NHS Devon & Devon Council

Dying Matters in Devon‘Let’s talk about it’

Implementing the End of Life Strategy

Joint Engagement Board. Monday 18th October 2010

NHS Devon EOL Programme Manager: Lorna Potter

Graham Varley Strategic Development Lead ACST DCC

North Devon District Hospital & North Devon Hospice &

Children’s Hospice

South Devon Healthcare FT Hospital & Rowcroft Hospice

Plymouth Hospitals NHS Trust & St Luke’s Hospice

Dying Matters in Devon

• 267 Residential Care Homes

• 80 Dual Registered Nursing Homes

• 182 EMI Homes• 11,500 C/H staff• 12,000

Domiciliary Care Workers

Royal Devon and Exeter FT Hospital & Exeter Hospice

• 107 GPs• 8 GP

Consortia• 21

Community Hospitals

• Community Provider services

• Leadership – EOL SCG

Dying Matters in Devon• Population of

755,000 & rising• Higher proportion

of older old (26% over 65 yrs by 2021)

• 17% live alone

• Devon estimates 12,000 + have dementia

Number of small coastal & market towns, many small villages, Exeter city, plus a large rural area

• Poor public awareness, death & dying a taboo• EOL seemed low priority for local NHS & Social Care • Little interagency sharing of EOL plans• Poor co-ordination of care across sectors , big gap in 24

hour cover• High % dying in our acute hospitals sometimes against

their wishes – more choice wanted to die at home• Inadequate support for carers• Fragmented bereavement services• Inadequate educational provision for staff• Suboptimal care delivery seen in some of our hospitals,

care homes and the community• Care homes asked for help

Oct 2007 We asked …….The public told us….

NHS Devon & Devon County Council Partners

NHS Devon & Devon County

Council

General Practices

Hospitals

Community Nursing

PCT –commissioners & providers

Ambulance & Out of Hours Services

Domiciliary & Rapid

Response

Intermediate / Complex Care

Teams

Social Services

Mental Health

Teams (DPT)

Community Children & Young Peoples

Services

Hospices & Specialist Palliative

Care Teams

Social ServicesSocial &

Community Care

Nursing & Care Homes

PrisonsNHS Direct

Social Care, Devon Care Homes and domiciliary care

providers have a key role to play in hospital avoidance, promoting

wellness in clients, facilitating a ‘peaceful death’ and signposting in carer’s and families

into bereavement services when

required.

Place of death 2008-2009

Hospitals At home Nursing Home

Residential Home

Hospice Other

49.5% 20% 16.5% 7.16% 5.28% 2.02%

Approximately 8000 deaths per annum in Devon

Target is to reduce acute hospital admissions for dying people by half in the next five years

Target is to increase the range of choices for people to enable them to die at home (including nursing and care homes)

Target to reduce admissions hospital admissions from nursing and care homes by 10% per annum for next three years

Target is to increase the numbers of people with an Advance Care Plan

Roll out of GSF & LCP Best practice

Integrated Care Pathways

Universal Advance Care Plan Tools

Locality Palliative Care

Register

&

Practice Registers

Public & Professional Awareness

Single Point Access Co-ordination

Increase alternatives to

Hospital admission

Developing clinical or care champions in

all settings

Implementing the EOL Strategy in Devon

By March 2011…

OOH Doctors, Nurses &

24/7

4 GSF Care Home Facilitators

rolling education programme

+3yr

Dom

Care

5Macmillan GP GSF Facilitators

Education & Training resources targeted across health & social care

Rapid response helpline

Developing key worker & care champion roles

in

all

care settings

Increased Carer Support workers

&

Bereavement Services Directory

Just in case medicines

By March 2011…

Implementing the EOL Strategy in Devon

Dying Matters in Devon: so what are we doing…..

• Joint NHS Devon & Devon County Council EOL Strategy

• Dying Matters Stakeholder conference used to inform strategy July 10 & Nov 2nd

• Liaison with NHS Northeast – development of a good death charter

• Proposing a similar charter for Young People informed by Youth Ambassadors

• Senior Council for Devon & Locality forums – awareness raising workshops on Dying Matters

• Potential – Devon Retirement Pack

• All systems & organisational approach to implementing EOL strategy

• Developing a Health & Wellbeing Forum for Dying Matters – locality GPs, hospices, com’s leads, public health, voluntary sector = developing a locality approach to events

• Exploring utilising Dying Matters national material, web sites, local media – particularly local radio….

• Considering how to use Social Networking websites

• Bereavement Services Directory• Exploring work with the local Art

Colleges – developing education material

• Appointed Macmillan GSF Leads –peer educators

Dying Matters - the Challenge

Nationally only 29% of people talked about their wishes in 2009 - less than in 2006 (34%)

500,000 people die each year in England – 60 % in hospitals, yet 70% of people would like

to die at home

99% said death should be discussed ahead of time

63% had made a will

17% had documented their wishes

70% had discussed wishes with family

94% would be happy for their ACP to be stored on an electronic database in Devon - ADASTRA

Devon Population Snapshot survey 145 people 6th July 2010

Devon survey A /A45% wanted to die at home

5% said they would not

49% said don’t know

Consider legal and financial matters: Making a will, the costs of dying,

insurance, a funeral plan Financial help to support you and your

family with care costs, transport

Organ donation - saving other lives Make a plan for what you want

when you die: The type of care you would like

towards the end of your life Where you would like to die Whether you have any particular

worries you would like to discuss about being ill and dying

Whether you want to be resuscitated or not

Consider how you would like to be remembered: What would you like people to know

before you die Messages, memory boxes, videos for

loved ones

Plan your funeral arrangements: What do you want, burial, cremation,

green funeral, other Any service, celebration of your life What songs, messages, themes Who do you want to attend

Prepare for bereavement If you need help or advice, find out

where to go for support Find out what to do about

legal and financial mattersafter death

Planning for a ‘good death’

Behaviours• Wishes of dying people

discussed and recorded• Wishes to donate organs

discussed and recorded and more people donating organs-promoting positive ‘life-giving’

• Funeral wishes discussed and recorded

• More wills written • More open professional and public

discussion about death and dying and more wishes met

• More open discussion by public and professionals about grief and loss

Knowledge:• More carers aware of the wishes

of the cared for • More knowledge about possible

options that could improve quality of life

• More knowledge of financial implications of death and need for advanced planning

• Better understanding about sources of advice and support

Attitudes:• Less fear of death • and the process of dying• Less avoidance of dying

people and relatives• Less regrets- no rehearsal

Success Indicators

Questions for Public Consultation on the Devon EOL Strategy

•Is the Devon EOL Strategy clear and accessible?

•Will the strategy raise public awareness of Dying Matters in local communities?

•Will the strategic approach contribute to the people of Devon having more choice of being able to die at home if this is their wish?

•Does the strategy adequately cover issues of equality, diversity and human rights?

•Does the strategy reflect to the public, a joined up approach of all statutory agencies, the independent and voluntary sector?

Questions for Public Consultation on the Devon EOL Good Death Charter

• Dying Matters Conference 6th July consulted on the Good Death Charter. Feedback revealed having the charter was a good thing, but it should be further informed by public feedback.

• Delegates thought the charter should be consulted upon through the following mechanisms: word of mouth, via health & social care professionals, through hospices and charities communication leads, TV and local radio, local press, libraries, via internet and website responses, road-shows, leaflets, brochures / posters, via LINKs, Citizens Advice Bureaux, Health & Social Care Forum, Senior Council for Devon, Age UK (formerly Age Concern & Help the Aged), Carers Link, FUSION, Living Options.

1. Does the JEB Board support the principles of the Good Death Charter?

Request for JEB Boards Advice

• Are the questions we have identified the right questions to be asking the public to determine whether this is a good strategy?

• How will we ensure that we have consulted as effectively and comprehensively as is warranted by the strategy?