“The Milestones EOLC Package has proven to be a fantastic educational resource for us here at Barts Health. The materials, including the powerful short film, session plans, slides, and teaching notes provide everything needed to run an effective and engaging session with a wide range of staff.”
Graeme Hendry, EOLC Education Programme Manager at Barts Health NHS Trust

UCLPartners case study end of life care CS_on_setOverview

UCLPartners innovative educational materials have been developed as a resource for facilitators to teach End of Life Care (EOLC) to non-specialist staff across all health and care settings. The materials aim to increase staff confidence across areas including recognition, communication and physical care, for those in their last weeks and days of life.

Each set of materials include a short film, teaching slides and activities. The first film, Milestones, depicts a patient’s experience in an acute hospital, and the other, You Matter, shows the experience of a man dying in his own home. The materials centre on the films and utilise a reflective session to engage staff in discussion about what is important for people at the end of their life. The materials have been highly rated by trainers, and learners have reported an increase in confidence as well as a positive impact on their practice. The ultimate aim is to improve conversations between staff and patients and those important to them – in turn enabling patients’ wishes and preferences to be met, a decrease in avoidable hospital admissions, and an increase in those who die in their preferred place.

Challenge/ problem identified

End of Life Care (EOLC) is one of the core eight services inspected by the Care Quality Commission, and now a priority for the NHS.

  • By 2035 the total number of deaths in the UK per year will increase from 480,000 to 550,000, of which approximately three quarters are expected rather than sudden
  • Most people would choose to die at home, yet large numbers die in hospitals
  • Quality of EOLC has been highlighted by the Parliamentary and Health Service Ombudsman
  • In its 2014-15 and 2015-16 mandates Health Education England has prioritised education and training on care of the dying
  • The Leadership Alliance for the Care of Dying People report ‘One Chance to Get It Right’ outlined five priorities for the care of patients and those important to them: Recognise, Communicate, Involve, Support, Plan and Do

The UCLPartners education project aimed to embed excellent care, outlined by the five priorities of care, into routine practice for staff caring for patients and those important to them during the last days of life.

Actions taken

Funded by Health Education England North Central and East London, and led by Dr Caroline Stirling, Consultant in Palliative Medicine and Director for End of Life Care NHS England (London region) UCLPartners AHSN identified the need for an innovative educational resource. UCLPartners set about creating a suite of materials that could be used by facilitators to teach staff of all grades and disciplines, across all settings. The community materials were made in partnership with East London NHS Foundation Trust, who produced the You Matter film. The materials were disseminated through a train the trainer approach.

UCLPartners also established a Community of Practice for acute hospital EOLC Leads across London to support the improvement of EOLC, including workforce development, shared documentation and metrics, and other improvement initiatives.

Impacts/ outcomes

Between January 2016 and September 2017:

  • The materials have been utilised 360 times by 34 organisations across London, Essex, Hertfordshire UCLP End of life careand other areas
  • 2889 staff in acute hospitals and the community have been trained using the materials
  • Data analysis of pre and post training confidence surveys has shown an overall increase in confidence of ~20%
  • An in-depth evaluation of 54 learners (across acute hospitals and the community) 3-8 months post training found this increase in confidence was sustained
  • Evaluation of data for the acute hospital staff was analysed and it was found the sustained confidence levels were statistically significant
  • 83% of staff reported the training had a positive impact on how they deliver care

chart 1 purple

Bar chart showing self-reported learner confidence levels immediately before, immediately after, and 3-8 months post Milestones teaching session, data shows sustained increased in confidence (n=35)

chart 2 blueBar chart showing self-reported learner confidence levels immediately before, immediately after, and 3-8 months post You Matter teaching session, data shows sustained increased in confidence (n=19)

Potential patient impacts:

b&w chart 3Bar charts showing rating of impact of You Matter teaching on the learners delivery of care to patients and those important to them 3-8 months post teaching session, 94% agree or strongly agree with the statement above (n=19)

  • Early recognition of those that are at end of life – resulting in increase in DNACPR (do not attempt CPR) discussions and decisions, Advance Care Planning, Treatment Escalation Planning
  • Increase in sensitive communication, person centred care, and patient and family involvement
  • Improved end of life experience for patient and those important to them

Potential financial impacts:

  • Reduction in avoidable hospital admittance
  • More efficient discharge where place of care / death identified
  • Reduction in unnecessary treatments
  • Clinical time saved

Other impacts:

  • 34 organisations actively engaged across London, Hertfordshire, Bedfordshire and Essex
  • Funding secured to develop specific care home educational resource
  • Oral presentation at European Association of Palliative Care, 2017
  • Hong Kong Palliative Care Conference – Holistic Journey, 2017
  • Both Milestones and You Matter material have been included in University College London Medical School ‘Legal & Ethical decision making’ Undergraduate Year 5 module

The training helped me to identify that my patient was dying and explain my thoughts to the doctors looking after her.”
Milestones learner, North Middlesex University Hospital

Plans for the future

The current focus is to develop, pilot and test care home specific educational resources. These will consist of:

  1. a new film, depicting the experience of a female resident living with dementia in a care home from three different perspectives (the resident, her son, a carer)
  2. a training pack, which will include key learning and discussion points for facilitators, activities for learners, and signposting to further resources.

Data collection and dissemination of previous material is ongoing.

The team are also working on implementing a new bereaved carers survey template and data collection tool across London, as part of the work carried out with the Community of Practice (and the Cicely Saunders Institute at Kings College London), who the team continue to support.

Which national clinical or policy priorities does this example address?

  • Care and Quality
  • Funding and Efficiency
  • Health and Well Being
  • HEE Mandate
  • One Chance to Get it Right
  • Ambitions for Palliative and EOLC

Where did the innovation originate from?

  • Higher Education Institution – Funded by Health Education England North Central East London
  • NHS – Clinical Lead is Palliative Care Consultant

Start and end dates

  •  Start date: June 2014 (ongoing)
  • March 2018 Review to include evaluation of care home resources

Contact for help and advice

Project contact for further information
Dr Caroline Stirling, UCLPartners EOLC Clinical Lead
Ecaroline.stirling@uclpartners.com

Jenny Mooney, UCLPartners Head of Programmes, Population Health
E: jenny.mooney@uclpartners.com 

Media contact for further information
Amanda White, Head of Communications, UCLPartners
E: Amanda.white@uclpartners.com

Find out more

  1. Video of Milestones – accessible via https://www.youtube.com/watch?v=Rwcykb47PgM
  2. Video of You Matter – accessible via https://www.youtube.com/watch?v=il7dJMESCpY&t=5s
  3. Training pack for Milestones – accessible via http://bit.do/Milestones-EoLC
  4. Training pack for Matter – accessible via http://bit.do/YouMatter-EoLC