Professional Documents
Culture Documents
Title -
Overview - In 2008 the Department of Health published the National End of Life Strategy. This document was the start of a large initiative to improve end of life care for all patients across the whole of the United Kingdom. Participation in this project has been met enthusiastically from hospital teams, hospices, primary care teams, ambulance services and care homes. We will discuss the major themes of the National End of Life Strategy and how these have been implemented in North Somerset, a community of 200,000 people in the south west of England. We will look at how compassionate communities fit into this model.
Pathway; Commissioning; Measurement; Workforce; Care Homes; Analysis/Funding) Original intention had been to publish by December 2007 Linkage to Next Stage (Darzi) Review
discussion Low priority given to EOLC by the NHS and social care Clinicians difficulty in identifying people who are approaching the end of life Clinicians difficulty in initiating discussions Inadequate assessment and care planning Poor coordination of care Suboptimal services in hospitals, care homes and the community
certification of death; viewing facilities etc.) Inadequate involvement and support of carers Inadequate training and education Lack of robust measures of quality and effectiveness of care Inequalities in care Lack of dignity and respect provided to some people
whole systems approach An end of life care pathway Workforce development Measurement Funding
40 35 30 25 20 15 10 5 0
Hopital SW Acute Hospital Other Own Residence Nursing Homes Residential Homes Hospice Elsewhere
future Putting your affairs in order Making a will Writing an advance decision http://www.westonhospicecare.org.uk/wiki/?page=adva nce_planning
Core Information
Main diagnosis Co-existing disease, complications or details Is patient aware of above? RESUSCITATION STATUS Has a DNAR/Planning Ahead form been completed? Patient lives alone?
Does patient have an informal carer? Does the patient have professional care? Just in case box completed & in pt house/hospice? Syringe driver available with patient? End of life care pathway in use? (eg, LCP) Primary contact Access details
with appropriate health care professionals. Present on Planning Ahead and Register Place where wishes can be stored. Results and outcomes from Planning Ahead discussions Flexible up to date and can be changed Backed up by paperwork
A and E department
Hospital teams, including specialist nurses Hospice Community matrons and district nurses
All can see 24 hours per day up to date patient choices about end of life care
Use in GP surgeries
Palliative care meetings meetings at which patients
who have end of life needs can be discussed Does patient and carer have the right equipment for care, is there adequate support. Has there been a discussion about place of care and choices Review of what went well and what needs improving after the patient has died Not dependant on GPs making the decision to put patients on the register
information Uses the expertise of a variety of specialists The process of advance care planning can start in the hospital and get passed on to the community to continue Allows for discussion of patients who might not otherwise have been discussed
30
25 20 15 home care home hospice hospital
10
5 0
Percentage patients without preferred place of death, 6 month intervals from Jan 09 with hospital deaths
70 60
50
40
hospital
30 no ppd
20
10
0 1 2 3 4 5
No ppd
20 15 10 5 0
ppd
home
hospital
40
30
20
10
home
care home
hospice
hospital
100
80
60
40
20
home
care home
hospice
hospital
25
20
15
10
home
care home
hospice
hospital
Kerala Focus on improving community resource returning end of life care back into communities Palliative care support to develop networks of family, friends and neighbours Development of neighbourhood networks of people who have supported someone who has died.
months before patient dies Appropriate opportunity to start thinking about how care at home can take place Considerable challenges to current culture of communities in the modern day. Research grant application made in combination with Professor Tony Walter, Centre for Death and Society, University of Bath Application made for a Big Lottery grant through first phase