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Welcome to the NHS England

Webinar

‘Transforming EoLC

in hospitals’

On attending the Webinar, please mute yourself

to avoid background noise

If you have any questions during the webinar, please

email these to [email protected]

17 October 2016 – 14:00-15:00

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Webinar Agenda Time Topic Presenter

14:00-14:05

Welcome and introduction

Professor Bee Wee

14:05-14:15

NHS Improvement’s approach

Daljit Athwal & Sherree Fagge

14:15-14:25

Use of the core enablers

Richard Alleyne & Julie Raj

14:25-14:45

Building on the Best Programme

Paul Hayes, Dr Amy Pharaoh,

Dr Catherine O'Doherty & Dr Dee Traue

14:45-14:55

Patient and Family Centered Care

Programme

Bev Fitzsimons & Mary Kirk

14:55-15:00

Meeting close

Professor Bee Wee


0%

10%

20%

30%

40%

50%

60%

70%

80%

North South Midlands &East

London

Outstanding Good Requires improvement Inadequate

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

North South Midlands &East

London

Outstanding Good Requires improvement Inadequate

CQC – Overall score by region

NHS

Improvement’s

approach

Daljit Athwal

www.england.nhs.uk

Daljit Athwal

Deputy Chief Nurse (Nottingham University Hospitals)

Nursing Fellow (Trust Development Authority)


Patient Safety function from

NHS England (including National Learning &

Reporting System)

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Geographical Set up

7

• NHS Improvement will have a strong

regional presence to support the 238 NHS

and Foundation Trusts.

• We will have a physical presence in each

region and currently have offices in:

Newcastle

Leeds

Manchester

Derby

Birmingham

Cambridge

London

Taunton

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Nursing Directorate Priorities with patients being at the heart of everything we do…

8

Quality Priorities

Patient Experience

Infection Prevention &

Control

Workforce

Mental Health Services

Maternity Services

End of Life care

Pressure Ulcers

Clinical collaboration

Quality Improvement

Professional Development

Falls


Background to EoLC Work

• EoLC & Trust Development Authority - National Partnerships

(NHSE, NCPC, Macmillan Cancer)

• CQC reviews– inadequate or requires improvement by each hospital site

• National Conference – Transforming End of Life Care in Acute Hospitals –

18 November 2015

• Initial cohort identified – 23 NHS Trusts

– Individual review with regional lead

– 3 Trusts removed from cohort due to wider strategic issue

– Final list of 20 Trusts contacted to arrange site visits


CQC Ratings By Hospital Site August 2016

• Outstanding 18 (2 Community)

• Good 134 (26 Community)

• Requires Improvement 96 (10 Community)

• Inadequate 9 (1 Community)


November Workshop Themes

• Programme of focussed support using improvement science and associated

methodologies to enable cultural change.

• Individualised programme(s) to fit local approaches to quality improvement (particularly

if already involved with schemes such as Virginia Mason) and based on what gaps exist

in the trust.

• Support to influence commissioning decisions so improvements along the whole

pathway can be made.

• Delivery of a range of toolkits to enable frontline clinical teams to make decisions and

secure optimal practice.

• Be able to peer review with ‘good’ trusts.

• Share best practice.

• Ensure any work streams are driven and led by the trust board


Site Visits – 20 NHS Trusts

• Letter sent from Director of Nursing TDA to Trust Director of Nursing

• Purpose of site visits

– Progress since CQC visit

– Improvement approach (Transform)

– Led by Trust

– Facilitative/Coaching

• Executive Lead for End of Life Care and EOLC team

• Pre-visit discussions – regional lead/Trust executive lead

• 1&1/2 to 2 hour visits – regional head of quality

• Observations of steering groups – 2 Trusts

• Opportunity to prep for CQC revisit


Transform Programme

Transforming end of life

care in acute hospitals –

The route to success

‘how to’ guide…..


Improvement support next steps

• End of Life Care - NHSI Nursing priority

• Two Regional Events for all Trusts with inadequate or requires improvement to

– Provide an overview of the most current direction in national policy for end of life care

– Give an insight into the plans for regulation of end of life care

– Share best practice re End of Life Care within the region to facilitate learning and networking

– Provide an opportunity for Trusts to review their approaches/improvement plans and prioritise/plan next steps

• Planning next stages of the improvement offer


Shape of Improvement Offer

• Continue to work in partnership with key national stakeholders

• Support the NHSI regional team visits to Trusts where end of life care is a concern

• Support with improvement plans in relation to end of life care

• Provide links to best practice

• Support/facilitate buddying arrangements and peer visits between Trusts in relation to

end of life care themes

• Facilitate further regional improvement collaborative events

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Use of the core

enablers

Transforming End of Life Care in Acute Hospitals

Richard Alleyne

Julie Raj

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Richard Alleyne Julie Raj

Julie Raj is the Chair of the Cheshire and

Merseyside Palliative and End of Life care Network

Hospital Transform subgroup. She works as a

Consultant in Palliative Medicine at Aintree

University Hospital, working across hospital and

community settings to develop integrated cross-

boundary services, and has a particular interest in

palliative care in the acute assessment areas and

the relationship between palliative care and

hospital mortality.

Dr Richard Alleyne is a Consultant

in Palliative Medicine at Dudley

Group NHS Foundation Trust

working in both the acute hospital

and community settings.

He is the lead for Education across

the economy for Palliative and End

of Life Care.


Transform Enablers • 138 Trusts participated in the audit

• Of which 42 had a CQC inspection

0

15

30

45

60

75

90

105

120

135

Advance care planning EPaCCS AMBER care bundle Rapid Discharge to Home Priorities of care for thedying person

No CQC score

Outstanding

Good

Requires Improvement

Inadequate

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Before 2012

20

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Sign up in 2012

21

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More Direction

22

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ACP (for example)

24

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Transforming End of Life Care

28

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Transform was the springboard

29

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30

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Modified Voices (Sept 14 - 15)

31

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Change in Culture of the

Organization

32

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33

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In a nutshell

34

“All of the organisation is now aware of the importance

of palliative and end of life care. Palliative Care is

empowered to make change with backing from board

level”

Dr Jo Bowen - Clinical Lead Palliative Medicine

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35

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If only…

36

“… well Palliative Care affects the whole trust…

so really, we should all be part of the division of

Palliative Care!!!”

Email exchange between Senior Clinician at the trust and

Palliative Medicine clinical lead re: which division Palliative

Care sits…

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Building on the

Best Programme

Paul Hayes

Dr Amy Pharaoh

Dr Catherine O'Doherty

Dr Dee Traue

www.england.nhs.uk

Improvement Programmes Building on the Best

• Total hospitals participated: 10

• Of which have had CQC inspection: 2

Point of Care foundation



NCPC Emergency Care EOLC



NHSI End of Life Care improvement



NHSIQ Transform



Multiple programmes per Trust

• 1 Trust is on Point of Care foundation and NHSI End of Life Care improvement

0

10

20

30

40

50

60

70

80

90

Hospitals with CQC inspection Hospitals without CQC inspection

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Paul Hayes

I am proud to say that I am an associate working for the National Council

for Palliative Care. Immediately prior to this, I worked for the National

Health Service as the end of life care lead for Northamptonshire.

Within this role I was responsible for writing a local strategy and delivering

service improvement for end of life care across a number of work

streams.

I am passionate about improving the quality of end of life care and helping

to promote choice for patients.

Prior to working with end of life care services I worked within the NHS for

both commissioning and provider trusts. All of my roles have involved

service or quality improvement including for patients with long term

conditions, planned and urgent care services.


Paul Hayes

National Council for Palliative Care

[email protected]

mailto:[email protected]

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Programme approach

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Amy Pharaoh

Consultant in palliative medicine

BMedSci, BMBS, MRCP

Areas of specialism

Non-malignant palliative care

About Dr Pharaoh

Dr Pharaoh graduated from Nottingham University in 1993 and worked at

Poole Hospital as a junior doctor before commencing her specialist

training in palliative medicine in Cambridge.

She carried out a period of research in Australia before moving back to

Dorset to complete her specialist training and commenced her post as a

consultant in palliative medicine in 2012.


• Compassion

• Choice

• Care

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Catherine O’Doherty

Dr Catherine O’Doherty is a consultant in palliative medicine based at

Basildon and Thurrock University Hospitals NHS FT, which has in-patient

palliative medicine beds, a hospital support team and out-patient clinics.

She also provides medical support to the South West Essex community

Macmillan palliative care team and provides cross-cover at St Luke’s

Hospice, Basildon. Dr O’Doherty helped to establish the cancer medicine

and palliative care ward at Basildon Hospital in 2007 and, as Trust Acute

Oncology lead, to develop an acute oncology service integrated into the

palliative care team. In 2015, she was appointed Lead Cancer Clinician for

Basildon Hospital.


Building on the Best

The BTUH story so far……


The beginning…

• Submitted application to Building on the Best December 2015

• Attended launch meeting in Keele, March 2016

MEDIA INFORMATION

24 February 2016

Basildon Hospital’s Macmillan team lead the way for

end of life care improvements

The Macmillan team at Basildon and Thurrock University

Hospitals NHS Foundation Trust is one of ten selected

to improve end of life care across the UK.


What we identified as key to our

project?

Incorporating the help of the BTUH Programme Director…for direction and

translation with the methodology and logic model jargon!


The Project Team • Executive Sponsor – Diane Sarkar – Director of Nursing

• Project Lead – Karen Andrews – Lead Nurse Macmillan/Palliative Care

• Clinical Lead – Dr O’Doherty – Consultant in Palliative Medicine

Project team – associated members

• Dawn Patience – Associate Director of Nursing & Quality

• Improvement Facilitator – Jenny Davis

• Emma Spicer-Bowen & Sarah Folan – Macmillan CNS’S

• BTUH – Elderly Care – Dr Luke Hounsom

• BTUH – Respiratory – Dr Mukherjee & Jo Peacock (CNS)

• BTUH – Cardiology – Dr Barbagallo & Donna Jessup (Nurse Manager)

• BTUH – Neurology – Lisa Mulryne (CNS)

• BTUH – Haematology – Dr Howard & Jill Ives (CNS)

• BTUH – Renal – Dr Cafferkey

• BTUH – Acute Medicine – Dr Simon

• BTUH – Director of Integrated Care – Michelle Stapleton

• Dawn Haigh – Bereavement Manager

• Macmillan GP – Dr Clearhill

BOTB Project Team

• Core Membership of 7

• Weekly action planning meetings

Extended membership

• Stakeholders – invited 25

• Monthly meetings


This is how it started!


We returned to the 4 Topic Areas?


Our focus for the project Overlaps with all 4 main topics areas


Prioritisation Matrix


How are we going to measure these

quality improvements? Outcome Measures

- Number of patients with an Individualised Care Plan (ICP)

- Number of patients with an Advance Care Plan (ACP)

Process Measures

- Bereavement survey

- Qualified/Unqualified staff with end of life competencies

- Nurse led training for DNACPR discussions

- Number of patients able to die at their preferred place of death

- Number of staff who have completed EOL Care ULearn core training module

Balancing Measures

Work in progress…

Measurement will be based on a run chart, overlaying where we have taken interventions in different specialities


Where are we now? - Bereavement Survey Pilot started 1st August

- Nurse led DNACPR policy and competencies written

- Nurse led DNACPR training for 6 nurses undertaken October 2016

- Starting to collect baseline data for measures

- Writing policy for nurse-led ACP clinic

- Clinic room secured for nurse-led ACP clinic to run alongside current

palliative medicine OP clinic


The Next Steps… - Further nurse led DNACPR training for another 6 nurses in November 2016

- Identify patient representation for the project groups

- Agreement of a prognostic indicator for respiratory patients to aid ACP

- Submission of a business case to roll out Macmillan Value Based Standards

across the Trust

- Start to identify patients suitable to attend nurse led ACP clinic:

initial focus on MND

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DEE TRAUE

I joined East & North Herts NHS Trust in 2015 as a Consultant in Palliative

Medicine, based at the Lister Hospital. Prior to this, I was Medical Director

at Isabel Hospice, Hertfordshire and Consultant at Addenbrooke’s

Hospital, Cambridge.

I am currently a member of the East of England Clinical Senate Council

and have previously been a member of the executive committee of the

Association for Palliative Medicine, medical representative on the Hospice

UK Care Support and Strategy Team and a member of the RCP Joint

Specialty Committee for Palliative Medicine. Between 2008 – 2012, I

worked for NHS Midlands & East (initially for East of England SHA), as the

Clinical Lead for End of Life Care for the east of England.


East & North Herts NHS Trust • Four hospitals

• Lister (acute) 720 bed DGH

• Mount Vernon (cancer centre and

NHS hospice)

• Hertford County & QE2 (OP and day

case only)

• EOLC may be delivered on any ward or

within any service of the trust

• ENH Trust 2014-15 1,735 deaths

(upper quartile for trusts in England)

• SHMI >110 but drops to 100 if corrected

for palliative care


Personalised Care Planning

with out-patients

Enhanced Supportive Care Clinics

Volunteer ACP Support

ENH CCG Pathway

We will look at new ways of engaging with

patients with life limiting illnesses to

support them in planning for their future

care

www.england.nhs.uk

• We will work with patients to identify what is important to them and support them to make informed decisions about treatment options

• Process

• Identify - SPICT

• Discuss - Serious illness conversations

• Document - Recommended Summary Plan for Emergency Care and Treatment

61

Shared Decision Making

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Patient and

Family Centered

Care Programme

Bev Fitzsimons

Mary Kirk

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Bev Fitzsimons Mary Kirk

Mary trained at St Thomas’ Hospital, London.

She then went on to undertake specialist

training in Intensive Care Nursing. She has

worked in the NHS, private healthcare and the

charitable sector. She has been a Nurse

Consultant for over 10 years specialising

initially in Cardiology and Heart Failure and

more recently focussing on End of Life care.

Mary is a Fellow of the England Centre for

Practice Development, and clinical lead for end

of life care for Kent Surrey and Sussex

Academic Health science Network.

Bev Fitzsimons is Head of Improvement at the

Point of Care Foundation, a small charity

whose mission is to humanise healthcare. Bev

is leading the Patient and Family Centred care

(PFCC) programme "living well to the very

end". The Foundation also offers training in

Experience Based Co-design. We also

support organisations to support their staff

through Schwartz Rounds. For more info, visit: www.pointofcarefoundation.org.uk

Bev will be recruiting new teams to join the

PFCC in the new year. Please get in touch via [email protected]

http://www.pointofcarefoundation.org.uk/

mailto:[email protected]

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If you have any questions, please email these to

[email protected]

We thank you for joining the NHS England Webinar

‘Transforming EoLC in hospitals’

#EoLC

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