Transforming End of Life Care in Acute Hospitals AM Workshop 1: EPaCCS 2020 ‘Where we are and...

www.england.nhs.uk

Workshop

EPaCCS 2020:Where we are and where we need to be

18 November 2015

www.england.nhs.uk

Agenda

1. Welcome

2. North West EPaCCS - Past, Present & FutureStephen Burrows, North West EPaCCS Project Lead

3. EPaCCS 2020: Where we need to beJeri Hawkins, Sustainable Improvement Team NHS England

4. Focused DiscussionAll

The North West EPaCCS –past, present & future!

Stephen BurrowsNorth West EPaCCS Lead

Greater Manchester, Lancashire and South Cumbriaand Cheshire & Merseyside Strategic Clinical Networks

4th November 2015

• records and shares people’s preferences and wishes about their end of life care, with everyone involved in their care

• improves co‐ordination of care by making information available 24 hours a day

• supports appropriate treatment decisions and interventions

• allows more people to die in the place of their choice

What is an EPaCCS?

December 2013End of life care service providers migrated to compliant systems. IT systems suppliers MUST comply with standard

(End of Life Care Co‐ordination: Core content Standard Specification, Dec 2012)

2015Rollout to 80% acute trusts, to increase deaths in usual place of 

residence from 39% to 47% by 2015(NHS Improving Quality ‐ Our Strategic Intent Mar 2013)

70% rollout of Electronic Palliative Care Coordination Systems (EPaCCS) across England (baseline 15%)

(NHS Improving Quality ‐ Our Strategic Intent Mar 2013)

EPaCCS Implementation deadlines

1st February 2016Public Health England audit of local areas

to collate EPaCCS and related data

April 2016Local digital roadmaps detailing steps to ensure

“all electronic health records will be fully interoperable so that patient records are paperless” –

i.e. 100% rollout of Electronic Palliative Care Coordination Systems (EPaCCS) across England by 2020 

(Five Year Forward View / Personalised Health and Care 2020 )

EPaCCS Implementation deadlines cont.,

• Use existing systems

• Avoid / reduce duplication of existing EoLCrecording

• Replace / reduce other non-electronic EoLCcommunication

• Quick and easy to use, avoiding over use of text

• Ensure sustainability and make ‘future-proof’

North West requirements

Potential North West issues

• Standardise (as much as possible) the processes and flow of information to NWAS from 34 CCGs

• Use of other shared resources (e.g. hospices / other organisations that cross boundaries)

• Patients that cross boundaries (e.g. 15% -20% of EoLC patients in one acute trust not from that locality) or move

• Providing patient access• Reporting and monitoring of outcomes (measuring

‘like for like’)

• Identification of 22 EPaCCS ‘localities’ across the North West, and subsequent setting up of EPaCCS Task Groups to meet regularly and represent the range of stakeholders within a locality involved in End of Life Care (EoLC).

• Creation of a common dataset – the North West EPaCCSdataset – a minimum implementation of which ensures ISB 1580 compliance, but which also includes other frequently used information commonly shared by end of life care services. Accepted by all localities in 2013, and continually updated to reflect changes to the standard. 

The North West EPaCCS –achievements so far ‐ 1

• System supplier created, nationally available, EPaCCS templates based upon the NW EPaCCS dataset available and in use in local systems – EMIS Web/LV/PCS (available since 2013), INPS Vision+ (available since 2014), TPP SystmOne (now available locally), iPMLorenzo (Morecambe Bay), Graphnet (available since Nov 2014) etc.

• Training materials for the national EPaCCS templates to support local rollout of their use, and provide resource for EoLC facilitators etc involved in supporting EPaCCS use.

The North West EPaCCS –achievements so far – 2

• A North West template for an EPaCCS Information Sharing Agreement (ISA), shared with all localities for their adaptation and completion.

• An ISB compliant End of Life View available in the MIG (Medical Interoperability Gateway) supplied by Healthcare Gateway. This is currently the only commercial solution allowing for the streaming of information recorded on GP systems to be shared with other organisations.

The North West EPaCCS –achievements so far ‐ 3

NWAS

NW generic approach –GP Master Record

OOH ‐ AdastraAmbulance System ‐ERISS

OOH / 111

GP(plus others if 

a shared clinical system)

Social worker

Mental health worker

DN

Hospital Consultant 

CMN

EoLC view

A&E?

• Regional support and networking provided through the creation of EPaCCS Network Implementation Groups (NIG) – for Cheshire & Merseyside, Greater Manchester, and Lancashire & Cumbria – that meet quarterly, and share best practice / developments via a Yammer network.

• Targeting and support for locality EPaCCS implementation set through the Eight Key Areas document, RAGB‐rated on a quarterly basis, and fed back through SCNs and AHSNs to organisations. In GM this has been developed into an AHSN supported performance dashboard to be rolled out further.

The North West EPaCCS –achievements so far – 4

Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15

0.1 Project Plan R R R R R C C C C C R R R R R A G G G G

1 Scope and Census R R R R R G G G G G R R R R R A A A A A

2 EPaCCS Task Group A A A A G G C C C C C C R R R R R R C C C C C C

3 EPaCCS Recording R R R R R R A G G G G G R R R R R R G G G G G G

4 Information Governance R R R R R R A G G G G G R R R R R R C C C C C C

5 EPaCCS Sharing R R R R R R R G G G G G R R R R R R A A A A A A

6 GSF Meetings R R R R R R A A G G G G R R R R R R G G G G G G

7 EPaCCS Reporting R R R R R A A A A A R R R R R A A A A A

8 Electronic Documentation R R R R R R A A A A A A R R R R R R R R R R R R

Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15 Nov-14 Jan-15 Feb-15 Mar-15 Apr-15 Aug-15

0.1 Project Plan C C C C G G G G G R R R R G G

1 Scope and Census A A A A G G G G G R R R R G G

2 EPaCCS Task Group C C C C C R G G G G G R R R R A A G G

3 EPaCCS Recording A A A A A A A A A G G G G G G R R C C

4 Information Governance C C C C C A G G G G G G G G G A A G G

5 EPaCCS Sharing G G G G G R G G G G G A A A A R R G G

6 GSF Meetings A A A A A R G G G G G R R R R R R G G

7 EPaCCS Reporting R R R R A A A A A A A A R A A

8 Electronic Documentation R R R R R R G G G G G A A A A A A G G

Comments No task group as yet - assumption of red status.

No update received from Feb 2015. Have assumed no change.

No task group set up yet - assumption of red status.

Ref Area

RAG Status / Plan

RAG Status / Plan

Area RAG Status / Plan RAG Status / Plan

Trafford(PM - TBA)

Wigan(Robert Walters)

RAG Status / Plan

RAG Status / Plan

Bolton(PM - Gill Baker)

Manchester(Mohamed Abas)

EPaCCS RAG Status (Aug15)

Stockport(PM was Jane Owens)

Tameside & Glossop (Philippa Robinson)

Comments

Ref

EPaCCS RAG Status (Aug15)

North East Sector(PM - TBA)

Salford(PM was Steve Gene)

RAG Status / Plan RAG Status / Plan

Status of EPaCCS Implementations across GM Conurbation

• First examples of real‐time EoLC information being shared through EMIS to EMIS, and via the MIG with other services including OOH etc. happening across the region.

• Continuing work with NWAS and The Christie to agree a co‐ordinated means of receiving real‐time EoLC information either through the MIG Shared Record Viewer or Graphnet.

The North West EPaCCS –achievements so far – 5

• Link into Lancashire Patient Record Exchange System (LPRES) and Datawell interoperability solutions for Lancashire & Greater Manchester.

• Work begun on a ‘Why EPaCCS’ video to encourage and promote the use of EPaCCS by clinicians in all EoLC services.

• Work ongoing to promote EPaCCS implementation through Transform agenda.

The North West EPaCCS –achievements so far – 6

TransformingEndofLifeCareintheCommunity

• About• Based on the Transforming End of Life in Acute Hospitals Programme• Commenced in March 2015• Encompasses ACP, DNACPR, Communication and End of Life Care training for Primary Care as well as

promoting the roll out of EPaCCS to the GP practices• Why

• To reduce unnecessary hospital admissions / deaths• To increase the choice for patients to die in their UPR

• Aims• Promote discussions about end of life care and translate into workable documents• To support patients to achieve their wishes and preferences at the end of life• To encourage GP’s to find their ‘1%’

• How• Delivering sustainable education programmes to Community practitioners• Initiating and maintaining cross-community communication

• So far• Surgeries/District Nurses/Health centres• GSF Meetings

• Future• Commencement of Transforming End of Life Care in Care Homes

Read only Read and write Via a third party (eg call centre, another team)

GPs Lancs NthPennine LancsSalfordManchesterTameside & GlossopSouth Cheshire, Vale Royal & Eastern CheshireBlackpool, Fylde & WyreWest CheshireWigan BoroughLiverpoolSouth SeftonStockportCumbria

Out of hours GP service Lancs NthPennine LancsSalfordTameside & GlossopWigan BoroughLiverpoolCumbria

ManchesterStockport

District nursing service Pennine LancsCumbria

SalfordManchesterSouth Cheshire, Vale Royal & Eastern CheshireLiverpoolSouth SeftonStockport

Specialist palliative care - community services

Pennine LancsWigan BoroughCumbria

Lancs NthSalfordManchesterSouth Cheshire, Vale Royal & Eastern CheshireLiverpoolSouth SeftonStockport

Care homes with nursing ManchesterStockport

Salford

NHS IQEPaCCS Baseline 

Questionnaire responses

Read only Read and write Via a third party (eg call centre, another team)

Acute hospital community Lancs NthPennine LancsWigan Borough

SalfordManchesterStockport

Acute hospital specialist palliative care in patient

Lancs NthPennine LancsTameside & GlossopSouth Cheshire, Vale Royal & Eastern CheshireWigan BoroughLiverpoolSouth SeftonCumbria

SalfordManchesterStockport

Acute hospital A&E department / acute admissions

Lancs NthTameside & GlossopSouth Cheshire, Vale Royal & Eastern CheshireWigan BoroughLiverpoolSouth SeftonCumbria

SalfordManchesterStockport

Acute hospital - discharge teams / processes

Lancs NthWigan Borough

SalfordManchesterStockport

Hospice Tameside & GlossopWigan BoroughLiverpoolSouth Sefton

SalfordManchesterSouth Cheshire, Vale Royal & Eastern CheshireStockport

Social care SalfordThe Christie Salford

Tameside & GlossopPatient Cumbria

Challenges in progressing EPaCCS 

• Leadership

• Clinical engagement

• IT engagement

• Finance

Stephen BurrowsNW EPaCCS Project Leadstephen.burrows@nhs.net

www.england.nhs.uk

EPaCCS 2020:Where we need

to be

Jeri HawkinsSustainable Improvement Team18 November 2015

www.england.nhs.uk

• Some Current Understandings (End of Life Care

and EPaCCS)

• National Ambitions

• Current Priorities

• Some Proposed National Support

Agenda

www.england.nhs.uk

Some Current Understandings

End of Life Care&

EPaCCS

www.england.nhs.uk

End of Life Care,Some Current Understandings

• Important information in What we know now 2014 (PHE, June 2015)

An increasing proportion of people die at home or in care homesPatients with an Electronic Palliative Care Co-ordination System (EPaCCS) record are more likely to die in the place of their preferenceTwo in five people with dementia die in hospitalFactors most important to people at the end of their life were having pain and other symptoms managed effectively, being surrounded by loved ones and being treated with dignityMore GPs are having conversations with people about their end of life care wishes but 25% still say they have never initiated such a conversation

www.england.nhs.uk

EPaCCS, Some Current Understandings

• Information from various evaluations and most recently the 2013 Survey

• “68% of CCGs have a working EPaCCS”

What does the statement mean?How is information shared?Who is connected and sharing?What are they sharing and for how many patients?When will everyone be sharing?What kind of help might they need?

National Ambitions

National Palliative and End of Life Care Partnership

www.england.nhs.uk

• 27 organisations; patients, voluntary sector, social care, colleges & councils, regulators, hospice, health education, NHS

• Equal partners to provide a collective, collaborative, cooperative approach to create the change everyone wants in end of life care

National AmbitionsNational Palliative and End of Life Care Partnership

www.england.nhs.uk

National AmbitionsNational Palliative and End of Life Care Partnership

www.england.nhs.uk

National AmbitionsNational Palliative and End of Life Care Partnership

www.england.nhs.uk

National AmbitionsNational Palliative and End of Life Care Partnership

www.england.nhs.uk

National AmbitionsNational Palliative and End of Life Care Partnership

www.england.nhs.uk

National Ambitions

National Information Board (NIB)&

NHS England

www.england.nhs.uk

• National Information Board (NIB)Membership includes CEOs of all major health & care organisations including Simon StevensProgresses the ambitions of the Care Act 2014, the Government Digital Strategy (2013), the DH Digital Strategy: Leading the Culture Change in Health and Care (2012) and the proposals in the DH’sPower of Information (2012)

• Personalised Health and Care 2020Builds on the commitment to exploit information revolution outlined in the Five Year Forward Viewhttps://www.gov.uk/government/publications/personalised-health-and-care-2020

National AmbitionsNational Information Board & NHS England

www.england.nhs.uk

• Align EPaCCS development with NIB work programme, ergo the Five Year Forward View and digital ambitions, e.g. a paper-free NHS by 2020

• 100% EPaCCS implementation throughout England by 2020, compliant with the core information standard SCCI 1580

• 100% compliance with EPaCCS Recommended IT Systems Requirements by 2020

National AmbitionsNational Information Board & NHS England

www.england.nhs.uk

National AmbitionsNational Information Board & NHS England

• What’s it all for?Joined up, safer carePatient / carer involvementBetter informed and efficient careSystem interoperability

• All of which go way beyond EPaCCS

www.england.nhs.uk

National AmbitionsNational Information Board & NHS England

• To meet the challenges of the 2020 digital agenda we need to get from here:

• To here:

www.england.nhs.uk

Current Priorities

www.england.nhs.uk

• Changes were made to the national information standard. These were published 25/09/15

http://www.endoflifecare-intelligence.org.uk/news/

Current Priorities

www.england.nhs.uk

• Changes were also made to the supporting EPaCCS Recommended IT System Requirements and this document has also been published

http://systems.hscic.gov.uk/qipp/library/epaccsreq.pdf

Are you & your suppliers working with these documents?

Current Priorities

www.england.nhs.uk

Current Priorities• Personalised Health & Care 2020 (NIB) requires each

and every CCG to produce:A footprint and governance template for 30 October 2015A complete digital roadmap for 1 April 2016. http://www.england.nhs.uk/digitaltechnology/info-revolution/digital-roadmaps/

Is your organisation feeding into this process?

• Establishing a new national understanding through delivery of a new baseline for EPaCCS

Commissioned by NHS England and the NIBDeadline November 15To help identify where CCGs are now so that a longer term work programme can be defined to support getting where everyone needs to be

www.england.nhs.uk

Some Proposed National Support

www.england.nhs.uk

• Transforming End of Life Care event today (Network!) • Quantitative & qualitative EPaCCS evaluation (end-February 16)• National EoLC Intelligence Network economics-based research

project into the costs of EPaCCS (end-March 16)• A new community of practice

A national forum for EPaCCS usersConnecting with and learning from this communityShowcase event(s) and Case Studies

• Development of a practical longer term support plan• National EPaCCS conference(s)• Review and revamp support and guidance documents• Develop a national compendium of best practice resources

Some Proposed National Support

www.england.nhs.uk

Your Turn

Focused Discussion

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Questions for you

• Are your EPaCCS going to meet the ambitions for 2020?

• What do you see as the major barriers to meeting the ambitions for 2020?

• How can the national team help you to meet the ambitions for 2020?