END OF LIFE STRATEGY MELANIE WRIGHT MACMILLAN CLINICAL NURSE SPECIALIST

1. END OF LIFE STRATEGYMELANIE WRIGHT MACMILLAN CLINICAL NURSE SPECIALIST PROVIDER FORUM 10th June 2009

2. END OF LIFE STRATEGY July 2008 Preceded by NHS END OF LIFE CARE PROGRAMME 2004 - 2007

3. CONTEXT 500,000 Deaths per year two-thirds over 75 year age group large majority of deaths following chronic illnesses i.e. heart disease, cancer, stroke, respiratory disease, neurological disease, dementia

4. Why a need for an End of Life Strategy? Over 90% of the final year of a persons life is spent in the community. Only 35% of people die in community settings despite 90% requesting home as preferred priority of care.

5. LOCATION OF DEATH:- • 58% Hospital • 18% Home • 17% Care Homes • 4% Hospices • 3% Elsewhere

6. s STRATEGY AIM • Promoting high levels of care for all adults at end of life

7. OBJECTIVES OF THE STRATEGY • To promote more choice about where they would like to live and die • Encompasses all adults with a progressive illness • Encompasses all care settings

8. MAIN AREAS OF THE STRATEGY • Raise the profile of death and dying in the general population • Identify patients approaching end of life • Opportunity to discuss and document priority choices so that all services involved can work towards these choices • Co-ordinated care and support using a system or pathway • Rapid Specialist advice and clinical assessment and access to care

9. M MAIN AREAS OF THE STUDY cont… • High quality care and support throughout the last phase of life, promoting dignity and respect pre and post death in all locations • Involvement and support of carers during the illness and after the death (specific child support) • Appropriate commissioning of services • Measurement and research

10. The End of Life Care Pathway

11. FUNDING Main areas of expenditure in end of life care are:- Hospital admissions Hospices and Specialist Palliative Care Services Community Nursing Services Care Homes

12. Government Manifesto Commitment for Increased Resources to Implement the End of Life Strategy £88m in 2009/2010 £198m in 2010/2011

13. HOW ARE WE MEETING THE END OF LIFE STRATEGY REQUIREMENTS?

14. Gold Standard Framework Delivering Choice Programme Advanced Decision to Refuse Treatment E.M.A.S forms on DNAR Advanced Care Planning Mental Capacity Act Development of Registration of Power of Attorney medical and financial Preferred Priorities of Care Out of Hours Green Card Unified IT Systems Systmone Continuing Care Funding Commissioning of Appropriate Services:- Co-ordination Centres, 24/7 Specialist Care and Generalist Care Provision, Home Care Services

15. GOLD STANDARDS FRAMEWORK Provides the Primary Health Care team with tools to improve the planning of palliative care in association with the multidisciplinary team/agencies Identifies the group likely to be in the last year/few months of life Promotes use of best of hospice care advances in the community setting Promotes numerous good practice occurring in Practices, Nursing Homes and associated community services, encourages sharing of good practice Impacts on the effective use of resources, reducing hospital admissions and improving user satisfaction

16. GOLD STANDARDS FRAMEWORK Palliative Register Communication meetings - multidisciplinary Anticipation of crises and medication requirements Case Review

17. GOLD STANDARD FRAMEWORK 7 C’S A programme of community palliative care centred around 7 components of care provision:- *Communication *Continued Learning *Co-ordination *Carer support *Control of Symptoms *Care of the Dying *Continuity Liverpool Care Pathway

18. : LIVERPOOL CARE PATHWAY FOR END OF LIFE • Diagnosing dying/last 48 hours • Anticipate/control symptoms and issues – concentrating on main physical symptoms:- nausea/vomiting, pain, agitation, secretions, breathlessness • Planning around patients preferred priority of death • One record/documentation promoting ongoing assessment • Stopping non essential medication/futile treatments and cares appropriately • Carer support • Bereavement planning • Gives professionals the opportunity to review after the patients death

19. WHAT DOES THE END OF LIFE CARE STRATEGY AND GOLD STANDARD FRAMEWORK CHANGES MEAN FOR CARE HOMES, SUPPORT WORKERS AND OTHER SERVICES?

20. Unified programme of working • Facilitates multidisciplinary communication • Recording of patient and carer priorities • Reduces the number of crises, out of hours calls and unnecessary hospital admissions • Allows assessment of patients care • Liverpool Care Pathway ensures all involved have same aim in last days of life • Better educated, prepared and more knowledgeable staff • Encourages achievement of best practice in palliative care for all patients in community settings

21. COMMISSIONING IMPLICATIONS? Nursing Homes may be required by Continuing Care to identify that they have acquired GSF registration to provide End of Life Care

22. Macmillan Gold Standards Framework Facilitator for Care Homes Lynne Goodliff – 01775 652257

23. Thank you for listening. Any questions?