we help to improve social care standards March 2014 Improving End of Life Care across the Yorkshire & Humber area Sally Gretton Area Manager Skills for Care

Yorkshire and the Humber End of Life Care Homes project  an overview of the findings from the EoLC project in Yorkshire and the Humber (YH) for care homes

Yorkshire and the Humber area  Over 1650 care homes for adults  Over 700 registered Domiciliary care providers  17,500 individual employers – who employ 25,000 personal assistants (health and social care workforce)  5000 nurses employed in social care Source National minimum data set for social care

Aim of the programme  The work streams/projects anticipated to achieve sustainable outcomes for care home that include:  An increase in the number who have advance care plans in place  An increase in the number who die in their place of preference  An increase in the number who are allocated a key worker as they approach the end of their lives  An increase in the number who are entered onto an EoLC care pathway.

Programme plan  Manager and Champion Development programme  Development of Networks  Development of a guide to support care homes  Commissioner/ regulator/ contractor development  E-learning project

How we evaluated the project -  Questionnaires to managers and champions prior to starting and 6 months after the development programme… some difficulties  Stakeholder questionnaire and interviews  Feedback from care homes regarding the usefulness of the resource guide  Feedback from Care Quality Commission inspectors  Feedback from Commissioners following Contract Compliance sessions

Barriers…  Major changes to NHS and Local Authorities  Gold Standards Framework been delivered in some areas  Lack of awareness of the project  Target was 800 – YH is one of the highest areas for manager turnover.

Outputs  From the 1650 registered care homes in YH, 511 care homes across YH accessed the programme. 516 managers 489 champions (over 1000 people trained)  17 networks in place across YH, on average 8-10 care homes at networks  Over 2000 copies of the resource guide disseminated

Outcomes from the EolC Care Homes project  The proportion of residents with advance care plans in place rose from 34% to 45%  The proportion who died with a specified place of preference rose from 46% to 72%  The proportion who died in their place of preference remained the same at 88%  An increase in the number of managers who looked into when a resident had died in a place other than their place of preference 69% to 79%

Outcomes  Local authorities are including end of life care as part of workforce strategies  NHS and Local authorities are including end of life care as part of the contracting arrangements  Over 50 inspectors were engaged in the project.  Integration of end of life experts with social care has greatly increased within networks

What the managers are saying about the development programme  The end of life programme has highlighted to the management and staff the need for continuous end of life care.”  “I have thoroughly enjoyed this programme and the support and help from the End of life care trainers has been amazing.”  “a strong reminder of the need for quality end of life care, excellent course”

What the champions are saying about the development programme  “ I feel I have gained more knowledge and understanding towards end of life care and applying it in-house”  “have improved confidence and knowledge for use in the workplace”  “should be expanded its great”

Value of the networks  17 networks currently exist  158 managers and 91 champions who have undertaken the training have attended a network  267 additional care homes attend the networks who have not had staff complete the training programme.  Overall 425 care homes are engaged with the networks  162 Community Matrons, End of life Care Facilitators, Discharge Co-ordinators, Performance and Contract Managers from the NHS and Local Authorities

Networks – what did managers say  An opportunity to share information and good practice between the managers  Sharing local strategies in dealing with hospital admissions/discharges  Staff difficulties in having the Eolc conversation with residents  Difficulties in completing developing care plans when residents are in advanced stages of dementia.

Case studies 15 care homes have written a case study about the changes they have made since completing the development programme. The changes include; new advanced care plans, training for all staff in EolC, tools to help with having an EolC conversation with residents and relatives and improved relationships with GP’s and Community staff

Comments from stakeholders  Stakeholders indicated that integrated working, raised awareness of end of life care issues and levels of confidence in care home staff had significantly improved during the life of the project.  With care homes taking more people with complex needs, people nearer to death, raising awareness of end of life care was a necessity and had largely been achieved.  There are requests to extend the current scope of the project to include other sub-sectors such as domiciliary care and amend the training programme to suit.

Added value  Integration of health and social care partners working together to improve practices – delivery of training, networks and events in sharing good practice  The networks and resource guide will continue beyond the life of the project with the inclusion of other care homes and domiciliary care providers.

recommendation  Respondents gave examples of challenges they had encountered in trying to improve their end-of-life care, which usually fell into the categories of dealing with family members, GPs, resistance by staff / shortage of staff, and updating paperwork / documents. Managers generally felt that continued networking and good communication of all parties, and continued and on-going training / refresher training were important in sustaining the programme in future.

recommendation  Forming relationships in the local areas sooner – working with NHS and LA from the beginning  Assess need in each local area and offer a more flexible approach to learning – QCF units/hospice training/support from Eolc specialists  Deliver training programme in partnership with hospice or NHS and include all staff – healthcare assistants, paramedics, staff in hospices, community based staff, qualified staff where appropriate.

National and future picture of end of life care?

National stats…..  Decrease in the number of people dying in hospital – down from 58% to 51%  Death in usual place of residence increased from 38% to 44%  People with an Advanced Care Plan spend 18.1 days in hosp with 26.5 who did not have one

Waiting - govt response  Neuberger review on LCP  Plus Cavendish  Francis report  Berwick review  Keogh report  Ann Clywd report..investigation of complaints

Questions Any questions

Name: Sally Gretton Phone: