Improving palliative care in Scottish acute hospitals – a three strand approach

ABSTRACT

BackgroundHospitals remain an important and necessary place of care for people nearing the end of their lives, and in Scotland nearly 1 in 3 hospital beds are occupied by someone who will die within the next 12 months (Clark, Armstrong, Allan, et al., 2014. Palliat Med. 28474). Despite this, resources to support improvement activity across the country remain underdeveloped and ad hoc.AimBuilding on the Best (Phase 2) a three-year, Macmillan funded project aimed to improve the experiences and outcomes for patients and families in Scotland’s hospitals.MethodsWeCreated a multidisciplinary national network for hospital specialist palliative care team (HSPCT) members.Supported a range of quality improvement projects across the country.Facilitated public engagement via the projects and other stakeholders.ResultsThe Scottish Network for Acute Palliative Care (SNAPC) was launched in Jan 2020. It facilitated the HSPCTs across Scotland to work very effectively and efficiently to collaborate and contribute to the development of COVID-19 specific palliative care guidelines;share local work nationally;and develop new collaborative connections.9/12 QI projects successfully completed in six health boards showing local improvements to the care being offered to patients and their families specifically in planning ahead and bereavement care.Public engagement activities included participation in focus groups to develop resources for introducing the ReSPECT document and feedback on bereavement follow up.ConclusionsThe successes and limitations of this project were defined by the pandemic. While the SNAPC network flourished and developed as a need for information and sharing experiences with colleagues was required, barriers to engaging with the public restricted engagement activities. A sense of urgency amongst HSPCT to improve care, an infrastructure to support information sharing and collaboration and resource to support small projects has led to impactful change in the care experiences in several hospital settings across Scotland.