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

2. 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

3. 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?

4. 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%)

5. Classified according to GSF

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

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

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

14. Great majority were within 1 week of death

15. 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

16. 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