NHS England: National Update

Transcription

1 NHS England: National Update Prof Bee Wee National Clinical Director for End of Life Care NHS England; Consultant in Palliative Medicine, Oxford University Hospitals NHS Trust 17 th April 2018

2 The scale of our challenge Number of deaths registered in England and Wales ,000 (5.6% more than in 2014) Projected 628,659 by 2040 Scottish study over 1 in 4 of hospital inpatients were dead within 12 months; a third of these died during index admission (Clark et al, 2014) Projected number needing palliative care (Etkind et al, 2017): Increase by 25 42% Dementia and cancer will be main drivers of increased need Size of older population over next 20 years (ONS): Aged 85 or more: from 1.7 to 3.7 million Aged 75-84: from 4.1 to 6.3 million

3 Prevalence of multimorbidity by age and socio-economic status Source: Barnett et al, Lancet 2012

4 Average hospital cost per day in last 90 days of life (n=1.22 million) Source: Georghiou & Bardsley: Exploring the cost of care at the end of life, Nuffield Trust, Sept 2014

5 Dying in the hospital setting: Ranked domains of importance Patient Family 1. Effective communication & SDM 1. Expert care 2. Expert care 2. Effective communication & SDM 3. Respectful & compassionate care 3. Respectful & compassionate care 4. Trust & confidence in clinicians 4. Trust & confidence in clinicians 5. Adequate environment for care 5. Financial affairs 5. Minimising burden Virdun et al: Pall Med (2015)

6 Wider context Supporting STPs/ICSs in addressing their priorities Drawing attention to variations and inequalities

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8 Financial information: Sarah s story Analysis by provider Sub-optimal Optimal Optimal % Third Sector 2,880 1,219 42% Acute 50,757 3,542 7% Ambulance service 2, % Community hospital 3,843 2,404 63% Community teams 3,025 7, % Primary care 702 1, % Social services 4,466 8, % Grand total 68,004 24,282 36% Please note the financial costs are calculated on a cost per patient basis and local decisions would need to take a population view of costs and improvement.

9 What works: Nuffield trust 9

10 Wider context Supporting STPs/ICSs in addressing their priorities Drawing attention to variations and inequalities Being integral to whole population approach to personalised care

11 Shared decision making Social prescribing Personal health budgets Health literacy

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13 16/04/2018

14 Unpacking the vision (universal): what does this mean for the person? 1. Condition recognised as advanced or getting worse 2. Personalised planning - leading to coordinated action - is offered for treatment, care and support 3. High quality experience anywhere anytime

15 Unpacking the vision (universal): what does this mean for the person? 3. High quality experience anywhere anytime Staff who know what they are doing Timely access to medicines, equipment, etc. Feeling safe physically and emotionally Family/those important to me are supported

16 NHS Mandate Overall 2020 goals: Significantly improve patient choice, including in maternity, end-of-life care, elective care and for people with long-term conditions : Increase the percentage of people identified as likely to be in their last year of life, so that their End of Life Care can be improved by personalising it according to their needs and preferences.

17 Slide deleted because of purdah but will be shown on the day and will be available after the local elections in May.

18 How do we measure what matters?

19 My care was dignified it was professional but it missed the point. I can t help wondering what my health care would be, what it would be like, if it understood the point: that it s not what health care does that matters; it s rather how well health care helps us with our deepest our realest needs. How it touches our souls. Don Berwick, IHI National Forum 2009