End of Life Care

Introduction

End of life care is support for people identified as being in the last years or months of their lives, to help them live as well as possible and die with dignity. Palliative care, to make people as comfortable as possible through managing pain and symptoms, is part of end of life care. End of life care should take account of people’s needs and preferences and can take place in any setting.

As a result, EOL care is delivered across a wide range of services and many healthcare professionals provide end of life care as part of their roles. To support strategy development, the End of Life JSNA panel was commissioned to develop a shared understanding of what ‘good’ end of life care looks like and the key enablers to delivering this.

End of Life Care JSNA Needs Assessment

Current Picture

In 2020, there were 9,376 deaths in Dorset, Bournemouth, Christchurch and Poole. Thirty-five percent of deaths occurred in hospital, 30% at home, 28% in care homes and 6% in hospices. Over the last few years, the leading cause of death has been from Dementia and Alzheimer’s disease, followed by heart disease and stroke.

In Dorset we have an ageing population, living longer but with increasing co-morbidities. This can increase the support needs and complexity of health and care services required to manage people’s conditions, make them comfortable and support their wishes and choices at end of life. Locally we’ve seen increasing rates of people on the palliative / supportive care register – there were 6,457 people registered in 2019/20 which is higher than England and South West prevalence.

Pallative/supportive care: QOF prevalence (all ages) for NHS Dorset CCG

The proportion of people dying in hospital is reducing and increasing in other settings and at home. Supporting choice and options for care emphasises the importance of consistent access and quality across settings and within the community, to ensure that everybody has the opportunity to experience the same ‘good’ end of life. The CQC reported that end of life care is variable for some groups, because of their diagnosis, ethnic or demographic characteristics. Not understanding or considering the needs of individuals or communities was a barrier to the provision of quality end of life care.

Percentage of deaths that occur in hospital (all ages) for NHS Dorset CCG

Local Insights

Reflecting local and national data, the importance of these elements was re-iterated through workshops with local end of life care practitioners and health and care partners. When setting out to describe what ‘good’ end of life care looks like from their perspective, key elements included;

Personalistion of service and providing 'what matters' is a central element to enabling a 'good' end of life
Relationship building and trust is crucial to engagement and having early and open coversations with people, their families and loved ones
Partnership working and shared communication between organisations allows them to build a 'full' picture of the person and co-ordinate care where multiple services may be involved to meet needs
Staff support and resilience as supporting end of life care is emotionally demanding, particularly where this is not a regular experience in your day-to-day role.

In addition, workshop participants reflected on their experiences during the COVID-19 pandemic. Although experiencing many challenges through this period, it was felt the pressing need to discuss end of life options facilitated early and open conversations. In addition, the necessity to move to digital working facilitated communication and information transfer.These local insights highlighting 3 key challenges for delivering end of life care;

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