Prof Bee Wee National Clinical Director for End of Life Care NHS England 2 nd May 2019 NHS Long Term Plan Personalised approach New service models older people children and young people ID: 1046973
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1. National End of Life Care UpdateProf Bee WeeNational Clinical Director for End of Life Care, NHS England2nd May 2019
2. NHS Long Term PlanPersonalised approachNew service models – older people, children and young peopleGP Quality and Outcomes FrameworkPriorities and approach for 2019/20 Responding to challengesNational updatePresentation title
3. NHS Long Term Plan: Para 1.42Para 1.42. With patients, families, local authorities and our voluntary sector partners at both national and local level, including specialist hospices, the NHS will personalised care, to improve end of life care. By rolling out training to help staff identifyand support relevant patients, we willintroduce proactive and personalised careplanning for everyone identified as beingin their last year of life……..
4. NHS Long Term Plan: Para 3.41Children’s palliative and end of life care – …increase contribution by match-fundingCCGs who commit to increase their Investment in local children’s palliative and end of life care services including children’s hospices – up to acombined total of £25 million/year by2023/24.
5. Investment and Reform:5 year framework for GP Contract Reform:QOF reformsAims - improvement in:Early identification and support for people with advanced progressive illness who might die within the next 12 monthsWell-planned and coordinated care that is responsive to the person’s changing needs with the aim of improving the experience of careIdentification and support for family/informal caregivers, both as part of the core care team around the patient and as individuals facing impending bereavement
6. Investment and Reform:5 year framework for GP Contract Reform:QOF reformsPractices need to:Evaluate current quality of their end of life care and identify areas for quality improvement – e.g. retrospective death auditIdentify quality improvement activities and set improvement goalsImplement the improvement planParticipate in a minimum of 2 GP network peer review meetingsComplete QI monitoring template in relation to this module
7. Investment and Reform:5 year framework for GP Contract Reform:Focus on: contractor engagement, participation in quality improvementactivity in own practice and shared learning across network
8. Comprehensive Model for Personalised Care All age, whole population approach to Personalised CarePeople with long term physicaland mental health conditions30%Peoplewithcomplex needs5%Supporting people to stay well and building community resilience, enabling people to make informed decisions and choices when their health changes.Supporting people tobuild knowledge, skillsand confidence and to livewell with their healthconditions.Empowering people,integrating care andreducing unplannedservice use.SpecialistIntegrated Personal Commissioning, including proactive case finding, and personalised care and support planning through multidisciplinary teams, personal health budgets and integrated personal budgets.TargetedProactive case finding and personalised care and support planning through General Practice. Support to self manage by increasingpatient activation through access to health coaching, peer support and self management education.UniversalShared Decision Making.Enabling choice (e.g. in maternity, elective and end of life care).Social prescribing and link worker roles.Community-based support.Plus Universal and Targeted interventionsPlus Universal interventionsWhole population100%PEOPLE MOVE AS THEIR HEALTH AND WELLBEING CHANGESINCREASING COMPLEXITYINTERVENTIONSOUTCOMESTARGET POPULATIONS
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10. Shared decision makingSocial prescribing & community-based support In 2017/18 SDM was embedded into:Musculoskeletal elective care pathways across 13 CCGsRespiratory elective care pathways in 8 CCGs68,977 referrals in 2017/18331 link workers employed in local areasPersonalised care and support planning142,904 people had a personalised care and support plan between April 2017 and September 2018Over 204,000 people supported by integrated, personalised approachesSupported self managementEnabling choice97% of CCGs have now completed Choice Planning and Improvement self-assessmentOf these, 85% report compliance with at least 5 (of 9) choice standards32,341 PHBs by September 2018Up 110% year-on -year in 2018 (to end Q2)23% jointly funded with social care55,511 Personal Maternity Care Budgets delivered by September 2018 across 36 CCGsPersonal health budgets & integrated personal budgets101,637 patient activation assessments by September 2018Over 44,093 people referred to community-based supportOver 59,545 people referred to self-management education or health coachingSignificant delivery of Personalised Care
11. Other high level commitments from 2019/20Maternity52% of women will receive a personalised care plan by March 2020 (32% by March 2019)End of Life CareIncrease the percentage of people who have died who had been offered the opportunity for personalised care and support planning, from 39.6% to 75% in 10 years
12. Core ObjectivesDH MandateIncrease the percentage of people identified as likely to be in their last year of life, so that their End of Life Care can be improved by personalising it according to their needs and preferences.UPC TargetIncrease the percentage of people who have died who had been offered the opportunity for personalised care and support planning, from 39.6% to 75% in 10 years.Long Term Plan (1.42)Roll out training to help staff identify and support relevant patients, we will introduce proactive and personalised care planning for everyone identified as being in their last year of life.
13. DeliverablesImplementation of QOF QIThe Quality and Outcomes Framework - Quality Improvement (QOF QI) aims to improve; early identification and support for people, well-planned and coordinated care and identification and support for family/informal caregivers. Improved outcomes and experience in EoLC Survey of Bereaved People (VOICES-SF). Collaboratively working with the Insight and Feedback team to focus on local options to gain feedback on the Quality of care delivered in the last 3 months of life for adults who died. NHSI Getting to Good ProgrammeAs part of an ICS or place based project this aims to reduce the number of trusts rated as inadequate or requires improvement by the CQC.Early identification tools within electronic systems using read codesThe project will look to commence a wider testing of the screening tools (test sites) as well as translating the toolkit from EMIS to SystmOne. CHC SIPUsing a place-based approach properly test the hypothesis that improved identification, and personalised EoLC will reduce the use of CHC Fast track. Build and continue to develop a joint narrative with CHC SIP/ADASS/EoL
14. EvidenceNational Support offerDelivery Innovation (formerly Testing) Programme DemonstratorProgrammeChampion and Mentor ProgrammeWorkforceProfessionalWider CommunityPatients and CarersEnablers (LE, FCC etc)Policy and Infrastructure
15. National Support offer- available to allSharing good practice, signposting, peer supportHospice UK – Awareness Raising (Commitments)NHS England has commissioned Hospice UK to work with a limited number of hospices to explore mechanisms for raising awareness and expectations about the governments 6-point commitment amongst patients, their families and the wider community – case studies will be available in 19/20 Q2. RSA Student Design AwardsNHS England has sponsored a Moving Pictures Brief to raise awareness about the importance of talking about death and dying, planning for the future, and thinking and talking about a time when you are going to be less well, including when you are dying. The winning animation will be announced in 19/20 Q1.Hospice UK - HolisticNHS England has commissioned Hospice UK to identify the critical components of hospice-led interventions and service models that are effective in preventing avoidable admission to hospital, or supporting early discharge and transfer from hospital for people approaching the end of life. The report is due 19/20 Q1 and will provide an evidence-base for end of life care service re-design.
16. National Support offer- cont’dCommissioning Models for PEoLC for CYPA group of stakeholders have developed a service specification & commissioning model which is to be tested in 2 regions over the next 12 months. This draft model will be published in 19/20 to share best practice commissioning for C&YP. Generic MailboxThe EoLC mailbox is single point of access, the team will respond or signpost as appropriate. ENGLAND.endoflifecare@nhs.netCollaboration PlatformThe Personalised Care Group NHSFuture Collaboration platform will signpost to the knowledge hub on the Ambitions website and our resources page.Webinar SeriesWebinars provide support to professionals by raising awareness of subjects, they also share good practice. Webinar recordings are available on the NHS England website, slides are available upon request.
17. National Support offer- cont’dAmbitions PartnershipThe Ambitions website contains published best practice, case studies, implementation guidance and lessons learnt, the National EoL Programme Board papers are also available.National EoLC Practitioners networkTo share good practice, develop best practice, peer support, collaborative working, getting to outstanding in EoLC, sharing the national agenda and the LTP, support the CNO and NCD in ensuring EoLC continues to improve, share the outputs and support service improvement requirements of the NACELPalliative and End of Life Care Clinical LeadersTo provide a focus for strategic clinical leadership for palliative and end of life care reaching across every STP/ICS and maximising potential for effective communication and shared learningSupport/Mentoring (PCG demonstrator site leads)End of Life Care Team can provide support and signposting for site leads.
18. Place offerPlace based project in each of 7 regionsSupports delivery of the core objectives and one or more of the proposed deliverables for 19/20Project assurance provided by the National EoL Team
19. Neighbourhood offer - available to Primary Care Networks Support for QOF Quality Improvement Work with our partners to develop and deliver a support offer for GP practices and Primary Care Networks to demonstrate continuous quality improvement focused on end of life care
20. EoL Programme: how it all fits together6 point commitmentHonest conversationsInformed decisionsDeveloping personalized care plan Sharing plan with professionalsInvolving family to the extent wishesKnow who to contact
21. NHS Long Term PlanPersonalised approachNew service models – older people, children and young peopleGP Quality and Outcomes FrameworkPriorities and approach for 2019/20 Responding to challengesNational updatePresentation title
22. More demandLess workforceMore expectationsKnow more about lessStruggle with acknowledging limitsDiminished respect for authority, expertiseSpeed of communicationComplex challenging worldPresentation titlehttps://www.bluehomepm.com/common-myths-investing-in-florida-real-estate-from-canada/complex/
23. Crosses biomedical, social and societal boundariesApproach that integrates art and scienceAttracts public, media and political interestDying and death happens to everybodyHugely emotive – personal storiesManaging boundariesPalliative care leaders:driving forward the specialtysupporting colleagues at generalist levelmanaging expectationsseeing wood for treesPalliative care: specific featuresPresentation title
24. Of 1.4 million people who work in the NHS in England:> 50% unable to meet all the conflicting demands at workNearly 40% - unwell as a result of stress in the past yearAround 50% more debilitating levels of work stress compared with general working population44% only - able to make improvements in their area of workBurning platform…..Presentation titleSource: West M, King’s Fund 2017
25. Link between quality of patient care and staff wellbeingLow staff engagement – leads to:Lower patient experienceLower productivityIncreased risk of workplace accidentsHigher levels of staff turnoverHigher rates of burnoutStaff wellbeingPresentation title
26. How leaders think: shift in mental modelSwensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.
27. Person-centrednessFront line engagementRelentless focus – on vision and strategyTransparency – results, progress, aims, defectsAcross boundariesHow leaders behaveSwensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.or
28. IHI high impact leadership framework:where leaders focus effortPresentation titleSwensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. Cambridge, MA: Institute for Healthcare Improvement; 2013. Available on www.ihi.org.