Thursday, 24 October 2013

Liverpool Care Pathway - Integrating The Death Lists

The only way is down...
Downsizing the demand on the supply.

The Lists are fast moving ahead at a pace.

More Yellow Folders...

The Central Norfolk Alliance for End of Life Care has been recently established in response to a common determination to improve care, choice, dignity, and control for all our citizens. At the heart of this is long term system redesign: we have an excellent but ageing NHS Hospice, very good hospital and community services, but a lack of coherence - the system is not managed around the needs of the patient and family. We have started work on creating a single unified patient held record - the Yellow Folder - for the short term; and an electronic palliative care record for the future. A single record - fully accessible to the patient, family, and all health professionals will be a significant step forward in ensuring that every health professional can access - and can therefore respect - the patient's care plan.

End of Life care


The quality premium target referred to in the operating plan states:

By year end 80% of practices are holding monthly multidisciplinary team meetings to discuss all patients listed on the palliative care register. The identified needs of patients, including preferred place of death should be recorded and shared with all appropriate stakeholders using the relevant read codes of the practice clinical system. Minutes of all meetings to include list of attendees should be submitted to the CCG.
Information sharing… 
The attendees of MDTs should include GPs, relevant practice staff, Community Nurse, MacMillan Nurse, Practice Nurse, Hospice staff, Care Home Staff and other individuals involved in the care of the patient.

Primary Care Investment scheme

PCIS covers these aspects. PCIS Monitoring Form sent out to all GP Practices at end of September. It specifically requests information on MDT Meeting arrangements, listing of patients with palliative or end-of-life care needs and coordination arrangements. Monitoring forms are now being returned and indications are that many Practices are listing patients and discussing them at regular MDT meetings.
Same terminology, same jargon...
The End-of-Life Improvement Project aims to ensure care is in the right place and the right time; to reduce inappropriate deaths in hospital and increase the number of deaths in the place of choice and in accordance with a patient’s advanced care wishes.
The emphasis is not on upsizing, but on downsizing...
The project is led by Keech Hospice working closely with CCS and other colleagues. Setting up the main part of the project commenced in September, although therapies at Keech (as an alternative to hospital) started in April. The main challenges for the project has been recruitment to the teams, establishing appropriate IT and information systems, and agreeing referral processes.
Anyone who has entered hospice has already downsized their care expectations or had them downsized. This is the way forward to downsizing NHS budgets by downsizing care options; from prolonging life to limiting life.

SystmOne is a centralised clinical IT system that provides healthcare professionals with a complete management system including access to electronic patient records. It is being rolled out across GP Practises.

A patient app has been released...

For patients to have access to SystmOnline, their GP surgery needs to have enabled the free service through SystmOne, and switched on the various parts of functionality for each patient. There are currently more than 1,700 SystmOne practices using SystmOnline.- ttp SystmOne

The Yellow Folders  'dynamic' Advance Care Planning Discussion document may be updated as grooming progresses and the care expectations progressively downsized.

More from Luton CCG about SystemOne access –
Project details:

Single Point of Access and Locality Register - CCS are currently acquiring a new unit for SystemOne to manage EoLC patients. The existing unit has proved inadequate, after much discussion it was advised to have a separate unit. Information and users of information, which will include details of patients advanced care plans, have been identified.

Care Coordination Team

o Project Manager – recruitment undertaken, with appointment to start at beginning of October, but failed to take up post at last minute. Alternative, interim arrangements now being considered.

o Co-ordinators – recruitment completed – (2 full-time and 2 part-time) and to start extensive induction shortly.

Direct Care Team – Keech working with other service providers to ensure their palliative care / end-of-life support workers are integrated with existing services, particularly during out of hours.
'Extensive induction' is required. These are delicate matters.
"Discuss with family and friends how to get care and help at different times. Specifically advise that calling 999 is very seldom appropriate and may result in resuscitation, transfer and admission."- June 2010 Macmillan End of Life Care Newsletter
The EoLC Team will be summoned and attend.
Care Pathways - have been discussed in depth between CCS/Keech and Continuing Health Care (CHC). Links established with the ambulance trust to ensure that they are aware of the register and offer them support in how it may be of use to them.

All comms teams have been approached and are aware of the service.
The ambulance dispatcher will take the call and will respond accordingly.
End of Life Care Joint Strategy

Draft Strategy in process of being updated to take account of recent developments such as the replacement of the Liverpool Care Pathway. The Strategy is being reviewed by the EoLC and Palliative Care Locality Implementation Group, with initial summary submitted to Joint Commissioning Group.
This is here, this is now; it is all being put in place. The dots are being joined up; the jigsaw is piecing together.
Future actions
Continue to monitor Implementation of Improvement Project at Keech Hospice, through Task and Finish Group, with expected delivery of full service by 1st December 2013
On-going implementation of PCIS
Support update of EoLC and Palliative Care Strategies through the Locality Implementation Group, including the integration of national direction on Individualised Care Planning (replacing Liverpool Care Pathway).

Involvement in ‘Better Together’ projects, with EoLC providing a good example of integrated service.
 It's better together. 
This programme is central to the health partners plans, encompasses a wide range of proposed changes and is the single most significant priority for the local NHS over the next three years.Better Together
"Integration, integration, integration, then and now the key to the door of the NHS's future success."
- No apologies to Tony
1. Investment for healthier and more Independent patients - Reducing variation in Emergency Admissions activity (up to 50p per patient) – PAYMENT ON ACHEIVEMENT

2. Primary care ‘solutions’ menu Investment (up to 55p per patient) – PAYMENT ON DELIVERY
End of life – primary care 

This could be as lucrative as PPC (Pay Per Click)!

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