This case study from NHS England looks at how the Royal Wolverhampton NHS Trust and Compton Care made sure that patients with chronic obstructive pulmonary disease (COPD) who were approaching the end of their life were accessing the services available to them and had the right support to best manage both their condition and emotional wellbeing.
This project introduced by the Palliative Care Team at the Royal United Hospitals Bath NHS Foundation Trust aims to support the education, development and support for staff to increase the quality of end of life care for patients, families and staff across the Trust | NHS England | The Atlas of Shared Learning
Nursing leadership in the Palliative Care Team at the Royal United Hospitals Bath NHS Foundation Trust identified that staff had more confidence in supporting patients with palliative and end of life care in the last few days of life compared to the weeks and months prior to a patient dying. This unwarranted variation led to the Palliative Clinical Nurse Specialists initiating a response with ‘The Conversation Project’.
The Conversation Project was developed to support and provide the focus for change that had been identified as needed.
The things that needed to change included:
An earlier recognition that the patient is approaching the end of their life or is facing an uncertain future;
To facilitate and raise awareness for the need for earlier conversations with patients and families about their current situations;
To improve the documentation of those important conversations;
To include these discussions in the ward multidisciplinary team (MDT) meetings to support a shared involvement and understanding of the needs of the patient and family;
To improve the transfer of information pertaining to a patient’s end of life on discharge or transfer of care;
To bring about a cultural shift in how their hospital recognised and engaged in the care of the dying;
To ‘normalise’ end of life conversations and to help staff recognise that anyone of us could be with patients when they wish to discuss their fears and wishes as their condition deteriorates.
Access to hospice and other forms of expert palliative and end of life care is currently inequitable. Hospice UK is working to tackle this inequality and widen access to hospice and palliative care | via Hospice UK
Hospice UK along with Marie Curie, Together for Short Lives and others, have produced a resource outlining work in progress to improve personalised end of life care for Gypsies and Travellers, LGBT people and people experiencing homelessness.
Offering top tips and describing simple effective approaches for success, this practical guide is intended for commissioners, service providers and those involved in caring for and supporting children, young people and adults living with advanced illness towards the end of their lives.
End of life care in England: a briefing paper | IPPR
This paper provides a brief summary of issues around end of life care including the impact of location on the quality and cost of care; analyses data on the current location and cost of end of life care in England; and appraises the current policy agenda in this area, suggesting key areas where improvements should be made.
NHS Improvement have published information about the End of life care collaborative. They ran a 150-day programme, involving 16 volunteer trusts, to improve end of life care across a number of settings to improve the experience and quality of care received by patients at end of life. They have published the following case studies:
This guidance document provide resources and tips for commissioners, service providers and health and social care staff providing, or delivering care to people with a learning disability at the end of their lives. | NHS England
The resource provides a number of ‘ambitions’ regarding end of life care for people who have a learning disability, and contains ‘top tips’, resources and good practice examples to support the achievement of each ambition.
A systematic review was undertaken to examine the quantity and quality of data-based research aimed at improving the (a) processes and (b) outcomes associated with delivering end-of-life care in hospital settings | BMC Palliative Care
A total of 416 papers met eligibility criteria. The number increased by 13% each year (p < 0.001). Most studies were descriptive (n = 351, 85%), with fewer measurement (n = 17) and intervention studies (n = 48; 10%). Only 18 intervention studies (4%) met EPOC design criteria. Most reported benefits for end-of-life processes including end-of-life discussions and documentation (9/11). Impact on end-of-life outcomes was mixed, with some benefit for psychosocial distress, satisfaction and concordance in care (3/7).
More methodologically robust studies are needed to evaluate the impact of interventions on end-of-life processes, including whether changes in processes translate to improved end-of-life outcomes. Interventions which target both the patient and substitute decision maker in an effort to achieve these changes would be beneficial.
Struggling to keep up to date and informed on changes impacting on palliative and end of life care? Not sure where to find the latest resources and improvement examples?
Then you will be pleased to hear we have launched a tailor made national End of Life Care (EoLC) Knowledge Hub providing you with a ‘one stop shop’ of palliative and EoLC information.
This hub provides anyone involved in the commissioning or provision of palliative and end of life care with a quick and easy way to source information, including helpful tools and resources to drive delivery of the Ambitions for Palliative and End of Life Care – a national framework for local action.
This report is aimed at commissioners of end of life care services to support new ways of commissioning through using public health approaches to build compassionate communities. The key objectives of the research were to understand the awareness and knowledge of community end of life care across a number of key audiences; their perceptions of community end of life care; their experiences of end of life care and any community initiatives; and any improvements that could be made to community end of life care.