Dying well at home: the case for integrated working
Practice example 3: Gold Standards Framework
The National Gold Standards Framework Centre in End of Life Care runs quality improvement programmes and accreditation to enable a ‘gold standard’ of care for all people nearing the end of life. Gold Standards Framework (GSF) training in primary care, care homes, domiciliary care, acute hospitals, community hospitals and dementia care involves a three-step programme to empower health and social care workers to:
- better identify people in the final year of life and include them on a register
- assess their clinical and personal needs with recorded advance care planning discussions
- proactively plan well-coordinated care in alignment with their preferences to reduce avoidable hospitalisation and enable more to live and die in their preferred place of care.
All programmes recommend recording and reviewing an advance care plan as standard. Advance care planning is a way of clarifying, formalising and recording the wishes, needs and preferences of people as they approach the end of their life and ensures that this information is communicated to others involved in their care. For example, if a person expresses a wish to die at home, this can then be planned for and coordinated with carers and the family involved. It also increases the person’s sense of choice and control and has been shown to help reduce numbers dying in hospital significantly.
A key requirement for GSF accredited care homes is that every resident is offered an advance care plan discussion, including a resuscitation, ‘allow natural death’ and ‘best interests’ discussion with those with dementia. GP practices that have undergone the GSF ‘Going for Gold’ training and accreditation have seen their proportion of patients recording such discussions quadrupling from 15 per cent to 60 per cent. This leads to a doubling of people dying in their preferred place of care, and a halving of inappropriate crisis admissions and hospital deaths at the end of life. GSF programmes in acute and community hospitals have also demonstrated reduced length of stay and better communication with GPs. GSF accreditation is recognised as a marker of quality assurance by the Care Quality Commission, the Department of Health, commissioners and others.