National End of Life Care Update Prof Bee Wee
Description: National End of Life Care Update Prof Bee Wee National Clinical Director for End of Life Care, NHS England 2nd May 2019 NHS Long Term Plan Personalised approach New service models older people, children and young people GP Quality and
Related Topics
Download Presentation
"National End of Life Care Update Prof Bee Wee" is the property of its rightful owner. Permission is granted to download and print the materials on this website for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Presentation Transcript
slide1. National End of Life Care Update Prof Bee Wee
National Clinical Director for End of Life Care, NHS England
2nd May 2019<br>
slide2. NHS Long Term Plan
Personalised approach
New service models – older people, children and young people
GP Quality and Outcomes Framework
Priorities and approach for 2019/20
Responding to challenges National update Presentation title<br>
slide3. NHS Long Term Plan: Para 1.42 Para 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 identify
and support relevant patients, we will
introduce proactive and personalised care
planning for everyone identified as being
in their last year of life……..<br>
slide4. NHS Long Term Plan: Para 3.41 Children’s palliative and end of life care –
…increase contribution by match-funding
CCGs who commit to increase their
Investment in local children’s palliative
and end of life care services
including children’s hospices – up to a
combined total of £25 million/year by
2023/24.<br>
slide5. Investment and Reform: 5 year framework for GP Contract Reform: QOF reforms Aims - improvement in:
Early identification and support for people with advanced progressive illness who might die within the next 12 months
Well-planned and coordinated care that is responsive to the person’s changing needs with the aim of improving the experience of care
Identification and support for family/informal caregivers, both as part of the core care team around the patient and as individuals facing impending bereavement<br>
slide6. Investment and Reform: 5 year framework for GP Contract Reform: QOF reforms Practices need to:
Evaluate current quality of their end of life care and identify areas for quality improvement – e.g. retrospective death audit
Identify quality improvement activities and set improvement goals
Implement the improvement plan
Participate in a minimum of 2 GP network peer review meetings
Complete QI monitoring template in relation to this module<br>
slide7. Investment and Reform: 5 year framework for GP Contract Reform: Focus on: contractor engagement, participation in quality improvement
activity in own practice and shared learning across network<br>
slide8. Comprehensive Model for Personalised Care
All age, whole population approach to Personalised Care People with long term physical
and mental health conditions
30% People
with
complex needs
5% Supporting people to stay well and building community resilience, enabling people to make informed decisions and choices when their health changes. Supporting people to
build knowledge, skills
and confidence and to live
well with their health
conditions. Empowering people,
integrating care and
reducing unplanned
service use. Specialist
Integrated Personal Commissioning, including proactive case finding, and personalised care and support planning through multidisciplinary teams, personal health budgets and integrated personal budgets. Targeted
Proactive case finding and personalised care and support planning through General Practice. Support to self manage by increasing
patient activation through access to health coaching, peer support and self management education. Universal
Shared 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 interventions Plus Universal interventions Whole population
100% PEOPLE MOVE AS THEIR HEALTH AND WELLBEING CHANGES INCREASING COMPLEXITY INTERVENTIONS OUTCOMES TARGET POPULATIONS<br>
slide10. Shared decision making Social prescribing & community-based support In 2017/18 SDM was embedded into:
Musculoskeletal elective care pathways across 13 CCGs
Respiratory elective care pathways in 8 CCGs 68,977 referrals in 2017/18
331 link workers employed in local areas Personalised care and support planning 142,904 people had a personalised care and support plan between April 2017 and September 2018
Over 204,000 people supported by integrated, personalised approaches Supported self management Enabling choice 97% of CCGs have now completed Choice Planning and Improvement self-assessment
Of these, 85% report compliance with at least 5 (of 9) choice standards 32,341 PHBs by September 2018
Up 110% year-on -year in 2018 (to end Q2)
23% jointly funded with social care
55,511 Personal Maternity Care Budgets delivered by September 2018 across 36 CCGs Personal health budgets & integrated personal budgets 101,637 patient activation assessments by September 2018
Over 44,093 people referred to community-based support
Over 59,545 people referred to self-management education or health coaching Significant delivery of Personalised Care<br>
slide11. Other high level commitments from 2019/20 Maternity 52% of women will receive a personalised care plan by March 2020 (32% by March 2019) End of Life Care Increase 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<br>
slide14. Evidence Workforce Professional Wider Community Patients and Carers Enablers (LE, FCC etc) Policy and Infrastructure<br>
slide20. EoL Programme: how it all fits together 6 point commitment Honest conversations
Informed decisions
Developing personalized care plan
Sharing plan with professionals
Involving family to the extent wishes
Know who to contact<br>
slide21. NHS Long Term Plan
Personalised approach
New service models – older people, children and young people
GP Quality and Outcomes Framework
Priorities and approach for 2019/20
Responding to challenges National update Presentation title<br>
slide22. More demand
Less workforce
More expectations
Know more about less
Struggle with acknowledging limits
Diminished respect for authority, expertise
Speed of communication Complex challenging world Presentation title https://www.bluehomepm.com/common-myths-investing-in-florida-real-estate-from-canada/complex/<br>
slide23. Crosses biomedical, social and societal boundaries
Approach that integrates art and science
Attracts public, media and political interest
Dying and death happens to everybody
Hugely emotive – personal stories
Managing boundaries
Palliative care leaders:
driving forward the specialty
supporting colleagues at generalist level
managing expectations
seeing wood for trees Palliative care: specific features Presentation title<br>
slide24. Of 1.4 million people who work in the NHS in England:
> 50% unable to meet all the conflicting demands at work
Nearly 40% - unwell as a result of stress in the past year
Around 50% more debilitating levels of work stress compared with general working population
44% only - able to make improvements in their area of work Burning platform….. Presentation title Source: West M, King’s Fund 2017<br>
slide25. Link between quality of patient care and staff wellbeing
Low staff engagement – leads to:
Lower patient experience
Lower productivity
Increased risk of workplace accidents
Higher levels of staff turnover
Higher rates of burnout Staff wellbeing Presentation title<br>
slide26. How leaders think: shift in mental model Swensen 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.<br>
slide27. Person-centredness
Front line engagement
Relentless focus – on vision and strategy
Transparency – results, progress, aims, defects
Across boundaries How leaders behave Swensen 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<br>
slide28. IHI high impact leadership framework: where leaders focus effort Presentation title Swensen 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.<br>
National Clinical Director for End of Life Care, NHS England
2nd May 2019<br>
slide2. NHS Long Term Plan
Personalised approach
New service models – older people, children and young people
GP Quality and Outcomes Framework
Priorities and approach for 2019/20
Responding to challenges National update Presentation title<br>
slide3. NHS Long Term Plan: Para 1.42 Para 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 identify
and support relevant patients, we will
introduce proactive and personalised care
planning for everyone identified as being
in their last year of life……..<br>
slide4. NHS Long Term Plan: Para 3.41 Children’s palliative and end of life care –
…increase contribution by match-funding
CCGs who commit to increase their
Investment in local children’s palliative
and end of life care services
including children’s hospices – up to a
combined total of £25 million/year by
2023/24.<br>
slide5. Investment and Reform: 5 year framework for GP Contract Reform: QOF reforms Aims - improvement in:
Early identification and support for people with advanced progressive illness who might die within the next 12 months
Well-planned and coordinated care that is responsive to the person’s changing needs with the aim of improving the experience of care
Identification and support for family/informal caregivers, both as part of the core care team around the patient and as individuals facing impending bereavement<br>
slide6. Investment and Reform: 5 year framework for GP Contract Reform: QOF reforms Practices need to:
Evaluate current quality of their end of life care and identify areas for quality improvement – e.g. retrospective death audit
Identify quality improvement activities and set improvement goals
Implement the improvement plan
Participate in a minimum of 2 GP network peer review meetings
Complete QI monitoring template in relation to this module<br>
slide7. Investment and Reform: 5 year framework for GP Contract Reform: Focus on: contractor engagement, participation in quality improvement
activity in own practice and shared learning across network<br>
slide8. Comprehensive Model for Personalised Care
All age, whole population approach to Personalised Care People with long term physical
and mental health conditions
30% People
with
complex needs
5% Supporting people to stay well and building community resilience, enabling people to make informed decisions and choices when their health changes. Supporting people to
build knowledge, skills
and confidence and to live
well with their health
conditions. Empowering people,
integrating care and
reducing unplanned
service use. Specialist
Integrated Personal Commissioning, including proactive case finding, and personalised care and support planning through multidisciplinary teams, personal health budgets and integrated personal budgets. Targeted
Proactive case finding and personalised care and support planning through General Practice. Support to self manage by increasing
patient activation through access to health coaching, peer support and self management education. Universal
Shared 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 interventions Plus Universal interventions Whole population
100% PEOPLE MOVE AS THEIR HEALTH AND WELLBEING CHANGES INCREASING COMPLEXITY INTERVENTIONS OUTCOMES TARGET POPULATIONS<br>
slide10. Shared decision making Social prescribing & community-based support In 2017/18 SDM was embedded into:
Musculoskeletal elective care pathways across 13 CCGs
Respiratory elective care pathways in 8 CCGs 68,977 referrals in 2017/18
331 link workers employed in local areas Personalised care and support planning 142,904 people had a personalised care and support plan between April 2017 and September 2018
Over 204,000 people supported by integrated, personalised approaches Supported self management Enabling choice 97% of CCGs have now completed Choice Planning and Improvement self-assessment
Of these, 85% report compliance with at least 5 (of 9) choice standards 32,341 PHBs by September 2018
Up 110% year-on -year in 2018 (to end Q2)
23% jointly funded with social care
55,511 Personal Maternity Care Budgets delivered by September 2018 across 36 CCGs Personal health budgets & integrated personal budgets 101,637 patient activation assessments by September 2018
Over 44,093 people referred to community-based support
Over 59,545 people referred to self-management education or health coaching Significant delivery of Personalised Care<br>
slide11. Other high level commitments from 2019/20 Maternity 52% of women will receive a personalised care plan by March 2020 (32% by March 2019) End of Life Care Increase 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<br>
slide14. Evidence Workforce Professional Wider Community Patients and Carers Enablers (LE, FCC etc) Policy and Infrastructure<br>
slide20. EoL Programme: how it all fits together 6 point commitment Honest conversations
Informed decisions
Developing personalized care plan
Sharing plan with professionals
Involving family to the extent wishes
Know who to contact<br>
slide21. NHS Long Term Plan
Personalised approach
New service models – older people, children and young people
GP Quality and Outcomes Framework
Priorities and approach for 2019/20
Responding to challenges National update Presentation title<br>
slide22. More demand
Less workforce
More expectations
Know more about less
Struggle with acknowledging limits
Diminished respect for authority, expertise
Speed of communication Complex challenging world Presentation title https://www.bluehomepm.com/common-myths-investing-in-florida-real-estate-from-canada/complex/<br>
slide23. Crosses biomedical, social and societal boundaries
Approach that integrates art and science
Attracts public, media and political interest
Dying and death happens to everybody
Hugely emotive – personal stories
Managing boundaries
Palliative care leaders:
driving forward the specialty
supporting colleagues at generalist level
managing expectations
seeing wood for trees Palliative care: specific features Presentation title<br>
slide24. Of 1.4 million people who work in the NHS in England:
> 50% unable to meet all the conflicting demands at work
Nearly 40% - unwell as a result of stress in the past year
Around 50% more debilitating levels of work stress compared with general working population
44% only - able to make improvements in their area of work Burning platform….. Presentation title Source: West M, King’s Fund 2017<br>
slide25. Link between quality of patient care and staff wellbeing
Low staff engagement – leads to:
Lower patient experience
Lower productivity
Increased risk of workplace accidents
Higher levels of staff turnover
Higher rates of burnout Staff wellbeing Presentation title<br>
slide26. How leaders think: shift in mental model Swensen 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.<br>
slide27. Person-centredness
Front line engagement
Relentless focus – on vision and strategy
Transparency – results, progress, aims, defects
Across boundaries How leaders behave Swensen 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<br>
slide28. IHI high impact leadership framework: where leaders focus effort Presentation title Swensen 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.<br>