Delivering Choice

1
Delivering Choice

• Jill George
• Hospice _at_ Home

2
What is Choice?

• To select from a number of alternatives (OED)

3
Changing the Culture

• Are we equipped to have open communication with
  our patients and their families?
• Talk!
• Preferred Priorities of Care
• Advanced Care Planning
• Care Planning
• Identify issues that may hinder choice

4
What factors influence our choices?

• Older people and women are less likely to die at
  home than younger people, (Higginson et al 1998,
  Grande et al 1998)
• Patients with informal carer support are more
  likely to die at home and access palliative home
  care.
• Some GPs reluctant to share care (Grande, 1998)

5
Continued..

• Identification and communication that the patient
  is dying
• Patient and family need to have a true picture of
  what services are available
• Those services need to reflect the promise
• Specialist services need to willingly share their
  knowledge

6
Marie Curie - delivering choice

• Lincolnshire
• Launched in 2004
• To support all terminally ill patients across the
  UK, irrespective of diagnosis
• Deaths at home UP from17 to 42
• Deaths in hospital DOWN from 63 to 45
• Cost neutral (Kings Fund report)

7
How does their project work?

• Phase 1 Understand the current state of
  services
• Phase 11 Design new service models
• Phase 111 Implement and monitor the service
  models

8
Solutions in other areas

• Rapid response teams 24/7
• Discharge community liaison nurse
• Palliative care co-ordination centres
• Health and personal care assistants
• Palliative care ambulance

9
Strategic plans

• Identify the gaps in services in our area that
  need to be filled
• Identify the most effective and efficient way to
  fill those gaps
• Publicize the services that are available and
  expand if required
• Begin to change the culture by talking to our own
  friends and families

10
How to achieve real choice

• Vocalising a choice to stay at home
• Less likely to die alone
• More likely to attain choice (Seale et
  al1997)
• Reassurances to informal carers
• Sharing our knowledge with carers
• Planning care
• Individualised care
• 24 hour access to advice and care
• Key worker (or team) to avoid confusion
• Talk !