End of Life Care in London Achievements and next steps Dr Caroline Stirling – Clinical Director, NHSE/I (London region) EOLC Clinical Network Pan-London EOLC event 2nd May 2019 Outline – workstreams this uyear and next year Thank you All of you involved in advocating for EOLC – as commissioners, as members of the public and as providers Thank the EOLC team, the CLG, the care homes teams, the regional team – clare O’Sullivan, Selina Robinson, Lyndsey Williams, Lucy Quiinn, Paul Trevatt replaced by Laura Cook, Niam and Shreya Shah Thjank the Care homes team

Passion Enthusiasm Teamwork Perseverence Inddividuals, teams, services and commissioners All are compromised – financially, with time and staff Rising need – numbers, complexity, expectations –from our colleagues, from the 50,000 Londoners who die each year and their carers, and ourselves Health care leaders of new york – word cloud - innovation, leadership, pt –centred approach, and a desire for high quality care

System wide data Ongoing rise in deaths outside hospital Rise in care home deaths cf flattening of national average data Continue to keep ahead of national average in terms of home deaths October 2018 – 13 beds at pembridge closed June 2018 – 16 beds at Michael sobell house closed - replaced within the cancer centre http://www.endoflifecare-intelligence.org.uk/home

NHSE (London region) EOLC Clinical Network – 2018/19 End of Life Care Clinical Leadership Group EOLC in Care Homes Homelessness Identification Review of CMC Access to EOLC Medicines Bereaved carers resource London Metropolitan Police Commissioners Network group Support for STPs CCG Visits

National EOLC leads network London teams / networks / projects Strategic engagement National EOLC leads network London teams / networks / projects CMC review STPs / Integrated Care Systems: Joint meetings – sharing of strategies, data, challenges etc Individual support / engagement CCGs: Commissioners network meetings 27/32 individual visits Knowledge, enthusiasm and desire for change All have improved EOLC services c.f survey (2017) Recognition of and support for use of CMC Areas of development - BAME, homeless, public engagement 2019/20: Ongoing meetings / support Joint commissioners / clinical leads meetings 16 CCG visits with clinical leads

Phase 1: Data packs for 5 STP footprints No of care homes and beds No of deaths in care homes – c.f 75+ and care home beds LAS call outs and conveyances Use of CMC Meetings /sharing of data Phase 2 – 2019/20 Evaluation of NHS 111*6 line use: Liaison with CQC, larger care home providers Ongoing production of data packs Questionnaires, data, call review Small project – Charlotte Bryan, Josh Brewster, Charlene Chigumira, clare o’Sullivan, Lucy Quinn

Facilitate engagement Resource collation and cascade Homelessness Aim: Share expertise Facilitate engagement Resource collation and cascade http://www.londonscn.nhs.uk/wp-content/uploads/2014/11/Homelessness-and-EOLC-Useful-Resources.pdf Effective interventions Parallel planning Multi-agency meeting In-reach to hostels Training Specialised services London 2016/17 2017/8 No of deaths 49,086 49,622 No of predicted deaths (n x 0.75) 36,814 37,216 No of deaths with CMC record 4789 4892 % of deaths with a CMC record (range / CCG) 9.7% (0.3-18.6%) 9.8% (0.6-18.8%) % of predicted deaths with a CMC record (range / CCG) 13% (0.3-25%) (0.8-25%) Barnet Bromley Croydon (~30% of expected deaths) People on CMC not at end of life? ? Percentage of people who died who had a CMC recorde

Access to Palliative Care medications Aim: to reduce inequity of access to EOLC medications in community Joint project with NHSE (London region) Pharmacy team Working group: Case for change Draft specification List of medications Communication – August 2018 and April 2019 2019/20 – ongoing support of Pharmacy team to deliver project. Scoping meeting to explore options for unified approach to Medication and Administration Record in London Dissemination of outputs and next steps 20 medications – some with more than one doseage and 5 in the extra list

Bereaved carers’ resource Aim: single resource for registrars throughout London Development and testing 2019/20 – dissemination Enhancing physical and mental wellbeing working group – lay member Brian Andrews, Andre Verceuil Lyndsey Williams.

Metropolitan Police – multi-agency working Aim: Improved response to community deaths May 2018 – statement cascaded Working Group formed: Mapping exercise Scoping of priorities 2019/20 – development of communication, education, clarification of roles, responsibilities etc Last

Identification CMC records 2016/17 2017/8 2018/19 No of CMC records created 10,267 15,560 15,479 No of deaths with CMC record 4789 4892 3294 % of deaths with a CMC record (range / CCG) 9.7% (0.3-18.6%) 9.8% (0.6-18.8%) 6.6% % deaths outside hospital of those with a CMC record 79% 78% 88%

Identification – place based project Support for delivery of 2019/20 EOLC QI project within GP contract: Top tips guidance Co-development of GP-system (EMIS, SystmOne, Vision) based search tool to support identification of those likely to be in the last year of life Publication of tool Place-based project in Newham to implement tool and deliver QI project Dissemination of learning Single metric for London

Elements of End of Life Care Identification Of those who might be the last year / days of life In all settings By everyone Compassionate conversations With person & those important to them To undertake shared decision making - establish understanding, priorities etc High quality care Of person & those important to them In all settings With optimal use of hospital care Without identification the rest wont happen – highlight evidence base ACP preventing hosp adm and support PPD. Drive CMC but need to identify Collaboration With person & those important to them Between health, social and third sector providers Between primary and secondary care Between in and out of hours care