed (92%)

Classified according to GSF

Other Risk Factors Living alone 76 (22%) Housing 7 (2%) Carer Incapacity 18 (5%) Dementia diagnosis 65 (19%) Confusion 43 (12%) (no dementia specified)

Remembering that the B forms are a smaller sample – STH accounts for exactly 50% of total Oct07 deaths

Alternatives identified subject to acuity of patient (AEP status) plus also the potential for alternatives in terms of GSF and the Liverpool Care Pathway

Great majority were within 1 week of death

Contacts near the end of life Chaplaincy (13/200 dying in hospital) Community palliative care (65/104 with cancer) Heart failure nurses (4/47) COPD nurses (8/67) Social care (138/147 frailty patients) Survey data have been amended where additional data available from these sources Dependent on data availability, systems insufficient for district nurse/ community matron

An Integrated Model for End of Life Care Cancer Patient at End of Life Shared IT Common Data Risk registers Oncology team Surgeon Geriatricians Psychiatrists Primary Care teams Community Nurses Community Rehab Voluntary Organisations Cancer Patient at End of Life Cancer Charities Pain/Symptom Control team Frail Patient at End of Life Home care Nursing Homes Social Care Equipment Community Pharmacists Psychology Chaplaincy & Faith services Palliative Care teams Community matrons Carers Intermediate Care Hospices Carers Palliative Care teams An Integrated Model for End of Life Care Specialist medical teams Home care Specialist nurses Patient with Chronic Disease at End of Life Nursing Homes Carers Palliative care teams