A collaborative approach to Specialist Palliative Care and the difference this is making in Dudley

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1 A collaborative approach to Specialist Palliative Care and the difference this is making in Dudley Dr Joanne Bowen, Dudley Foundation Trust Nicole Woodyatt, Macmillan Cancer Support

2 The Midhurst Macmillan Service Knowing that there is a team of people who are on call and who know everything about your wife s illness, and therefore can step in and just deal with anything that comes up, gives you a huge amount of comfort. Nigel, husband and carer to a patient in Midhurst

3 Testing in Different areas Principles:

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5 Managing Uncertainty Managing Uncertainty

6 Single point of Dudley Macmillan access work stream Specialist Care at Home HUB referrals (43% non-cancer) in 22 months % Contact within 5 days (or 24 hrs if urgent) Monthly analysis of data Ongoing streamlining 25 0

7 What Referrers Single point of Really helpful, provided excellent help & reassurance say Brilliant, got the advice I needed quickly & easily access work stream Improves continuity Reduces Duplication Found it very helpful in a difficult situation in a patients home communication and efficiency improved Has made the team more accessible and their ability to respond is better

8 Collaboration work stream Specialist Palliative Care MDT Hospital/ Hospice/ Community PRIMARY CARE MDTs (46 practices) Aligned to member of community team Locality Integrated meetings (5 localities) named consultant for each locality Hospital Cancer MDTs Mortality & Morbidity Respiratory Dementia System wide frailty group Muscular Dystrophy 16 Acute wards aligned to member of hospital SPCT EAU - daily presence

9 Workforce work stream Palliative Care Champions Potential for champions to disseminate core principles to over 600 other staff Improved referral of of appropriate Specialist cases, Specialist when cases, Core when level Core already level already implemented Improving access to Specialist Palliative Care regardless of of setting or diagnosis

10 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Deaths in Hospital (%) 70% Proportion of Deaths deaths in in Hospital, Hospital, Dudley Dudley Residents, Residents, Month month and and Year Year of Registration, of Registration, January January 2012 to 2012 December to Dec % 50% 40% 30% 20% 10% 0% Percentage of Deaths in Hospital Annual average 2012 Annual average 2013 Annual average 2014 Annual average 2015 Annual Average 2016 Data Source: ONS Mortality Statistics Month Public Health Intelligence, Dudley MBC

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12 Summary of outcomes 3666 referrals in 22 months (43% non-cancer diagnosis) More people achieving preferred place of death Hospital deaths reduced Over 100 palliative care champions

13 Professionals have fed back: the change that you ve made has made a huge difference, we no longer feel that there s any duplication of work. GP - Project team focus group I think before we started the project there was an element of collaborative working across Dudley as a health economy. But bringing the project together has made all parties really buy into collaborative working. I think for me that s a huge thing, and it helped that we d got relationships there before. Project team focus group

14 Community of Practice The community of practice has been running for two years now and that builds up trust. Some of the conversations can be not just about successes but about some things that they wish had gone better. I think there s more learning then than when discussing successes alone. Tudor Humphreys, Macmillan Development Manger Sometimes when you re in the thick of a problem and you think that you ve gone down every avenue you possibly can, somebody might be able to come at it from the outside and throw in a new idea that you hadn t necessarily thought of yet. Helen Richings, Project Manager, West Norfolk

15 Better is possible, it does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. Above all it takes a willingness to try. Dr Atul Gawande Author of Being Mortal