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Lighting a spark within teams to improve end of life care

To mark Dying Matters Week, NHS England and Improvement’s Head of Nursing for End of Life Care (EoLC) provides unique insight into the work to improve end of life care and enhance the experience for individuals’ and their families:

Dying Matters weeks offers an opportunity to raise awareness, both for staff and patients, about death and dying.

It is also an opportunity to share good practice and encourage important conversations.

I have had the privilege to work as Head of Nursing for End of Life Care at NHS Improvement (NHSI) for two and a half years and to lead this work nationally for the nursing directorate.

I work with partners across the system and represent NHSI on the National Board to ensure a consistent approach and have also regularly shared our work at the Ambitions Partnership meetings.

In Autumn 2016 there were 92 trusts that had an ‘inadequate’ or ‘requires improvement’ Care Quality Commission (CQC) rating for their end of life care service. Our work was to support those trusts in improving care for patients in the last 12 months of life and the last days of life. We also wanted to ensure that we were able to use the opportunity of supporting trusts with the one chance to get this right for families and those close to them.

How did we do this?

We invited trusts to join us on an EoLC collaborative, where they could come together and learn about quality improvement methodology and then apply this to a service improvement in their end of life care service and treatment escalation plans. The networking opportunities that it provided were also valuable and there was often a great buzz in the room as ideas and work were exchanged.

16 trusts joined us for these events and focussed on various areas of improvement including training and development, individualised care planning and communication.

All of the trusts improved their ratings, which demonstrates such an amazing commitment from the staff to improve care. I often talk about “lighting a spark within teams to help focus on this most important aspect of care.” The staff involved in EoLC are so passionate and keen to improve and often we were able to provide the focus to ensure improvements were made.

We also worked jointly with Hospice UK to support eight further trusts in improving care in emergency departments. The case studies for these really do show a difference and included a patient walkthrough to help improve the environment for patients and families.

We have completed over 40 visits to trusts to review EoLC services and have seen some fantastic work happening. Chaplains, patient representatives, bereavement teams and staff involved have all shown such personal and professional commitment. Many of them have talked about individual patients and families and how they have gone the extra mile to make final days special for them. Lots of wonderful examples of weddings on inpatient wards, pets coming to visit and access to open spaces to share precious time with family and friends.

In 2018 we ran ‘Getting to Good’ masterclasses using the #OurPreciousTime with four learning areas, including: examples of pre-hospital initiatives; early hours of a patient’s presentation to hospital; avoiding lingering in hospital and keeping patients safe and comfortable at home. 32 trusts were represented and the value of sharing each other’s work was immeasurable.

I have recently launched an EoLC practitioners’ operational network and we had 200 expressions of interest, again demonstrating how committed staff are to be involved in this work and make a difference.

Our end of life care work has delivered around 55% improvement in trust CQC ratings over the last two years. Ultimately, this translates to around 55% improvement in care for patients – something we are determined to continue through joined up working across the NHS.

There is currently one trust remaining with an ‘inadequate’ rating and they have completed lots of improvement work that is patient focussed and are ready for the next inspection.

There are 39 trusts still with a ‘requires improvement’ rating – we will continue to provide support to reach a position of 0 trusts in ‘inadequate’ in EoLC and a further 50% reduction in trusts with ‘requires improvement’.

It will be great to see many of our trusts aspire and attain an ‘outstanding’ rating for their EoLC care – the patients and families are the winners here.

Sherree Fagge

Sherree Fagge RN, DMS, MBA is the Head of Nursing for End of Life Care, NHS England and Improvement. She began her nursing career as a Cadet Nurse and worked in a psychiatric hospital during placements. She trained at Cuckfield and Crawley School of Nursing.

Sherree held various nurse leadership roles throughout her career, including Ward Manager on a male surgical ward and then on a gynae ward. She was successful in obtaining directorate leadership roles in surgery and critical care and has also worked as a service manager in medicine and a general manager in orthopaedics.

Sherree has previously been responsible for inpatient access, so manging patient flow and admissions both elective and emergency, over three sites and 1040 beds.

She has also worked as Chief Nurse for a large teaching hospital in Sussex. This included the Executive lead for End of Life Care and ensuring patients and carers at the hospitals received the very best care during the last phase of their lives.

Sherree seconded to NHSI to lead EoLC in the nursing directorate and to support trusts to improve care in this area. She continues to work in this substantive role, working with partners across the system to make a difference to patients.

Sherree has now celebrated 45 years in the NHS and has continued to enjoy her nursing career throughout this time. She finds privilege in nursing and caring for people at times of vulnerability.

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