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

2. The Sheffield study for NAO Support and participation of Sheffield University Teaching Hospitals NHS Foundation Trust Sheffield PCT St Lukes 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?

7. Other Risk Factors Living alone76 (22%) Housing 7 (2%) Carer Incapacity18 (5%) Dementia diagnosis65 (19%) Confusion 43 (12%) (no dementia specified)

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)

16. Shared IT Common Data Risk registers Primary Care teams Community Nurses Community Rehab Voluntary Organisations Social Care Equipment Community Pharmacists Psychology Chaplaincy & Faith services Cancer Patient at End of Life Surgeon Oncology team Cancer Charities Pain/Symptom Control team Carers Hospices Palliative Care teams Frail Patient at End of Life GeriatriciansPsychiatrists Nursing Homes Home care Carers Community matrons Intermediate Care Palliative Care teams Patient with Chronic Disease at End of Life Specialist medical teams Specialist nurses Carers Home care Nursing Homes Palliative care teams An Integrated Model for End of Life Care