NHSE Subsegment / Condition Definitions

All people who have a diagnosis of liver failure (including liver transplant) who are in the last 5 years of life.

• All people with liver failure recorded during:
  • a hospital admission (liver failure is recorded either as the reason for admission or
    as a co-morbidity, or a relevant procedure is recorded such as liver transplant),
  • an outpatient appointment (diagnosis or relevant procedure recorded), or
  • an attendance at a specialist service for liver transplant
• All people with Chronic Liver Disease who have also had liver failure symptoms, recorded during a hospital admission or outpatient appointment, such as varices, ascites or malnutrition

All people who have a diagnosis of Motor Neurone Disease (MND), Multiple Sclerosis (MS), Parkinson’s Disease (PD), Progressive Supranuclear Palsy (PSP) or Huntington’s Disease whose condition is considered severe due to their symptoms or healthcare needs, and who are in the last 5 years of life.

• All people with MND, PSP, or Huntington’s disease recorded during a hospital admission (either as the reason for admission or as a co-morbidity) or outpatient appointment
• All people with Multiple Sclerosis recorded during a hospital admission (either as the reason for admission or as a co-morbidity) or outpatient appointment, who also meet one of the following criteria:
  • Experience dysphagia (recorded during a hospital admission or outpatient appointment)
  • Experience dysarthria or anarthria (recorded during a hospital admission or outpatient appointment)
  • Receive end of life care (in the community or in hospital)
  • Have a diagnosis of dementia (recorded during a hospital admission, outpatient appointment, A&E attendance, or a mental health service appointment or admission a mental health service appointment or Organ Failure admission including for ‘Improving Access to Psychological Therapies’ services)
• All people with Parkinson’s Disease recorded during a hospital admission (either as the reason for admission or as a co-morbidity) or outpatient appointment, or during a referral to community services for their PD care, who also meet one of the following criteria:
  • Had severe PD symptoms such as hallucinations, recorded during a hospital admission or outpatient appointment,
  • Had 2 or more hospital admissions where a fall is recorded within 6 months
  • Are resident in a care home (recorded during a hospital admission as the admission source)
  • Have intermediate or high risk of frailty (based on the Hospital Frailty Risk Score)
  • Have a diagnosis of depression, serious mental illness, or dementia (recorded during a hospital admission, outpatient appointment, A&E attendance, or a mental health service appointment or admission including for ‘Improving Access to Psychological Therapies’ services)
  • Receive end of life care (in the community or in hospital)

All people with a diagnosis of COPD, whose condition is considered severe due to their symptoms or healthcare needs and in the last 5 years of life.

Severe COPD is defined using a number of evidence-based criteria from the Global Initiative of Chronic Obstructive Lung Disease (GOLD), NICE and the Gold Standards Framework (GSF).

All people with COPD recorded during a hospital admission (either as the reason for admission or as a co-morbidity), outpatient appointment or A&E attendance, and meet one of the following criteria:

• had 2 or more emergency hospital admissions for their COPD in the last 12 months,
• an emergency hospital admission for respiratory failure or that required a critical care intervention (such as for non-invasive ventilation), or
• are receiving end of life care (in the community or in hospital)

All people with a diagnosis of heart failure, whose condition is considered severe due to their symptoms or healthcare needs, and in the last 5 years of life.

Severe heart failure is defined using a number of evidence-based criteria from the New York Heart Association (NYHA) and the Gold Standards Framework (GSF).

All people with heart failure recorded during a hospital admission (either as the reason for admission or as a co-morbidity), outpatient appointment, or A&E attendance, and that meet one or more of the following criteria:

• aged less than 75 years with 3 or more emergency hospital admissions for heart failure or a heart failure related condition in the last 6 months
• aged 75 years and over with 1 or more emergency hospital admission for heart failure or a heart failure related condition, or
• are receiving end of life care (in the community or in hospital)

All people with a diagnosis of pulmonary fibrosis, and in the last 5 years of life.

All people with pulmonary fibrosis recorded during:

• a hospital admission (recorded either as the reason for admission or as
  a co-morbidity), or
• an outpatient appointment