What does the JSNA say?

  • About 1,200 people die each year in Richmond.
  • Most people die in hospital, while most people would prefer to die at home (given they have the right support). (Source: End of Life Care Strategy, 2008)
  • In addition, hospital admissions before death are expensive. A reduction of at least one admission in last 12 months for each patient with long term conditions at end of life care may result in around £1.3 million savings.
  • National and local strategies therefore aim to increase the number of people that die in their preferred place of death (including End of Life Care Strategy, 2008; Richmond CCG Better Care Fund; Richmond Out of Hospital Care Strategy, 2014-2017)

What have we done?

  • Co-ordinate My Care – electronic, web based system that allows health care professionals document and share care plans
  • Community Palliative Care Nurses
  • Care Home Pilot which provides nurse specialists working with care home staff to provide those living in care homes with the right support to have their end of life care needs met
  • Targeted training and support for Care Homes on identification and advanced care planning
  • Training for primary, community and social services
  • Liverpool Care Pathway
  • Gold Standards Palliative Care Framework
  • End of Life Care Commissioning for Quality and Innovation (CQUIN) in both Kingston and West Middlesex Hospitals
  • In addition to these existing or completed schemes, further reducing the percentage of deaths in hospital is a priority in Richmond CCG’s Better Care Fund. Initiatives that are planned in Richmond upon Thames to integrate health and social care and that may reduce hospital deaths include: Community Independent Living Service, Carers Support Services, GP led model of Integrated Care, Community Respiratory Care Services, and Assistive Technology Services.

How has this affected Richmond residents?

  • Since implementation of the End of Life Care Strategy in 2008, the percentage of deaths in hospital has decreased and the percentage of deaths at home or in a care home has increased (as shown in the figure below).
  • Between 2008 and 2013, the percentage of deaths in hospital reduced from 63% to 49%. The percentage of deaths at home or in a care home increased from 30% to 41% (home: 20% to 24%; care home: 10% to 16%).
  • The percentage of deaths at home or in a care home in Richmond CCG (41.3%, 2013/14) is higher than the London average (37.1%) and similar to the England average (44.7%).

Figure 1. Death registrations for Richmond borough residents 2008 to 2013: Annual percentage of deaths by place of death

Source: Annual data from the Primary Care Mortality Database.

Document Information

Published: December 2014
Topic Lead: Anna Raleigh, Consultant in Public Health