Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
www.england.nhs.uk
Welcome to the NHS England
Webinar
‘Transforming EoLC
in hospitals’
On attending the Webinar, please mute yourself
to avoid background noise
If you have any questions during the webinar, please
email these to [email protected]
17 October 2016 – 14:00-15:00
www.england.nhs.uk 2
Webinar Agenda Time Topic Presenter
14:00-14:05
Welcome and introduction
Professor Bee Wee
14:05-14:15
NHS Improvement’s approach
Daljit Athwal & Sherree Fagge
14:15-14:25
Use of the core enablers
Richard Alleyne & Julie Raj
14:25-14:45
Building on the Best Programme
Paul Hayes, Dr Amy Pharaoh,
Dr Catherine O'Doherty & Dr Dee Traue
14:45-14:55
Patient and Family Centered Care
Programme
Bev Fitzsimons & Mary Kirk
14:55-15:00
Meeting close
Professor Bee Wee
www.england.nhs.uk 3
0%
10%
20%
30%
40%
50%
60%
70%
80%
North South Midlands &East
London
Outstanding Good Requires improvement Inadequate
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
North South Midlands &East
London
Outstanding Good Requires improvement Inadequate
CQC – Overall score by region
NHS
Improvement’s
approach
Daljit Athwal
www.england.nhs.uk
Daljit Athwal
Deputy Chief Nurse (Nottingham University Hospitals)
Nursing Fellow (Trust Development Authority)
www.england.nhs.uk 6
Patient Safety function from
NHS England (including National Learning &
Reporting System)
www.england.nhs.uk
Geographical Set up
7
• NHS Improvement will have a strong
regional presence to support the 238 NHS
and Foundation Trusts.
• We will have a physical presence in each
region and currently have offices in:
Newcastle
Leeds
Manchester
Derby
Birmingham
Cambridge
London
Taunton
www.england.nhs.uk
Nursing Directorate Priorities with patients being at the heart of everything we do…
8
Quality Priorities
Patient Experience
Infection Prevention &
Control
Workforce
Mental Health Services
Maternity Services
End of Life care
Pressure Ulcers
Clinical collaboration
Quality Improvement
Professional Development
Falls
www.england.nhs.uk 9
Background to EoLC Work
• EoLC & Trust Development Authority - National Partnerships
(NHSE, NCPC, Macmillan Cancer)
• CQC reviews– inadequate or requires improvement by each hospital site
• National Conference – Transforming End of Life Care in Acute Hospitals –
18 November 2015
• Initial cohort identified – 23 NHS Trusts
– Individual review with regional lead
– 3 Trusts removed from cohort due to wider strategic issue
– Final list of 20 Trusts contacted to arrange site visits
www.england.nhs.uk 10
CQC Ratings By Hospital Site August 2016
• Outstanding 18 (2 Community)
• Good 134 (26 Community)
• Requires Improvement 96 (10 Community)
• Inadequate 9 (1 Community)
www.england.nhs.uk 11
November Workshop Themes
• Programme of focussed support using improvement science and associated
methodologies to enable cultural change.
• Individualised programme(s) to fit local approaches to quality improvement (particularly
if already involved with schemes such as Virginia Mason) and based on what gaps exist
in the trust.
• Support to influence commissioning decisions so improvements along the whole
pathway can be made.
• Delivery of a range of toolkits to enable frontline clinical teams to make decisions and
secure optimal practice.
• Be able to peer review with ‘good’ trusts.
• Share best practice.
• Ensure any work streams are driven and led by the trust board
www.england.nhs.uk 12
Site Visits – 20 NHS Trusts
• Letter sent from Director of Nursing TDA to Trust Director of Nursing
• Purpose of site visits
– Progress since CQC visit
– Improvement approach (Transform)
– Led by Trust
– Facilitative/Coaching
• Executive Lead for End of Life Care and EOLC team
• Pre-visit discussions – regional lead/Trust executive lead
• 1&1/2 to 2 hour visits – regional head of quality
• Observations of steering groups – 2 Trusts
• Opportunity to prep for CQC revisit
www.england.nhs.uk 13
Transform Programme
Transforming end of life
care in acute hospitals –
The route to success
‘how to’ guide…..
www.england.nhs.uk 14
Improvement support next steps
• End of Life Care - NHSI Nursing priority
• Two Regional Events for all Trusts with inadequate or requires improvement to
– Provide an overview of the most current direction in national policy for end of life care
– Give an insight into the plans for regulation of end of life care
– Share best practice re End of Life Care within the region to facilitate learning and networking
– Provide an opportunity for Trusts to review their approaches/improvement plans and prioritise/plan next steps
• Planning next stages of the improvement offer
www.england.nhs.uk 15
Shape of Improvement Offer
• Continue to work in partnership with key national stakeholders
• Support the NHSI regional team visits to Trusts where end of life care is a concern
• Support with improvement plans in relation to end of life care
• Provide links to best practice
• Support/facilitate buddying arrangements and peer visits between Trusts in relation to
end of life care themes
• Facilitate further regional improvement collaborative events
www.england.nhs.uk
Use of the core
enablers
Transforming End of Life Care in Acute Hospitals
Richard Alleyne
Julie Raj
www.england.nhs.uk
Richard Alleyne Julie Raj
Julie Raj is the Chair of the Cheshire and
Merseyside Palliative and End of Life care Network
Hospital Transform subgroup. She works as a
Consultant in Palliative Medicine at Aintree
University Hospital, working across hospital and
community settings to develop integrated cross-
boundary services, and has a particular interest in
palliative care in the acute assessment areas and
the relationship between palliative care and
hospital mortality.
Dr Richard Alleyne is a Consultant
in Palliative Medicine at Dudley
Group NHS Foundation Trust
working in both the acute hospital
and community settings.
He is the lead for Education across
the economy for Palliative and End
of Life Care.
www.england.nhs.uk 18
Transform Enablers • 138 Trusts participated in the audit
• Of which 42 had a CQC inspection
0
15
30
45
60
75
90
105
120
135
Advance care planning EPaCCS AMBER care bundle Rapid Discharge to Home Priorities of care for thedying person
No CQC score
Outstanding
Good
Requires Improvement
Inadequate
www.england.nhs.uk
www.england.nhs.uk
Before 2012
20
www.england.nhs.uk
Sign up in 2012
21
www.england.nhs.uk
More Direction
22
www.england.nhs.uk 23
www.england.nhs.uk
ACP (for example)
24
www.england.nhs.uk 25
www.england.nhs.uk 26
www.england.nhs.uk 27
www.england.nhs.uk
Transforming End of Life Care
28
www.england.nhs.uk
Transform was the springboard
29
www.england.nhs.uk
Transform was the springboard
30
www.england.nhs.uk
Modified Voices (Sept 14 - 15)
31
www.england.nhs.uk
Change in Culture of the
Organization
32
www.england.nhs.uk
Transform was the springboard
33
www.england.nhs.uk
In a nutshell
34
“All of the organisation is now aware of the importance
of palliative and end of life care. Palliative Care is
empowered to make change with backing from board
level”
Dr Jo Bowen - Clinical Lead Palliative Medicine
www.england.nhs.uk
Transform was the springboard
35
www.england.nhs.uk
If only…
36
“… well Palliative Care affects the whole trust…
so really, we should all be part of the division of
Palliative Care!!!”
Email exchange between Senior Clinician at the trust and
Palliative Medicine clinical lead re: which division Palliative
Care sits…
www.england.nhs.uk
Building on the
Best Programme
Paul Hayes
Dr Amy Pharaoh
Dr Catherine O'Doherty
Dr Dee Traue
www.england.nhs.uk
Improvement Programmes Building on the Best
• Total hospitals participated: 10
• Of which have had CQC inspection: 2
Point of Care foundation
• Total hospitals participated: 10
• Of which have had CQC inspection: 4
NCPC Emergency Care EOLC
• Total hospitals participated: 5
• Of which have had CQC inspection: 0
NHSI End of Life Care improvement
• Total hospitals participated: 22
• Of which have had CQC inspection: 5
NHSIQ Transform
• Total hospitals participated: 84
• Of which have had CQC inspection: 28
Multiple programmes per Trust
• 1 Trust is on Point of Care foundation and NHSI End of Life Care improvement
0
10
20
30
40
50
60
70
80
90
Hospitals with CQC inspection Hospitals without CQC inspection
www.england.nhs.uk
Paul Hayes
I am proud to say that I am an associate working for the National Council
for Palliative Care. Immediately prior to this, I worked for the National
Health Service as the end of life care lead for Northamptonshire.
Within this role I was responsible for writing a local strategy and delivering
service improvement for end of life care across a number of work
streams.
I am passionate about improving the quality of end of life care and helping
to promote choice for patients.
Prior to working with end of life care services I worked within the NHS for
both commissioning and provider trusts. All of my roles have involved
service or quality improvement including for patients with long term
conditions, planned and urgent care services.
www.england.nhs.uk 40
Paul Hayes
National Council for Palliative Care
www.england.nhs.uk
www.england.nhs.uk 42
Programme approach
www.england.nhs.uk
Amy Pharaoh
Consultant in palliative medicine
BMedSci, BMBS, MRCP
Areas of specialism
Non-malignant palliative care
About Dr Pharaoh
Dr Pharaoh graduated from Nottingham University in 1993 and worked at
Poole Hospital as a junior doctor before commencing her specialist
training in palliative medicine in Cambridge.
She carried out a period of research in Australia before moving back to
Dorset to complete her specialist training and commenced her post as a
consultant in palliative medicine in 2012.
www.england.nhs.uk 44
• Compassion
• Choice
• Care
www.england.nhs.uk 45
www.england.nhs.uk
Catherine O’Doherty
Dr Catherine O’Doherty is a consultant in palliative medicine based at
Basildon and Thurrock University Hospitals NHS FT, which has in-patient
palliative medicine beds, a hospital support team and out-patient clinics.
She also provides medical support to the South West Essex community
Macmillan palliative care team and provides cross-cover at St Luke’s
Hospice, Basildon. Dr O’Doherty helped to establish the cancer medicine
and palliative care ward at Basildon Hospital in 2007 and, as Trust Acute
Oncology lead, to develop an acute oncology service integrated into the
palliative care team. In 2015, she was appointed Lead Cancer Clinician for
Basildon Hospital.
www.england.nhs.uk 47
Building on the Best
The BTUH story so far……
www.england.nhs.uk 48
The beginning…
• Submitted application to Building on the Best December 2015
• Attended launch meeting in Keele, March 2016
MEDIA INFORMATION
24 February 2016
Basildon Hospital’s Macmillan team lead the way for
end of life care improvements
The Macmillan team at Basildon and Thurrock University
Hospitals NHS Foundation Trust is one of ten selected
to improve end of life care across the UK.
www.england.nhs.uk 49
What we identified as key to our
project?
Incorporating the help of the BTUH Programme Director…for direction and
translation with the methodology and logic model jargon!
www.england.nhs.uk 50
The Project Team • Executive Sponsor – Diane Sarkar – Director of Nursing
• Project Lead – Karen Andrews – Lead Nurse Macmillan/Palliative Care
• Clinical Lead – Dr O’Doherty – Consultant in Palliative Medicine
Project team – associated members
• Dawn Patience – Associate Director of Nursing & Quality
• Improvement Facilitator – Jenny Davis
• Emma Spicer-Bowen & Sarah Folan – Macmillan CNS’S
• BTUH – Elderly Care – Dr Luke Hounsom
• BTUH – Respiratory – Dr Mukherjee & Jo Peacock (CNS)
• BTUH – Cardiology – Dr Barbagallo & Donna Jessup (Nurse Manager)
• BTUH – Neurology – Lisa Mulryne (CNS)
• BTUH – Haematology – Dr Howard & Jill Ives (CNS)
• BTUH – Renal – Dr Cafferkey
• BTUH – Acute Medicine – Dr Simon
• BTUH – Director of Integrated Care – Michelle Stapleton
• Dawn Haigh – Bereavement Manager
• Macmillan GP – Dr Clearhill
BOTB Project Team
• Core Membership of 7
• Weekly action planning meetings
Extended membership
• Stakeholders – invited 25
• Monthly meetings
www.england.nhs.uk 51
This is how it started!
www.england.nhs.uk 52
We returned to the 4 Topic Areas?
www.england.nhs.uk 53
Our focus for the project Overlaps with all 4 main topics areas
www.england.nhs.uk 54
Prioritisation Matrix
www.england.nhs.uk 55
How are we going to measure these
quality improvements? Outcome Measures
- Number of patients with an Individualised Care Plan (ICP)
- Number of patients with an Advance Care Plan (ACP)
Process Measures
- Bereavement survey
- Qualified/Unqualified staff with end of life competencies
- Nurse led training for DNACPR discussions
- Number of patients able to die at their preferred place of death
- Number of staff who have completed EOL Care ULearn core training module
Balancing Measures
Work in progress…
Measurement will be based on a run chart, overlaying where we have taken interventions in different specialities
www.england.nhs.uk 56
Where are we now? - Bereavement Survey Pilot started 1st August
- Nurse led DNACPR policy and competencies written
- Nurse led DNACPR training for 6 nurses undertaken October 2016
- Starting to collect baseline data for measures
- Writing policy for nurse-led ACP clinic
- Clinic room secured for nurse-led ACP clinic to run alongside current
palliative medicine OP clinic
www.england.nhs.uk 57
The Next Steps… - Further nurse led DNACPR training for another 6 nurses in November 2016
- Identify patient representation for the project groups
- Agreement of a prognostic indicator for respiratory patients to aid ACP
- Submission of a business case to roll out Macmillan Value Based Standards
across the Trust
- Start to identify patients suitable to attend nurse led ACP clinic:
initial focus on MND
www.england.nhs.uk
DEE TRAUE
I joined East & North Herts NHS Trust in 2015 as a Consultant in Palliative
Medicine, based at the Lister Hospital. Prior to this, I was Medical Director
at Isabel Hospice, Hertfordshire and Consultant at Addenbrooke’s
Hospital, Cambridge.
I am currently a member of the East of England Clinical Senate Council
and have previously been a member of the executive committee of the
Association for Palliative Medicine, medical representative on the Hospice
UK Care Support and Strategy Team and a member of the RCP Joint
Specialty Committee for Palliative Medicine. Between 2008 – 2012, I
worked for NHS Midlands & East (initially for East of England SHA), as the
Clinical Lead for End of Life Care for the east of England.
www.england.nhs.uk 59
East & North Herts NHS Trust • Four hospitals
• Lister (acute) 720 bed DGH
• Mount Vernon (cancer centre and
NHS hospice)
• Hertford County & QE2 (OP and day
case only)
• EOLC may be delivered on any ward or
within any service of the trust
• ENH Trust 2014-15 1,735 deaths
(upper quartile for trusts in England)
• SHMI >110 but drops to 100 if corrected
for palliative care
www.england.nhs.uk 60
Personalised Care Planning
with out-patients
Enhanced Supportive Care Clinics
Volunteer ACP Support
ENH CCG Pathway
We will look at new ways of engaging with
patients with life limiting illnesses to
support them in planning for their future
care
www.england.nhs.uk
• We will work with patients to identify what is important to them and support them to make informed decisions about treatment options
• Process
• Identify - SPICT
• Discuss - Serious illness conversations
• Document - Recommended Summary Plan for Emergency Care and Treatment
61
Shared Decision Making
www.england.nhs.uk 62
www.england.nhs.uk
Patient and
Family Centered
Care Programme
Bev Fitzsimons
Mary Kirk
www.england.nhs.uk
Bev Fitzsimons Mary Kirk
Mary trained at St Thomas’ Hospital, London.
She then went on to undertake specialist
training in Intensive Care Nursing. She has
worked in the NHS, private healthcare and the
charitable sector. She has been a Nurse
Consultant for over 10 years specialising
initially in Cardiology and Heart Failure and
more recently focussing on End of Life care.
Mary is a Fellow of the England Centre for
Practice Development, and clinical lead for end
of life care for Kent Surrey and Sussex
Academic Health science Network.
Bev Fitzsimons is Head of Improvement at the
Point of Care Foundation, a small charity
whose mission is to humanise healthcare. Bev
is leading the Patient and Family Centred care
(PFCC) programme "living well to the very
end". The Foundation also offers training in
Experience Based Co-design. We also
support organisations to support their staff
through Schwartz Rounds. For more info, visit: www.pointofcarefoundation.org.uk
Bev will be recruiting new teams to join the
PFCC in the new year. Please get in touch via [email protected]
www.england.nhs.uk
If you have any questions, please email these to
We thank you for joining the NHS England Webinar
‘Transforming EoLC in hospitals’
#EoLC