Palliative Care in Ontario and the Declaration of Partnership and Commitment to Action Canadian Association of Health Services and Policy Research Conference May 2014 Denise Marshall, MD, CCFP, FCFP Palliative Care Consultant Physician, McMaster University and Hamilton Health Sciences Provincial Palliative Care Lead, LHIN Collaborative and Cancer Care Ontario 1
CONTEXT: Palliative Care Systems in Ontario Today Current State Leading Practices and Evidence Services are siloed and episodic Patient is not the centre Inequity in the availability and accessibility of services Informal networks No authority to set or enforce standards across boundaries Leads to avoidable pain, suffering and resource use Formalized integration A coordinated system within and across sectors Standardized processes Patient and family centered Grows capacity in healthcare and social care sectors Equal access to regional based services. 2
Declaration of Partnership Six Priorities Articulated = 94 action items Broaden Access & Increase Timelessness of Access Strengthen Caregiver Supports Strengthen Service Capacity & Human Capital in all Care Settings Improve Integration & Continuity Across Care Settings Strengthen Accountability and Introduce Mechanism for Shared Accountability Build Public Awareness
Declaration of Partnership and Commitment to Action Includes a shared vision and goals for the system, key measures of success to guide system transformation, and action plans for achieving improvements in palliative care delivery Serves multiple functions as proposed actions are directed to all participant groups Organizations and care providers for changing care delivery practices and processes LHINs for regional planning, performance monitoring and establishing shared organization accountability for outcomes Ministry for policy consideration and stewardship 4
Evolution of the Declaration of Partnership Dec 2012 HPC Prov. Steering Committee Formed Apr-July 2012 LHINs & QHPCCO implementation plans Sep-Dec 2011 Provincial review completed Declaration April 2011 Minister announces provincial HPC review Oct 2010 Policy Brief submitted to government by Coalition June 2010 Grand Bend retreat Creating an Integrated HPC System Spring 2010 group votes to become QHPCCO & appoint HPCO as Sect. Fall 2009 working group starts to meet to move forward June 2009 CCO & OCFP host think tank on improving HPC
Quality Hospice Palliative Care Coalition of Ontario 1 institute 4 Universities 1 PC Centre Research Universities and Institutes 14 Networks Provincial End-of-Life Care Network (PEOLCN) Regional Cancer Centres Cancer Care Ontario Quality Endof-Life Care Coalition of Canada Ontario College of Family Physicians (OCFP) 9,300 family physicians Alzheimer s Society Ontario 24,000 physicians Ontario Medical Association MOHLTC Policy Advocacy Quality Hospice Palliative Care Coalition of Ontario (QHPCCO) Heart & Stroke Ontario Funding Funding LHINs Accountability Accountability Health Service Providers 430 LTC Homes Ontario Long- Term Care Association Provincial Palliative Care Consultants Network 35 Consultants across Ontario Ontario Association of CCACs 14 CCACs Coalition Secretariat 600+ organizational and individual members Ontario Caregiver Coalition Various Caregiver Groups Ovarian Cancer Canada Canadian Working Group on HIV/Aids (Ontario)
HPC Provincial Steering Committee Purpose Establishing momentum to focus on implementation of the Action Plan from the Declaration. Ensuring the implementation efforts are aligned with the Declaration and are consistent with the 14 LHINs regional plans. Continuing to extend the dialogue and discussion to identify further opportunities to advance and improve the value of palliative care delivery in Ontario.
Hospice Palliative Care Provincial Membership Ministry of Health and Long Term Care Local Health Integration Networks Quality Hospice Palliative Care Coalition of Ontario Hospice Palliative Care Ontario Cancer Care Ontario (CCO) CCO Palliative Care Physician Group College Nurses of Ontario Community Care Access Centres Community Support Services Providers Ontario Caregiver Coalition Table Steering Committee Ontario College of Family Physicians Ontario Home Care Association Ontario Hospital Association Ontario Long Term Care Association Ontario Medical Association Palliative Medicine Researchers Provincial Council for Maternal Child Health Provincial End of Life Care Network 8
HPC Provincial Steering Committee Governance Structure Hospice Palliative Care Provincial Steering Committee Annual Report Clinical Council 20-25 Clinical Leaders. Advisory to SC and clinical implementation of Declaration. Chaired by the Prov. HPC Clinical Lead along with Vice Chair Coalition / Associations 15 seats Change Agent for delivery of related action commitments supporting integration of services to better support the individual and family. Collaborative Shared Leadership (exec.) Quality Hospice Palliative Care Coalition (HPCO/Coalition) Local Health Integration Networks (LHINs) Ministry of Health and - Long Term Care (MOHLTC) Cancer Care Ontario (CCO) LHINs 2 seats Change agent for regional planning & implementation including clear accountability and organizational collaboration to drive improvements and on-the-ground changes MOHLTC 2 seats Change agent for health system stewardship and legislative, regulatory and policy considerations Produce annual status report Of implementation against actions identified in the Declaration of Partnership With renewal of actions and priorities CURRENT Shared Work Groups under Steering Committee s Priority Communication and Awareness Data and Performance Residential Hospices Other Declaration priorities managed by partners
Structure Primary Role MOHLTC Relationship of HPC Structures In Ontario MOHLTC Policy Stewardship LHINs Regional Planning Transformation Accountability LHINS Funding Coalition Service Delivery & Integration Provincial Associations + Universities Health Service Providers Hospice Palliative Care Provincial Steering Committee Clinical Council Guides Priorities for transformation of Hospice Palliative Care by the partners
Vision Declaration of Partnership Adults and children with progressive life-limiting illness, their families and their caregivers will receive the holistic, proactive, timely and continuous care and support they need, through the entire spectrum of care both preceding and following death, to: help them live as they choose, and optimize their quality of life, comfort, dignity and security. Triple Aim Goals Quality: To improve client/family, caregiver and provider experience by delivering high quality, seamless care and support Population Health: To improve, maintain and support the quality of life and health of people with progressive life-limiting illnesses Sustainability: To improve system performance by delivering better care more costeffectively and creating a continuously selfimproving system
Recommendations Build public awareness Strengthen accountability Broaden access and increase timeliness of access Themes Improve integration and continuity Strengthen caregiver supports Strengthen service capacity and human capital 12
Declaration of Partnership Framework of Priorities Caregiver Supports Strengthen Capacity and Human Capital Improve Access Early Identification Public Awareness Measure Performance and Experience Accountability and Shared Accountability Integration and Continuity Across the Continuum of Care
Shared Priorities Identified from Survey (November 2013) 1. Ensure early identification and access to supports and care options for palliative patients, 2. Provincial level policy guidance and direction, 3. Create effective planning and measurement tools to ensure needs-based resource allocation and optimal utilization, 4. Consistent and standard education and competency requirements for all levels of care provision (primary, secondary and tertiary) across care settings, and 5. Physician engagement for palliative care. 14
Adult/ Child Palliative Care Chronic Disease Continuum Promotes early identification and is fluid and integrates chronic disease management and palliative care from diagnosis until death and through to bereavement. 15
Sustainable foundation 16
Potential Policy and Funding Impacts Policy Impact: Community-based Residential Hospices Policy Delivery of palliative care services in Ontario Communication and awareness of palliative care services and resources for caregivers and families Funding Impact: Integration among Palliative Care Health Service Providers New Funding envelopes across care settings Primary Care Long Term Care Settings Reallocation of LHINs and ministry s funding to meet Palliative Care priorities locally and provincially 17
Integration and Quality Related Hospice Palliative Care Provincial Steering Committee Active HPC now a priority for system transformation in all LHINs All LHINs have committed to implementing: 10% reduction in one or more of the following areas: overall palliative-related ALC days, inpatient days per capita among patients that died in hospital, and palliative-related avoidable hospitalizations (repeat ER visits/readmissions) Regional HPC programs Achievements Focus is on integration of HPC services, reduction of duplication and costs, improving access and quality of care Implementation of 70 Palliative Care Nurse Practitioners (5 per LHIN) Community Palliative Care On-Call Program launched to provide 24/7 support Community based Interdisciplinary Palliative Care Outreach teams rolling out
Integration and Quality Related Achievements 34 Residential hospices now open (241 beds) with 21 in planning (184 beds) ICCP learnings across Ontario for in-home clients Speak Up Ontario has distributed over 8,000 Advance Care Planning Workbooks since April 2013 Community of Practice has over 100 people trained as ACP trainers Uptake by the broader health care sector includes long-term care homes, the developmental disabilities communities, seniors communities All regions now have some form of ACP initiative underway and several have funded outreach and training to physicians and long-term care homes Ontario Medical Association HPC priority for 2014; ACP and MD education Many other achievements at the local and regional level