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About

The End of Life Care Integrator (EOLCI) was established in 2015 by Social Finance. It is funded by the Care and Wellbeing Fund, with investment from Macmillan Cancer Support and Big Society Capital and grant support from The Health Foundation, together with funding from The National Lottery Community Fund.

We enable health and social care systems to make change happen so that people live and die well.

We do that by:

  • Analysing what works and providing sympathetic capital as a catalyst to invest in community-based models of care
  • Developing outcomes-based contracts to ensure personalised end of life care (EOLC), focused on the outcomes that really matter to people
  • Driving the use of applied analytics to inform decision makers and ensure agile service management; we are wedded to the outcomes, and systematic learning/design, not the service model

 

What is end of life care?

Every year around 550,000 people die in England, two thirds of them aged over 75.  Three quarters of these deaths follow a long term illness requiring access to end of life care.

End of life care seeks to support individuals with advanced, progressive, incurable illness to live as well as possible until they die.

For many a ‘good death’ involves being without pain, in a familiar place with friends or family and being treated with dignity and compassion.  

Of the 79% of people who prefer to die at home, only half are able to do so.

The average cost of care in the community in the last three months of life is £1,000 per person who died, while in hospital it is £4,500 per person who died (source: The Nuffield Trust).

 

Our projects

We are planning to expand our footprint with our next wave of investment.

Project name

Advance Care Planning in Care Homes

Area

Haringey​

Unmet need

Health inequalities. People in care homes spend more time in hospital in the last 12 months of life than those who live in their own homes.

What changed

Care Home Facilitator to identify people in the last 12 months of life and ensure that they have Advance Care Plans in place.

Outcome

People in care homes will ‘die well’. Improved health and wellbeing for people in care homes.

Project name

Telemedicine for Care Homes​

Area

North West London

Unmet need

Health inequalities. People in care homes spend more time in hospital in the last 12 months of life than those who live in their own homes.

What changed

Telemedicine support for care home staff to support them to support people to remain in the care home if they want to and it is clinically appropriate.

Outcome

People in care homes will ‘die well’. Improved health and wellbeing for people in care homes.

Project name

Single Point of Access (SPA) and Rapid Response Nursing​

Area

Hillingdon

Unmet need

Independence and Dignity. People in Hillingdon are not dying where they would like to because there is a lack of community-based support.

What changed

New model of care: SPA and rapid response nursing to support people in the community.

Outcome

People in care homes will ‘die well’. Improved health and wellbeing for people in care homes.

Project name

System Transformation Project

Area

Waltham Forest

Unmet need

Independence and dignity. People in Waltham Forest are spending more time in hospital and not dying where they would like to because there is a lack of community-based support.

What changed

System integration: Enhanced community provision and integrated decision making and operational delivery.

Outcome

People will ‘die well’. Improved health and wellbeing in the last 12 months of life.

Project name

Sutton Palliative Care Coordination Hub

Area

Sutton

Unmet need

Independence and Dignity: People in Sutton are spending more time in hospital than they need to/want to because there is a lack of coordination.

What changed

New model of care: Coordination Hub established to ensure that people and their carers are supported outside of hospital where possible.

Outcome

People will ‘die well’. Improved health and wellbeing in the last 12 months of life.

 

Our people


Katy Saunders
Agent Director of EOLCI Board and Associate Director for the EOLCI

Katy Nex
End of Life Care Integrator Development Manager

Rosanna Hardwick
Digital Labs’ Health Analytics Manager
Gina Mirow
Associate for the End of Life Care Integrator
Sarah Churchill
Senior Analyst for the End of Life Care Integrator

The EOLCI team at Social Finance has a wide range of backgrounds including NHS senior management, central government policy experience and clinical leadership. Social Finance has worked on a wide range of health-related projects, including designing and raising capital for new services, advising both commissioners and social enterprises, and helping to manage and evaluate the delivery of innovations.

The Integrator’s success is also shaped by some of the sector’s leading voices.

Nigel Hopkins
Chair of EOLCI Board, Experienced non-executive director
Adrienne Betteley
Strategic Advisor to the EOLCI. Strategic Advisor Macmillan Cancer Support and Co-Chair of National Ambitions Partnership
Dr Iain Lawrie
Strategic Advisor to the EOLCI. Consultant & Honorary Clinical Senior Lecturer in Palliative Medicine. President, The Association for Palliative Medicine of Great Britain & Ireland
Sam Cheverton
Strategic Advisor to the EOLCI. Director of Strategy and Impact Marie Curie UK
Sarah Russell
Non-Exec Director of the EOLCI. Development Practitioner Dementia UK. Visiting Fellow, Southampton University
Dr Pauline Love
Strategic Advisor to the EOLCI. EOL Clinical Lead Derby & Derbyshire CCG. Dales Place Alliance GP. Macmillan GP Advisor. East Midlands Derbyshire LMC representative.

We also have a strategic partnership with NHSE/I, and have been asked to contribute to two national workstreams; Commissioning, Contracting and Finance and Digital Development for End of Life Care.

 

Associates

The EOLCI is fortunate to benefit from the experience of several associates who provide specialist expertise:

Di – Clinical
Experienced registered nurse with over 30 years’ experience in palliative care. Roles include Leadership of an EOLC team in a large multi-site hospital.

NHSX accredited clinical safety officer, and was involved in the design and development of digital urgent care plans for London.

Caroline – Finance and Business
Business expert with over 25 years’ experience in the commercial sector. Originally trained as an investment banker, before leaving to join a film financing business. Found and run businesses, first financing projects in the creative industries, then a record label. Responsible for developing innovative financing solutions including a number of tax- and insurance-based products for investors in the creative industries. Has also worked recently in a senior role with the campaigner Gina Miller.

Owen – Contract and Finance
Experienced Chartered Accountant/Finance Director with 30 years post qualification experience in the NHS and Commercial Sectors, including multinational Telco and IT organisations. Health experience from across a number of systems with roles on both provider commissioner side; including DoF, Deputy CFO and Contract Director; and with responsibilities covering acute, mental health and community sectors. A passionate believer in systems working better together and building relationships to facilitate greater co-operation supported by innovation and structure within contracts and commercial relationships.

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Partners

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Case studies

1. WALTHAM FOREST, LONDON

Patient profile: Mrs. B was a patient with end-stage lung cancer. She was known to district nursing, clinical nursing specialists, and EPIC teams. There was an integrated and co-ordinated approach to care planning and delivery. Mrs. B.’s two main carers were her two sons who were not sure how to cope with the personal care of their mother, or what to expect as she approached the end of her life. Mrs B. was adamant about caring for herself and wanted to retain her privacy and independence as long as possible.

EPIC support: The EPIC representative (nurse) met the family to talk about options for her to be able to remain at home, to retain her dignity and not feel embarrassed about her personal care needs. One of her sons struggled to cope and would regularly call the nurse upset and frustrated and needing to offload emotionally. When her physical condition deteriorated after a few weeks, the nurse discussed the EPIC HCAs providing personal care in the day and respite for the family overnight. By this point the nurse had built a relationship of trust with Mrs. B and her sons

Outcomes: A care package wasn’t needed as Mrs. B deteriorated rapidly and was able to die in her preferred place of death i.e. at home with her sons. Her sons both said they couldn’t have managed without EPIC and wrote to thank the EPIC team and praise  the service they’d received.

2. HARINGEY, LONDON

Patient profile: Sally was a 95-year old lady with advanced dementia. Her family had already discussed advance care planning prior to her admission to the home. They agreed resuscitation was not appropriate given her age and frailty but wanted her to be transferred to hospital if she developed a reversible condition, e.g. chest infection. One of the senior carers noted Sally was not “her usual self”; she was less chatty and was not acknowledging staff; additionally she was eating and drinking less than previously and would often fall asleep during meals. These concerns were raised with the GP.

Action: The GP assessed Sally and noted she had distended chest wall veins. He sought advice from the Community Matron who was visiting with the elderly care consultant later that week. The Community Matron and the consultant felt the distended veins could indicate a malignancy, so contacted Sally’s next of kin to discuss options. The Advance Care Planning Facilitator met with the family on their next visit to review Sally’s Advance Care Plan. The family agreed they would still like treatable or reversible conditions such as infection to be treated in the nursing home environment, but no longer wanted Sally to be admitted  to hospital. If oral treatment in the nursing home was ineffective, they would want Sally to be made comfortable and allowed to die naturally in the nursing home.

Learning: The senior carer did not know what was wrong with Sally but recognised a change and felt able to raise this with the GP. Her concerns were taken seriously, and Sally was reviewed by the wider Multi-disciplinary Team. Staff were able to see that ACP is a fluid process and preferences can be reviewed in response to changes in condition.

3. NORTH WEST LONDON (TELEMEDICINE)

Patient profile: Mrs L, 73, was a patient living in a care home who had become confused and tired over a some days, then developed a moderately high temperature of 37.6 degrees Celsius. She had a Coordinate My Care (CMC) advance care plan that stated she wished to have any treatment in the care home and not be transferred to hospital.The carers called for advice.

Action: The carer reported that Mrs L’s urine had an offensive odour, which indicated a possible urinary tract infection.The carer was asked to perform a urine dipstick test which seemed to confirm this.They were also asked to send a urine sample to the GP surgery for lab analysis. The carer was advised to administer paracetamol to bring down Mrs L's temperature, and to encourage her to drink plenty of fluids.The patient was referred to the out of hours (OOH) GP, with the background information and findings, and a request for a prescription of oral antibiotics.The carer was advised to collect the new medication from the pharmacy and start the treatment. The carer was advised to call back if the patient deteriorated further, and the signs of sepsis explained. A follow up call was arranged for the next morning. The next day, after the commencement of antibiotic therapy, the patient was feeling better, and the urine was no longer odorous.The care home updated their records and amended Mrs L’s care plan to include the need for more fluid intake. Mrs L’s regular GP was updated.

Learning: The Telemedicine service conducted a thorough assessment, offered education / advice for the carer and co-ordinated care with the out of hours GP.

4. NORTH WEST LONDON (TELEMEDICINE)

Patient profile: Mr L, aged 93, had recently been admitted to a care home. He had a diagnosis of multiple sclerosis (MS), was bed-bound, and used a long-term urethral catheter.

Action: The nurse in charge called to say that the catheter had ‘fallen out’ and that she was not qualified to insert a new catheter. The nurse requested an ambulance to take Mr L to A&E to have a new catheter inserted. Our assessment showed that Mr L was comfortable, clinically stable, not agitated, and had no signs of urinary retention.The care home had no information about when the catheter had been inserted, or whether it had been in hospital or in his previous home. The nurse was asked to monitor Mr L whilst Telemedicine tried to find an a way to solve the problem that did not involve an A&E attendance, and to call back if there was any deterioration in his condition. Note that Mr L (as a care home resident) was not known to district nurses. The local Rapid Response Team was contacted, and an urgent referral made for re- catheterisation.They were able to do this promptly and successfully, without Mr L needing to leave his bed.

Learning: The Telemedicine service avoided conveyance to hospital, which would have caused distress to a patient who was bed-bound and needed hoisting, and increased Mr L’s confidence in the ability of his new care home to manage his needs.

 

Our future

We are currently working to finalize our next wave of investments and build our pipeline.

Areas of interest include racial injustice and rural poverty. We are also keen to develop ways to measure personalised care for people in the last 12 months of life.

We are working to build a community of interest in Social Impact Bonds for EOLC, sharing learning across sites and across networks, and working on new approaches to outcomes based commissioning in a time of Covid and changes to NHS contracts.

 

Contact

If you would like to hear more about our work please email eolci@socialfinance.org.uk

 

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