1 / 22

National Audit Office Value for Money Study Place of End of Life Care

National Audit Office Value for Money Study Place of End of Life Care. Karen Taylor 2nd December 2008. What does the National Audit Office do?. Scrutinise the economy, efficiency and effectiveness of public spending.

haley
Download Presentation

National Audit Office Value for Money Study Place of End of Life Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. National Audit Office Value for Money StudyPlace of End of Life Care Karen Taylor 2nd December 2008

  2. What does the National Audit Office do? • Scrutinise the economy, efficiency and effectiveness of public spending. • Totally independent of Government and headed by the Comptroller and Auditor General, who is an Officer of Parliament. • Audit the accounts of all Central Government bodies; • AND produce around 60 value-for-money reports each year (7 on health issues) • Work closely with the Parliamentary Committee of Public Accounts (PAC), whose hearings and investigations are based on our work. • Save the taxpayer £9 for every £1 it costs to run the NAO (savings of £582 million in 2006-07)

  3. Study of End of Life Care • Chairman of PAC requested study in 2005. NHS End of Life Care Programme ongoing at the time therefore study deferred until 2008 • In intervening time Mike Richard’s remit extended to End of Life Care • Report Published 26th November • Parliamentary hearing 17th December

  4. Study of End of Life Care • Study examined • Whether effective EOLC is being commissioned and provided in appropriate settings and the extent and costs of these services across England; • Equality and consistency of access; • Barriers that certain individuals face in accessing these services; and • Whether current provision of services is of good quality and respects patient choice and dignity

  5. End of Life Care

  6. Methodologies • Census of PCTs • Census of independent and NHS run hospices • Survey of doctors and nurses • Survey of care homes • Focus groups of patients, current and bereaved carers • Review of deceased patients’ records • Economic modelling of costs and potential savings • In-depth PCT case studies • Use of existing data and research

  7. High Level Findings • Some people receive high levels of care but many do not – with many aspects of NHS and social care not meeting basic needs on dignity and respect. • There is a gap between preferred and actual place of death (up to 74 % prefer to die at home – in reality 58% occurred in a hospital setting ( range 46 – 77% across PCTs) – also varies by age and condition – cancer patients more likely to die at home or in a hospice. • Proportion of patients with cancer expressing a preference for home care decreases as death approaches (from 90% to 50%) replaced by a preference for hospice care (from 10 to 40%) - 94% of all hospice deaths are patients with cancer. • A lack of prompt access to services in the community leads to people being unnecessarily admitted to hospital

  8. High Level Findings • PCT data is limited, what they can provide shows wide variation e.g. specialist palliative care spend per death (£154 to £1,684) • PCTs’ contracts with hospices limit hospices ability to deliver services, and funding varies widely (provide on average 26% (£130 million) of independent hospices expenditure – also 70% have only annual contracts and 97% say funding doesn’t cover costs. • Cancer patients account for 27% of deaths yet make up majority of patients receiving specialist palliative care – and more likely to get active case management. Over 70& of PCTs say the group with the greatest un-met need are people with diagnoses other than cancer.

  9. High Level Findings • Coordination of services between health and social care is poor and hampered by different funding streams • Lack of progress on national tariff • Not all carers receive the assessment they are entitled to, and respite care is not available in all PCTs • There is a lack of pre-registration training for nurses and doctors in end of life care (only 29% doctors and 18% nurses), but training in the national tools (GSF LCP PPC) has improved confidence.

  10. High Level Findings • The number of non-cancer patients who receive specialist palliative care services is increasing but remains low • Potential to improve services within existing resources (£104 million could be released for redistribution) • Good practice examples show what is and can be done (appendix 6 – including Marie Curie delivering choice project)

  11. Analysis of Medical Records • Looked at 348 deaths in Sheffield PCT 52% of which occurred in hospital – cancer patients had the highest proportion of deaths outside hospital – but still scope to decrease the number of cancer patients who died in hospital as there was capacity in the local hospices. • Of all deaths over three quarters were over 65 years old and a quarter had dementia. • 40% of people (80 patients) who died in hospital had no medical reason to be there at the point of admission.

  12. Analysis of Medical Records • 40% for whom an alternative was identified were in hospital less than 1 week before dying –(? not identified or care not managed). • 19/42 who were in hospital for a month or more could also have been cared for in an alternative setting. (? Discharge arrangements) • Patients with an alternative spent 1,500 days in hospital at a cost of £375,000 (£4.5m per year)

  13. Alternative place of care by condition

  14. Actual and potential place of death

  15. Economic Modelling • Calculated a baseline of current cost of care and examined effect of reduced hospital use ( On average cancer patients who died in 2006-07 spent 345 days at home; 17 days in hospital and two days in a hospice prior to death) • We estimated that the cost of caring for cancer patients in last year of life was £1.81bn) • Potential to release considerable levels of resources while reducing length of time people spend in hospital • £104 million could be released by reducing length of stay per admission by 3 days and number of admissions by 10% for cancer patients alone (27% of all deaths)

  16. Achieving reductions in hospital utilisation • Reducing admissions requires services to respond quickly to needs 24/7 – (are a number of service models but few 24/7) • Reducing average LOS requires effective and timely discharge arrangements involving multiple agencies with appropriate packages of care.

  17. Feedback from Focus groups

  18. Overall Conclusions • A lack of support means many people die in hospital when there is no clinical reason for them to be there. • There is scope to improve training of NHS and social care staff, and extend specialist palliative care services to all need them, whatever their condition. • More effective partnerships between the NHS, social services and the voluntary sector is required • The skills developed in the hospice movement, primarily in working with cancer patients, could be extended to patients with other terminal conditions. • The Department should support PCTs to reconfigure services and to better meet the needs of their population

  19. Further Information • www.nao.org.uk • Karen.Taylor@nao.gsi.gov.uk or • Karen.jackson@nao.gsi.gov.uk • 020 7798 7161

More Related