End of Life Care Gordon J Pownall Community Commissioning Manager Commissioning Lead for End of Life and Palliative Care NHS Hertfordshire

Usual place of residence The latest figures from the Care Quality Commission show there are over 460,000 residents living in 17,740 nursing and residential homes across England. Latest statistics indicate that 18% of people died in care homes between 2008 – 2010 compared with 29% of those on an Electronic Palliative Care Co-ordination System (EPaCCS) who say they would prefer to die in their care home setting. Meanwhile 16% of care home residents are still admitted to hospital within the last week of their life and die there What we know now that we didn’t know a year ago: New intelligence on end of life care in England. NEoLCIN, May 2012.

Integrated Care for End of Life TIME Curative CarePalliative Care Death Old concept Supportive and Palliative Care Curative Care / disease modifying treatment Bereavement Care Death Integrated Concept

Place of death 2011/12

What are the issues…? Care homes are often seen as the poor relation when it comes to end of life care training and awareness-raising. The rapid turnover of the workforce combined with heavy workload demands can make it particularly challenging to organise training and embed the learning. Homes are often isolated from each other and often the rest of health and social care services – this serves to exacerbates the issue of poor integration. Perception of additional pressures (financial and human) on smaller organisations / services taking staff away from primary roles in service delivery Lack of understanding what is being asked of you and more importantly…WHY…!

Implementation of AMBER in East and North Herts Hospital Hospice opening 24/7 – Pilot in West Herts Extension of Hospice at Home to cover the gap in St Albans and Harpenden Extension of funding to education in care and nursing homes Planned implementation of cAMBER pilot in West Herts Actions – we have… Additional investment for 2012/13 on pilot initiatives :- £500,000

So what is the current picture? A recent NEoLCP survey of 56 end of life care facilitators, representing 5,693 care homes, showed significant increases in the implementation of :- – Gold Standard Framework – ACP – Liverpool Care Pathway between 2010 and A more in-depth survey of 12 of these facilitators, representing 1,768 homes, indicates that the uptake is still quite low. – Just over 20% of homes were making use of ACP while use of tools such as GSF, LCP, PPC and local approaches were significantly below this. Even in the nursing home sector, uptake of each of these approaches was below 50%.

Making adjustments and supporting initiatives It is also crucial to have the support of the care home manager and to have people working on the ground as (end of life) care champions, ensuring the individual is always at the centre of the care planning process.

What challenges can we overcome…? Invest in activities that promote advance care planning (to reduce hospital admissions, A&E attendances, unnecessary use of ambulances) Invest in services that support people to remain where they wish (to encourage and promote respect for an individual to choose to die in their preferred place whether you are staff, relative or other professional) To understand the impact on the wider community where we react rather than respond (to promote and make best use of the limited resources we have available and ensure the right care is always available)

We need your support to :- Record your activity – evidence the work Don’t tell me – show me…! Admissions to Hospital Advance Care Planning DNACPR decisions How you support service users through care planning and involve them in the decision making Show how you ensure service users are active participants, not passive recipients Without this evidence, we cannot promote and influence the changes you know are needed

Actions – we will… Encourage GP’s to identify their 1% Continue to work closely with social care colleagues Benchmark all health commissioned providers against the NICE Quality Standards for End of Life Care for Adults Respond to the scrutiny recommendations - Tel :