Further deployment of ‘Deciding Right’ across the North East and Cumbria

‘Deciding Right’ is an initiative that aims to help people make healthcare decisions in advance. Individuals of all ages who do not have capacity, or who may lose capacity in the future, are empowered to make decisions about the care they would like to receive in an emergency or at the end of their lives. Forward planning in this way should reduce the number of deaths that occur in hospital and increase the number of people who are able to die in their own homes. This project: delivered practical training on the use of ‘Deciding Right’ documentation across the North East and Cumbria; developed a ‘Deciding Right’ app. to guide healthcare professionals in the assessment of mental capacity; and brought ‘Deciding Right’ into the public domain through a media launch.

‘Deciding Right’ is the UK’s first initiative to integrate the principles of making healthcare decisions in advance for individuals of all ages.

At last, an empowering app. useful to all persons who may be concerned, involved, confused or seeking support on MCA and decision making.
Darren Oakshott, Independent Best Interest Assessor.
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Planning ahead can ensure that individuals receive the care they want, even when they can no longer express their wishes. It is welcomed by the majority of older people, yet is often not routinely offered. Care planning can also reduce emergency hospital admissions.

‘Deciding Right’ is an initiative that was developed in the North East. It is specifically designed to help people to plan ahead and to make healthcare choices now for a possible medical situation in the future. Whilst ‘Deciding Right’ is particularly relevant for people with a long term condition or terminal illness, it really applies to all individuals as everyone should think about planning their future care.

The four main ways of ensuring a person’s wishes are considered are:

  • Advance Statement: where wishes and preferences, beliefs and values are documented.
  • Advance Decision to Refuse Treatment (ADRT): e.g. DNACPR (do not administer cardiopulmonary resuscitation).
  • Lasting Power of Attorney (LPA): where a person can appoint someone to make important decisions on their behalf.
  • Emergency Health Care Plan (EHCP): this gives directions for health care professionals and carers in a health emergency.

‘Deciding Right’ provides the template for any healthcare organisation to ensure their policies are compliant with national guidelines and legislation, and focuses on the shared decision-making partnership between health care professionals and individuals.

  • 15 ‘Deciding Right’ training events were held during 2014-15: including regional events, CCG level events, and workshops in individual general practices and hospices. Participants rated the training highly and particularly valued the clear practical guidance on assessing mental capacity and completing the various ‘Deciding Right’ documents.
  • The public launch of ‘Deciding Right’ took place in July 2015 with media coverage on BBC Radio news, BBC Look North and in the local print press.
  • Following this launch, there was a 177% increase in hits to the ‘Deciding Right’ website.
  • The ‘Deciding Right’ app. has been adopted as the NHS preferred app. for assessing mental capacity and applying the Mental Capacity Act (MCA).The app. is available on Google apps and the Apple app store. It was downloaded 14,613 times between Oct 2014 and Nov 2016.
  • To patients: confidence that they have made care decisions that are most appropriate for them, and that their families and healthcare staff are aware of those decisions.
  • To staff: improved understanding of how to complete the ‘Deciding Right’ documents; ability to give appropriate care at all times and respect patient wishes; access to easy-to-use app. to help with application of the Mental Capacity Act and confidence that MCA guidelines are complied with.
  • To trusts and CCGs: cost savings due to fewer inappropriate hospital admissions and more deaths at home.

The AHSN provided £28,405 to support the project (April 2014 – August 2015). This investment was matched jointly by Health Education North East and St Oswald’s Hospice. The funding supported an implementation manager for the project, clinician time to deliver training sessions across the region, and funding to develop and promote the ‘Deciding Right’ app.

  • ‘Deciding Right’ has now been adopted by several areas outside the North East region with the app. currently being adapted for use in Scotland.
  • Throughout the Network, work is ongoing for ‘Deciding Right’ adoption to plan ‘step up’ urgent care. A North East and North Cumbria wide bespoke education package is under development in conjunction with a ‘train the trainer’ programme, provided on behalf of the Clinical Network by St Benedict’s Hospice, Sunderland.
  • ‘Deciding Right’ is used regionally to support the national TRANSFORM programme
  • The ‘Deciding Right’ initiative is being promoted nationally through the National Palliative Care and End of Life Network.