Health and care organisations in Nottinghamshire have formed End of Life Care Together, a partnership working to deliver integrated palliative and end of life care.
About this innovation example
In 2018, health and care organisations in mid-Nottinghamshire launched Better Together, an alliance working towards providing joined up care.
The End of Life Care Together partnership grew out of Better Together and involves:
- Beaumond House Community Hospice
- Nottinghamshire Healthcare NHS Foundation Trust
- Nottinghamshire Hospice
- Primary Integrated Care Services
- Sherwood Forest Hospitals NHS Foundation Trust
- Cruse Bereavement.
The partnership also works closely with other services such as Primary Care and ambulance services.
End of Life Care Together works to deliver integrated palliative and end of life care at ‘place’ level within the Nottingham Integrated Care System (ICS). (An ICS is made of multiple ‘places’, of between 250,000 to 500,000 people).
Benefits for organisations
Everyone in the alliance has the same goal – they all want people to be identified early, supported to live well then die well. Being part of the alliance has improved members’ awareness of the local services that are available to patients.
For smaller organisations such as the independent hospices, the alliance gives them a bigger voice and extra sustainability. They are more able to input into service planning, shaping services to meet the needs of their community.
What the alliance has achieved
Since its development, End of Life Care Together has developed a joint vision and co-designed a model of integrated palliative and end of life care (PEoLC). The alliance negotiated for funding from health commissioners, and now holds a contract for service delivery, having its own autonomous board.
- A single point of contact for PEoLC
- Hospice at home services
- In-patient hospice beds
- Specialist PEoLC nurses carrying out in-reach and outreach in hospitals
- Day hospice services
- A flexible night service, which was launched in 2019
- Bereavement services
- Carer support.
The ReSPECT process has also been implemented to make sure PEoLC patients are able to record their wishes about how they would like to be treated in a medical emergency.
Hospital admissions for people with PEoLC needs have decreased, because patients are now able to access the services they need at the right time.
Facilitators, challenges and advice
Organisations in Nottinghamshire have been working together for a while, which meant that helpful connections and relationships were already developing when End of Life Care Together began.
The Integrated Care Board (ICB) is supportive of the alliance and attends the alliance’s board meetings.
The partners in the alliance share risk. Some of the bigger organisations have been able to underwrite financial risk for the smaller organisations.
The alliance has employed a Head of Service, Carl Ellis, to co-ordinate and develop its work.
The Ambitions for Palliative and End of Life Care provided a helpful framework to assess the delivery of palliative and end of life care in the integrated care system.
As the partnership includes several organisations, there were challenges around implementing one integrated delivery contract for the alliance as a whole. To solve this problem, every organisation continues to have its own contract with the ICB – but each contract is exactly the same. Funds are paid to the alliance, rather than to individual organisations. The alliance has developed a Service Operations Manual, which sets out how resources are allocated and shared (this does not need to be agreed by the ICB).
Following the QIPP (Quality, Innovation, Productivity and Prevention) efficiency and savings programme, the ring-fenced budget for the alliance was less than the previous combined contracts.
There have also been challenges in sharing and comparing data between organisations. Most (but not all) organisations use the same data system.
Tips and advice
The service was co-designed from the beginning with stakeholders. This is highly recommended. Include key GP leaders, relevant social care leads, clinicians and managers from your Acute Trusts as well as hospices and specialist palliative care services. It takes time to build mutual respect and trust.
Ensure that data collection systems are robust so that you can clearly demonstrate effectiveness from a baseline. You need to be able to show cost-effectiveness and better patient outcomes. Metrics including patient reported outcomes need to be agreed with commissioners from the outset.
In the future the alliance is planning to use fast-track resources in a new, more bespoke way within the service provision, incorporating personal health budgets.
It has also begun to investigate ways to deploy staff more innovatively and effectively across organisations, use data collections to further reduce inequities and share training resources.