End of Life
What did we say in Healthy Ambitions?*
1
The End of Life Pathway found that the quality of care we provide to people nearing the end of their lives suffers as a result of the disinclination to talk about death and dying. We are not meeting patients wishes towards the end of their lives with patients dying in hospital when they would prefer to die at home.
PCTs across Y&H have worked with the SHA to agree which of the recommendations in the end of life pathway should be taken forward locally and which might need action at regional level.
They therefore recommended that:
- Every NHS area to develop a better range of services for people nearing the end of their lives
- Clinical teams caring for patients, their families and carers should deliver agreed standards of care
- Each area to establish a single care co-coordinator
- Every patient should have access to a ‘key worker’ contact through their practice
- Advanced care planning should happen everywhere
- End of life care to form part of training and education for NHS staff
- We should create a more open climate to discuss end of life care.
End of life care is every one’s business – not just specialist palliative care staff – all clinicians in all settings should be able to address the care of patients and families at the end of their lives.
*Full details can be found at: www.healthyambitions.co.uk/end_life.html
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When is it happening?
2
The actions to be taken forward in the first year of implementation for the End of Life pathway are shown in fig.3.
Where is it happening already?
3
PCTs have prioritised the recommendations in Healthy Ambitions in light of the needs of their local community and the current position of their services.
Working with their local partners and providers they have all set out the action that they will take to start to turn the recommendations in Healthy Ambitions into reality in their five year strategic plans.
An example of the actions being taken by NHS Leeds is shown in fig.4.
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How could you help?
4
Everyone with an interest in improving end of life services can play a part in taking forward the recommendations in the End of Life chapter of Healthy Ambitions.
In fig.5 we have set out some of the suggestions from staff about how people could help implement these recommendations.
As an NHS publication – this section has just focussed on the roles that NHS Staff could play – but we very much recognise that our partners have a big contribution to make if we are to deliver the recommendations of the end of life chapter in Healthy Ambitions. We know that local authorities, care homes and third sector organisations have a big part to play – e.g. supporting people to maintain independence towards the end of their life, helping them to die in the place of their choosing and in helping to remove some of the taboos associated with discussion of death and dying. We are committed to working with our partners to help make this happen.
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Who will make sure that this work happens?
5
Locally
Each PCT is responsible for working with local providers and partners to ensure the delivery of recommendations in line with their local priorities and their own strategic plans.
Collaboratively and Regionally
Delivery will be overseen by a Pathway Delivery Board – as described in the governence chapter.
For End of Life the chair will be Alan Wittrick Chief Executive at NHS Wakefield he will act in a sponsorship role, championing the end of life care work within the wider PCT CEs community and the region.
June Toovey, Nurse Director, Yorkshire Cancer Network and David Levy, Consultant Clinical Oncologist at Sheffield Teaching Hospitals, are the clinical pathways leads who will oversee progress against the end of life pathway recommendations; act as champions for the recommendations; advise on delivery processes and encourage regional colleagues to continue to focus and give priority to the end of life pathway group recommendations.
The lead SHA director is Karl Milner, NHS Yorkshire and Humber Director of Communications, he is responsible for overseeing the delivery of the end of life pathway recommendations.
Sue Proctor, Director of Patient Care and Partnerships, will oversee the allocation of central monies for training in the Gold Standard Framework and the Liverpool Care Pathway in accordance with national timelines.
Tim Gilpin, SHA Director of Workforce, will influence the content of the core curricula so that end of life care is part of it, continuing professional development and revalidation for all those likely to be involved in delivering end of life care.
How will we measure success?
6
We have developed a “Healthy Ambitions Dashboard” based on a small number of key indicators which taken together can be used to start to measure the success of the Healthy Ambitions programme as a whole. This is underpinned by trajectories which each PCT will set and which will show the measurable improvements they are making in each pathway area. This will supplement the “vital signs” indicators and trajectories which support delivery of the targets set out in the NHS Operating Framework and the selection of outcome measures which PCTs have included in their strategic plans. All of these measures will feature in PCTs annual operating plans to be agreed with the SHA and be the basis for the SHA’s performance management regime.
Recognising that the pathway recommendations are many and various we intend start by tracking progress against the key pathway pledge, which for the end of life pathway is to double the number of people able to die at home rather than hospital.
We know that this doesn’t tackle all the priorities in this chapter. Liverpool care pathway implementation and deaths at home will be tracked through existing routes. Percentage of deaths occurring at home is in the Vital Signs, whilst wards compliant with the Liverpool care pathway by acute provider is a CQUIN measure.
The key indicators we will track in the “Healthy Ambitions Dashboard” will be:
- The percentage of patients who die at home
- The percentage of all hospital wards where patients may be expected to die in which Liverpool Care Pathway, or equivalent, has been introduced.
We hope to develop further metrics in time, including:
- Percentage of patients dying on an EoLC register
- Percentage on the register with an advanced care plan.
Work has been undertaken to establish baselines for the indicators and by the end of March ’09 trajectories for improvement will have been agreed between the SHA and PCTs and will be reflected in annual operational plans.* We intend to publish progress against individual trajectories.
*More details can be found in the performance metrics chapter.