Improving the Delivery of End of Life Care

Following NHS reform, West Kent, a newly formed Clinical Commissioning Group (CCG), wanted to improve services for people at the end of their life including enabling people to die in the place of their choice, which for many people would be their own home.

Working through a series of workshops, the stakeholders developed a simulation pathway in Scenario Generator software to represent the services accessed by people in the last year of their life that helped to define the End of Life Care strategy for the CCG.

The Challenge

There are many healthcare professionals that can be involved in providing end of life care, depending on the needs of the patient. Hospital doctors and nurses, GPs, community nurses, hospice staff might all be involved, as well as social services.

In deciding to improve this service for their community, West Kent needed to be sure of the impact any change would have on each service in this complex network.

“It helped me step back from my part of the service and really understand the challenges people face and the services people access as move through the pathway.”

Hospice Worker, NHS West Kent

Understanding the current process

With the support of the NHS Institute for Innovation and Improvement and SIMUL8 Corporation, West Kent brought together a wide group of stakeholders and used simulation to help develop a greater understanding of the current use of services and which interventions would best help them to achieve their aims.

Working through a series of workshops, the stakeholders developed a simulation pathway to represent the services accessed by people in the last year of their life. The pathway helped everyone to understand what services were being used and the relationships between the different providers. One important question was to understand the difference between the services accessed by someone who was registered as being at the end of their life, and someone who wasn’t.

Key Findings

This finding led West Kent to make their first big decision. They would concentrate initially on trying to improve the pathway for deaths from organ failure (or people with long term conditions) given that this was the biggest group of deaths and the group most likely to die in hospital.

West Kent data showed that over 70% of people on the End of Life Care Register were cancer patients, which helped to explain the difference in the types of care and place of death between organ failure and cancer death groups.

This led to a helpful discussion about the difficulties of identifying end of life patients with long term conditions and to the “light-bulb” moment that planning for good end of life care for this group of patients involved the same interventions as good long term conditions care.

The key interventions for improvement interventions were agreed to be:

  • An electronic data-sharing system across providers
  • A 24/7 Rapid Response Service

It’s a great way of focusing on the things we can do that will really make a difference. We would definitely use simulation again when working through an issue like this.

West Kent Clinical Commissioning Group

Assessing the Impact on Social Care

Kent County Council was keen to understand the possible impact of changing health services on the need for social care. It was assumed that if more people died at home, then more social care support, as well as community nurse support might be required. The simulation was extended to show these impacts.

Scenarios Tested in the Simulation

  • What if more patients were identified as being at the end of life and 60% of patients were identified as being at the end of their life?
  • What if an electronic data-sharing system was in place and 80% of patients used it, avoiding unnecessary hospital admission?
  • What if a 24/7 rapid response service, including availability of emergency oxygen, IV fluids and antibiotics, carer support were available in the community and was accessed by 50% of patients not on the End of Life Register?

The Result

Following this work the key elements of the End of Life Care strategy were agreed to be the development of an electronic data-sharing system between partners and a 24/7 Rapid Response service.

The group agreed that good Long Term Conditions care will also be good End of Life care, and joint business cases for both interventions are currently being developed.

More action was agreed to be necessary to identify End of Life care patients from the long term conditions group, and risk profiling is expected to help.

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