A system wide palliative care alliance

Project overview

The Bath and North East Somerset, Swindon and Wiltshire (BSW) Palliative and end of life care (PEoLC) Alliance was formed in 2020. It is co-chaired by Wayne de Leeuw, CEO of Dorothy House Hospice, Irene Watkins (CEO at Prospect) and Dr Pippa Baker (Clinical Director, Salisbury Hospice), and has 75 members representing 23 partners within the ICS including health and care providers and commissioners.

In 2021 the Alliance presented its vision for PEoLC to the integrated care board (ICB). It made eight recommendations, which are based on local population health data and the Ambitions for Palliative and End of Life Care framework.

1. Creating a Palliative and End of Life Care Alliance
2. Adopting “what matters to you?”
3. Consistent identification of end of life care needs
4. Personalised care planning
5. Improved use of data and digital technology
6. Single point of contact and co-ordination of care
7. Adopting a “Compassionate community” approach
8. Adopting a system-wide approach to workforce planning and PEoLC education and research 

Outcomes

Working together as an alliance has enabled PEoLC providers to see ways to link services together for the benefit of their community, for example in the roll out of the ReSPECT tool across the local system. At the time of writing, the Alliance is achieving against six of the eight recommendations it made in 2021, with the remaining two in plan.

The integrated care system (ICS) was using “Start well, Live well, Age well” as key themes for population health. The work of the Alliance means that a fourth and vital component is now part of the ICS strategy: that people should “Die well”. 

Other key achievements include:

• Creation of a Palliative and End of Life Care Community of Practice which feeds into both the Alliance and the ICS Academy. 
• A baseline audit that included looking at population health data and running a population needs assessment/survey to gather data on how many people need (and get) PEoLC support.
• Identifying the importance of consistent and early identification of end of life care need and imbedding this within the existing frameworks in general practice. This work is being led by a local GP lead.
• Encouraging the creation of a strategy for PEoLC for children and young people which will be aligned to the strategy for adults ensuring a seamless service from birth to death.
• Rolling out the use of Supportive and Palliative Care Indicators (SPICT) to improve identification of people at the end of their life.

Key facilitators

Relationships have matured as the Alliance has progressed. There is honesty and ownership between members and the annual priorities reviewed by the whole group. The focus is on serving the needs of the communities rather than individual organisations’ interests: creating an “ecosystem” of mutual and equal collaboration not an “egosystem” associated with any single provider. 

The ICS has a duty to support local alliances, which has been very helpful. The Alliance has been given a devolved budget and a dedicated project manager.

There is a direct link between the Alliance and the Integrated Care Board (ICB): the Alliance reports to ICB and as co-chair, Wayne de Leeuw is invited to strategic ICB meetings.

Challenges

Co-chairing the Alliance takes up a significant amount of time for Wayne, and it is deliberate that Dorothy House has a strong leadership team that can support this as part of its work as a system partner.

The Alliance plans to develop a care co-ordination hub – a 24/7, single point of contact for people in the last year of life. This will be delivered in partnership with the local 111 provider.