CCG provides support and enables patients to co-design and personalise their end of life care, resulting in 82% of people dying in their preferred place of care

Challenges

The issue was that patients receiving end of life care had very little choice or control over the support they received and were excluded from decisions about who would support them or what the support would entail. This contributed to the low percentage of patients who were able to die in their preferred place of care. The ambition was to redesign the Fast Track process to put patients at the centre of decisions and to co-design their end of life care with them, to create more individualised, creative packages that would enable them to fully meet their health outcomes.

Actions 

- This model was piloted in partnership with St Rocco’s Hospice, the local hospice in Warrington. They agreed to see if patient care in the community could be improved by supporting the patients to co-design their end of life care around their needs, wishes and lifestyles. This has now been rolled out further due to the pilot’s success.

- Each patient was allocated the cost of the traditionally commissioned service with which to plan their care (£700 per week). The aim was to be cost neutral but with better outcomes for the patient.

- Patients were supported to co-design their care by hospice nurses and all funding requests were submitted to the continuing healthcare team for approval. The patient’s individual experiences of their health condition and symptoms were just as valuable as the expertise of the health professional when arranging the care and support.

- All staff involved were given training in support planning, development of health outcomes and how to co-commission with patients. This resulted in high level of staff buy-in due to evidence of being able to provide better care to patients without funding cuts or other negative possibilities.

-£42,000.00 to employ a Personal Health Budget Implementation Manager full time for 1 year was the only additional cost as this staff member managed all elements of the pilot. This employee now manages the implementation of all personal health budgets across the CCG.

- Patients who are eligible for Fast Track funding for their end of life care are now at the heart of planning their own care with their family and health professionals. The relationship between patient and health professional is much more equal and the support plan is holistic, looking at the person as a whole rather than as a list of conditions, symptoms and needs.

- Patients were encouraged to be creative and focus on what would work best for them. Some wanted to focus more on reducing their anxiety about death by purchasing a wider variety of support rather than having four visits a day for care that their family was already providing.

- Health outcomes are a key component of personal health budgets. They set out the benefits that using the funds will provide and are a way of monitoring the care being provided. They provide the rationale for approving funding and afford insight into why we are commissioning each service.

Results 

- 0% of people commissioned their care to look like the traditional offer.

- 82 % of people were able to die in their preferred place of care.

- Care was co-designed with the patients in a truly individualised way.

- 100% of personal health budgets resulted in reduced or neutral spend compared to the traditionally commissioned option.

- Patients used voluntary services to maximise their budgets, and arranged their care and support around their lifestyles.

- Patients purchased services not previously available through the traditional offer.

- 100% of personal health budgets were approved on the date of submission.

Spread 

- Personalised commissioning has been rolled out to all patients eligible for Fast Track funding, and involves all referring nurses including hospice and district nurses as well as acute discharge teams.

- Personal health budgets are available to patients eligible for continuing healthcare funding and from 1st April will also be available for patients requiring section 117 aftercare.

- The continuing healthcare team are engaged with personalising and co-designing care with patients.

- 32 CCGs have received mentoring and best practise sharing by our Personal Health Budget Implementation Manager to enable personalisation of end of life care to spread further.