Making a difference in end of life care: what has the Building on the Best programme achieved in the last two years?

Jul 30, 2018

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Over 100 people gathered in London in late June to jointly mark the end of the successful Building on the Best programme, and to celebrate the work of the NHS Improvement Collaborative. The event itself is the first step in building connections with other acute Trusts across the country working in partnership with NHS Improvement. The event was jointly attended by Building on the Best participants and a wide network of end of life care colleagues from the NHS Improvement collaborative.

The two year programme was developed and led by Macmillan Cancer Support and The National Council for Palliative Care (NCPC), and then Hospice UK following the merger between NCPC and Hospice UK in summer 2017. In Scotland it has been delivered by the Scottish Partnership for Palliative Care. The programme was funded by Macmillan Cancer Support, and throughout has worked closely with NHS Improvement and NHS England.

Ten NHS hospital Trusts in England were recruited to the programme in Feb 2016 to take part in the two-year programme, with three sites in Scotland joining from May 2016 onwards. These 10 teams were selected from over 40 applicants already undertaking successful end of life work, and represent a variety of geographies across the country.

The sites focused on one or more of four themes for potential improvement:

  • shared decision making between people approaching end of life, those close to them and their health care professional / team
  • pain and symptom management
  • opportunities at outpatient appointments to address end of life care and planning
  • improving the sharing of end of life care information in the handover between acute and primary care.

Each site developed a plan responding to one or more of these themes taking account of their existing local systems and priorities. The teams from the participating sites also met regularly in person and online as a community of practice, sharing ideas, successes, and supporting each other through the challenges they faced.

Teams have reported a number of successes, including:

  • new anticipatory care prescribing guidelines which has led to more person-centred prescribing
  • improved treatment escalation plans which have supported better shared decision making for individuals and clinicians 
  • improved Advance Care Planning materials in public areas to encourage people to start discussing their end of life care wishes
  • more volunteers trained to be with and support people nearing death and their families.

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Participating teams also found the community of practice highly beneficial: thanks to the programme, seven of the sites reported a total of 15 changes made thanks to ideas shared among the community of practice. These include:

  • introducing and training over 200 staff in the use of a new after-death care pathway, reducing paperwork errors and subsequent upset to grieving families
  • successfully relaunching treatment escalation plans, leading to a 530% increase in use
  • in one hospital, a 30% increase in the number of patients known to the specialist palliative care team, and a 36% increase in patients known to be Gold Standards Framework registered
  • another hospital saw a 27% increase in referrals to palliative care as a result of its Building on the Best programme
  • a streamlined provision of bereavement services, aiming for the completion of all paperwork and transfer to funeral directors within five days
  • successfully developing a hospital-wide culture of “EoLC is everyone’s business” – in line with the Ambitions for End of Life Care
  • training and supporting ward staff to introduce the concept of future care planning or treatment escalation plans, and then including ACP information with discharge notes.

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The event included presentations from Professor Bee Wee, National Clinical Director for End of Life Care for NHS England; Ellen Armistead from the Care Quality Commission; James Sanderson, Director of Personalised Care at NHS England; doctor and author Dr Kathryn Mannix; and Lucie Rudd End of Life Care Advisor, Macmillan Cancer Support.

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The participating trusts also offered their “elevator pitches” – two minute summaries of their research and learnings. Some were very inventive and included role plays and “Are You Being Served?” parodies, some definitely went over two minutes, but all highlighted the excellent work done by sites and how they will continue.

Although the Building on the Best programme has formally ended in England, all the participants have committed to keep the community of practice going as a means of continuing mutual support and to share ideas and learning. Anyone interested in joining the community of practice in the future should contact Claire Henry at Hospice UK. The first phase of the programme will come to an end in Scotland in September 2018, and consideration is currently being given to next steps.

Claire Henry, Director of Transformation and Improvement for Hospice UK, said:

“It’s wonderful to celebrate all that Building on the Best has achieved in the last two years. It’s been a lot of hard work from hospital staff and colleagues, but the outcomes are already making a difference to people and their families. The next step is to share this widely across the country through a mixture of methods, so that many more can benefit from what the sites and staff have jointly developed here.”

Lucie Rudd, End of Life Care Advisor at Macmillan Cancer Support, said:

“Macmillan is proud to have funded and supported the Building on the Best programme and it was wonderful to be part of the celebration event. The passion and commitment across all the site teams was evident, and each team demonstrated through their posters and presentations the real outcomes they have achieved which have helped to improve the experience and quality of end of life care in their hospitals.”

Mark Hazelwood, CEO of the Scottish Partnership for Palliative Care, said:

“Effecting change in acute hospitals is not easy. It is encouraging to see the progress which teams in England and Scotland are making to improve people’s experiences in hospital towards the end of life.”

For more information, visit the Building on the Best pages on the Hospice UK website.

The participating trusts are:

  • Basildon & Thurrock University Hospital NHSFT
  • Great Ormond Street Hospital NHSFT
  • Guys & St Thomas’ Hospital NHSFT
  • University Hospitals Birmingham NHSFT
  • East and North Hertfordshire NHS Trust
  • Doncaster and Bassetlaw NHS Trust
  • Leeds Teaching Hospitals NHS Trust
  • Southport & Ormskirk NHS Trust
  • Poole Hospital NHSFT
  • Worcester Acute Hospitals NHS Trust
  • The Royal Infirmary of Edinburgh
  • Royal Alexandra Hospital, Paisley
  • Ninewells Hospital, Dundee

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