In the second of two articles about working as part of an integrated care system, Mark Jarman-Howe, chief executive of St Helena in North Essex and CEO Lead for the North East Essex Health and Wellbeing Alliance, explains how the hospice is implementing an integrated end of life care model.
In North East Essex, our Alliance is aiming to bring together a wide range of system partners, to deliver reduced inequity and improved end of life care outcomes to the whole population.
To achieve this, the Alliance is committed to an inclusive approach – recognising that improving the health and wellbeing of the population needs to take into account the full determinants of health and as such the broadest range of partners. This includes taking a full life course approach, supporting all ages of the population.
End of life care has been recognised from the outset as a key part of the integrated care vision in the local area. In fact, we were successful in identifying it as one of three initial priority areas for the Accountable Care System (ACS) Group that preceded the Alliance.
The project brief was to produce a draft integrated care model for end of life care in North East Essex. The scope was all aspects of physical and mental health (primary, community and acute), social care and housing-related support for adults identified as being in the last year of life, registered with a GP practice in North East Essex. From this, an integrated end of life care model, and draft system outcome measures, were approved by the ACS Group in October 2017.
Our Clinical Director at St Helena, Dr Karen Chumbley, was appointed as Senior Responsible Officer for a North East Essex end of life care programme in spring 2018. An End of Life Care Programme Group was established with representation from across the Alliance.
During 2018 work on the integrated end of life care model has focused on incremental delivery of the model within the constraints of current contracting arrangements through a combination of goodwill between partners and the effective use of non-recurrent funding. Progress has included:
- The creation and implementation of a new integrated IT solution for the My Care Choices Register. There is now interest from the STP Board in rolling this solution out across Suffolk.
- Delivery of a Local Enhanced Service for end of life care in primary care.
- Delivery of the nationally recognised Gold Standards Framework training and quality assurance programme to local care homes, domiciliary care agencies, dementia wards and community mental health teams. As well as locally tailored education and training to local sheltered housing providers in partnership with district councils.
- Introduction of Project Echo, a tele-mentoring methodology supported by digital technology, enabling the creation of separate care home and GP Communities of practice.
- Several one-day education conferences held locally, run jointly by representatives from local Alliance partners and involving some Suffolk organisations.
- Development, introduction and marketing of the new hard-copy My Care Choices Record as well as a widespread and innovative marketing campaign direct to the public through local pharmacies, GP practices and the backs of local buses!
- An in-depth audit of acute and community hospital deaths over the past two years, which will help shape commissioning of community end of life care capacity over the coming years.
- The piloting of a new approach end of life care beds at Clacton Community Hospital, with St Helena working alongside the community provider to increase choice and quality of expert support available for patients and families in this historically under-served area.
- Development of a virtual ward pilot as an extension of the SinglePoint service between St Helena and the community service provider, as well as extending the use of acute hospital admitting rights to hospice beds, as part of local system resilience plans.
There have been challenges arising from engaging with different models of care and approaches to funding too though. Changes to commissioning arrangements and pressures within the local care market combined to cause St Helena to close its Home Care service and our long-term local partner Marie Curie to stop delivering its local night nursing service. This has resulted in the loss of specialist palliative care led domiciliary care capacity for people in their last weeks of life.
More promisingly though we have been able to build on the progress already made by the End of Life Care Programme Board to secure transformation funding from the Alliance to work with the Oxford Centre for Triple Value Healthcare (led by Professor Muir Gray) to deliver the following:
- Develop an Atlas of Value to understand what is presently happening in North East Essex from a value perspective and to build the case for change;
- Create a shared understanding on what it means to deliver Population and Personalised Health and Social Care using a Triple Value approach, thereby establishing agreement from the Alliance leadership on giving the End of Life board greater authority and responsibility;
- Develop and gaining agreement on a new terms of reference for the End of Life board, required (analytical, financial and Programme Management Office) support for the End of Life board, and how it will be held accountable- namely making it a Community of Value;
- Gain agreement on how end of life value improvement plans relate to overall Alliance financial and operational commissioning and contracting plans; and
- Create a toolkit and write the case study so learning from this project can be used by the Alliance.
The outcomes from the project will provide the basis for developing an outcome based specification and service delivery proposal for an integrated end of life care model that will be embedded within future Alliance contracting arrangements, hopefully with effect from 2020/2021.
With the right engagement with emerging integrated care systems and alignment of models of care with wider principles it is possible for end of life care to not only get the attention it warrants, but to actively lead the way in applying population health management principles in a way that improves outcomes for local people.
For more information visit St Helena
Read part one of this blog here
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