“I live in a community where everybody recognises that we all have a role to play in supporting each other in times of crisis and loss. People are ready, willing and confident to have conversations about living and dying well and to support each other in emotional and practical ways” Ambition Six

I was recently at a funeral of a close family friend who died at the tender age of 55. He left behind his wife and two teenage children, who as you would expect, were completely devastated. This close family friend was a man who served his community well and who enjoyed life whilst continuously encouraging others to do the same.  He was particularly supportive of young people engaged in sport, and will be deeply missed by them too. There were over 300 mourners at the funeral and their shock and grief was palpable.

At the Ambitions Partnership meeting this week, Alison Penny from the National Children’s Bureau gave a deep dive presentation on bereavement services and approaches to supporting people who are grieving. She emphasised the importance of understanding and assessing each person who may be grieving, acknowledging the loss and working in a timely but considered way with each individual. She stressed the importance of being mindful of clusters of people who may be experiencing the same situation but are not directly connected to one another. We must not underestimate the needs of a wider community in grief but ensure they are allowed to grieve in the way that is best for them.

Alison further emphasised that there is no universal timescale or pattern of grief and that a range of support systems are needed. Her presentation resonated strongly with me as I reflected on my experience last week of seeing people of all ages coming to terms with the loss of such a loved and valued man. I wondered how so many will get through this trauma. Some will grieve at the funeral and move on quickly, others will benefit from family or peer group support over longer times and then others who will need more considered and structured support maybe on a one-to-one or small family group basis. One thing is sure - whether end of life is planned or unexpected, bereavement and loss is always in need of service options to help people move on and live their lives to the full. Much is made of planning for end of life, quality of care and individual wishes, but without services to support those left behind the impact of the death will have huge repercussions, however well planned.

For more information and access to resources to help you improve your approach to those that are left behind, check out the following link to the National Bereavement Alliance. https://nationalbereavementalliance.org.uk/


Other highlights include:

End of Life Programme Board update - 16 October 2018. Kindly provided by Brenda Scanlan (Assistant Director, Royal Borough of Greenwich)

The main items presented (which I found particularly relevant) were the updates from NHSI and CQC respectively on how quality drives improvement – with a focus on end of life care in the acute hospital environment.   

We heard how those Trusts which had been judged as “Inadequate” or “Requires Improvement” by CQC for end of life care could benefit from a range of support interventions.  These include masterclasses, opportunities for nurses and other clinical staff to learn from one another and improved relationships with community and other providers, including hospices.

I followed up with questions on whether there is evidence of a link between organisations’ structural architecture and the quality of patients’ experience. For example, had CQC observed any significant quality differences in vertically integrated Trusts, as arguably the pathway for end of life patients might be better developed where acute and community provision was part of a single organisation? I took away the understanding that the analysis hasn’t been done in this way.  However, the CQC presenter (Deputy Head of Hospital Inspectorate) did link her presentation to CQC’s wider approach with Local System Reviews (LSRs) which look at the integrity and quality of the whole pathway experience from patients’ perspectives in terms of a well led local system.

Other points I noted:-

  • Regions Update – Governance is in place to ensure the Regions are aligned/integrated with the objectives of the national programme.
  • NHS Long Term Plan – End of Life care will be referenced.  It will be linked with Frailty and the Older People’s work stream, Urgent Community responses and Enhanced Health in Care Homes. “Living Well at the End of Life” submission also should have a positive impact.
  • In terms of NHSI and NHSE “joining up” some of their functions, Regulation is to take place in the Regional Teams.  


DToC roadshow

Our bi-annual DToC roadshow took place on the 31 October 2018 with 200 delegates from across health, social care telehealth and telecare providers. The focus of the event this time was to move the narrative away from DToC and shift to supporting the wellbeing of individuals within the community. The golden thread and challenge throughout the day was: ‘Does your approach meet the needs of someone in their last year of life’?

Sharing good practice covered the following:

  • Admission Avoidance - social care enhancing wellbeing - Brenda Scanlan, Senior Assistant Director, Royal Borough of Greenwich
  • Facilitating flow within the acute setting - Claire Old, Urgent Care Director, Shropshire Telford and Wrekin, and Clinical Specialist, Emergency Care Intensive Support Team (ECIST)
  • Maximising People’s Independence through Integrated Care and Active Recovery - Erica Daley, Director of Integrated, Commissioning, NHS Hull Clinical Commissioning Group & Tracy Meyerhoff, Head of Social Care and Health Integration, Hull City Council

The keynote address was delivered by colleagues from the London Fire Brigade on the Fit, Safe and Well project

The afternoon session was chaired by Dr Caroline Stirling, Clinical Director, EOLC Clinical Network. The main focus was on reviewing the High Impact Change Model (HICM) which was replicated in the other 8 ADASS regions. For the London event, the focus was reviewing the HICM through an EoLC lens.

Presentation slides are available via the following link https://londonadass.org.uk/events/dtoc-roadshow-preparing-for-winter-2018-19/

Top tips

In collaboration with the EoLC network and NICE colleagues we have drafted our top tips for enhancing the experience of those in their last year of life. The product has two elements:

  • Leadership - creating the right environment to maximise good quality approach to end of life care
  • Operationalising the NICE quality standards for professionals, commissioners and providers

I hope to launch these in my December 2018 blog


We have a range of videos to support this area of work