Help the Hospices Conference - New commissioning environment

Thomas Hughes-Hallett's presentation  described how many private companies are now working in end of life and palliative care and could be in direct competition with hospices, he challenged the audience to consider the following:

• Virgin Assura runs healthcare in Surrey 
• Allied Health has now been taken over by Saga in end of life care in Oxford. SAGA will have 20,000 staff caring for chronically ill, dementia care and end of life care by Christmas 2011
• Primecare is working in Nene Valley delivering end of life and palliative care
• PCT allocation per dying person varies between £150 and £6,000 
• Whether it is time for hospices to share back room resources e.g. training, IT etc.
• It may become legal right for people at end of life to have their needs assessed and their care coordinated
• Marie Curie is working in partnership with Cancer Research processing research applications 

Some Hospices are responding to this changing climate and the need for more income by establishing social enterprises or community interest companies, some of which are delivering home care (like a care agency). One session heard from Martletts and Matt Knop about the setting up of such companies and the support available. Perhaps before diversifying, hospices first need to ensure that their current business of delivering services is running as efficiently as possible and that all income funding streams are as profitable as possible. 

Tim Harford at the Help the Hospices 2011 Conference

Tim Harford's  presentation followed Barbara Monroe's and carried on her themes of adaptation and working differently, that we need to value self criticism and move away from the "God complex" that we know best!

Tim's book Adapt  suggests that one should try at something small, be prepared for failure, and whilst our instinctive reaction might be denial, we should learn from our mistakes. The stronger the feedback loops are in an organisation the better it can learn and develop. He goes on to describe some very successful organisations that devolve more power and responsibility to managers and people at the front line rather than keep the power at the top, encouraging people to try different things.

Apparently Google expects 80% of its products to fail (although as Tim said they don't make parachutes). A recent example of this is the news that Google is dropping products that have failed to take off). The key must be that it can afford to take these risks and has a back up plan. Perhaps hospices should be better at trying out more variations of care. Tim recommended Testing Treatments as a guide for research. However he reminded us that generally we averse to trying things out and getting it wrong because we don't like loss. I am sure this might apply even more when working in hospice care and increases the need for managers to be skilled in supporting their staff in trying out new ideas.

Help the Hospice Conference 2011 my reflections on key speakers

The Help the Hospice 2011 Widening Horizons Conference  in Bournemouth, demonstrated a mix of innovation, best practice and how to operate in the changing NHS climate.

Andrew Lansley Secretary of State for Health set the scene, he spoke of his personal experiences of palliative care and hospice care and that it was about the quality of relationships. He highlighted:

• New standards for EOLC would be released in the autumn
• Voices will be used as an indicator of how well we are doing with end of life care, Voices is a survey conducted with bereaved relatives (this means there will be no emphasis on surveys of patients receiving care)
• He was committed to cut red tape and support the patient statement "no decision about me without me"
• The need for more innovation and encouraged commissioners to listen to patients wishes as who should provide care
• The proposed tariff would be piloted in 25 areas to be completed by 2013 for implementation in 2015.

This changing environment meant that hospices needed to consider:

• That some hospices will be working with many different consortia 
• The "Any Qualified Provider" scenario could result in a poor quality provider 
• That Hospital support teams not part of the picture 
• Joining together.

Dame Barbara Monroe challenged us to think about service redesign and the role of community and volunteers. Her presentation given at Lancaster last year gives you an overview of her ideas. She suggested that there are multiple people who are disadvantaged and do not receive good palliative care. We should

• Think about the family 
• The cost of providing care 
• Look at scale and replicability 
• Focus less on data about current users and more about data from non users
• Change attitudes 
• Create leaders of teams
• Have the courage to have conversations about a time to die
• Focus on the education of nurses - hospices are one  of the few places that uses a traditional model of nursing 
• Not over privilege the psychological above the social, social support can be a priority.