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ehospice speaks to...Professor Max Watson

Author: Leila Hawkins
19 January 2018

In this new series ehospice will be speaking to leaders in the hospice and palliative care sectors, and individuals who are helping to raise awareness of the importance of the work hospices do. Our first interviewee is Professor Max Watson, an eminent palliative care clinician, author of several books on palliative care, an academic with positions including visiting professor at St Margaret's Hospice, and the driving force behind Project ECHO in Northern Ireland.

Professor Watson joined Hospice UK’s clinical team last May as Project ECHO Programme Director, playing a key role in delivering the programme in support of Hospice UK’s five-year strategy. 

Project ECHO is a lifelong learning and guided practice model that revolutionises medical education and clinical team support. ECHO - which stands for Extension of Community Healthcare Outcomes - was originally developed at the University of New Mexico, in the US.

At the heart of the ECHO model are its hub-and-spoke knowledge-sharing networks. These networks are supported to form ‘communities of practice’ which share knowledge and expertise. A trained facilitator, who is based at a hub, guides their virtual meetings, with the support of a dedicated administration and IT team. Here Professor Watson speaks about his role at Hospice UK and his career highlights so far.  

What opportunities do you see in your role at Hospice UK?

There are fantastic opportunities. Currently only four per cent of deaths in the UK take place in hospices. The majority of people are dying in hospitals, or care homes, and so for us to maximise our impact we need to reach out and work with others in a collaborative way.

The ECHO methodology allows hospices to, for example, reach out to support nursing homes or to provide ongoing training and mentorship to the Hospice Nurse specialist teams who often work in relative isolation. However it is in creating communities of practice with colleagues in old age medicine, frailty management, renal medicine, respiratory disease, cardiology and other chronic disease teams that we have a real chance of multiplying our impact and improving the care for all our patients.  

What are your goals for the next year or so?

The first goal was to get us ready to be a training centre, or a superhub. In order to do that we had to start running our own ECHOs, and demonstrate to the ECHO Institute in New Mexico that we were suitable to work as a superhub, training new centres across the UK.

We have already had interest from more than 80 organisations who want to be trained to become ECHO hubs. By the end of 2018 our goal is that we  will have trained at least 30 hubs across the country working with our training collaborators in Highland Hospice in Inverness and St Luke's Hospice in Sheffield. We will be able to provide immersion training for new ECHO hubs  in Scotland, Yorkshire, London, and in our recently opened offices in Belfast.

What has the impact of ECHO been so far? 

The first ECHO in the UK was in the Northern Ireland Hospice for their community palliative care nurses all over the region, nearly 40 nurses. ECHO was shown to have improved the knowledge of the nurses, and improved self-efficacy, - increased confidence in handling different conversations and clinical scenarios. 

The Northern Ireland Government then asked us to run five ECHO networks and evaluate the impact.

One of these was with opticians and supporting their care for patients with glaucoma and macular degeneration. After just nine ECHO sessions we were able to see the referral patterns of those opticians managing glaucoma and macular degeneration had changed significantly. Local opticians were more confident in looking after such patients  while the Professor of Ophthalmology was also much more confident in the quality of care that they could deliver for these particular patients.

ECHO allows people to reconnect, to get that support, that knowledge, and that peer-to-peer encouragement.

What do you see for the future of ECHO, both in the UK and around the world? 

Around the world ECHO is really taking hold. I was involved in helping to set up an ECHO in South India which connects palliative care workers right across India and into Bhutan and Nepal. That ECHO began in February [2017] and it has already had an impact on the lives of more than 200,000 patients.

As a way of linking people and sharing knowledge it has been really good at improving the quality of decision making and thus democratizing specialist knowledge  while at the same time keeping the specialists in contact with the real needs of the real world. The IT involved is simple now with the advent of affordable hand held devices and the growth of broadband. If a country like India, with all the vagaries of its electric and IT systems  can work so effectively with ECHO, it shows the way forward.

In Uruguay, I witnessed ECHO being used to link  their main palliative care centre hospital in Montevideo with 24 rural centres, and that network now been running for nearly two years, adding to the consistency in care across the country. My hope for ECHO internationally is that it will maximise our very special but limited palliative care resource so that many more people can be helped at this very important part of life.

Within the UK, my hope is that in line with Hospice UK's strategy, ECHO will help us to reach out to more people, to more groups who have not had access to our services, and to link in with others who are delivering palliative care. That across the UK individual hospices will maximise their impact by linking in with care homes, with their community teams and then with their clinical colleagues in the NHS, to improve the care for the growing population of people with conditions like frailty who need a wide variety of inputs and supports in order for them to have the best of care, - care which balances all the individual persons’ needs.

I hope these communities of practice will spring up across the country and the NHS will see what hospices are providing through Project ECHO and say “we want some of that too.”

Over the course of your career what have your highlights been so far?

I trained in theology and changed to general practice, then went to Nepal, and that changed my life. I worked in Nepal for eight years, seeing the real relevance of palliative care in resource-limited countries. I then came back, moved into palliative care and had the privilege of being trained in London at Esher and Sydenham with Dame Cicely Saunders, and then in Belfast

I had the real fortune of being mentored and supported by Dr Caroline Lucas and Dr Andrew Hoy at the Princess Alice Hospice in Esher where I went for training, and they were so supportive of my projects to develop the European Certificate in Palliative Care, and the Palliative Adult Network Guidelines, which then led to the Oxford Handbook of Palliative Care.  We took the European Certificate to India, that was translated, and more than 18,000 people have completed it across the world, which is just amazing.

I have been very fortunate in having relationships that have been very supportive and encouraging, and that have allowed me to have a very interesting career in writing, education and reaching out to people at home and across the world.

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