Transcript Physicians Grand Round 4 June 2014

Post LCP EOLC conference
14 May 2014
Unpacking the guidance –
how we can best apply it
Brendan Amesbury (St Wilfrid’s Hospice & St Richard’s Hospital)
and
Sarah Pearce (Coastal West Sussex CCG)
Tony Bonser,
Chair of People in Partnership Group,
National Council for Palliative Care and
Dying Matters coalition
“We’re at a turning point.
End of life care is on the agenda.
We have a chance, as never
before, to get it right”
Leadership Alliance for the Care of the
Dying Person – LACDP – interim statement
January 2014
• Starting point has to be a common understanding
between patients, families sand professionals about what
good EOLC looks like: hence extensive consultation
• LACDP will produce a prompt sheet to help professionals
who care for dying people to consider the important
elements of care
• CQC hospital inspections will include EOLC as one of
eight core areas
• New NICE EOLC guidance by summer 2016
LACDP – second interim statement
March 2014
• Five priority areas for EOLC identified
• Service providers and commissioners will be expected to
create the systems and learning opportunities that
enable the priority areas to be implemented
• Organisations/professionals to review the care they
deliver for dying people against these five priority areas,
including considering how they will demonstrate delivery
of each priority
• LACDP working on description of what dying people and
those who are important to them should expect
• LACDP working on a statement of the responsibilities of
health and care staff for delivering the priority areas
Summary of LACDP’s five priority areas
1. Possibility a person may die recognised and
communicated
2. Sensitive communication
3. Dying person is involved in decisions
4. Needs of family explored, respected and met
5. Individual plan of care
Note first 4 are all about communication …
Expand those headings …
1. Possibility a person may die recognised
and communicated
• The possibility that a person may die within the next
few days or hours is recognised and communicated
clearly, decisions made and actions taken in
accordance with the person’s needs and wishes, and
these are regularly reviewed and decisions revised
accordingly.
2. Sensitive communication
• Sensitive communication takes place between staff
and the person who is dying, and those identified as
important to them.
3. Dying person is involved in decisions
• The dying person, and those identified as important
to them, are involved in decisions about treatment
and care to the extent that the dying person wants.
4. Needs of family explored, respected and
met
• The needs of families and others identified as
important to the dying person are actively explored,
respected and met as far as possible.
5. Individual plan of care
• An individual plan of care, which includes food and
drink, symptom control and psychological, social and
spiritual support, is agreed, coordinated and
delivered with compassion.
How have we begun to address implementation of
the five priority areas this locally?
Collaborative group, co-ordinated by CCG, established
involving:
• CCG
• GP
• Sussex Community Trust
• Western Sussex Hospitals Trust
• Three local hospices
• Involvement with WSCC Health and Well-Being Board
• Consultation with care homes
National Council for Palliative Care
conference November 2013
EOLC strategy: New ambitions
• Conference set up 5 years after publication of the EOLC
strategy in 2008
• What is there to do in the future?
National Council for Palliative Care report
from March 2014
EOLC strategy: New ambitions
• In the same way as no replacement for LCP, no refreshed
EOLC strategy, but NHS England expected to publish a
“new set of ambitions and actions”
• CWS commissioners and providers expect to follow these
locally once published
Key challenges identified at NCPC conference
1. Personalised care must be commissioned on the basis
of local needs
2. Challenges across all care sectors in working together:
defining roles & accountabilities
3. Improving data and intelligence about EOLC
4. Care must be universal, for everyone who needs it
5. Better conversations about death and dying
6. Creating compassionate communities
Recommendations for action in NCPC report
1. New set of ambitions and actions for EOLC must have
high level of authority and ambition
2. New ambitions & actions for EOLC must link to other
national priorities eg dementia
3. Must be a “proper national conversation about dying”
as in Neuberger’s More Care, Less Pathway
4. Measure of death in usual place of residence is a useful
proxy measure, but need a means to measure individual
quality
5. Plans submitted to Better Care Fund should always
address EOLC
6. Good EOLC must be available for everyone
How are local providers and commissioners
engaging with challenges and
recommendations from NCPC report? 1
• Engaging with public about dying – eg WSHT Dying
Matters day; hospice open days; St Barnabas bus
• Promoting non-cancer SPC referrals – eg SWH KPI of 10%
non-cancer or MND referrals in 2013-14 (achieved 13%)
• SPC services are keen to encourage EOL dementia and
old age/frailty referrals if meet referral criteria
Single SPC referral criteria at WSHT, SWH and SBH
(similar for Midhurst Macmillan Service)
Referrals for specialist palliative care are accepted for
patients who
• have active, progressive, advanced disease of any
diagnosis with a probable prognosis of less than 12
months
• have a complex level of need exceeding the skills and/or
capacity of the current caring team and
• are over 18 years of age
Supportive care for those earlier in diagnosis
Note “any diagnosis”
If referrer not sure, please phone and ask!
How are local providers and commissioners
engaging with challenges and
recommendations from NCPC report? 2
• Promoting Advance Care Planning for people with
progressive disease
• “If you have another episode of …. what do you
want? Active hospital care? Or stay in care home?”
• Encouraging healthcare professionals to talk
prognosis to patients when well, not when ill
• “Just in case” medications in patients homes
• Form is available
on websites eg
SCT, SWH
• Use in
community or
acute
• COPD, heart
failure, dementia
SP next slides
How are local providers and commissioners
engaging with challenges and
recommendations from NCPC report? 3
• Two year project at CCG to look at EOLC pathway
• Working collaboratively – eg hospices funding new SPC
CNS posts at WSHT
• Working collaboratively – eg CCG funding admissions
avoidance pilots with Sussex Community Trust, hospices
and WSHT
What has the local group drafted to address
LACDP proposals?
1. Guidance for the patient in last few days of life – single
one page flow chart for use by all organisations which
includes all five priority areas
2. Guidance on outcomes which highlight care areas
needing at least daily review in a dying person. Includes
basic initial drug guidelines
3. Each provider will need to determine how the individual
plan of care for each dying person will be implemented
in their service
Recognise training will be needed once documents agreed
Consultation today on how the approach
feels to the audience
• Copies of the two guidance sheets are in your packs
• Your help!
• Small groups to discuss and provide us with feedback
• Integrate your feedback in the local groups plans
Consultation today on how the approach
feels to the audience
Is there anything
we’ve
overlooked?
Consultation today on how the approach
feels to the audience
How should training be
accomplished?
What approach works
best in your area?