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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

17th April 2018

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The scale of our challenge

• Number of deaths registered in England and Wales

• 2015 - 530,000 (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

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Prevalence of multimorbidity by age and

socio-economic status

Source: Barnett et al, Lancet 2012

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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

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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)

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Wider context

• Supporting STPs/ICSs in

addressing their priorities

• Drawing attention to variations

and inequalities

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https://www.england.nhs.uk/rightcare/products/ltc/

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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

£2,330 £0 0%

Community hospital

£3,843 £2,404 63%

Community teams

£3,025 £7,351 243%

Primary care

£702 £1,552 221%

Social services

£4,466 £8,214 184%

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.

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What works: Nuffield trust

9

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Wider context

• Supporting STPs/ICSs in

addressing their priorities

• Drawing attention to variations

and inequalities

• Being integral to whole

population approach to

personalised care

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Personal health

budgets

Shared decision making

Social prescribing

Health literacy

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www.england.nhs.uk 16/04/2018

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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

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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

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NHS Mandate 2018-19

Overall 2020 goals:

• Significantly improve patient choice, including in maternity, end-of-life care, elective care and for people with long-term conditions.

2018-19:

• 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.

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• Slide deleted because of purdah but will be shown on

the day and will be available after the local elections

in May.

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How do we measure what matters?

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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