This 'how to' guide builds upon the overarching framework set out in The route to success in end of life care - achieving quality in acute hospitals, published in 2010. The route to success highlighted best practice models developed by acute hospital Trusts, providing a comprehensive framework to enable hospitals to deliver high quality care to people at the end of life.
This 'how to' guide aims to help clinicians, managers and directors implement The route to success more effectively, drawing on valuable learning from the NHS Institute for Innovation and Improvement's Productive Ward: Releasing time to care™ series.
This guide contains individual sections that can be worked on in any given order, dependent upon the individual hospital and its current end of life care provisions. These can be downloaded below:
Introduction
Section 1: prepare
Section 2: assess and diagnose
Section 3: plan
Section 4: treat
Section 5: evaluate
Section 6: sustain
Section 7: further resources
Cover
It places emphasis on existing 'enabling' tools and models, which support and follow a person-centred pathway. These are Advance Care Planning, Electronic Palliative Care Co-ordination Systems (EPaCCS), AMBER Care Bundle, Rapid Discharge Home to Die Pathway, and the Liverpool Care Pathway.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
2. Section 7
The National End of Life Care
Intelligence Network
The End of Life Care Quality
Assessment tool (ELCQuA)
The network aims to improve the collection
and analysis of information about end of life
care services. This intelligence will help drive
improvements in the quality and productivity of
services.
This is an online tool that has been updated
recently and enables you to monitor how you
are doing and compare your services with
similar organisations locally and nationally.
Progress can be assessed against a set of core
specifications based on the Department of
Health’s quality markers and measures for end
of life care.
The network’s website includes:
End of life care profiles – data and
statistics on end of life within each local
authority area broken down by age,
gender, place of death and cause of death
Resources – data, reports, analysis
and links to other useful sources of
information
Data sources – a guide to key health,
social care and related data sources in the
field
Advice and information – signposting to
advice and information for individuals,
their relatives and carers.
www.endoflifecare-intelligence.org.uk
The ELCQuA website is intended for use by
health and social care organisations providing
and commissioning end of life care. The tool
will enable you to:
Plan and monitor your priorities for end
of life care
Assess your services in a local and national
context
Share good practice with other
organisations
Enable the best investment decisions for
people at the end of life
Gather the information you need to
complete Care Quality Commission and
other assessments.
www.elcqua.nhs.uk
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3. The route to success ‘how to’ guide
e-ELCA
The e-ELCA was commissioned by the
Department of Health and aims to enhance
the training and education of health and social
care staff involved in delivering end of life care.
It contains over 150 interactive sessions, which
are free to access and focus on:
Advance care planning
Assessment
Communications skills
Symptom management, comfort and well
being
Social care
Bereavement
Spirituality
There is also an integrated learning module
which covers specific settings and conditions.
Blended learning pathways using e-ELCA have
been developed and are being uploaded onto
the NEoLCP website. They are;
Induction of Band 5 Nurses working in
Specialist Palliative Care Services
GP Trainees on placement within
Specialist Palliative Care Services
Ambulance Services
Registered professionals working within
acute hospitals
Clerical staff working in Palliative Care and
End of Life Care Services
Out of Hours (OOHs) Urgent Care
Practitioners
Volunteers within Palliative Care Services
Feedback on using these to the e-ELCA
team would be particularly useful
www.e-lfh.org.uk/projects/e-elca
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4. Section 7
Podcasts for end of life care
facilitators
The National End of Life Care Programme has
developed a range of podcasts for facilitators
to provide information on:
Managing conflict – how to prevent a
conflict situation from spiralling out of
control in order to improve chances of
securing a positive outcome
Creating impact – the steps you need to
feel at ease when meeting others, so you
can make the most of the opportunities
that arise and create the kind of impact
you want
Different perspectives – provides the tools
to see a situation from someone else’s
perspective, ensuring you can create
greater influence and avoid conflict
Listening to improve – one of the most
important skills you have in your influence
tool kit is listening, a key component of
building rapport with people
Storytelling – the power of storytelling as
a leadership tool and how to use stories
to create indirect influence.
www.endoflifecare.nhs.uk/supportadvice/facilitators-and-champions/
podcasts.aspx
4
DNACPR
This web resource aims to explore issues
around DNACPR but is not intended to be
guidance or provide definitive answers. The
range of speakers in the podcasts reflect
different perspectives and it is hoped that the
resource will encourage discussion and analysis
of the complexities and different perspectives
that surround existing guidance and legislation.
www.endoflifecare.nhs.uk/dnacpr
Transforming End of Life Care in
Acute Hospitals Podcast
The Podcast describes the journey front line
clinicians from some of the Acute Hospitals
have undergone during the first year of
participating in the Transform Programme
and the difference they feel this has made to
individual patient care at the end of life.
www.endoflifecare.nhs.uk/searchresources/multimedia/transformprogramme.aspx
5. The route to success ‘how to’ guide
NHS Change Model
The model has been created to support the
NHS to adopt a shared approach to leading
change and transformation. The model brings
together collective improvement knowledge
and experience from across the NHS into eight
key components and by applying all eight
components change can happen.
www.changemodel.nhs.uk
Commissioning person centred
end of life care – A toolkit for health
and social care
To help achieve a ‘good death’ for all, the
NEoLCP and its partners have produced a
short interactive guide to commissioning
person centred end of life care. It provides a
wide range of links to tools and sources of
support for both commissioners and providers
of services and seeks to indicate what a well
commissioned end of life care service looks like.
www.endoflifecare.nhs.uk/searchresources/resources-search/publications/
commissioning-toolkit.aspx
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6. Section 7
Advance Care Planning:
It all ADSE up
‘ADSE’ stands for Ask, Document, Share and Evaluate and this toolkit provides practical
information on resources available to support the Advance Care Planning (ACP) process.
Within the toolkit there are challenges and top tips as well as links to other useful sources of
information and guidance, aiming to enable care providers to approach the planning process
with confidence and knowledge.
www.endoflifecare.nhs.uk/search-resources/resources-search/publications/acp-guide.
aspx
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7. The route to success ‘how to’ guide
The route to success
series
The series consists of National
End of Life Care Programme
publications that aim to provide
practical support and guidance
for health and social care
professionals responsible for
delivering end of life care. The
publications cover:
Care homes (June 2010)
Acute hospitals (June 2010)
Hostels and homeless
people (Dec 2010)
People with learning
disabilities (Feb 2011)
Domiciliary care (Feb 2011)
Occupational therapy (June
2011)
Nursing (July 2011)
Environments of care (Aug
2011)
Prisons (Sept 2011)
Ambulance services (Feb
2012).
Lesbian, gay, bisexual and
transgender people (June
2012)
Social work (July 2012).
www.endoflifecare.nhs.uk/tools/core-tools/rtsresourcepage
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8. Section 7
The route to success support sheets
These are also available to help support the implementation of The route to success series.
The 18 short summaries cover:
1. Directory of key contacts
11. Quality markers for acute hospitals
2. Principles of good communication
12. Mental Capacity Act
3. Advance care planning
13. Decisions made in a person’s best
interests
4. Advance decisions to refuse treatment
5. Quality markers for care homes
6. Dignity in end of life care
7. Models/tools of delivery
8. The dying process
9. What to do when someone dies
10. Flow chart for supportive care:
Care home/sheltered housing
14. Using the NHS Continuing Health Care
fast track pathway tool
15. Enhancing the healing environment
16. Holistic assessment
17. Independent Mental Capacity Advocates
18. Preferred priorities for care
www.endoflifecare.nhs.uk/tools/core-tools/rtsresourcepage
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9. The route to success ‘how to’ guide
Disease specific end of life care resource guides and implementation frameworks are
available covering a range of conditions:
Advanced kidney disease:
www.endoflifecare.nhs.uk/
search-resources/resources-search/
publications/imported-publications/
end-of-life-care-in-advanced-kidneydisease.aspx
Dementia:
www.endoflifecare.nhs.uk/
search-resources/resources-search/
publications/imported-publications/
care-towards-the-end-of-life-forpeople-with-dementia.aspx
Heart failure:
www.endoflifecare.nhs.uk/
search-resources/resources-search/
publications/imported-publications/
end-of-life-care-in-heart-failure.aspx
Neurological disease:
www.endoflifecare.nhs.uk/
search-resources/resources-search/
publications/imported-publications/
improving-end-of-life-care-inneurological-disease.aspx
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10. Section 7
A framework for
social care at the
end of life
was developed by the
National End of Life Care
Programme with the
involvement of a group of
senior professionals and
other stakeholders in social
care. ‘Supporting people to
live and die well’ sets out a
direction of travel for social
care at end of life.
www.endoflifecare.nhs.uk/search-resources/resources-search/publications/importedpublications/supporting-people-to-live-and-die-well.aspx
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11. The route to success ‘how to’ guide
The National Audit
Office end of life
care report (2008)
found that some people
receive high quality end of
life care, but that there is
room for improved coordination between health
and social care services in
planning and delivery.
www.nao.org.uk/publications/0708/end_of_life_care.aspx
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