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www.hospiceuk.org
Network Recording DeclarationDuring this ECHO session discussions will be recorded so that people who cannot attend will be able to benefit at another time. Filming is regarded as ‘personal data’ under the General Data Protection Regulations (GDPR) under that law we need you to be aware that this Data will be stored with password protection on the internet.
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www.hospiceuk.org
Network Recording DeclarationDuring this ECHO session discussions will be recorded so that people who cannot attend will be able to benefit at another time. Filming is regarded as ‘personal data’ under the General Data Protection Regulations (GDPR) under that law we need you to be aware that this Data will be stored with password protection on the internet.
This Data will be available for as long as your network continues to meet and will then be taken down from the internet and either stored securely at the Superhub or deleted.
Your ongoing participation in this ECHO session is assumed to imply your agreement to the use of your data in this way.
If you are NOT willing for your data to be used in this way, please LEAVE the session at this point.
Through improving outcomes
that matter with the resources
given increase the value of
care for people aged 18 years
and over in the last 12 months
of life in North East Essex
The aim of the population approach
Adults who would benefit from higher
value EoL care but do not receive it
Adults who receive higher value EoL care
Using resources optimally so more people benefit equitably from higher value care and better
outcomes
The case for a population approach to end of life care is…
• Lots of people die in hospital (nearly 1 in 2)
• Most people don’t want to (less than 1 in 20)
• Hospital EOLC is more expensive than community EOLC
• We spend more than twice as much on hospital EOLC than community EOLC in last year of life
• In North East Essex we’ve developed a population approach to EOLC that could change this
• Social investment could be the catalyst for the change
Invest in community EOLC
Spend less on hospital EOLC
1. More people die where they want
2. More cost effective for the health and care system
3. Releases acute capacity for appropriate activity
To know
Care in line
with
preferences
24 hour
support
Dignity
Good
symptom
control
Avoid over
medicalisation
Sensitive and
honest
conversations
Carers
support
£30,111,…
£5,188,000
£3,110,000
£1,474,876
The majority of financial resources analysed are used on hospital admissions
Expenditure (£) on selected services for people in the last year of life in North East Essex from four sources of funding, 2018/19.
(Source ICHP analysis, St Helena Hospice, NE Essex CCG)
Hospital admissions
Fast Track
NHS Hospice Funding
Charitable Hospice Funding
There is a significant association between higher use of MCCR and dying outside of hospital
Place of death (in hospital; out of hospital) for people in the last year of life in NE Essex in relation to MCCR usage by the general practice at which they were registered 2018/19 (Source: ICHP analysis)
Which remains when we group practices by high medium and low MCCR use rates
Place of death (in hospital; out of hospital) for people in the last year of life in North East Essex in relation to the level of MCCR usage for the general practice at which they were registered, 2018/19 (Source: ICHP analysis).
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
High MCCR use Medium MCCR use Low MCCR use
Died in hospital Died out of hospital
This is true for people dying of non-cancer conditions
0%
10%
20%
30%
40%
50%
60%
70%
80%
High MCCR use Medium MCCR use Low MCCR use
Died in hospital Died out of hospital
For people with a non-cancer condition, place of death (in hospital; out of hospital) in North East Essex in relation to level of MCCR usage for the general practice at which they were registered, 2018/19. (Source: ICHP analysis).
…and is especially true for people dying with cancer
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
High MCCR user Medium MCCR user Low MCCR user
Died in hospital Died out of hospital
For people with cancer, place of death (in hospital; out of hospital) in relation to the level of MCCR usage of the general practice at which an individual was registered, 2018/19. (Source: ICHP analysis).
Higher MCCR use is associated with lower end of life hospital costs
Correlation between General Practice MCCR utilisation (as a % of deaths) and average cost of admission in the last 90 days 2018/19. (Source ICHP analysis)
Dying out of hospital is associated with lower spend on admissions in the last year of life
£10,260 £9,492
£1,096
£13,379
£11,538
£6,259 £5,529
£738
£10,836
£6,556
£-
£2,000
£4,000
£6,000
£8,000
£10,000
£12,000
£14,000
£16,000
All admissions Emergencyadmissions
Planned admissions People who die ofcancer
People who died ofnon-cancer conditions
Died in hospital Died out of hospital
Average expenditure (£) on all admissions, emergency admissions and planned admissions to hospital per person who died (in hospital; out of hospital) in North East Essex, 2018/19. (Source: ICHP analysis)
Which leads to opportunities for disinvestment -people dying of cancer
735 people dying with cancer in NE Essex
160 registered with MCCR use practice
575 registered with Med/Low use practices
Shift practices to high use
166 additional patients die out of hospital
Additional 166 people
who would die of
cancer at home each
with a lower spend of
£2543 = £422,138
Which leads to opportunities for disinvestment- people dying of non-cancer conditions
2165 people dying with non-cancer conditions
in NE Essex
515 registered with High use practices
1650 registered with Med/Low use practices
Shift practices to high use
347 additional patients die out of hospital
Additional 347
people who would
die at home each
with a lower spend of
£4982 = £1,728,754
• St Helena has taken on coordination role for all out of hospital EOLC activity during the pandemic
• Increased 24/7 non-medical prescribing cover
• Joint hospice and community hospital bed plan
• Increased Virtual Ward. Partnership with Bluebird care agency and Continuing Health Care team
• Realigned hospice community nursing team with local Primary Care Networks working with ACE teams
• Clinical Director providing EOLC support to care homes as part of local cell
• Partnership approach to VCS delivery with Age Concern, C360 and CVS Tendring
• Coordinated approach to bereavement support
Covid-19 has accelerated operational integration
Agreed commissioning model
• St Helena acts as the investment vehicle
• Between c£1m of phased investment to be repaid over 5 years
• Risk share agreement between hospice, CCG and acute hospital
• Outcomes based on:
• Increase in My Care Choices Register numbers
• Reduction in time in hospital in last 90 days of life
• Increase in proportion of deaths in own home and care home
• St Helena underwrites the principal to the extent outcomes not achieved
• CCG/acute hospital share gains with social investor out of marginal growth
Further information
Link to full report:
https://www.sthelena.org.uk/more-about-us/reports
Any other questions:
Adult and children’s hospice
Maximising the Use of Data
DATA HUB
Provide
transparent,
effective and
timely reports
Enable evidence
based discussions
Support more informed decision
making
Adult and children’s hospice
The Data Hub The Beginning
1. Demand2. Changes in the way we
use our data3. Identified gaps in
our data sets4. Inconsistent messages
Adult and children’s hospice
How?
Identify gaps in service
Influencing decisions
Identifying trends
Secure funding
assurance
Reporting to and Influencing National data sets/policy, Care Quality Commission, Commissioners, Grants and
Trust Funds, Local Service Development, Hospice Trustees, Hospice Management, Hospice Strategy, CSDS
Trustworthy
Adult and children’s hospice
ell
Specialist ServicesIPU Beds
TargetedServices
Complementary Therapies
Universal ServicesBereavement
Adult Services2011/12
Total Patients 266
Specialist ServicesIPU Beds
TargetedServices
Therapies, Nurse Led Clinics, Wellbeing Centre,
Social Work, Carers Group
Universal ServicesBereavement, Hospice at Home, MCCT, Wellbeing
and Independence Service
Adult Services2015/16
Total Patients 1009
Specialist ServicesIPU Beds
TargetedServices
Therapies, Nurse Led Clinics, Wellbeing Centre,
Social Work, Carers Group, Outreach, One Stop Clinics, Secondary Chemo, Carers Support
Universal ServicesHospice at Home, MCCT,
Wellbeing and Independence Service
Adult Services 2018-23 Strategy
Be
reav
em
en
t
Ref
err
al P
roce
ss
Covid ?
Adult and children’s hospice
Patient
Activity/
Service Use
User
Experience
Patient
Demographics
Outcome
Measure
(ipos,
pos)
Patient Safety
Information
Staff
Volunteers
Supporters
Hydrotherapy
pool
Identified gaps
in
our data sets
Adult and children’s hospice
The Benefits of the Data
Hub
DATA HUB
Inter-department
working
Presentation
materialsTriangulation of Data
All data is
quality assured
Consistent
approach
Skilled team
Adult and children’s hospice
Right Reports, Right Place, Right
Time
Governance/
Well LedAssurance to the Board
• Strategic dashboards
Directorate/Heads OfAssurance tools and Data Reports
• Performance Committee Dashboard
• Quality Report
• Data Sheet
Operational/Department• Department Level Reports
• Dashboards
Commissioners and Trusts
Adult and children’s hospice
Where Are We Now?
• Covid Pandemic Response
• Recent & Future Developments in our Data
Adult and children’s hospice
Covid Slide
Covid-19 Strategic Map
Steps Phase Data Support
Step OneMarch – April
Safety Review • Urgent Response Log• Covid Risk & Action Log• Consolidated Government Advice• Data Support to Trustee Advisory Group• PPE Audit
Step TwoApril - June
Stabilise the organisation
• Furlough arrangements• Income plans• Mobilise resource to best effect• Mobilise Volunteers ‘Keech Army’• Reduce costs/Forecasting/Cashflow• Government Support packages
• Cashflow Modelling• Capacity Tracker• Incident/Accident/Complaint Tracking• Sickness & Isolation Tracking• Staff WFH Morale & Wellbeing Survey• Root Cause Analysis – Outbreak• Corporate Risk Register• Staff & Volunteer Individual Risk
Assessment
Step ThreeMay - present
Respond to needs of our community
• Care services plan• Volunteering plan
• Weekly data to commissioners• Children’s Services Review• Patient Surveys/Feedback
Step FourJune onwards
Restoration, Transition and Resilience building
• Phased restoration plans by service• Re-imagine future state• Building resilience for the future
• Environment Assessments• Tracking regulatory requirements • (H&S, CQC, ICO)• Covid Workplace Risk Assessments• Board request to respond to ‘Beyond
Lockdown Paper’
Step FiveOngoing
Consolidate review and evaluate • Dashboards • Committee & Board Reports• Surveys
Adult and children’s hospice
Recent Developments in Our
Data• Cost Modelling – Understanding our cost base• Income Risk Register• Cranfield Partnership – Social return on investment
(e.g. Statutory funding £1 = £9.53)• Review and Refresh Corporate Dashboards
Upcoming Developments in Our Data
• CSDS Submission of Data (test data Feb 2021/Live data from April 2021)• Geographical Mapping• Strengthen Data Insights Triangulation• Digital Input → Digital Output
Adult and children’s hospice
Questions?
Liz Searle, CEO Keech Hospice Care ([email protected])
Paula Welsh, Head of Quality & Governance ([email protected])