Top Tips
Ten steps to achieving improvements in end of life care:
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Be familiar with national and local drivers for the Programme - Building on the Best (2003); NICE Supportive and palliative care IOG (2004); ‘Our health, our care, our say’ (2006); 'End of Life Care Strategy' (2007). Local Primary Care Trust Palliative Care Strategy, End of Life Care: Health and Social Care Review (2007); NHS Next Stage Review (2007); ‘Our NHS, our future’ (DH 2007).
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Identify local end of life care provision - a scoping exercise can provide information on areas of good practice, gaps in provision or potential barriers. Understanding the local context sets a baseline from which to start measuring changes.
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Draw up an action plan - based upon the initial scoping exercise an action plan can be drawn up linked to PCT priorities and setting realistic milestones with timescales and appropriate measurement methods.
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Identify and nurture local champions who can offer effective leadership - local champions can offer support with early milestones and form part of a local steering group, which will help drive the work, and help continue to sustain changes after implementation. Linking with patients and carers is important to support the creation of the vision for the improvement.
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Introduce/adapt/develop the End of Life Care Tools/approaches - use the available tools but allow flexibility to suit the requirements of the setting in which they are being applied. Ensure new documentation is recorded on clinical governance registers.
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Communicate - identify who needs to receive communication and people’s preferences for how they wish to communicate and be communicated with. Consider any barriers to communication. Agree and establish methods which are acceptable, appropriate and manageable for all parties.
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Improve skills and knowledge at all levels - empower staff to implement End of Life Care models/tools with confidence by initiating whatever training and education programme is identified as being appropriate to local needs.
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Measure, evaluate and report any changes made - this will give feedback to those involved, check if things are going well, identify if things need to be amended and provide information for management and commissioners.
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Support and manage change - be available to respond to queries or issues. Allow adaptation and local ownership. Encourage multidisciplinary team working and communication.
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Plan for sustainability - nurture individuals who may continue to lead. Train trainers/supporters. Ensure resources/tools remain readily available. Create ongoing monitoring systems and create a culture of continuous improvement.
Utilise the existing facilitators guide and the 10 High Impact changes and other MA work.
