Transforming end of life care in acute hospitals - introduction 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. Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013

1. Transforming End of Life Care in Acute Hospitals
Route to Success Implementation Guide
The route to success
Introduction

2. Introduction
Foreword
Some years ago I nursed and cared for my daughter who had breast
cancer. Wanting and needing to provide the best possible care for her
I worked hard to ensure that this would happen. However due to fear
and lack of knowledge, at the very end of her journey I had to call 999
which resulted in an emergency admission.
The ambulance took four hours to arrive and my daughter died in a
busy accident and emergency department on a Friday evening. This
had a profound and devastating effect on me, leaving me with a heavy
burden of guilt even to this day.
Far more recently I was able to stay beside my mother-in-law in the
hospital during her last days. The palliative care which she received
was wonderful. I was able to assist with some of her care and she
was treated with dignity and respect. I feel that I am able to look back
without any guilt about her death knowing that it was almost as good
as it could have been.
For the sake of the person dying and their carers, let us work towards
a system of which we can all be proud, thus relieving families of
unnecessary anxiety and guilt.
Roberta Lovick
User/carer representative – acute hospitals end of life care steering group
2

3. The route to success ‘how to’ guide
Foreword
Over 50% of people die in acute hospitals in England, many of whom do not
currently receive optimal end of life care. For this reason the importance of
improving end of life care in hospitals was highlighted in the 2008 national End of
Life Care Strategy.
The route to success in end of life care – achieving quality in acute hospitals
published in 2010 formed the first step in a national improvement programme. It
provided practical support for managers and clinicians responsible for delivering
end of life care. The next step is a major initiative to launch this ‘how to’ guide,
bringing together the National End of Life Care Programme and the NHS Institute for
Innovation and Improvement’s Productive Ward: Releasing time to caretm series.
The guide embraces the expertise of these two national programmes using service
improvement methodology, including five key enablers and key metrics to implement
best practice for end of life care in acute hospitals.
A first wave of hospital Trusts will lead the implementation in 2012 followed by a
cascade model to other hospitals across the country.
It is now time for acute hospitals to embrace a positive culture in end of life care,
and recognise that it is a core responsibility of every hospital and health care
professional to deliver excellence for people at the end of life and their families.
Professor Sir Mike Richards
National Clinical Director for Cancer and End of Life Care
3

4. Introduction
This guide contains
individual sections that
can be worked on in the
order of your choosing,
dependent upon your
individual hospital and its
current end of life care
provisions.
These include:
1: Prepare
3: Plan
5: Evaluate
4
6: Sustain
2: Assess and
diagnose
4: Treat
7: Further
resources

5. The route to success ‘how to’ guide
Introduction
The Department of Health’s End of Life Care
Strategy (2008)1 is a blueprint for improving
the care of all dying people over the next ten
years, regardless of diagnosis. It emphasises
that improved end of life care provision in
acute hospitals is crucial given that currently
more than half of all deaths take place there.
As well as ensuring that those who die in
hospital have a ‘good death’, the strategy
called for improved discharge arrangements
and better co-ordination with a range of
community and social care services so that
more people can die at home if that is their
preferred choice.
The route to success in end of life care –
achieving quality in acute hospitals (2010)2
highlights best practice models developed
by acute hospital Trusts and supported by
the National End of Life Care Programme. It
provides a comprehensive framework to enable
acute hospitals to deliver high quality person
centred care at the end of life.
www.dh.gov.uk/en/Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_086277
2
www.endoflifecareforadults.nhs.uk/publications/route-tosuccess-acute-hospitals
3
www.institute.nhs.uk/quality_and_value/productivity_
series/productive_ward.html
1
This guide builds on that overarching
framework. It draws on the valuable
learning from the NHS Institute for
Innovation and Improvement’s Productive
Ward: Releasing time to care™ series3.
The Productive Ward uses service
improvement principles to offer practical
and helpful tips on how to prepare your
organisation for implementing The route
to success in end of life care – achieving
quality in acute hospitals, as well as how
to maximise your ability to sustain success.
This guide encourages NHS managers
and clinicians and other frontline staff
to use existing models and tools already
identified as examples of good practice.
It aims to make the links between
the use of five key enablers, or their
equivalent, which support and follow a
person-centred pathway. These are:
Advance Care Planning (ACP)
Electronic Palliative Care Co-ordination
Systems (EPaCCS) formerly known as
end of life care locality registers
AMBER Care Bundle
Rapid Discharge Home to Die Pathway
(RDP)
Liverpool Care Pathway (LCP) for the
Dying Patient.
5

6. Introduction
Ensuring quality of care and putting people’s
needs at the heart of the healthcare system
requires a workforce that is equipped with the
right knowledge, skills, competences, attitudes
and behaviours.
Education, training and workforce
development are essential elements that
require embedding as core requirements in
corporate governance frameworks to enable
the achievement of the aims of the The route
to success.
1.
Meeting the Quality, Innovation, Productivity
and Prevention (QIPP) agenda4 is a challenge
for all. Utilising the principles of continuous
improvement within the Productive Ward will
help Trusts to reshape how their staff work with each other, with the people receiving care
and their families, and with community and
social care partners. The Productive Ward’s six
step approach may help you to achieve this:
2.
Prepare
3.
Assess
Diagnose
6.
Figure 1:
six step continuous improvement
diagram from The Productive Ward:
Releasing time to care™
(© NHS Institute for Innovation and
Improvement)
4
6
4.
Evaluate
Plan
5.
www.dh.gov.uk/en/Healthcare/Qualityandproductivity/QIPP/index.htm
Treat

7. The route to success ‘how to’ guide
Acknowledgements
This ‘how to’ guide has been written and
developed with input from numerous individuals
and organisations. These include clinicians,
support staff, lay people, users of services and
their carers.
Special thanks go to:
NHS Institute for Innovation and Improvement
National End of Life Care Intelligence Network
Social Care colleagues
Strategic Health Authority end of life care leads
Teams from the 26 Trusts participating in the
transform programme
The National End of Life Care Programme’s
acute hospitals steering group
All those who have contributed to the good
practice examples and podcasts available
throughout this guide.
These contributions have been invaluable in
making this guide a tool that can be used by a
wide range of staff involved directly or indirectly
in end of life care, ranging from frontline staff to
educators and service commissioners.
The acute hospitals initiative would not be
possible without the dedicated work of Professor
John Ellershaw, Anita Hayes, Chris Sutcliffe, Jackie
Main, Kate Henry and the National End of Life
Care Programme team.
7

8. www.endoflifecareforadults.nhs.uk
Published by the National End of Life Care Programme
ISBN:
978 1 908874 04 7
Programme Ref: PB0005 A 02 12
Publication date: Feb 2012
Review date:
Feb 2014
© National End of Life Care Programme (2012)
All rights reserved. For full Terms of Use please visit www.endoflifecareforadults.nhs.uk/terms-of-use
or email information@eolc.nhs.uk. In particular please note that you must not use this product or
material for the purposes of financial or commercial gain, including, without limitation, sale of the
products or materials to any person.
Supported by the NHS Institute for Innovation and Improvement