Background Mid Nottinghamshire’s population has a higher than average population of over 85s and a steadily increasing death rate, set to increase by over 50% in the next 30 years (Popnat). Providing quality care for this cohort is a huge challenge to the NHS and social care.
Aims Mid Notts CCG contracted a joint contracting mechanism to test whether a combined contract could produce savings whilst increasing quality. End-of-life care including specialist palliative care was the second service to adopt this approach.
Methods Mid-Notts End of Life Care Together Alliance (EOLCT) was commissioned in 2016. With a collaboratively designed strategy we were given a £3million envelope to provide services for a population of 356,000. A 10% QUIPP target applied in the first year. The budget was ringfenced: surplus could be used to improve services.
One acute trust, ambulance trust, one community trust, two independent hospices, two third-sector organisations and primary care partnered together, with close engagement with social care.
A care-coordination service (Call4Care) was started and staffed 24/7 with access to specialist palliative care nurses. Five key metrics were agreed. Our GSF-based EPaCCS template was used by all community partners with notifications to EMAS and 111. The A&E department had a readable version. EOLCT went live in October 2018.
Results EPaCCS (trend 2017-2020)
· Larger trusts provided financial assurance to third-sector partners.
· Earlier patient identification (0.22-0.66%).
· Those on register DIUPR (54.7-87%) with 61.9% overall. Nottinghamshire average fell to 56.6% during this time.
· Reduced hospitalisation and system savings.
· Better outcomes for individuals (commendations, fewer complaints).
Conclusion True partnership working arose from the process. The savings target was achieved and at a time where end-of-life admissions were rising, Mid Notts dropped. Further evaluation is planned with a view to possible further expansion.
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