1. Delivering Choice Jill George Hospice @ Home

2. What is Choice? To select from a number of alternatives (OED)

3. Changing the Culture Are we equipped to have open communication with our patients and their families? Talk! Preferred Priorities of Care Advanced Care Planning Care Planning Identify issues that may hinder choice

4. What factors influence our choices? Older people and women are less likely to die at home than younger people, (Higginson et al 1998, Grande et al 1998) Patients with informal carer support are more likely to die at home and access palliative home care. Some GPs reluctant to share care (Grande, 1998)

5. Continued…….. Identification and communication that the patient is dying Patient and family need to have a true picture of what services are available Those services need to reflect the promise Specialist services need to willingly share their knowledge

6. Marie Curie - delivering choice Lincolnshire Launched in 2004 To support all terminally ill patients across the UK, irrespective of diagnosis Deaths at home UP from17% to 42% Deaths in hospital DOWN from 63% to 45% Cost neutral (Kings Fund report)

7. How does their project work? Phase 1: Understand the current state of services Phase 11: Design new service models Phase 111: Implement and monitor the service models

8. Solutions in other areas Rapid response teams 24/7 Discharge community liaison nurse Palliative care co-ordination centres Health and personal care assistants Palliative care ambulance

9. Strategic plans Identify the gaps in services in our area that need to be filled Identify the most effective and efficient way to fill those gaps Publicize the services that are available and expand if required Begin to change the culture by talking to our own friends and families

10. How to achieve real choice Vocalising a choice to stay at home; Less likely to die alone More likely to attain choice (Seale et al1997) Reassurances to informal carers Sharing our knowledge with carers Planning care Individualised care 24 hour access to advice and care Key worker (or team) to avoid confusion Talk !