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National End of Life Care Update

National End of Life Care Update. Prof Bee Wee National Clinical Director for End of Life Care, NHS England 2 nd May 2019. National update. NHS Long Term Plan Personalised approach New service models – older people, children and young people GP Quality and Outcomes Framework

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National End of Life Care Update

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  1. National End of Life Care Update Prof Bee Wee National Clinical Director for End of Life Care, NHS England 2nd May 2019

  2. National update • 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 Presentation title

  3. 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……..

  4. 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.

  5. 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

  6. 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

  7. 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

  8. Comprehensive Model for Personalised Care All age, whole population approach to Personalised Care TARGET POPULATIONS INTERVENTIONS OUTCOMES People with long term physical and mental health conditions 30% 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. People with complex needs 5% Plus Universal and Targeted interventions 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. Supporting people to build knowledge, skills and confidence and to live well with their health conditions. INCREASING COMPLEXITY PEOPLE MOVE AS THEIR HEALTH AND WELLBEING CHANGES Plus Universal interventions 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. Supporting people to stay well and building community resilience, enabling people to make informed decisions and choices when their health changes. Whole population 100%

  9. Significant delivery of Personalised Care Personalised care and support planning Enabling choice Shared decision making • In 2017/18 SDM was embedded into: • Musculoskeletal elective care pathways across 13 CCGs • Respiratory elective care pathways in 8 CCGs • 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 • 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 Personal health budgets & integrated personal budgets Social prescribing & community-based support Supported self management • 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 • 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 • 68,977 referrals in 2017/18 • 331 link workers employed in local areas

  10. 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

  11. Wider Community Workforce Champion and Mentor Programme Demonstrator Programme Patients and Carers Professional Evidence Delivery Innovation (formerly Testing) Programme Policy and Infrastructure Enablers (LE, FCC etc) National Support offer

  12. EoLProgramme: 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

  13. National update • 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 Presentation title

  14. Complex challenging world • More demand • Less workforce • More expectations • Know more about less • Struggle with acknowledging limits • Diminished respect for authority, expertise • Speed of communication https://www.bluehomepm.com/common-myths-investing-in-florida-real-estate-from-canada/complex/ Presentation title

  15. Palliative care: specific features • 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 Presentation title

  16. Burning platform….. 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 Presentation title Source: West M, King’s Fund 2017

  17. Staff wellbeing • 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 Presentation title

  18. 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.

  19. How leaders behave • Person-centredness • Front line engagement • Relentless focus – on vision and strategy • Transparency – results, progress, aims, defects • Across boundaries 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

  20. IHI high impact leadership framework:where leaders focus effort 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. Presentation title

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