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|Topic title||End of life|
|Topic owner||Rachel Sokal|
|Topic author(s)||Caroline Keenan|
|Topic quality reviewed||January 2017|
|Topic endorsed by||Nottingham City Clinical Commissioning Group Long Term Conditions Strategic Group|
|Linked JSNA topics|
This assessment examines end of life care in Nottingham City which encompasses the holistic assessment and management of the full range of physical, psychological, social, spiritual, cultural and environmental needs of patients and their families and carers in their place of choice, during the last years, months or days of life and after death.
End of life care focused on achieving quality of life for patients and their families, friends and carers is provided by a range of people including informal carers, medical, nursing and other health and social care professionals and within a range of settings including people’s homes, hospitals, hospices, palliative care units and care homes. End of life care provision must be person-centred and coordinated and commissioning should place citizens at the heart of its approach, as illustrated in Figure 1.
Figure 1: The person centred coordinated end of life care approach
The national End of Life Care Strategy (Department of Health, 2008) sets the standard for high quality individual-focused end of life care that enables people to die without symptoms in the company of family, friends and carers in a place of their choosing. The Strategy recognises the importance of coordinated care within teams and between services in primary and secondary care. With 33% of informal carers reporting that hospital services do not work well together with GP practices and other services outside of hospital (Office for National Statistics, 2015c), a whole systems approach to end of life care remains of paramount importance. In Nottingham City major progress has been made towards this approach with the introduction and development of the Electronic Palliative Care Coordination System (EPaCCS).
The Nottinghamshire Guideline for Care in the Last Year of Life acknowledges that end of life care is the responsibility of all health and social care providers that provide for people with less than one year to live, people with a chronic and eventually fatal illness and people diagnosed with a condition from which they will eventually die. The guideline is focused around the five priorities for care of a dying person: promoting recognition of the diagnosis; communicating with patients and their families and carers; achieving choice; provision of support to families and carers; and recording the patient’s individual care plan (Nottinghamshire Healthcare NHS Trust, 2015).
This assessment shows that whilst quality and equity of end of life care in Nottingham City is improving there are some areas within which further improvement is required. With projected increases in future demand for end of life care and complexity of the citizens who would benefit from it, it is important that the whole system approach embedded in Nottingham City continues to develop and evolve.
Insight Specialist – Public Health
Nottingham City Council