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