In December 2015 the Scottish Government published The Strategic Framework for Action on Palliative and End of Life Care 2016 – 2021. Within the Strategic Framework for Action, the Scottish Government has made ten commitments, (appendix 1). Healthcare Improvement Scotland (HIS) has been asked to deliver commitment 1:
“Support Healthcare Improvement Scotland in providing Health and Social Care Partnerships with expertise on testing and implementing improvements in the identification and care co-ordination of those who can benefit from palliative and end of life care.”
About 1% of general practice patients will die each year. It is important to find ways of identifying these patients so that their needs and preferences can be assessed in order to plan for them and to provide the right services at the appropriate time. About one-quarter will die from cancer; these are the patients that have generally been thought of when initially discussing palliative care. In addition about one-third will die from organ failure, e.g. heart failure and COPD, and about one-third will die from multiple organ failure, frailty or dementia.
There are variations in access to palliative care by condition (particularly cancer vs. non-cancer), age, location, ethnicity and the identification challenges posed by multiple medical conditions. Longer periods spent living with life-limiting illness can make it difficult to know when the time is right for professionals to introduce a palliative care approach.
The Palliative and End of Life Care workstream supports Health and Social Care Partnerships to test new approaches to identify people who would benefit from palliative and end of life care and new approaches to co-ordinate care that enable people to spend more time living well in the community in the last six months of life that would otherwise be spent in hospital.
We are working with six Health and Social Care Partnerships HSCPs in East Ayrshire, Fife, Glasgow, Dundee, Perth and Kinross and the Western Isles. Each of these HSPCs has an associate improvement advisor in place who is working with local stakeholders to understand and map the provision of palliative care within their area. Each area will then choose an aspect of palliative and end of life care to focus on, and will undertake improvement work around the identification and co-ordination of care for the people within this group.
NHS boards and Health and Social Care Partnerships.
Benefits of programme
Most people say that they would like to be cared for at home when they reach the end of their life, yet only 21% actually die at home.