11 February - non-executive directors

This week’s non-executive directors webinar opened in conversation with Paul Jennings, chair of Hospice UK, associate NED at University Hospitals Birmingham NHS Foundation Trust, and former CEO of Birmingham and Solihull CCG, where he was also system lead.

Paul said: “The pathway to end-of-life care is very varied. We are trying to extend the reach and range of hospice end-of-life care so that everybody has access to excellent care. That needs to be delivered wherever and whenever the person wants it. Even in the hospice system people see the beds and services very often but actually 80 or 90% of what hospices do is in a community setting.

“In terms of the pathways, in some parts of the country it is better integrated than others and in an ideal world what we would love to see is that each ICS has a well described, well-articulated end of life care pathway.”

[…]

“The issue around the relationship with acute care is a philosophical thing. The job of the NHS ever since it was created has been to pluck people from the river of ill health. There’s remarkably little realisation that the river of ill health ends in the sea of eternity and we’re all going there at some point, no matter how good the surgeons are or the GPs are. We need to be much more coordinated and accepting that there is an end to the journey for everybody and we need to build that into the way we approach our services.”

[…]

“On average about a third of all costs in health and care are expended on the last year of life. There are lots of unnecessary interventions and lots of unnecessary referrals.”

Also overheard during the discussion:

“’You matter because you are you and you matter till the very end of your life.’ I would say you matter beyond the end of your life. A lot of our work is about loss and grief and care for the family and loved ones. With the fundraising and voluntary work, you have levels of staffing to do that.”

“We might save some of the money we throw at trying to keep somebody alive through medical interventions. Flipping our philosophy into thinking ahead – that actually it isn’t a failure to die but a failure not to give someone a good death.”

“We are all comfortable with birth and close down conversation on death.”

“Overmedicalisation still is a big challenge. It’s a multifactorial problem and there is a lot of cultural ideas around it. It is a massive societal issue. COVID has changed some attitudes to this as well.”

“One issue is communication across the system, you can set up your advance care planning and have a conversation with the family but if someone ends up calling an ambulance and the person gets admitted the care planning goes out of the window.”

“How or who ultimately makes that decision that a person really has reached the end of life rather than restorative? This has real implications that can be driven by loved ones not wanting to give up. Faith and beliefs play into the decisions that can drive clinicians to carry on restorative care.”

“My mother’s faith meant that giving up was committing suicide. She wouldn’t discuss her end of plan after being in hospice care for quite a long amount of time.”

“We do not as a nation talk about death and a death plan. We need have discussions when we are fit and healthy and make the individuals thoughts known whilst they are mentally capable. We have to start talking openly.”

These meetings are by invitation and are open to all NHS non-executives directors, chairs and associate non-executive directors of NHS providers. Others may attend by special invitation.

If you have any comments, questions or suggestions about these webinars, please contact: events@good-governance.org.uk