“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
  • Health Education England has prioritised education and training on care of the dying in its 2014-15 to 2017-18 mandates and draft health and care workforce strategy for England to 2027
  • 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 EOLC 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 quarterly Community of Practice for acute hospital EOLC Leads across London and the South East, to support the improvement of EOLC including workforce development, shared documentation and metrics, and other improvement initiatives.

Through the Community of Practice, UCLPartners have developed a Bereaved Carers Survey template and data collection tool in partnership with the Cicely Saunders Institute at King’s College London. The template supports service improvement and benchmarking, and is currently in use in at least seven acute trusts across London.

Impacts/ outcomes

Between January 2016 and March 2018:

  • The materials have been utilised 386 times by 34 organisations across London, Essex, Hertfordshire UCLP End of life careand other areas
  • 2,937 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

UCLPartners have been commissioned by Health Education England to develop and pilot educational materials to give care home staff the knowledge and skills needed to deliver excellent care for patients at the end of life.

We have created What’s Best For Lily? – an 11-minute educational film showing the last months, days and weeks of a patient’s life through the eyes of a care home resident with dementia, her son, and a carer. Accompanying resources support facilitators to deliver teaching sessions and activities on topics including recognising gradual and sudden deterioration; asking about a resident’s wishes and making a plan of care; prompts to review before calling 999; supporting loved ones and involving them with care; and dealing with the death of a resident.

A small-scale implementation pilot of the educational materials is being conducted in care homes in Camden and Enfield. The What’s Best For Lily? educational resources will be made available to download for free by June 2018.

Data collection and dissemination of Milestones and You Matter is ongoing.

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)
  • July 2018 review to include evaluation of care home resources.

Contact for help and advice

Project contact for further information
Chris Larkin, End of Life Care Education Project Manager, UCLPartners
Echris.larkin@uclpartners.com

Media contact for further information
Frances Sheridan, Communications Manager, UCLPartners
E: frances.sheridan@uclpartners.com

Find out more

  1. Video of Milestoneswatch here on YouTube
  2. Video of You Matter – watch here on YouTube
  3. Training pack for Milestones – download here
  4. Training pack for Matter – download here