Compassionate Care at End of Life in Hospitals:

Hospice Friendly Hospitals Conference: April 2016

Palliative and end of life care in the UK

Professor Bee Wee

National Clinical Director for End of Life Care, NHS England

Consultant in Palliative Medicine, Oxford, UK

www.england.nhs.uk

Context: NHS and social

care

Palliative and End of Life

Care

Focus on hospitals

Reflections and

lessons

www.england.nhs.uk

DH Parliament

10 Strategic

Health Authorities

152 Primary Care

Trusts

CQC 3

NHS Trusts

NHS Foundation trusts

Monitor

NHS TDA

National

improvement

bodies, e.g.

NEoLCP

www.england.nhs.uk

NHS England

NHS Improve

ment

CQC HEE

PHE

Dept

of

Health Local

Authorities

Parliament

Mandates Clinical

Commissioning

Groups

www.england.nhs.uk

• Health and wellbeing gap

• Care and quality gap

• Finance and efficiency gap

www.england.nhs.uk

Source: http://olh.ie/about-us/our-heritage/

www.england.nhs.uk

National End of Life Care Strategy 2008:

‘End of Life Care Pathway’

Step 2

Assessment,

care planning

and review

Step 3

Coordination

of care

Step 4

Delivery of

high quality

services in

different

settings

Step 5

Care in the

last days

of life

Step 6

Care after

death

Discussions

as the end

of life

approaches

Step 1

Social care

Spiritual care services

Support for carers and families

Information for patients and carers

www.england.nhs.uk

The year of 2013

• Francis Report – Mid Staffs (Feb)

• Health and Social Care Act (April)

• Neuberger Report – Liverpool Care Pathway (July)

18/05/2016

www.england.nhs.uk

www.england.nhs.uk

www.england.nhs.uk 18/05/2016

www.england.nhs.uk 18/05/2016

www.england.nhs.uk 18/05/2016

www.england.nhs.uk 18/05/2016

www.england.nhs.uk 18/05/2016

www.england.nhs.uk 18/05/2016

www.england.nhs.uk 18/05/2016

www.england.nhs.uk

‘Transform Programme’

• Core enablers

• Advance care planning

• Electronic palliative care coordinating systems

• Rapid discharge to home

• AMBER care bundle

• Care in last days of life

• Quality improvement methodology

• Central teams to support implementation

www.england.nhs.uk

Programme Oversight

Board

Transforming EoLC in hospitals

www.england.nhs.uk

Patient and Family Centred Care

Select a care experience

Establish a guiding council

Evaluate current situation – through eyes of patients and families

Develop PFCC care experience working group

Creating shared vision through written ‘ideal experience’

Identify PFCC improvement projects and form project improvement teams

http://www.kingsfund.org.uk/projects/pfcc

https://www.pointofcarefoundation.org.uk/our-work/patient-family-centred-care/

www.england.nhs.uk

Prods

Proactive support

Speed up improvem

ents

People focused

Adapted from: Allcock et al

Constructive comfort: accelerating change in the NHS

Health Foundation, Feb 2015

CQC Inspection

National audit

Incentives

Improvement strategy

& support

Sharing ‘best’ practice

Buddies and peer systems Education & training

CPD

Contracts & welfare

www.england.nhs.uk

Reflections and lessons

• Terminology – semantics and unintended consequences

• Specialist palliative care teams and generalist teams – roles different but interdependent

• Risks of over simplistic reliance on tick boxes: provides a ‘cloak’ for whom?

• Need to understand what is artefact and what is beneath the surface of any experience or intervention

• Measuring what really matters not just what’s measurable