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The benefits of partnerships - locally and nationally

Author: Adrienne Betteley
13 April 2018

Adrienne Betteley, Specialist Advisor in End of Life Care for Macmillan, writes about the projects the charity is working on with Hospice UK.

Since the merger of the National Council for Palliative Care (NCPC) and Hospice UK, Macmillan Cancer Support has continued to work in partnership with Hospice UK on former projects from the Macmillan/NCPC partnership. The two main initiatives are the National Bereavement Alliance and Building on the Best.

National Bereavement Alliance

The National Bereavement Alliance aims to support bereaved people through raising awareness of bereavement, promoting best practice, bringing practitioners together, and signposting professionals and the public to bereavement services.

Macmillan gave a two-year grant to NCPC to support the initial growth of the National Bereavement Alliance, with an additional grant given for website development. This work has continued with Hospice UK.

Successes to date include:

  • The publication of ‘A guide to commissioning bereavement services in England’ which sets out what bereavement services should be available in each local area
  • Well-attended ‘Bereavement Research into Practice’ meetings, where researchers and practitioners shared findings and influenced the future agenda for research into bereavement
  • Influencing the Government’s attitude to and support for bereaved people through consultation responses, briefings and draft amendments, including to the Parental Bereavement (Leave and Pay) Bill, the Social Fund Funeral Expenses review and the review into returning to work after a period of caring
  • Launch of a website with details of training, job opportunities, policy and resources for. This is available at National Bereavement Alliance

Building on the Best

Building on the best is a quality improvement project to test out ways to improve end of life care in hospitals. There are 10 sites in England and we are also working with the Scottish Partnership for Palliative Care in Scotland.

The priority areas for quality improvement are:

  • Hospital outpatient
  • Communication around handover to GP and services in the community
  • Shared decision making with patients and those important to them on treatment options
  • Improved pain and symptom management

The final evaluation for the programme will be completed in June 2018, but we are already seeing the benefits of collaborative team working, quality improvement coaching and cross-team partnerships locally. This has led to significant improvements in care delivery.

In the Leeds pilot site, the palliative care team have sat in on cardiology outpatients’ appointments to support the outpatients’ team in starting conversations around Advance Care Panning. Both teams have found this to be extremely valuable, with the palliative care nurses saying that they really appreciated the different perspective on end of life conversations with patients in an unfamiliar care setting.

In the Worcester pilot site, the Hospice UK and Macmillan teams have been able to collaborate to support the site palliative care team, through facilitating meetings with other Trust colleagues to discuss end of life care in their Trust and where they believe improvements could be made. This has led to better engagement internally, but also an improved understanding of how Hospice UK and Macmillan can support their work in their area.

We have been working with several partners and are keen to ensure the learning from the programme is spread and shared.

National influencing

The End of Life Care Coalition is a group of six large national charities including Macmillan and Hospice UK, which campaign together to call for better quality care and support for those approaching the end of their lives. The coalition works to influence the Government and stakeholders in health and social care to ensure high quality, personalised care is available for people approaching the end of their life, wherever and whenever they need it. More information is available at End of Life Campaign  

For further information about the national work of Macmillan Cancer Support please contact Adrienne Betteley, Specialist Advisor for End of Life Care.

Local partnerships

The North-East Hospice Collaborative

At a local level, there are some great examples of partnership working between hospices and Macmillan and one such example is in the North East of England.

The North-East Hospice collaborative, Hospices North East, aims to give hospices a stronger voice, and a firmer base, from which to campaign for the provision of more and indeed better care across the region.

There is a strong case to be made that the provision of good palliative care results in cost savings across the NHS. The collaborative has partnered with senior NHS decision makers such as NHS Improvement, Academic Health Science Network, Health Education England – North and multiple NHS Trusts to build this case and discuss what the future looks like across the region at a senior level. 

Together, hospices are better placed to capture the data and make that argument for patients and their families in the North East of England

Importantly, the biggest benefit from this project will be seen by patients and their loved ones. The aim was to ensure greater collaboration between the relevant hospices, helping them realise they can do more together than apart.   Any cost savings achieved will be fed into services so hospices can help patients and their families more efficiently or perhaps in new ways.

In addition, hospices can learn from each other in terms of improved clinical delivery that will ensure patients and their families receive better care and support. Macmillan is supporting the establishment of baseline data which will inform plans for the joint delivery of numerous hospice services and the appropriate sharing of resources.

This has resulted in:

  1. Empowering patients and their families to make appropriate and timely decisions
  2. Delivering care which is tailored to the needs of the patient at the right time
  3. Supporting the patient’s loved ones throughout the process
  4. Helping the patient and their loved ones feel part of a community which understands what they are going through
  5. Most importantly, we want to ensure that as many people as possible experience a good death

Hospices North East has required a significant amount of time to facilitate agreement from both CEOs and trustees of the independent hospices and this has been supported by Macmillan. Currently consultation with each independent hospice and a legal team is in progress to explore what the legal model/structure needs to be to ensure they can income generate to ensure sustainability.

It was evident from early scoping that resources for hospice staff education, learning and organisational development was a factor that could be better managed through a collaborative approach. Year one involved a deep dive in to current provision and need, and year two has offered a designated nurse educator to implement and deliver educational resource and packages to each hospice. Year three will see expansion of this project into NHS organisations and external organisations.

This is just one example of partnership working with hospices and Macmillan –there are many more. Macmillan Cancer Support has developed geographic strategies and implementation plans for cancer services based on evidence and insight around local needs and existing services. In some areas, Macmillan has identified end of life care as a high priority. If you want to know more about these local plans or discuss potential opportunities for collaboration please contact the relevant Head of Service for your area. The map above shows how Macmillan’s Geographies are divided and the contact emails for each Head of Service are listed in the box on the right.

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