Pioneering programme shows how NHS hospitals can improve end of life care

Aug 01, 2018

An independent report evaluating a pioneering programme has identified ways to improve the quality of end of life care in NHS trusts. The English component   of Building on the best recently ended after two years, and the evaluation report from consultants Whole Systems Partnership shows what has been learned since 2016. The programme will continue in Scotland until September. 

Building on the best is an initiative of Macmillan Cancer Support, NHS England and NHS Improvement and the former National Council for Palliative Care. Hospice UK took over the delivery of the programme when it merged with NCPC in July 2017. In Scotland the Scottish Partnership for Palliative Care delivered the programme with Macmillan. The programme was funded by Macmillan Cancer Support, and throughout has worked closely with NHS Improvement and NHS England.

The goal of Building on the best was to develop new areas of focus for improving end of life care. By concentrating on four themes, and how those can be developed with different groups, the programme produced a range of learning that can be applied across the NHS. The independent evaluation report from Whole Systems Partnership takes a thorough look at the successes and challenges of the programme, and identifies the areas that other NHS Trusts and hospitals can learn from. 

The evaluation found that the programmes interventions undertaken by local sites had been effective in delivering improvements for patients and carers, alone or as part of other trust or hospital improvement programmes. There was also some evidence of having a positive impact on culture and practice change within the wider acute care system, outside of specialist EOLC teams. 
The evaluation found good evidence that the programme created an environment that encourages professional openness and sharing. There is also good evidence that it built on the learnings of previous programmes such as NHS England  Transform programme, and supported sites to spread their improvement work beyond the boundaries of palliative and end of life care.
The summary report contains recommendations for both commissions and participants on how to make the most of Building on the best. 

The Building on the best 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 have 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

A recent event marked the end of the programme in England – a write-up with more information about the successes of the programme can be found here.

Claire Henry, Director of Transformation and Improvement for Hospice UK, said “This report sets out in detail all that the Building on the best teams have developed, discovered and shared over 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 and to download a summary of the evaluation report, see



What does hospice care mean to you?