How we worked with partners to coordinate and improve end of life care

Virgin Care’s District Nursing Service in Surrey partnered with North West Surrey Clinical Commissioning Group and several other healthcare providers and a charity to lead on the delivery of a new model of community-based end of life care. This ensured patients receive better support and care at home during the last six to eight weeks of life, resulting in almost 96% of patients in our care dying in their preferred place of death compared to just 54% nationally.

Cosi KSS AHSN award win

Introduction

The District Nursing Service in Surrey, which Virgin Care run as part of our Surrey Community Adult Services contract, use their knowledge and skills to help improve the health and wellbeing of older people across Surrey and provide end of life care support to families and patients.

The Coordinated, Safe, Integrated (CoSI) End of Life Care partnership initiative was designed to help deliver and improve the care for people needing home-based support in the last six to eight weeks of life. Our commissioners, North West Surrey CCG, felt that there was a need to create a new model of care in collaboration with a number of providers – Woking & Sam Beare Hospice, Princess Alice Hospice, Ashford & St Peter’s Hospitals NHS Foundation Trust and charity Marie Curie – to deliver a service that made a difference to the support the patient and families receive.

Virgin Care were a key partner in designing the provision with our District Nursing Team involved in steering groups that let us work closely together with all providers to ensure the project was designed correctly, and gave people a more smooth experience.

This yielded real benefits to the local health economy and the patient experience which saw almost 96% of patients under the care of CoSI die in their preferred place of death compared to just 54% nationally and 81% of patients under the care of CoSI did not have any admissions to hospital or attendances at A&E departments.

End of life care presents many challenges

Nationally, end-of-life care presents many challenges for NHS staff, as well as for patients and their families. Challenges faced by the dying patient are substantial and potentially overwhelming, but for staff who oversee the treatment there are often obstacles to providing optimal care.

Among these obstacles include inadequate preparation for facilitating difficult conversations and personal discomfort with dying and death, while patients experience pain, depression, a variety of intense emotions, the loss of dignity, hopelessness, and the seemingly mundane tasks that need to be addressed at the end of life.

An understanding of the dying patient’s experience would help clinicians improve their care of the terminally ill.

Working in partnership to improve end of life care

To improve the care our patients were receiving in Surrey, we partnered with our CCG and worked alongside Woking & Sam Beare Hospice, Princess Alice Hospice, Ashford & St Peter’s Hospitals NHS Foundation Trust and Marie Curie to introduce a new model of community-based end-of-life care, which would help improve the patient’s experience of receiving care at home in the last six to eight weeks of life.

We were a key partner during the steering group by working together in designing, planning, delivery and monitoring of the project – the Coordinated, Safe, Integrated partnership, (CoSI) as it is known.

The project was first piloted in September 2014 and was later, following further evaluation, commissioned for roll-out in June 2015.

Through CoSI we now help provide and lead on round-the-clock specially-skilled nursing support and care assistance to people approaching the end of life in Surrey as well as a dedicated CoSI coordinator, also available 24/7, who has the ability to rapidly facilitate access to a range of other professional inputs across the partnership, including:

  • Robust advance care planning
  • Specialist pain and symptom management
  • Psychological support
  • 24/7 specialist nursing and medical advice
  • Carers and family support including respite
  • Community nursing
  • Social care and Continuing Healthcare Packages

Through this partnership we were able to centralise coordination and standardisation across end of life care providers which has enabled a change in care that’s yielded real benefits to local people and the patient experience.

CoSI delivered firm changes to improve patients’ experience

By working together and introducing the programme we helped to overcome a number of prominent healthcare challenges to service provision that can often determine the experience of care for patients – specifically the provision of a single point of system coordination and the delivery of an equitable 24/7 service.

Virgin Care has helped deliver firm changes which have improved patients’ experience, an increase in the proportion of people dying in their preferred care setting, a reduction in acute admissions in the last months of life, improved feedback from patients and families and improvements in efficiency and helped deliver cost savings to the health economy.

There is now an agreed care plan in place for all patients documenting decisions and preferences for end of life care to ensure the patients benefit from better outcomes in the last six to eight weeks of life by our service and the partnership.


Ensuring patients 

96% of terminally ill people died in their preferred place of death compared against a population average of just 54%.


During the pilot, the programme made a significant difference to the care patients received. A 100% of individuals referred to CoSI were contacted within 24 hours of their referral being received and 96% of individuals under the care of CoSI died in their preferred place of death, compared against a population average of just 54%.

This had a big impact on the number of admissions to hospital, with 81% of patients under the care of CoSI not having any admissions to hospital or attendances at A&E. This had a real benefit with regards to the cost effectiveness of the programme.


Better care for patients

81% of patients under the care of CoSI not having any admissions to hospital or attendances at A&E


There was a significant reduction observed in the frequency and complexity of admissions into acute hospitals resulting in a saving per patient of £1,974 to the health economy.

The clearest and most important benefit of the CoSI model is best demonstrated in the feedback received from local people and families. The most recent quarterly feedback survey, at the time of writing, reported that:

  • 100% of respondents said that the CoSI service fully met their expectations when caring and supporting their loved ones
  • 71% of respondents said that with the support of the CoSI service they were able to care for their loved ones at home without the need to go to hospital
  • 100% of service users stated that they trusted and had confidence in the CoSI team

Service user feedback

“My very special CoSI girls, Thank you from the bottom of my heart for everything you do for C and myself. I could never begin to repay you all for your kindness. I’m incredibly proud to have met you and I will never forget you.”


Across the healthcare system, professional relationships now exist with providers also now working more efficiently with one another to better understand each partner’s pressures and constraints, working together for the patient to provide better quality of care as a result of changing the way in which services are coordinated and delivered, a direct result of the project which Virgin Care was a key partner in.

Recognition

The CoSI project promotes a sense of shared ownership and accountability for the service’s success and enables any operational problems to be discussed and solved with all parties quickly and openly, while the central point of coordination also enables people to access the support they need regardless of organisational boundaries.

As a direct result of the project, patients across North West Surrey now have a much more seamless experience.  The project was recognised by the Academic Health Science Network for its “comprehensive and seamless support and reassurance which vastly improves patient and family experience and enables those that wish to, to die at home”.

The collaborative community care project won the Kent Surrey Sussex Academic Health Science Network Award for End of Life Care in 2016.End-of-life-care

 

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