Palliative Care Funding Review Summary

I have had a quick look at the report published at 9am this morning and have pulled out these key points.

The report  published this morning reports that 470,000 people currently die each year, however it states that not all of these people will need palliative care.

The review estimates that the total palliative care needs of the population in England is around 355,000 people (with a maximum of 457,000) requiring care every year. The numbers who currently receive specialist palliative care is around 171,000. They estimate that around 92,000 people per year have unmet palliative needs, but this could be as many as 299,000.

The report recommends that the NHS should fully fund:

• A regular  assessment of the needs of a patient 
• All the clinically assessed palliative care needs of a patient irrespective of setting, as in any other branch of clinical care
• A coordinator for the patient who will guide them through their journey, signposting patients and families to the full range of services including those provided by society and not funded by the state 
• At the end of life, as an addition to the tariff, the social care needs of a patient after they are added to an end of life locality register (removing the need for social care means assessment for patients on an end of life locality register)
• Palliative care education and training for NHS professionals.

But will not fund:

• Episodes of care which are not assessed as a clinical need
• Support for families and carers
• Bereavement care (except for a prebereavement assessment), spiritual care, complementary therapies, support for carers and families, information and advice, respite care for adults, play therapy, and other similar interventions. 

Current funding:

A survey by the Department of Health estimated that PCTs spent £460m on adult palliative and end of life care in 2010/11, with one PCT spending £0.2m on specialist palliative care alone, and another £21m. This means that  one PCT spent approximately £186 per death on specialist palliative care, while another spent £6,213. A total of, 61% of all PCTs spend less than £1,000 per death in their PCT. However the majority of funding comes from voluntary donations through fundraising. By increasing the provision of services outside the hospital could lead to a potential reduction in hospital costs of £180m per annum. 

Costs will be relative to a 4 stage classification system, based on the system in Australia

1. Stable
2. Deteriorating
3. Unstable
4. Dying

This system could then be further combined with a system to capture the other drivers (provider type, problem severity, functional status and age), the system would need to be split between adults and children. 

Key classification criteria proposed:

Adults

• Phase of illness  
• Provider type 
• Problem severity 
• Functional status 
• Age 

Children

• Age 
• Phase of illness 
• Problem severity

Providers will be paid on an activity basis, the level of payment will be based on the complexity and resources needed. with episode payments for each phase of illness.

The review recommends that once a patient reaches the end of life stage, and are put  on the end of life locality register, all health and social care should be funded by the state and free at the point of delivery; but the social care additional tariff would not not include accommodation costs. The report acknowledges further work on this is undertaken and pilots established to test the model.

Recommendations: 

• Commissioning levels for palliative care services per population for adults and children should be set at a minimum population level of 300,000, and up to £1.5m
• Implementation of a per-patient funding model based on the presented classification system
• The development of a  statement by the Government describing the palliative care support and services that patients, families and carers can receive, if they need them, from the NHS.
• A lead provider for palliative care is identified in every Clinical Commissioning Group, to coordinate all palliative care services, including those not funded by the NHS.
• Every Clinical Commissioning Group (or at commissioning network level) should be required to hold an end of life locality register
• Focus on 24/7 community care
• Drugs and pharmacy services still fully funded by NHS
• A leadership board be put in place, with representatives from across both the adult and children’s palliative care sector working in partnership with Government to manage and drive forward the transition to the new system. 
• A new national data set will need to be developed, with nationally agreed methods to report, collate and analyse palliative care provision.  

Ensuring availability of palliative care in hospital and community settings, and supporting early referral to palliative care, could therefore potentially lead to significant cost savings for the NHS on hospital costs in the last year of life. 

Next steps:

• The current minimum data set is expanded to support the tariff and its collation made mandatory for all organisations providing NHS dedicated palliative care services. 
• Outcomes measures are developed which are supported by the dataset and the NHS outcomes framework. 
• Transition phase to the new system supported by national funding

Timeline

From April 2012 build up community services

April 2012 - March 2014 - Undertake two-year pilots and collection of reliable and consistent data

April 2014 - March 2016 Shadowing of currencies and tariffs

April 2016 full implementation

News

It has been a long time since I last posted some news.

During the last year the Hospice has developed a strategy that will try and ensure that more people have access to the support that the Hospice can give.

Having finished a Masters in Hospice Leadership I am now starting a PhD in Palliative Care at Lancaster University.

I am looking forward to reading the report about the new payment system for end of life care as reported by the BBC and how it will impact on how St Nicholas Hospice Care will be paid.

New Strategy

Over the next few months I will be talking with our staff, volunteers, service users, local GPs and District Nurses about the future direction of the Hospice.

We have supported thousands of people over the last 26 years, many have appreciated and benefited from the support we have given to them and their families. Some of the challenges we have been discussing have included:

• More people with cancer are referred to the Hospice than people with any other illness like serious heart or lung conditions.
• Many people are anxious about being referred to the Hospice, but when they meet one of our team in their own homes or come to the Hospice they realise we are here to help people live life to the full and sometimes people wish they had been in contact with the Hospice earlier in their illness.

Families and patients tell us that they appreciate that we are able to have those difficult conversations about dying - helping them to prepare and plan for death - something that will happen to all of us one day.

We need help with ideas how we can promote the message that we here to help with quality of life and are here to support the families as well.

These are some of the things we do, (but not everyone knows):

• Give advice to GPs, District Nurses and Doctors working Out of Hours (e.g. Harmoni)
• Attend meetings at GP practices to discuss how to support people at the end of their lives
• Give advice and support to care homes
• Organise school visits to the Hospice
• Give advice about talking to children about serious illness in the family

We are also developing a new website - are there things you would like to see on there?

Please post your comments, thoughts and suggestions and I will look forward to receiving your feedback.

Vision, Mission and Values

In preparing the Hospice for the future we need to agree our Vision, Mission and Values. The vision is where we want to get to (aspiration), the Mission describes what we do (perspiration) and the values are how we work (inspiration) and what hold as important.

This Mission gives greater emphasis on working with others, because as demand increases we will need to enable others to give care and support.

Following meetings with staff, volunteers and users I have put together this draft and would welcome your comments.

Our Vision
Services - To improve the quality of lives of patients and their families during life-limiting illness, death and bereavement.
People - A great place to work, inspiring staff and volunteers to be the best they can.
Organisation - Continually strive for excellence and lead in the field of Hospice Care.
Financial - To work with financial integrity, giving best value and securing our long term future.
Partners - To build successful partnerships with our local community, in a socially responsible way.

Our Mission
To work compassionately in the fields of life-limiting illness, death and bereavement by:

• Enabling patients and families to live with illness and bereavement
• Empowering communities to care for those affected
• Giving specialist care
• Teaching and influencing others

Our Values

• Leadership
• Communication
• Integrity
• Resilience
• Learning
• Developing
• Quality
• Teamwork
• Respect
• Equality

Technology

This timeI thought I would talk about some new technologies that could help save time. Links to other websites are embedded in my blog. If you right click the links you can open a new window or tab.

With technology becoming an increasing part of our world at the Hospice we have been looking at new ideas. Basecamp was one of the first web based products we tried that has helped us with the refurbishment project. Recently Vicky has been developing online questionnaires that at the same time stream information directly into a spreadsheet using a product called Zoho creator.

For some time I have been recommending Firefox as a safer browser this page tells you why Firefox is so good and here you can download Firefox 3.

Once you have Firefox I would recommend you having a Google account, not only does it give you a good email account it gives you access to all sorts of free products click here to sign up and see what else you can do.

A video about RSS feeds explains a way of keeping up to date with news from your favourite websites or blogs, use Google reader as your feed reader and then you can put your Google reader on your home page by customizing your home page on Google.

So now you are set up and surfing the web, but how to save the links to sites - rather than saving your bookmarks in Firefox you can keep them on a bookmarking website, then you can access them whichever computer you are using - Commoncraft is a site that explains this.

The bookmarking site some of us started using is Diigo and we have a Group called St Nicholas Hospice that we can add links to.

All these ideas may be new to some of you the links will stay on my blog feel free to try as many of them as you would like to and let me know how you get on

Multidisciplinary Team Meetings

Last week I was teaching in Oxford about improving the assessment and support of families. Part of the day was encouraging participants to think about the patient and the family (using the word family in the broadest sense) as one unit and then describing what was happening in the family in relation to:

• Family organisation and character
• Parenting
• Communication
  
• Emotional Life
• Alliances
  
• Identity
  
• Adaptability

Many struggled to separate the work they were doing with the families to what was happening in the family. There was much discussion and in trying to generate ideas we discussed how complex MDT meetings were and how threatened people felt. Many felt such meetings could be helped by:

• Displaying the family genogram
• Summarising the key issues for the family (not what their focus of intervention was)
• Asking the team to generate ideas about what was happening rather than give suggestions about what the clinician could do

It would be the responsibility of the team to come up with ideas rather than the critique what was already being done

May

A month has gone by and this is the first time I have had to update my Blog. The Hospice has been busy with moving patients onto the Summer Ward and clearing the IPU ready for refurbishment. Colin and is team of helpers have worked all hours to make sure it is ready for the builders.

I have finished my first assignment for my Masters and am awaiting the results. Writing 5000 words seemed an enormous task initially and then the week before I was trying to reduce it from 6000 to 5000.

This week a journalist from the East Anglian Daily Times spoke to me about a topical video on the Internet by an American Randy Pausch who had given a Last Lecture about his life and written a book (he called a manual) for his family for after his death, the PowerPoint presentation he used for the lecture is also available. A shorter interview can be found on the Times online. Details about Randy are on Wikipedia.

You might ask what relevance this has for us at St Nicholas, well if you listen and read his words, Randy is talking about exactly what we do here at the Hospice - we help people prepare for their death and help their family make preparations as well.

There is nothing that can take away the pain of leaving someone you love but making preparations can help a little, though it may not be for everyone. Not everyone would want to make a video or write a book, but some make a Memory Box, leave a letter or a special item. Families left behind also value the opportunity to be prepared, I have known many husbands who have had some cooking lessons from their wives and wives who have been taught how to manage the fuse box.

Randy Pausch is leaving 3 young children - nothing can be worse for a parent and Winston's Wish gives advice on how to talk to children and manage a serious illness.

There is no right or wrong way to prepare for a death, but staff at the Hospice have the skills and training to support families who want to make their own preparations and help them live every day to the full.