1. 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

2. 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

3. 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

4. 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

5. 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

6. 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

7. Facilitate engagement Resource collation and cascade
Homelessness
Aim:
Share expertise
Facilitate engagement
Resource collation and cascade
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%
( %)
9.8%
( %)
% 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

8. 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

9. 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.

10. 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

11. 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%
( %)
9.8%
( %)
6.6%
% deaths outside hospital of those with a CMC record
79%
78%
88%

12. 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

13. 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