Network Recording Declaration

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.

COVID-19 (Business

Continuity) ECHO

NetworkWEEK 14 – Wednesday 21st October 2020

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.

www.hospiceuk.org

Welcome

Craig Duncan,

Chief Operating Officer

Hospice UK

Mark Jarman-Howe, Chief Executive St Helena

A population approach to end of life care

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

The My Care Choices Register (MCCR)

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


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


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


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:

[email protected]

https://www.sthelena.org.uk/more-about-us/reports

mailto:[email protected]


Adult and children’s hospice

Our Journey

with DataDecisions & Governance


Maximising the Use of Data

DATA HUB

Provide

transparent,

effective and

timely reports

Enable evidence

based discussions

Support more informed decision

making


The Data Hub The Beginning

1. Demand2. Changes in the way we

use our data3. Identified gaps in

our data sets4. Inconsistent messages


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


ell

Specialist ServicesIPU Beds

TargetedServices

Complementary Therapies

Universal ServicesBereavement

Adult Services2011/12

Total Patients 266


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


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 ?


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


Inconsistent messages


The Benefits of the Data

Hub

DATA HUB

Inter-department

working

Presentation

materialsTriangulation of Data

All data is

quality assured

Consistent

approach

Skilled team


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


Strategic/Governance/Well Led


Directorate/Department Heads


Operational


Where Are We Now?

• Covid Pandemic Response

• Recent & Future Developments in our Data


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


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


Questions?

Liz Searle, CEO Keech Hospice Care ([email protected])

Paula Welsh, Head of Quality & Governance ([email protected])



www.hospiceuk.org

Close of ECHO session

Next ECHO:

Wednesday 4th November

Documents

Network Recording Declaration