End of Life Care in London Achievements and next steps

1. End of Life Care in LondonAchievements and next steps Dr Caroline Stirling – Clinical Director, NHSE/I (London region) EOLC Clinical Network Pan-London EOLC event 2nd May 2019

3. System wide data http://www.endoflifecare-intelligence.org.uk/home

4. NHSE (London region) EOLC Clinical Network – 2018/19 End of Life Care Clinical Leadership Group EOLC in Care Homes Review of CMC Access to EOLC Medicines Bereaved carers resource London Metropolitan Police Homelessness Identification Commissioners Network group Support for STPs CCG Visits

5. Strategic engagement • National EOLC leads network • London teams / networks / projects • CMC review • STPs / Integrated Care Systems: • Joint meetings – sharing of strategies, data, challenges etc • Individual support / engagement • CCGs: • Commissioners network meetings • 27/32 individual visits • Knowledge, enthusiasm and desire for change • All have improved EOLC services c.f survey (2017) • Recognition of and support for use of CMC • Areas of development - BAME, homeless, public engagement • 2019/20: • Ongoing meetings / support • Joint commissioners / clinical leads meetings

6. Care Homes • Phase 1: Data packs for 5 STP footprints • No of care homes and beds • No of deaths in care homes – c.f 75+ and care home beds • LAS call outs and conveyances • Use of CMC • Meetings /sharing of data • Phase 2 – 2019/20 • Evaluation of NHS 111*6 line use: • Liaison with CQC, larger care home providers • Ongoing production of data packs

7. Homelessness • Aim: • Share expertise • Facilitate engagement • Resource collation and cascade • http://www.londonscn.nhs.uk/wp-content/uploads/2014/11/Homelessness-and-EOLC-Useful-Resources.pdf • Effective interventions • Parallel planning • Multi-agency meeting • In-reach to hostels • Training • Specialised services

8. Access to Palliative Care medications • Aim: to reduce inequity of access to EOLC medications in community • Joint project with NHSE (London region) Pharmacy team • Working group: • Case for change • Draft specification • List of medications • Communication – August 2018 and April 2019 • 2019/20 – ongoing support of Pharmacy team to deliver project. • Scoping meeting to explore options for unified approach to Medication and Administration Record in London • Dissemination of outputs and next steps

9. Bereaved carers’ resource • Aim: single resource for registrars throughout London • Development and testing • 2019/20 – dissemination

10. Metropolitan Police – multi-agency working • Aim: Improved response to community deaths • May 2018 – statement cascaded • Working Group formed: • Mapping exercise • Scoping of priorities • 2019/20 – development of communication, education, clarification of roles, responsibilities etc

11. Identification

12. Identification – place based project • Support for delivery of 2019/20 EOLC QI project within GP contract: • Top tips guidance • Co-development of GP-system (EMIS, SystmOne, Vision) based search tool to support identification of those likely to be in the last year of life • Publication of tool • Place-based project in Newham to implement tool and deliver QI project • Dissemination of learning • Single metric for London

13. Elements of End of Life Care Identification Of those who might be the last year / days of life In all settings By everyone Compassionate conversations With person & those important to them To undertake shared decision making - establish understanding, priorities etc High quality care Of person & those important to them In all settings With optimal use of hospital care With person & those important to them Between health, social and third sector providers Between primary and secondary care Between in and out of hours care Collaboration