Improving choice and access for people at the end of life

Delegates attending the session heard speeches from Tony Bonser, Chair of NCPC, Dr Chi-Chi Cheung, Consultant in Palliative Medicine, CMC Lead Clinician, Camden and Islington ELiPSe Palliative Care, Rachel Tyndall, NHS London and Susan Munroe, Marie Curie.

Key issues

Throughout the session speakers highlighted the importance of changing the existing culture around dying. They mentioned that there is often little discussion with patients about choices at the End of Life and there needs to a culture shift to encourage health care professionals to have conversations about death to patients so that they are able to make informed choices.

Speakers discussed the importance of the End of Life care register and how this could prove to be an important tool for stimulating discussions about death and could also work to improve the coordination of care.

 

 

The discussion panel.

In terms of commissioning palliative care services, one of the key problems highlighted in the discussions was the difficulty in defining what End of Life care encompasses.

Speakers mentioned that at present it is not clear to commissioners what the characteristics and costs of these services are. Another inherent problem is striking the balance between enabling services the freedom to provide a flexible, personal response whilst assuring commissioners that they are getting value for money.

At the moment commissioners will simply buy an hour of care, however it was suggested that there needs to be a move towards more outcome based commissioning. This may include setting targets such as preventing unscheduled admittance or preventing ambulance call out. Much of the discussion around commissioning solutions drew on aspects from the Palliative Care Funding Review including tariffs and pooling of health and social care budgets.

A key point raised during the discussion was that providers will need to help commissioners understand how they can commission End of Life care services differently.