End of Life Care provision in London Caroline Stirling, Clinical Director, NHSE (London region) EOLC Clinical Network Sarah Cox, Clinical Lead, RM Partners Palliative and EOLC Group
Background: RM Partners Palliative Care Group Palliative Care proposals for RMP cancer Vanguard status 2016 Seven day SPC availability NICE guidance 2004 Follow on from 2014 review across London Collaboration between RMP, SE London, PallE8 and London EoLC Clinical Leadership Group Enhanced EOL care Transformational potential Triangulated results with London EoLC Clinical Leadership Group 2
Background: End of Life Care Commissioners Checklist - published April 2016 Based on Foundations for excellence All Health and Social Care settings All diagnoses Use throughout commissioning cycle Use alongside other key publications / assessments 12 pages 3
Methods: EOLC Clinical Network Survey development Autumn 2016: Questionnaire developed by Transforming EOLC in acute hospitals and community working group. Essential and desirable elements of provisions for EOLC agreed by consensus Spring 2017: Questionnaire emailed to providers of SPC and commissioners of EOLC in each borough Telephone and email reminders sent Autumn 2017: Data collated and linked to foundations for Ambitions 4
Methods: RM Partners Palliative Care group Explore and present the evidence to support seven day SPC services Work with a national group to define what this would look like and using these standards to: Repeat the mapping exercise across London SPC services focusing on whether they provide 24/7 telephone advice and face-to-face services. Produce a template business case that could be used by providers in negotiation with commissioners to address inequities in provision of SPC services at weekends and bank holidays. 5
Methods: RM Partners Palliative Care group Review national models of enhanced EOL care to understand the key components from outcomes and costs related to different models of care Consult locally to understand what components of EOLC provision might be key in our geography Map enhanced EOLC in South and West London CCGs Produce business case for enhanced EOLC services 6
Methods: Data checking and combining December 2017 April 2018 Liaison and discussion to ratify and agree to share data Review of definition of 7/7 SPC provision in community and hospital setting Collection of data related to enhanced EOLC services in NC and NE London to obtain London-wide picture Final collation of results into single spreadsheet 7
Results: essential criteria Leadership CCG Lead for EOLC Social Service lead for EOLC Borough wide strategy for EOLC Borough wide steering group for EOLC 8
Results: essential criteria Specialist Palliative Care service provision by provider and care setting 120% 100% Community SPC service Hospice IPU/ hospital SPC IPU Hospital advisory service 80% 60% 8% 17% 100% 100% 40% 23% 20% 54% 50% 4% 25% 0% RMP + SEL UCLH/PallE8 RMP + SEL UCLH/PallE8 RMP + SEL UCLH/PallE8 19% 6% s 6 days Partial days 6 days only: 9-5 or equivalent 6 days/week Partial days: part of each day s/week 9
COMMUNITY SPECIALIST PALLIATIVE CARE SERVICE Results: Seven day Specialist Palliative Care service provision in the community - by provider Type of service Provider Barts Health NHS Trust Whipps Cross Hospital Margaret Centre Central London Community Healthcare Trust - Pembridge Palliative Care Centre community team Central & North West London NHS Foundation Trust - Camden & Islington ELiPSe Central & North West London NHS Foundation Trust - Hillingdon Community SPC Team Greenwich & Bexley Community Hospice - Community Outreach Service Guy's and St Thomas' NHS Foundation Trust (community palliative care service) London North West Healthcare Trust Brent & Harrow Community SPC team London North West Healthcare Trust - Ealing and Hounslow SPC Service Lewisham and Greenwich NHS Trust - University Hospital Lewisham Community SPC team North London Hospice Community Service Princess Alice Hospice Community Service Royal Free London Hospitals NHS Foundation trust North Camden Community Team Royal Trinity Hospice Community Service St Christopher's Hospice Community Service St Francis Hospice, Romford St John's Hospice Community Team St Joseph s Hospice, Hackney St Luke's Hospice (Harrow and North Brent) St Raphael's Hospice Community Team Availability at weekends and bank holidays (June 2017) Not available Not available Not available Urgent visits only Not available Partial days only Urgent visits only Partial days only Not available 10
Results: Seven day Specialist Palliative Care service provision and hospice admissions by CCG SPC visiting service - community SPC visiting service - hospital 7/7 a week hospice admissions 11
Results: Enhanced End of Life Care service availability Single Point of Access for EOLC Additional overnight sitting service availability 12
Results: essential criteria Other Out-Of-Hours services availability Access to equipment in community OOH Overnight community nursing service available Approximate time for approval of CHC fast track Community pharmacy stocking injectable medicines 13
Results: other essential criteria EPaCCs use, bereavement care, Health & Wellbeing Boards, emergency social care EPaCCS used within borough CCG Commissioned bereavement service in the borough EOLC papers presented at H&WBB OOH emergency social care service available 14
Results: other essential criteria Individualised care plans for last days of life Individualised care plan for EOL/last days of life in hospital Individualised care plans for EOL/last days of life in hospice Individualised care plan for EOL/last days of life in patients homes Individualised care plan for EOL/last days of life in care homes 15
Desirable services - relevant to provision of EOLC Commissioning of education by CCG in all settings Frailty hub Rapid discharge home pathway Rapid response services available OOH, and for EOLC patients Extended community pharmacy hours and Other sources of EOLC drugs OOH GP lead for EOLC 16
Conclusions Significant variation in provision of services essential for the provision of excellent EOLC between boroughs out of hours availability Strong case for these services in terms of experience and potential for cost saving Opportunity for commissioners and providers to review local results and provision Business case tools to be published, can be used to support addressing gaps in services Thank you! 17