Case Managers - End of Life Care The Liverpool Partnership Programme Rita Doyle 5 th July 2012

1. Case Managers - End of Life Care The Liverpool Partnership Programme Rita Doyle 5th July 2012

2. The Liverpool Partnership Programme - End of Life Care • is an exciting and innovative programme which aims to enhance • and transform end of life care in Liverpool. • The Partnership is a jointly funded venture between Marie Curie Cancer Care • and The Royal Liverpool and Broadgreen University Hospital NHS Trust (RLBUHT). • working together on specific projects including; • The introduction of Case Managers - End of Life Care, • working across RLBUHT and the Marie Curie Hospice Liverpool • The development of a Supported Discharge Service that will support • people being cared for at home, augmenting the existing services within the area, • thus increasing the number of people who are able to achieve their wish to die at home.

3. The Route to Success (2010) listed in particular a need to deliver improved outcomes by; • Enabling people to die in the place of their choice • Co-ordinating care and discharge planning based on assessed need and by working with patients and families, as well as partners in the community and social care. • Appointing a designated End of Life Care Discharge Planning Nurse

4. End of life care is one of several QIPP work streams. It focuses on improving systems and practice for identifying people as they approach the end of life and planning their care.

5. The CQuIN framework forms one part of the overall approach on quality, which includes: • defining and measuring quality, • publishing information, • recognising and rewarding quality, • improving quality, • safeguarding quality • staying ahead

6. Quality Domain Important Choices – Where to die when the time comes • Documented evidence of an assessment of Preferred Place of Care • post hospital treatment for 95% of all patients. • 70% of patients known to Hospital Specialist Palliative Care Team transferred to their preferred place of care post hospital

9. April 2011- (end) February 2012 Documented evidence of an assessment of Preferred Place of Care (PPC) for 95% of patients *Variance=valid reason also given 70% of patients known to Hospital Specialist Palliative Care Team transferred to their preferred place of care post hospital Better Health Better Life

11. QIPP estimate it costs £3000 per hospital death Of the 62 patients known to the HSPCT in 10 months = £186,000.00 Average of 1400 deaths per year in RLBUHT £4,200,000.00

12. May 2012 Case Managers start new role and commence robust Orientation Programme. Claire Griggs Cathy Colford Kate Gleeson (joining asap)

13. Involvement in preparation for role QIPP KPI 2 Audit – initial findings • Delayed recognition of deterioration. • Lack of discussions with patient and family. • Lack of access to documentation from other settings. • Lack of utilisation of end of life tools e.g. PPC, ADRT, Rapid Discharge Pathway. • Discharge planning a slow process.

14. Opportunities and Challenges • Communication and co-ordination between settings and services. • Recognition of and discussions around patients’ deteriorating condition and their preferences. • Category of patients; • Rapid • Fast track • Rapid fast tracks

15. The Benefits of Case Managers –End of Life Care • Allow a proactive approach to discharge at end of life to be taken. • Lead in organising Rapid Discharges Home to Die. • Build links between primary, secondary, independent and voluntary care providers • Facilitate communication between palliative care patients, the hospital, community, voluntary health and social teams • Act as an advocate for the patient and their carers • Provide education for palliative care patients, their carers and professionals • Ensure that patients are discussed and included on the Supportive Care Templates at their GP surgery.