Case study:

11 May 2010

End of Life Care Commissioning Strategy in Solihull Care Trust

Key points

Solihull NHS Care Trust has introduced a commissioning strategy aimed at developing end of life care services for all patients with advanced disease, with specialist and generalist providers of palliative care working together to allow people to be cared for in their place of choice.

The strategy, which was approved by the trust board in July 2008 following extensive public consultation, will reduce the gaps in current service provision, decrease inappropriate hospital admissions in the dying phase and increase patient choice.

The trust earmarked £375,000 in its 2008/09 Local Development Plan for end of life care and intends to invest a minimum of £315,000 in community support services in 2009/10 and £210,000 in 2010/2011. It has also appointed a specialist Continuing Care and End of Life Care Commissioning Manager whose role will include reviewing and managing the market for end of life care.

This involves first establishing the demand for particular services in an area and then acting as a broker to bring together all those, from both public and private sector, who might be able to provide them.

The pre-existing Palliative Partnership Planning Group, which includes representation from across the spectrum, acts as an advisory group to help develop the commissioning strategy and leads on development and sustainability of pathways and partnerships. This group is now turning into an End of Life Care Steering group.

There have been challenges in maintaining a consistent professional approach across localities and getting professionals to recognise this is an integral service to all care pathways. The new approach has also involved changes in practice and development of new skills within community services.

At the same time it is critical to prevent carers from feeling isolated at crisis points in the patient’s pathway and to establish proactive carers’ assessments and self-assessment questionnaires that support allocation of resources to family units.

The trust intends to use a number of indicators to ensure the strategy is effective. These will include monthly monitoring of the number of people dying in hospital after being admitted through A&E ( particularly those who die within the first two weeks) as well as keeping a tally of all those supported by the commissioned services and the number who do not have a diagnosis of cancer.

A community supportive care pathway is currently being implemented across the Care Trust. This forms part of the community care plan for all patients on the GSF register. The pathway includes supportive and palliative care, a record of preferred place of care and comfort care in the dying phase.

The trust will commission a survey in 2009/10 of patients’ and carers’ experience.