Overview of the Clinically Based Education and Training Initiative June Toovey 24 th March 2014

1. Overview of the Clinically Based Education and Training InitiativeJune Toovey24th March 2014

2. Covering • Background and aims of the initiative • Initiative summary and the approached taken • Achievements, challenges and learning so far

3. Background • Initiative developed as a direct result of a region wide mapping exercise to identify the barriers to improving EoLC • Main barrier – education and training to implement recognised EoLC tools into clinical practice (PPC, LCP, ACP, DNA CPR, GSF, AMBER care bundle) • Evidence that effective use of the tools improve EoLC and recommended in the 2008 EoLC Strategy

4. Aim To provide effective Education and Training to implement the EoLC tools into clinical practice Anticipated outcomes • Improves patient experience of care • Improves symptom control • Higher proportion of deaths in preferred place of care • Reduce inappropriate acute admissions and bed days • Reduce inappropriate investigations and treatments

5. Initiative Summary Teams 26 organisations were provided with funding over 2 years– with a total of 1,028 teams included • 240 hospital wards (acute and community) • 317 District Nursing and community teams • 471 GP practices

6. Initiative Summary Tools • ACP inc DNA CPR – Ward 134, DN 302,GP 406 • LCP – Ward 123, DN 66, GP 123 • GSF – Ward 14, DN 34, GP 28 • AMBER – Ward 63 • Early Identification – DN 33, GP 86 Funding • Between £10,000 and £200,000 per organisation – number of teams and number of tools • Average of £1,700 per team

7. Approaches • 13 organisations appointed EoLC Facilitators • 2 backfilled SPC CNSs to undertake the training • 9 commissioned specific education programmes with a variety of approaches form half day to 3 day • Specific plan re attendance • Defined % staff from teams to attend • Targeting of senior staff and leaders • Targeted at generalist staff delivering EoLC • 1 GPs funded to do benchmark audits • 1 locum SPC consultant to allow SPC team deliver Education and training

8. Achievements • In spite of all the changes in the health care economy during the initiative’s implementation, the education and training is still being delivered and funding is being used as intended. • Enthusiasm, commitment and tenacity to EoLC maintained • Specific external funding used as a lever to raise profile • Where funding used as part of wider EoLC work stream particularly effective • EoLC tools implemented into clinical practice

9. Challenges • NHS Reform • Engagement with and the educating of GPs. • Data collection from GP practices • Releasing staff to attend education training or spend time with the facilitator in clinical practice • Confidence of staff to start EoLC conversations • HR – for facilitators; process and availability of staff • Review of the LCP and impact • Engagement with senior executives and board level buy in • Sustainability of embedding the tools in practice • Rural areas: geographical spread of teams and staff

10. Learning Most effective when the following in place • EoLC is a priority at Board level • Senior executive level sponsor identified and active in supporting EoLC • EoLC a priority across a locality; strategy groups established • Managers and leaders of teams sign up • Education/facilitation provided by clinically credible clinicians • Over 50% (maybe 75-100%) of the staff in the team educated • Close working relationship with and support from the SPC team • Availability of data audits to demonstrate need and she improvements in EoLC

11. Conclusion • Successful initiative to implement EoLC tools into practice • Enthusiasm, commitment and tenacity can not be under estimated • Learning for future – what needs to be in place to be as effective as possible