EoLC accounts for a high proportion of NHS spending. It is estimated to be at least a fifth of NHS costs, and a total of £20 billion. Over the longer term, investment will need to shift away from the acute sector to the community, in order to reduce the number of people dying in hospital and to increase the number of people dying in their preferred place.
As we face the long-term challenge of an ageing population at a time of shrinking financial resources, it is vital that we get end of life care right. Failure to do so will result in spiralling costs for the public sector, and more importantly, a human cost for all of us who want to reach the end of our lives with dignity and control.
Of a population of 246,956 in Milton Keynes, approximately 1490 people die each year - which equates to 4 people a day. More than half of these people die in Milton Keynes Hospital.
Of the 1490 who die 1233 have palliative care needs.
Of the 1490 yearly adult deaths in MK, the leading cause of death is circulatory disease which reflects the national picture. However MK has a higher than average rate of deaths relating to respiratory disease. (Data from Marie Curie Cancer Care Atlas 2011)
The yearly spend on specialist palliative care in Milton Keynesis £1,139,000.
MK CCG Commissioning Intentions for EoLC are as follows:
1. To procure and embed a locality wide Electronic Palliative Care Coordination System. (EPaCCS)
This will provide a register of all patients perceived to be in their last year of life. The register will sit on the SystmOne patient database, and will initially be accessible by all GP practices, District Nurses and Willen Hospice.
2. To develop a community End Of Life Care Team to provide quality care, 24/7 and 365 days a year
MKCCG has recently invested in current night sitting services provided by Marie Curie to meet increasing demand. Plans to extend nursing visits from Urgent Care Services in out of hours periods are currently in development.
3.To develop common guidelines for the management of symptoms
The End of Life Care Medicines Group has developed unified guidelines for use in all provider services. A scheme for Just in Case medication is currently being implemented to ensure patients are able to have symptoms addressed effectively and in a timely manner
4. Develop effective mechanisms for rapid transfer of care
The End of Life Care Strategy Implementation Group has wide membership from primary, community, secondary, transport, voluntary and charitable organisation. Discharge and transfer of care issues are regularly discussed as an ongoing agenda item, and appropriate actions are developed, implemented and reviewed at subsequent meetings.
5. Develop the skills and competencies of the workforce delivering EoLC
There is extensive work being done to develop the skills and competencies of the workforce which delivers EoLC. This ongoing work includes care home and community nursing training from Willen Hospice, Ad-hoc sessions from the EoLC Lead as required, multi disciplinary training in EoLC for HMP Woodhill and EoLC study days provided byBedfordUniversitythrough LBR.
6. To ensure one point of contact for co-ordinated 24 hour care services
Funding has recently been secured to run a pilot 24 hour specialist palliative care telephone advice line service from Willen hospice. This service would be open to anyone inMilton Keyneswith a life limiting illness, any health or social care professional and carers/relatives. The call handler would arrange visits, provide advice, refer to a doctor, and provide follow up calls to review identified problems.
7. Develop a robust monitoring and performance framework
At the point that SystmOne is fully implemented into provider services, reports will be readily available, which will facilitate and support a robust monitoring and an effective performance framework.