Slide 1

Report
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
Dying Matters in Devon
North Devon District Hospital &
North Devon Hospice &
Children’s Hospice
• 107 GPs
• 8 GP
Consortia
• 21
Community
Hospitals
• Community
Provider
services
• Leadership –
EOL SCG
Plymouth Hospitals
NHS Trust & St
Luke’s Hospice
• 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
South Devon Healthcare
FT Hospital & Rowcroft
Hospice
Dying Matters in Devon
• Population of
755,000 & rising
• Higher proportion
of older old (26%
over 65 yrs by
2021)
• 17% live alone
Number of small coastal
& market towns, many
small villages, Exeter city,
plus a large rural area
• Devon
estimates
12,000 +
have
dementia
Oct 2007 We asked …….The public told
us….
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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
NHS Devon & Devon County Council Partners
General
Practices
Community
Nursing
NHS Direct
Prisons
NHS Devon &
Devon County
Council
Ambulance &
Out of Hours
Services
Intermediate /
Complex Care
Teams
Mental Health
Teams (DPT)
Hospices &
Specialist Palliative
Care Teams
Hospitals
PCT –
commissioners &
providers
Domiciliary &
Rapid
Response
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.
Social &
Social
Community
Services
Care
Community Children &
Young Peoples
Services
Nursing &
Care Homes
Place of death 2008-2009
Approximately 8000 deaths per annum in Devon
Hospitals
At home
Nursing
Home
Residential Hospice
Home
Other
49.5%
20%
16.5%
7.16%
2.02%
5.28%
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
Implementing the EOL
Strategy in Devon
Universal Advance
Care Plan Tools
Roll out of GSF &
LCP Best practice
Public & Professional
Awareness
Locality
Palliative Care
Register
Integrated Care Pathways
Single Point
Access Coordination
Increase
alternatives to
Developing
clinical or care
champions in
all settings
&
Practice Registers
Hospital
admission
By March 2011…
Implementing the EOL
Strategy in Devon
Developing key
worker & care
champion roles
5Macmillan GP
GSF Facilitators
OOH Doctors, Nurses &
Dom
Rapid response helpline
24/7
in
all
Care
care
Increased Carer
Support workers
&
Bereavement
Services Directory
Just in case
medicines
settings
Education &
4 GSF Care
Training resources
Home Facilitators
targeted across
health & social
care
3yr
rolling education
programme
+
By March 2011…
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
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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
99% said death should be discussed
ahead of time
Devon Population Snapshot survey
145 people 6th July 2010
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
Nationally only 29% of people
talked about their wishes in 2009 less than in 2006 (34%)
Devon survey A /A
45% wanted to die
at home
500,000 people die each year in England – 60
% in hospitals, yet 70% of people would like
to die at home
5% said they would
not
49% said don’t know
Planning for a ‘good death’
 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
 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
 Organ donation - saving other lives  Plan your funeral arrangements:
 What do you want, burial, cremation,
 Make a plan for what you want
green funeral, other
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
 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 matters
after death
Success Indicators
Behaviours
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Wishes of dying people
discussed and recorded
Wishes to donate organs
discussed and recorded and
more people donating organspromoting 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:
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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:
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Less fear of death
and the process of dying
Less avoidance of dying
people and relatives
Less regrets- no rehearsal
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
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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.
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?

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