On 30 October, the Trust held another Health Matters event in partnership with Science Oxford. The topic was Advance Care Planning, with a focus on planning for end of life care. The speakers were Kate Butcher and Claire Britton, Practice Development Facilitators for End of Life Care.
There are more than 500,000 deaths in England each year. Approximately one third of these are people who communicated their wishes in advance. A high proportion of those who die each year (72%) have been living with a Long Term Condition such as COPD, heart failure, neurological conditions or life limiting illness. Twenty eight percent have a diagnosis of cancer.
Kate and Claire gave a thought provoking talk on the principles of advance care planning and how it works in Oxfordshire. Kate set the scene, discussing the End of Life Care Strategy, published by the Department of Health in 2008 and how Advance Care Planning (ACP) is an intrinsic part of End of Life Care. She explained how a person’s capacity is a key factor when they are making decisions about future care, stressing the importance of making any such decisions before capacity is lost. The most important factor for Advance Care Planning is that this is led by the individual and not by the clinician. The ACP can be written independently or with support from a healthcare professional if the individual would like this. Another key factor is that the decision to make an ACP lies solely with the individual, recognising that not everyone will want to document their wishes.
Discussions around Advance Care Planning may include:
- the person’s understanding of their illness and prognosis,
- the types of care and/or treatments that may be beneficial in the future and their potential availability,
- the person’s preferences for future care and/or treatments,
- the person’s individual concerns, fears, wishes, goals, values and beliefs, and the need for spiritual or religious support,
- important views and personal goals for care.
Claire then went on to talk about ACP in Oxfordshire. Until recently there has been no formal process in place for Advance Care Planning in Oxfordshire. Although some individuals had documented their wishes most did not know that this was an option. Claire, Kate and colleagues established a working group involving a wide range of agencies across Oxfordshire, including local NHS organisations, social care, and the three local hospices. An already established patient user group was also asked to been involved in the project and has been a vital part of the process. Through the two groups, a system has been developed for Advance Care Planning. The groups have also introduced a form for people to use to document their wishes. Claire stressed that this was a form for individuals to use, rather than clinicians, and that the form would be kept by the individual than by healthcare services. By notifying their GP of the existence of the form and where to find it, all healthcare professionals across Oxfordshire would be alerted to this through electronic healthcare records systems. Claire highlighted how people’s preferences change as their illness progresses and how this form should be continually revisited and updated. She explained how having an ACP can be very important for families when a person is dying as the person’s wishes have already been identified and documented. This can help resolve some of the conflicts that can arise in terms of what is best for the person as well as relieve some of the emotion and distress that families experience.
A national survey carried out in 2012 showed that 63% chose their own home as their preferred place of death. In reality, only 21% of people who died in 2010 did so at home. In Oxfordshire the picture is very different with 49% of people dying at home.
The evening concluded with a lively discussion about Advance Care Planning with lots of insightful questions and comments from the audience.
For updates on future Health Matters’ events taking place across Oxfordshire and Buckinghamshire please visit https://www.oxfordhealth.nhs.uk/news/whats-on/