28 Oct 2020
As the South Island ACP (Advance Care Plan) facilitator role – supported by the South Island Alliance – comes to an end, I thought it was timely to reflect on the progress we have made with advance care planning.
Advance care planning is one of several priorities across the South Island. With the recent COVID-19 pandemic, it has brought the need for ACPs into sharper focus both for health teams, and for a person and their whānau. International evidence has found that advance care planning leads to less unwanted aggressive medical care, better quality of life near death, decreased rates of hospital admission – especially age residential care residents – and those who have completed an advance care plan are more likely to receive care that is aligned with their wishes.
For the past few decades, ACP conversations have evolved. In the early days, there was a focus by many on the document. These days, there is better recognition of the value of the process in supporting people to understand and share values, goals and preferences regarding future medical care. Given this, the process of advance care planning is usually a series of conversations, often with whānau and different providers. People’s goals and values change to reflect changing health, and the system to support advance care planning in the South Island aims to support this.
In addition to having a digital ACP, which can be shared across the South Island for those with access to Health Connect South/HealthOne, a new South Island digital solution was developed this year – ACP Progress Note. The tool provides the option to use a dropdown box and record a targeted advance care planning conversation using the serious illness conversation guide framework, or health teams can use the free text format to record the interactions and discussions that happen during the advance care planning process.
As of September 2020, we now have 4982 ACPs on Health Connect South – 869 completed by four DHBs who commenced their digital journey on 1 May 2019. Canterbury DHB has been using the digital system for seven years and has completed 4113 so far. All these plans can be accessed across the South Island health system. Such progress has been achieved by collaboration and alliance working. Regional leadership through the Health of Older People Service Level Alliance (HOPSLA) has contributed to working in a broadly similar manner across the South Island. While there are many regional projects to complete, these are on hold, awaiting resource.
Meanwhile, the more we can support people who live in the South Island to have these conversations, document them if they wish and share them electronically on Health Connect South/HealthOne, the more we’re able to be truly person-centred in our approach.