More to be done for end of life care in Norfolk

Norfolk's care provider has set itself an ambitious target of helping more people reaching the end of their lives to choose where they would like to die. Health correspondent Kim Briscoe reports.

Each year around 8,000 people die in Norfolk.

Two thirds of these are aged over 75 and the large majority of deaths follow a period of chronic illness such as heart disease, cancer stroke, chronic respiratory disease, neurological disease or dementia.

Given that a large proportion of deaths involve people with existing and chronic health conditions, NHS Norfolk has been reviewing how it can offer better care to these people as they near the end of their lives.

Speaking shortly before he left his post as chairman of NHS Norfolk's clinical executive team, Ian Mack said the end of life strategy was 'a very important piece of work' and its progress was being closely followed by Norfolk County Council's Health Overview and Scrutiny Committee.

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Dr Mack, who has now taken up a post as medical director of Norfolk Community Health and Care NHS Trust (NCH&C), said: 'This is about the choices we make at the end of our lives and where we would like to die, and often people would rather die at home.

'It is vital we have social health and care put in place to make that possible.'

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Dr Mack said health and social services needed to 'up the pace' of working with people from an early stage so their wishes could be identified and appropriate care put into place to support them and their families.

He said: 'People come to end of life through continuing long-term conditions and we need to develop integrated care so that we are supporting people and helping them make early choices about advanced care planning if they should wish to do so.'

David Stonehouse, NHS Norfolk's director of finance and deputy chief executive, said two years ago the End of Life Care Strategy was drawn up and since then some improvements had been made, but he admitted there was still more to do to support people at the end of their lives.

Progress so far includes providing an extra 1,330 more hours of respite care and support for families and carers, and creating posts to support care homes to manage end of life care to avoid hospital admissions.

When the strategy was first launched, just 20pc of deaths were happening at home, with 65pc in NHS hospitals.

Dr Mack said: 'We have an aspiration for 32pc to be able to die at home. The latest figures are that it is 25.9pc.

'That's really good in the national context, but not good enough for the people of Norfolk. They deserve more and they deserve better.'

The primary care trust is working with its health providers, such as the hospitals and community health services, to reduce the length of hospital stays, where appropriate, for individuals at the end of their lives to three days.

It also wants to increase the number of individuals dying in their preferred place of care to 90pc by 2015.

Another key part of the strategy is raising awareness among both clinicans and patients about advance care planning for patients nearing the end of life.

This includes how to manage advance requests and refusals of treatment.

It emphasises to doctors the importance of listening to patients and recording an advance care plan to help ensure that everyone involved in treating the patient can understand and follow their wishes.

Last year NHS Norfolk commissioned the East Anglian Children's Hospice (EACH) at Quidenham to provide on-call specialist nursing at home for youngsters who are terminally ill.

Now, at the most difficult time imaginable for any family, a team of hospice nurses will bring palliative care, management of symptoms and support at home whenever it is required, day or night.

The 24/7 on-call service began last year and it forms an extra component of the extensive service already provided by the care team at EACH.

Before it was introduced, the hospice was only able to offer planned short breaks in the family home, which are really appreciated by families, and emergency out-of-hours advice and support by telephone.

The extra funding from NHS Norfolk enabled EACH to put in place a formal home visiting service, staffed by their own paediatric nurses and with the aim of being on the doorstep within four hours.

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