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www.england.nhs.uk
Towards a 5 year vision
for EoLC: What
matters most?
Jacquie White - NHS England Deputy Director.
Long Term Conditions,
Older people & End of Life Care
23 Feb 2016
www.england.nhs.uk
Opening thoughts…
“The good physician
treats the disease; the
great physician treats
the patient who has
the disease.”
William Osler - 1800s
2
“How people die remains
in the memory of those
who live on.”
Dame Cicely Saunders
(founder of the modern
hospice movement)
- 1918 - 2005
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Scene setting – what we know
www.england.nhs.uk 4
1mPeople with frailty
10mPeople have two
or more LTCs
0.5mAt end of life
16mPeople have one
LTC
The case for change
www.england.nhs.uk 5
3.2%
6% / 82%
75%deaths from non-cancer/
long term/frailty conditions
20% / 75%
of people with LTCs
have a care plan
The case for change
recorded preferences/
supported to die in
preferred place as a
result
end stage LTC palliative care
before dying/
cancer patients receiving
palliative care before dying
www.england.nhs.uk 6
25
4
25% of hospital beds
occupied by someone dying
4% over 65s in care home
with 14% total emergency
admissions for over 65s
Three-fold increase in cost
of health care with frailty
The case for change
Good community based EoLC
could reduce hospital costs by
£180 million per year£180m
www.england.nhs.uk 7
1 in 9
1 in 5
received no practical support with caring
Nearly 1 in 2
(46%) said they had fallen ill but just had to continue caring
1.4 million
people providing fifty or more hours of unpaid care per week
£1bn
in Carer’s Allowance goes unclaimed each year
caree had emergency
care while the carer
recovered from illness
The case for change
www.england.nhs.uk
• People living longer but not always well
• The larger the number of co-morbidities a patient has, the lower their quality of life
• Increasing evidence on over-treatment and harm
• Death seen as a failure of treatment
• Nobody likes talking about death and dying
• Not just a medical or health issue – also a social and societal issue
• Social isolation/loneliness a risk factor for mortality in over 75s and should be supported as a co-morbidity
• Need to be able to stand back and make sure that services deliver for everybody
And…
www.england.nhs.uk 9
Gaps, System Challenges & Drivers
www.england.nhs.uk
Gap Challenge/Driver
Health and
well-being
• Behaviour change: how can the NHS work differently?
• Empowering patients / public
• Engaging communities – developing partnerships
Care and
quality
• Variations in outcomes
• Reshape care delivery, e.g. new care models
• Use of innovation and new technologies
Funding and
efficiency
• Relentless pressure on services and workforce
• Estimated funding gap of £30 billion by 2020/21
• Local Authorities under even greater pressures
• Driving efficiency
• Local leadership
For the NHS...
www.england.nhs.uk
• New relationship with patients and
communities
• Prevention
• Patient empowerment
• Community engagement
• NHS as a social movement
• New models of care:
• Multispecialty Community Provider (MCP)
• Primary and Acute Care Systems (PACS)
• Enhanced health in care homes (EHCH)
• Clinical priority areas
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Five Year Forward View - What Will
be Different?
www.england.nhs.uk 12
How will we achieve this?
www.england.nhs.uk
Framing delivery….
LTC Framework:
Empowered patient and carers
Professional collaboration
Best Practice (clinical and organisational)
Commissioning
Delivering Person Centred Co-ordinated
Care
Cf: ‘Roadmap for Strengthening people-centred health systems in the WHO
European Region: A Framework for Action towards Coordinated/Integrated
Health Services Delivery (CIHSD)’ (WHO 2013)
www.england.nhs.uk
Working with our Partners
Patients and Public representatives
Voluntary Sector
National Palliative and EoLC Partnership
Royal Colleges
Statutory Organisations
National Palliative and EoLC Network
www.england.nhs.uk
What have we achieved so far and
what does the future look like for
end of life care?
15
www.england.nhs.uk
Some of our Highlights so far…
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‘Every Moment
Counts’: the
narrative for
‘person-centred
coordinated care’
Guidance: on
personalised care
planning and
advance care
planning
Healthy Aging
guide
EPaCCS
Winter toolkit for
commissioners &
care home providers.
Clinical
Engagement
Established
National Network
for EoLC
Ambitions for
Palliative and
EoLC
TRANSFORM
www.england.nhs.uk
Quality and Choice Agenda
• ‘What’s Important to me; a review of Choice in End of Life Care’ – published
Feb 15. Builds a case for ‘good quality personalised end of life care for all, which
delivers the choices that people would like to make.’
• ‘Ambitions for Palliative and End of Life care’ - published September 15 by a
coalition of national organisations. Incorporates findings from all preceding
reports and sets out a vision for end of life care, encapsulated by the National
Voices definition for Person Centred Care
Without high quality care you cannot have a
meaningful choice offer.
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www.england.nhs.uk 18
The System-wide Vision for EoLCNHS England is one of the 27 partners who produced the ‘Palliative &
End of Life Care Ambitions: National framework for local action
2015-2020’.
www.england.nhs.uk
NHS England – EoLC workstreams
1. Enhancing physical and mental wellbeing of the
individual
2. Transforming experience of End of Life Care in
hospitals and the community
3. Commissioning quality services that are accessible
to all when needed
www.england.nhs.uk
Our Declaration
• Launched at Expo 2015
• The importance of person-centred care for
people with long-term conditions, what
needs to change and why we need to
change
• Co-produced with NHS England and
Coalition for Collaborative Care and
developed with health and care
professionals, policy makers and people
with long-term conditions
• To motivate and support health and care
professionals to help us make it a reality
#A4PCC – Action for Person-Centred
Care
www.england.nhs.uk
• Develop a “orientation” process: about the
condition(s), how to live with it, how to stay
healthy and independent, how to plan for a good
death
• Have a different conversations: ask a different
question - what matters to you/me today
• Use experience to inform decisions: plan on a
page, 3 questions
• Write letters to other services/clinicians together
and share them with everyone involved in the
care and support
• Jointly create care plans that focus on the whole
person and that are owned and move with the
person
• Help move through the system: care co-
ordinator/navigator
21
Moving to person-centred care
together
www.england.nhs.uk
What part will you play?
Make your declaration at
www.engage.england.nhs.
uk/survey/ltc-declaration
#A4PCC – Action for Person-
Centred Care
YOU CAN MAKE A DIFFERENCE
www.england.nhs.uk
@jaqwhite1
#A4PCC
www.england.nhs.uk/resources/resources-for-ccgs/out-frwrk/dom-2/
23
Thank you
