End of Life Care
Background
End of life care (palliative care) is an important, integral aspect of the health care provided to those living with and dying from any advanced or progressive and life-threatening condition. It is now possible to predict the progress of many of these conditions, enabling a planned approach to end of life care in ways which reflect, as far as possible, the needs and wishes of patients, carers and their families.
Living and Dying Well: A National Action Plan for Palliative and End of Life Care in Scotland was published in 2008 with the aim to provide focus and momentum to improve palliative and end of life care for everyone in Scotland who requires it regardless of their geographic or demographic circumstances, and to encourage efficient collaborative practice across health care, social care and voluntary sectors.
More recently (May 2010), the NHS Healthcare Quality Strategy was launched with the aim of delivering high quality healthcare services to people in Scotland. A direct action identified by the Quality Strategy was to develop a Quality Measurement Frameworksupporting a number of Quality Outcome Measures (QOMs). These measures cover a range of healthcare topics including; care experience, healthcare acquired infections, hospital mortality rates and end of life care.
Quality Outcome Measure 10: The percentage of last 6 months of life spent at home or in a community setting
QOM10 focuses on measuring the impact of "Living and Dying Well" and in particular on its objective to "produce achievable and measurable changes which will ensure quality improvement and enhance patient and carer experience".
Ideally, this measure would relate directly to the preferred place of care at the end of life. However, this can change over time and is, therefore, difficult to track. National data is not currently available at this level of detail so it is not possible to focus the measure directly on preferred place of death.
In the meantime, the proportion of time spent at home or in a community setting towards the end of life provides a high level indication of progress in implementation of the national action plan. These data can be inferred by measuring the amount of time spent in an acute setting during the last months of life (using hospital admissions data) and from this estimating the time spent at home or in a community setting.
It is envisaged that an increase in this measure will reflect both quality and value through more effective, person centred and efficient end of life care with people being better able to be cared for at home or closer to home with a planned approach to end of life care resulting in less time in an acute setting.
ISD have been working with the Quality Measurement Framework to develop this new measure and we intend to publish on an annual basis at health board, local authority and CHP level.
The first publication was released on 30th August 2011 presenting data up to 31st March 2010 and is available in the publications section.
The measure is under development and the definitions are subject to change in light of stakeholder feedback. This may result in future revisions to the published data in accordance with ISD's revisions policy.
ISD is currently engaging in a consultation exercise with NHS boards, local authorities, voluntary sector organisations and Scottish Government on the definitions of this measure. The responses received will inform the measure's further development and it is our intention to enhance future presentations of the data to include demographic and equality group detail such as age, gender and ethnicity (when data becomes available).
Main contacts
Richard Hunter
Email: richard.hunter@nhs.net
Mairi Watson
Email: mairi.watson@nhs.net
