Darzi Review and The End of Life Care Strategy

1. Darzi Review and The End of LifeCare Strategy A summary and initial analysis Graham Elderfield Chief Executive Earl Mountbatten Hospice 25.09.08

2. Chapter Headings • The challenges of end of life care 2. Death, dying and society • End of Life Care Pathway 4. Care in different settings

3. Chapter Headings • Support for carers and families 6. Workforce 7. Measurement and research 8. Making change happen

4. Summary • No real surprises in strategy apart from new money £280m • No move to PBR or quantification of Hospice funding • Moves responsibility for Palliative Care leadership to PCTs from others eg. Hospices, MCCC

5. Initial Reflections • EOLC becomes a priority • Tasks PCTs with improving co-ordination of care • All staff to be trained in communication skills • Widespread adoption of LCP, GSF

6. Initial Reflections • Improvements in verification of death, including by nurses • Spiritual and cultural needs should be part of training • Training is a key priority within the strategy • PCTs to review progress annually

7. Initial Reflections • PCTs to ensure 24hr availability, including rapid response • OOH staff appropriately trained • EOLC register • Quality standards set for Care Homes, Hospices, Hospitals

8. Initial Reflections • EOLC strategy sets out role for Ambulance services and support to Prisons • Carers should get a Carers Care Plan • Challenge for research and evidence base • EOLC intelligence network

9. Making it Happen • Additional money to be monitored by DOH • PCTs/LAs to develop 3yr plans • PCTs to work with the Third Sector • New investment to be focused on rapid response co-ordination of care, SPC in Hospital, workforce

10. Making it Happen • New role for Hospices • SHAs to examine workforce needs • National programme of bereavement surveys • Public awareness campaigns led by NCPC

11. A VISION OF END OF LIFE CARE IN 2018

12. Nature of Need in 2018 • Significant increase in proportion of population over 85 • Increase in numbers of people with complex co-morbities • By 2025 1 million people with Dementia, many in own homes • Total numbers of deaths rising after period of decline

13. Nature of Commissioning in 2018 • Implementation of world class commissioning in 2009/10 • Guidance on commissioning from independent sector issued to NHS • Greater use of competitive tendering • Model contracts for commissioning services from non NHS providers • Signals an end to ‘grant’ funding for Hospices

14. Demonstrating Outcomes • New system of quality assurance under Care Quality Commission • An end to commissioning for activity • Services commissioned on basis of patient/service users outcome • Providers expected to demonstrate qualitative outcomes as part of contract management

15. Funding Care in 2018 • Tariffs for Palliative Care in voluntary sector since 2012 • Personal budgets for NHS patients providing greater choice • Users as consumers of Health and Social Services • New Partnership model for paying for social care • Patients able to ‘top up’ their state provided personal budget for health and social care needs

16. The Palliative Care ‘Market’ in 2018 • Care Homes marketing themselves as ‘palliative care specialists’ • Increasing NHS provision of palliative care within Acute and Community Hospitals (especially within Foundation Trusts) • Widespread private sector provision encouraged by implementation of payment by results and personal budgets.

17. Society in 2018 • ‘Live for ever’ culture disappears • We discuss death as much as we discuss sex • Patients direct the care they receive • End of Life Care seen as important as Maternity Care

18. Thank you