Reflections on evaluating the Wandsworth Care Coordination Centre
Tuesday 20 September 2016By:
- Max Kowalewski
We recently completed our evaluation of the Wandsworth Care Coordination Centre, based at Royal Trinity Hospice, which is a pilot service providing coordination and care to people approaching end of life.
Overall we found the pilot to have been a success, with positive impacts for people at the end of life, their families and carers, as well as for other professionals working in the local end of life care system. Rather than repeating all our detailed findings here, I wanted to reflect on a few points which I personally found particularly interesting about this project and what the evaluation discovered.
The holistic view
Firstly, one of the real strengths of the Centre is how, through coordinating people’s end of life care support, it has an overview of people’s experiences and needs, and brings together all the services that help them in their last months and days. We found that this was positive for people and their families, as well as representing a more effective way of working for other health and social care professionals involved in end of life care. The crucial point here is that the Centre is able to take a holistic view of a person at the end of life and their care, which is invaluable in the complex end of life care landscape. The importance of this holistic view in end of life care is now widely recognised – not least as a key quality principle in NICE’s guidance for end of life care.
Secondly, what is true for the individual at the end of life, in terms of taking a holistic view, we also found to be true for the local end of life care system as a whole. It’s important to remember that the success of the Centre is linked to how well it interacts with other parts of Wandsworth’s local system, from district nurses and GPs, via Royal Trinity Hospice’s other services, to physiotherapists and specialised CNSs, relaying information back and forward, and coordinating the efforts and dedication of all the other professionals involved. But through coordinating all this activity, the Centre also gains a kind of holistic perspective on the local system overall; and in occupying this central, coordinating position, the Centre is able to identify systemic blocks in local processes, and try to have these resolved. In this way, it was able to improve pathways – ultimately bettering care provision for people. This represents an added benefit of having a coordinating function in a system as complex as end of life care.
Contributing to an under-researched field
The last point that really piqued my interest was methodological. We knew that the role of coordination in end of life care had been under-researched and under-evaluated. Particularly with regards to economic evaluation approaches for end of life care and care coordination, the evidence base is still rather slim (with some exceptions, such as the NAO’s study, and the economic evaluation of EPaCCS).
In our own small-scale, local economic evaluation of the Centre, we mainly worked with the Centre’s existing data, but nonetheless were able to demonstrate monetisable benefits for the Centre’s work. A lot of this hinges on assigning value to the reduction in avoidable admissions, with that reduction recognised as something that is notoriously difficult to quantify, and attribution in a system with multiple interventions is tricky. Nonetheless, we were able to run through scenarios for what kind of monetisable benefits the Centre may be achieving, suggesting that there is value in coordinating functions for end of life care (something we also found in a previous study we undertook for Macmillan).
There’s clearly still a lot more research to be done, but it’s been great to contribute to the development of knowledge in this field through our evaluation of the Centre. Of course, no two models are exactly the same, with local context a huge factor influencing variations in service provision; but hopefully the lessons we identified from Wandsworth can help other commissioners and service providers in considering whether such a model would work for them elsewhere.
If you want to talk to us about how we can support you to evaluate services in end of life care, please contact Chih Hoong Sin.