1. Transforming the quality of end of life care - a regional collaborative Dr Julian Abel Consultant in Palliative Care, Weston Super Mare, England Clinical Lead, End of Life Care, Southwest Strategic Health Authority 2008 - 2013

2. Our Health, Our Care, Our Say. Department of Health 2006. ‘Over 500,000 adults die in England each year. Although over 50 per cent of people say they would like to be cared for and die at home if they were terminally ill, at present only 20 per cent of people die at home.’ ‘We will establish end-of-life care networks, building on the co- operative approach suggested by the new urgent care strategy.’

3. South West Strategic Health Authority End of Life Care Network, 2008 – 2013 Population 5,289,000 42,000 deaths per annum

4. Formation of South West SHA end of life care network Invitation to all individual Primary Care Trusts Lead commissioners for end of life care, lead clinicians and specialist palliative care professionals Ring fenced mulitprofessional education and training budget, £1 million for 2008 – 9 and 2009 -10.

5. The End of Life Care Pathway, National End of Life Strategy 2008 (Primary and secondary drivers)

6. Micro, meso, macro MicroMesoMacro Hospices GP practices District Nursing Services Community Matrons Domiciliary Care Agencies Nursing Homes Residential Homes Out of hours GP services Ambulance services Primary Care Trusts Acute Hospitals South West SHA National meeting of SHA with National Clinical Director for End of Life Care Mike Richards National End of Life Care Programme

7. 3 year programme Year 1Year 2Year 3 Adoption of EPaCCS Advance care planning (ACP) Nursing Homes Education programmes building on year 1 Use of EPaCCS ACP Residential and nursing homes Transforming end of life care in Acute Hospitals national programme

8. Transforming End of Life Care in Acute Hospitals 5 key enablers 1.Use of electronic palliative care coordination systems 2.Use of advance care planning 3.Use of treatment escalation plan (eg Amber Care Bundle) 4.Use of rapid discharge home to die pathway 5.Use of Integrated Care Pathway for the dying (last 48 – 72 hours)

9. Where people with terminal illnesses choose to die

10. Impact of advance care planning on place of death

11. EPaCCS place of death data

12. ONS Mortality place of death compared to EPaCCS place of death (3007 EPaCCS deaths)

13. Percentage death in usual place of residence (DIUPR) Rolling three quarters 2010 to 2013

14. South West SHA First National Survey of Bereaved People 2012 Benchmark Ratings for key 11 questions about quality of care.

15. Dame Cicely Saunders (1918 - 2005) founder of the modern hospice movement How people die remains in the memory of those who live on