Improving the care of people with advanced illness is one of the five priority areas we are focusing on to improve the health and wellbeing of Central East residents.
People with advanced illness often receive care from many different services. When this care is not well coordinated, it can lead to repeated crises, unplanned hospital visits, and experiences that do not match what people want. This can affect the quality of life of the person and their family.
By identifying advanced illness early, proactively planning and joining‑up support across health and care services, we can help to prevent health crises. This approach helps reduce avoidable hospital admissions and supports people to stay in the place that is right for them, which is usually closer to their homes.
Why better care for people with advanced illness is a priority
There is an opportunity to improve outcomes, experience, and value for people with complex needs. Key reasons include:
- more people are living with severe frailty — numbers are expected to rise by more than 55% by 2047.
- better coordination reduces hospital use — multidisciplinary teams can reduce acute admissions by planning ahead and responding early.
- there is high use of hospital beds at the end of life — around half of all acute hospital beds are used by people in the last two years of their lives.
Improving coordination can help people receive care that better reflects their needs and preferences.
What we will do
We will scale up a proven collaborative care coordination model across health and care services. This will focus on:
- proactive support for people with advanced illness
- coordinated planning across teams
- reducing avoidable hospital admissions
- helping people stay in the most appropriate place for their care.
This approach aims to improve quality of life, reduce pressure on hospitals, and provide more consistent support for people and families.