One Chance to Get it Right Improving your

One Chance to Get it Right Improving your palliative care knowledge and skills

One Chance to Get it Right • 1. 30 pm: Overview from Mike Stockton • 1: 45 pm : Group Work / Case studies – Pain – Advanced Care Planning – Anticipatory Prescribing • Closing remarks: Gill Pottinger

Outcomes for the session To recognise when a patient is in the palliative care phase & the services/systems that are available to support them To ensure that patients symptoms are assessed and managed in a consistent way with the right intervention To feel confident making these decisions and having these conversations & knowing how to follow up with other health care professionals To make appropriate & timely referrals to palliative services to enable maximum support and symptom management.

Palliative and End of Life Care for Leeds Overview By Mike Stockton

Ambitions for End of Life Care National Framework 2015 -2020 Each person seen as an individual Each person gets fair access to care Maximising comfort and wellbeing Care coordinated All staff prepared to care Each community prepared to help

Identification…who may benefit Health is deteriorating despite maximal therapy Maximal therapy is not appropriate or desired Focus of care prioritises comfort, wellbeing and symptom management This may include patients whose prognosis is difficult to determine and could be more than a year. Consider all conditions including LTCs, dementia, frailty

Death in Leeds 6800 deaths per year 75% of deaths estimated to benefit from palliative care approach 5000 deaths per year across Leeds would benefit from palliative care

Death and Dying in Leeds • Age • Cause Disease Cancer Circulatory % 27% Respiratory 13% Dementia mentioned in 15% Rising Multimorbidity Age % 0 -64 17 65 -74 15. 5 75 -84 30. 2 85+ 37. 3

Death and Dying in Leeds • Where People Die… (2015) Hospital Home Care Home Hospice 45. 3% 23. 4% 20. 6% 8. 4% • Last 10 year trend Hospital Home Care Home Hospice 11% reduction 4% increase 6% increase 1% increase

Death and Dying Future Trends By 2040… • Annual deaths projected to rise 25% • Greatest rise in the 85+ group • Palliative care need may rise as high as 40% • In Leeds, up to 1, 700 additional patients per year requiring palliative care • Main drivers of need are predicted to be: • Cancer • Dementia • Frailty • LTC

Leeds Palliative Care Provision Palliative & End of Life Care Specialist Hospice In Patient St Gemma’s 32 beds Wheatfields 18 beds Hospice Community SPC CNS Medical Services Generalist Hospital SPC Team Community Neighbour End of Life Teams Primary Health Care Team Day Services Care Homes Adult Social Care Hospital EOL teams Site specific CNS Ward Teams

MCN…what is it? Collaborative partnership of all palliative and end of life providers Whole system issues and approach Delivering improved outcomes • Service improvement • Medicines management • Education and research • Information and technology

The Partners Core Group Peripheral Partners

Leeds MCN Highlights so far… Service improvement Medicines Management • Transfer of care • Heart failure project • Dementia and end of life group • Integration with Leeds frailty work • New guidelines for opioid prescribing • Anticipatory drugs at the EOL Information Management Education • Leeds Care Record • EPa. CCS & coordination • Metrics suite • New bereaved carers survey • Tele-education (ECHO) • TARGET • EOL learning outcomes • Refreshed communication skills training

THANK YOU…. Now Group Work