Guide for commissioners on end of life care for adults

This is an extract from the commissioning guide. The complete commissioning guide is available at www.nice.org.uk/guidance/cmg42

7 Further Information

Table 8 summarises national drivers that are relevant to commissioning end of life care services for adults. Local service redesign may address only one or two of them.

Table 8 National policy on end of life care

Document	Author	Year		Significance
NHS Outcomes Framework 2012/13	Department of Health	2011		Domain 4: ensuring that people have a positive experience of care. This includes indicator 4.6 which will be derived from the survey of bereaved relatives (see section 1.6).
NICE quality standard for end of life care for adults	National Institute for Health and Clinical Excellence	2011		The Quality Standard sets out markers of high-quality care
Quality, innovation prevention and productivity (QIPP)	Department of Health	2011		End of life care QIPP workstream
Transparency in outcomes: a framework for adult social care	Department of Health	2011		All four domains of the framework have relevance with end of life care (see section 1.6)
NHS operating framework for 2012/13	Department of Health	2011		QIPP is highlighted in 2011/12 operating framework as continuing to be important for 2011/12 financial plans.
Information and links for professionals who support people and their families at the end of life	Social Care Institute for Excellence	2011		SCIE have produced a resource for people who work with adults who are approaching the end of life. It aims to provide access to tools and resources to assist professionals in providing high-quality end of life care.
End of life care strategy: third annual report	Department of Health	2011		Includes a chapter about commissioning end of life care and includes service model examples
Commissioning End of Life Care: initial actions for new commissioners	National End of Life Care Programme / National Council for Palliative Care / National End of Life Care Intelligence Network (NEoLCIN) / Dying Matters Coalition	2011		Helps commissioners to identify the immediate priority actions to commission effective end of life care.
Critical success factors that enable individuals to die in their preferred place of death	National End of Life Care Programme	Expected February 2012	Presents an analysis of the critical success factors in improving end of life care
Using the Commissioning for Quality and Innovation (CQUIN) payment framework – a summary guide	Department of Health	2010		Makes a proportion of providers' income conditional on quality and innovation.
End of life care strategy: quality markers and measures for end of life care	Department of Health	2009		Supports implementation of the End of life care strategy.
End of Life Care Strategy - promoting high quality care for all adults at the end of life	Department of Health	2008		DH strategy which commissioners and providers should be aspiring to.

Useful sources of information for developing a service specification may include:

The standard NHS contracts for acute hospital, mental health, community and ambulance services.
NHS Evidence: provides free access to clinical and non-clinical information – local, regional, national and international. Includes a QIPP library with case studies, commissioning for long-term conditions section and commissioning zone.
The NICE shared learning database offers examples of how commissioners and service providers have used NICE guidance to create innovative and effective local implementation programmes for service improvements.
NHS Institute for innovation and improvement: The rough guide to experience and engagement for GP Consortia. Guidance for GP Consortia on the emerging national framework governing engagement and experience and an introduction to the Engagement Cycle tool.
NICE guides for commissioners on dementia, chronic obstructive pulmonary disease and heart failure, which provide condition-specific end of life care information.

General information on quality and corporate assurance can be obtained from the following sources:

Indicators for Quality Improvement Programme from the NHS Information Centre. A resource of robust indicators to help local clinical teams select indicators for local quality improvement and a source of indicators for benchmarking.
NHS Alliance online resources. NHS Alliance is the representational organisation of primary care and primary care trusts, and provides them with an opportunity to network and exchange best practice. The alliance supports its members with an open-access helpline, in-house and joint publications and briefings, internal newsletters and a website.
NHS Institute for Innovation and Improvement support for commissioners, includes products; The Productive Leader programme to enable leadership teams to reduce waste and variation in personal work processes, and 'Better care, better value indicators' to help inform planning, to inform views on the scale of potential efficiency savings in different aspects of care, and to generate ideas on how to achieve these savings
QOF is a voluntary quality incentive scheme that rewards general practices for implementing systematic improvements in the quality of patient care.
Skills for health works with employers and other stakeholders to ensure that those working in the sector are equipped with the right skills to support the development and delivery of healthcare services.

Sources of further information to help you in assessing local health needs and reducing health inequalities include:

The National End of Life Care Intelligence Network provide a wealth of resources including local profiles and a compendium of data sources.
NHS Evidence provides free access to clinical and non-clinical information - local, regional, national and international. Information includes evidence, guidance and Government policy.
Department of Health Delivering quality and value – focus on benchmarking.
NICE Health equity audit – learning from practice briefing.
NHS Comparators provides comparator data for NHS commissioning and provider organisations to enable users to investigate aspects of local activity, costs and outcomes.
The Disease management information toolkit is a good-practice tool for decision-makers, commissioners and deliverers of care for people with long-term conditions, which presents data on conditions that contribute to high numbers of emergency bed days. It models the effects of possible interventions that may be commissioned at a local level and helps users to consider the likely impact of commissioning options.
PARR (Patients at risk of rehospitalisation) is a risk-prediction system for use by primary care trusts to identify people at high risk of hospital re-admission.
PRIMIS+ provides support to general practices on information management, recording for, and analysis of, data quality, plus a comparative analysis service focused on key clinical topics.
The SHAPE (Strategic health asset planning and evaluation) application provides support to strategic health authorities and primary care trusts on strategic planning across a whole health economy.