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Professional advice

Building on the best – Paul Hayes (article)

July 15, 2017


By Paul Hayes, Quality Improvement Manager (Associate)

National Council for Palliative Care/Dying Matters


In partnership with Macmillan Cancer Support, NHS Improvement, England and The Scottish Partnership for Palliative Care, The National Council for Palliative Care (NCPC) launched the Building on the best programme in March 2016. The programme is due to complete in March 2018. The aim of the programme is improve the quality of palliative and end of life care working with ten acute National Health Service trusts from across England and three trusts in Scotland.

The vision for the Building on the best programme is ‘to provide the support, knowledge and leadership so that everyone approaching end of life in hospital will receive quality of care that is safe and respects their personal wishes and needs’. We recognise that will not be achieved within the lifetime of the programme. However, the programme team’s ambition is that they leave a legacy where sites continue to work together in a ‘community of practice’, improvements in the quality of palliative and end of life care continues and the impact of the programme if felt way beyond those sites participating

  • Prior to launch, the programme team had conducted a desktop review involving a wide literature search, user experience surveys to understand patients and carers perspectives, policy research and stakeholder engagement. The purpose was to identify potential opportunities for improvementHospital outpatients: advance care planning (future planning), anticipatory planning and coordination;
  • Communication on handover/transfer to GP and services in the community;
  • Shared decision making with patients and those important to them about treatment
  • Improved pain and symptom management.

Initially the programme started in England with acute hospital Trusts invited to apply to join the programme. From these applications, ten were chosen based on their applications and previous good practice as highlighted in adoption of the Transform programme and ‘good’ or ‘outstanding’ end of life care in their latest Care Quality Commission reports.
The ten hospital Trusts in England are:

  • Leeds Teaching Hospitals NHS Trust
  • Guys and Thomas’ NHS Foundation Trust
  • Basildon and Thurrock University Hospitals NHS Foundation Trust
  • University Hospitals Birmingham NHS Foundation Trust
  • Doncaster and Bassetlaw Hospitals NHS Foundation Trust
  • East and North Hertfordshire NHS Trust
  • Great Ormond Street Hospital for Children NHS Foundation Trust
  • Poole Hospital NHS Foundation Trust
  • Southport and Ormskirk Hospital NHS Trust
  • Worcester Acute Hospitals NHS Trust

Developing a theory of change, the project team ensured there was flexibility within the programme for site teams to identify their local areas for improvement within the four topic areas.

Supported by the programme team, the first six months of the programme focussed on analysis. What were the acute sites priority areas for change? How does the programme fit with existing strategies and priorities for end of life care within the hospital trusts? Building on the best is a quality improvement programme. To support this overall programme aim, at the launch event, in March 2016 we introduced improvement methodologies to the sites as tools to assist this analysis. Throughout Building on the best, the central programme team has been available to the site teams to provide expertise and support the development of capability by providing access to a range of practical tools and resources.

During those first six the programme team also started to develop the ‘community of practice’. The community of practice is the ten sites working in collaboration to exchange ideas,good practice,learning and to resolve together any challenges encountered. Monthly webex meetings were established to being sites together on a virtual learning platform. We also launched the monthly communications bulletin. In October 2016 three ‘cluster events’ were held which brought three or four of the sites together at each of those meetings. At that stage sites shared emerging areas of priority with each other and the programme team.

By December 2016 the ten hospital trusts in England had completed their analysis. All the sites met for a face to face event to share their developing clear aims and ides for testing change. By this stage the programme had been joined by a project manager in Scotland who had began working with the Ninewells Hospital in Dundee.

In parallel with site analysis work the programme team had developed requirements for an evaluation of the programme. . Following procurement, external partners were appointed in October 2016 to identify and report on a framework for evaluation of the programme. That report was produced in in February 2017. . The evaluation of the programme will continue in parallel with the changes being made by the sites. Sites will be submitting data at regular intervals for the remainder of the programme. An evaluation report will be completed after the end of the programme.

In addition to an evaluation report, each of the sites will be producing case studies to highlight the work of the programme and the changes that have been made. The programme team are currently developing a template for the case studies. The aim of the case study will be to spread knowledge. What has been learnt by the trusts through being part of the programme? What has been achieved and lessons learnt along the way? The programme team will be using innovative ways to promote interest in the case studies, including encouraging the use of film. encouraging the use of film.