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Developing a new approach to palliative care funding: A first draft for discussion

Based on a two year data collection from 11 sites covering both adults’ and children’s services, NHS England is developing a currency for palliative care which focusses on patient need. The aim of the work is to provide a transparent basis for palliative care commissioning

NHS England’s initial thoughts on the currency model have been published to allow the palliative care community including clinicians, commissioners and providers to help shape its further development.

Please send any comments on the document or queries to england.pcf@nhs.net.

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7 comments

  1. Adam Millican-Slater says:

    Thank you for your comments. We’ll take all the feedback we get and take it into account for the next iteration of the development currency document. Alongside this we will make available a question and answers note to address particular points of feedback.

  2. Mary Tehan says:

    Your report states that “the ANSNAP model identified the key cost drivers for palliative care to be phase of illness, age, functional status and severity of problem”. I agree with some of the commentary added below e.g. the need for Fast Track Continuing Health Care funding to be an essential available option for palliative care providers (in ageing populations the dying trajectory is labile within extended periods of time and death is often unexpected and sudden eventually (it’s hard to judge ‘dying’ when the patient stabilises up to 6-7 times prior to death). I also think that the health status (often ill themselves) and availability (working carers?) of carers caring at home is very influential in the cost of care. The patient may in fact be in better health (physical, emotional, social and spiritual) than the carer! Availability of volunteers is another driver not factored in anywhere (the demographics are changing rapidly here globally as cross-border movement of populations increases).

    • David Cowdrey says:

      I think one of the first steps is to introduce a standard definition of terminal illness, similar to the one used by Marie Curie and to use this across the whole of the UK in the NHS, Government, charters etc. This is one simple step to make sure everyone is on the same page and will receive the same level of care and support through terminal illness.

  3. E Holliday says:

    The mental health PBR tariffs looked a bit like these proposed ‘currencies’ and have been shelved in the too difficult box. How will commissioners and providers avoid antagonistic discussions about upcoding and cost containment?

    What about more unambigious threshold for palliative care discussions such as COPD and weight going down or ejection fraction below 25% or similar?

    Having said that, anything pushing diagnosis of end of life and open discussion about it is welcome.

  4. Ellen Davis-Eudall says:

    Psychological care should also be weigthed. In addition Fast track Continuing Health Care funding is often applied for to discharge someone home to die quickly but this doesn’t seem to be factored in.
    The illness phase doesn’t seem to capture the family dynamics that can influence care provided.

  5. Maxine Hanson says:

    Does NHS Continuing Healthcare ‘Fast track’ have a place within this process, as it provides a funding option for professionals to access for their rapidly deteriorating patients?

  6. Dr Meena Krishnamurthy (CCG Lead for End of Life Care in City and Hackney) says:

    In my experience the degree of complexity of any End of life situation is determined more by the psychological and social circumstances of the patient than by the disease or stage of illness.
    Family dynamics, care arrangements and mental health(particularly the presence of personality disorder) or alcohol or drug misuse are the issues which can make end of life more complex