1. National End of Life Care Update
Prof Bee Wee
National Clinical Director for End of Life Care, NHS England
2nd May 2019

2. National update NHS Long Term Plan Personalised approach
New service models – older people, children and young people
GP Quality and Outcomes Framework
Priorities and approach for 2019/20
Responding to challenges
Presentation title

3. NHS Long Term Plan: Para 1.42
Para With patients, families,
local authorities and our voluntary
sector partners at both national and
local level, including specialist hospices,
the NHS will personalised care,
to improve end of life care.
By rolling out training to help staff identify
and support relevant patients, we will
introduce proactive and personalised care
planning for everyone identified as being
in their last year of life……..

4. NHS Long Term Plan: Para 3.41
Children’s palliative and end of life care –
…increase contribution by match-funding
CCGs who commit to increase their
Investment in local children’s palliative
and end of life care services
including children’s hospices – up to a
combined total of £25 million/year by
2023/24.

5. Investment and Reform: 5 year framework for GP Contract Reform: QOF reforms
Aims - improvement in:
Early identification and support for people with advanced progressive illness who might die within the next 12 months
Well-planned and coordinated care that is responsive to the person’s changing needs with the aim of improving the experience of care
Identification and support for family/informal caregivers, both as part of the core care team around the patient and as individuals facing impending bereavement

6. Investment and Reform: 5 year framework for GP Contract Reform: QOF reforms
Practices need to:
Evaluate current quality of their end of life care and identify areas for quality improvement – e.g. retrospective death audit
Identify quality improvement activities and set improvement goals
Implement the improvement plan
Participate in a minimum of 2 GP network peer review meetings
Complete QI monitoring template in relation to this module

7. Investment and Reform: 5 year framework for GP Contract Reform:
Focus on: contractor engagement, participation in quality improvement
activity in own practice and shared learning across network

8. Comprehensive Model for Personalised Care
All age, whole population approach to Personalised Care
TARGET POPULATIONS
INTERVENTIONS
OUTCOMES
People with long term physical
and mental health conditions
30%
Specialist
Integrated Personal Commissioning, including proactive case finding, and personalised care and support planning through multidisciplinary teams, personal health budgets and integrated personal budgets.
Empowering people,
integrating care and
reducing unplanned
service use.
People
with
complex needs 5%
Plus Universal and Targeted interventions
Targeted
Proactive case finding and personalised care and support planning through General Practice. Support to self manage by increasing
patient activation through access to health coaching, peer support and self management education.
Supporting people to
build knowledge, skills
and confidence and to live
well with their health
conditions.
INCREASING COMPLEXITY
PEOPLE MOVE AS THEIR HEALTH AND WELLBEING CHANGES
Plus Universal interventions
Universal
Shared Decision Making.
Enabling choice (e.g. in maternity, elective and end of life care).
Social prescribing and link worker roles.
Community-based support.
Supporting people to stay well and building community resilience, enabling people to make informed decisions and choices when their health changes.
Whole population
100%

10. Significant delivery of Personalised Care
Shared decision making
Personalised care and support planning
Enabling choice
In 2017/18 SDM was embedded into:
Musculoskeletal elective care pathways across 13 CCGs
Respiratory elective care pathways in 8 CCGs
142,904 people had a personalised care and support plan between April 2017 and September 2018
Over 204,000 people supported by integrated, personalised approaches
97% of CCGs have now completed Choice Planning and Improvement self-assessment
Of these, 85% report compliance with at least 5 (of 9) choice standards
Personal health budgets & integrated personal budgets
Social prescribing & community-based support
Supported self management
68,977 referrals in 2017/18
331 link workers employed in local areas
101,637 patient activation assessments by September 2018
Over 44,093 people referred to community-based support
Over 59,545 people referred to self-management education or health coaching
32,341 PHBs by September 2018
Up 110% year-on -year in 2018 (to end Q2)
23% jointly funded with social care
55,511 Personal Maternity Care Budgets delivered by September 2018 across 36 CCGs

11. Other high level commitments from 2019/20
Maternity
52% of women will receive a personalised care plan by March 2020 (32% by March 2019)
End of Life Care
Increase the percentage of people who have died who had been offered the opportunity for personalised care and support planning, from 39.6% to 75% in 10 years

12. Core Objectives
DH Mandate
Increase the percentage of people identified as likely to be in their last year of life, so that their End of Life Care can be improved by personalising it according to their needs and preferences.
UPC Target
Increase the percentage of people who have died who had been offered the opportunity for personalised care and support planning, from 39.6% to 75% in 10 years.
Long Term Plan (1.42)
Roll out training to help staff identify and support relevant patients, we will introduce proactive and personalised care planning for everyone identified as being in their last year of life.

13. Deliverables Implementation of QOF QI
The Quality and Outcomes Framework - Quality Improvement (QOF QI) aims to improve; early identification and support for people, well-planned and coordinated care and identification and support for family/informal caregivers.
Improved outcomes and experience in EoLC
Survey of Bereaved People (VOICES-SF). Collaboratively working with the Insight and Feedback team to focus on local options to gain feedback on the Quality of care delivered in the last 3 months of life for adults who died.
NHSI Getting to Good Programme
As part of an ICS or place based project this aims to reduce the number of trusts rated as inadequate or requires improvement by the CQC.
Early identification tools within electronic systems using read codes
The project will look to commence a wider testing of the screening tools (test sites) as well as translating the toolkit from EMIS to SystmOne.
CHC SIP
Using a place-based approach properly test the hypothesis that improved identification, and personalised EoLC will reduce the use of CHC Fast track.
Build and continue to develop a joint narrative with CHC SIP/ADASS/EoL

14. Regional offer for NHSE/I teams
Wider Community
Workforce
National Support offer
Delivery Innovation (formerly Testing) Programme
Demonstrator
Programme
Champion and Mentor Programme
Patients and Carers
Professional
Evidence
Policy and Infrastructure
Enablers (LE, FCC etc)
Regional offer for NHSE/I teams
System offer for ICS/STPs
Place offer for CCGs
Neighbourhood offer for Primary Care Networks

15. National Support offer- available to all
Sharing good practice, signposting, peer support
Hospice UK – Awareness Raising (Commitments)
NHS England has commissioned Hospice UK to work with a limited number of hospices to explore mechanisms for raising awareness and expectations about the governments 6-point commitment amongst patients, their families and the wider community – case studies will be available in 19/20 Q2.
RSA Student Design Awards
NHS England has sponsored a Moving Pictures Brief to raise awareness about the importance of talking about death and dying, planning for the future, and thinking and talking about a time when you are going to be less well, including when you are dying. The winning animation will be announced in 19/20 Q1.
Hospice UK - Holistic
NHS England has commissioned Hospice UK to identify the critical components of hospice-led interventions and service models that are effective in preventing avoidable admission to hospital, or supporting early discharge and transfer from hospital for people approaching the end of life. The report is due 19/20 Q1 and will provide an evidence-base for end of life care service re-design.

16. National Support offer- cont’d
Commissioning Models for PEoLC for CYP
A group of stakeholders have developed a service specification & commissioning model which is to be tested in 2 regions over the next 12 months. This draft model will be published in 19/20 to share best practice commissioning for C&YP.
Generic Mailbox
The EoLC mailbox is single point of access, the team will respond or signpost as appropriate.
Collaboration Platform
The Personalised Care Group NHSFuture Collaboration platform will signpost to the knowledge hub on the Ambitions website and our resources page.
Webinar Series
Webinars provide support to professionals by raising awareness of subjects, they also share good practice. Webinar recordings are available on the NHS England website, slides are available upon request.

17. National Support offer- cont’d
Ambitions Partnership
The Ambitions website contains published best practice, case studies, implementation guidance and lessons learnt, the National EoL Programme Board papers are also available.
National EoLC Practitioners network
To share good practice, develop best practice, peer support, collaborative working, getting to outstanding in EoLC, sharing the national agenda and the LTP, support the CNO and NCD in ensuring EoLC continues to improve, share the outputs and support service improvement requirements of the NACEL
Palliative and End of Life Care Clinical Leaders
To provide a focus for strategic clinical leadership for palliative and end of life care reaching across every STP/ICS and maximising potential for effective communication and shared learning
Support/Mentoring (PCG demonstrator site leads)
End of Life Care Team can provide support and signposting for site leads.

18. Place offer Place based project in each of 7 regions
Supports delivery of the core objectives and one or more of the proposed deliverables for 19/20
Project assurance provided by the National EoL Team

19. Neighbourhood offer - available to Primary Care Networks
Support for QOF Quality Improvement
Work with our partners to develop and deliver a support offer for GP practices and Primary Care Networks to demonstrate continuous quality improvement focused on end of life care

20. EoL Programme: how it all fits together
6 point commitment
Honest conversations
Informed decisions
Developing personalized care plan
Sharing plan with professionals
Involving family to the extent wishes
Know who to contact

21. National update NHS Long Term Plan Personalised approach
New service models – older people, children and young people
GP Quality and Outcomes Framework
Priorities and approach for 2019/20
Responding to challenges
Presentation title

22. Complex challenging world
More demand
Less workforce
More expectations
Know more about less
Struggle with acknowledging limits
Diminished respect for authority, expertise
Speed of communication
Presentation title

23. Palliative care: specific features
Crosses biomedical, social and societal boundaries
Approach that integrates art and science
Attracts public, media and political interest
Dying and death happens to everybody
Hugely emotive – personal stories
Managing boundaries
Palliative care leaders:
driving forward the specialty
supporting colleagues at generalist level
managing expectations
seeing wood for trees
Presentation title

24. Burning platform…..
Of 1.4 million people who work in the NHS in England:
> 50% unable to meet all the conflicting demands at work
Nearly 40% - unwell as a result of stress in the past year
Around 50% more debilitating levels of work stress compared with general working population
44% only - able to make improvements in their area of work
Presentation title
Source: West M, King’s Fund 2017

25. Staff wellbeing
Link between quality of patient care and staff wellbeing
Low staff engagement – leads to:
Lower patient experience
Lower productivity
Increased risk of workplace accidents
Higher levels of staff turnover
Higher rates of burnout
Presentation title

26. How leaders think: shift in mental model
Volume
Patient satisfaction
Increase revenue
Organised through large hospitals
Quality departments and experts
Value
Patient as partner
Decrease per unit cost and waste
Redesign delivery of care
QI in daily work for all
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; Available on

27. How leaders behave Person-centredness Front line engagement
Relentless focus – on vision and strategy
Transparency – results, progress, aims, defects
Across boundaries
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; Available on

28. IHI high impact leadership framework: where leaders focus effort
Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; Available on
Presentation title