Medicine 2019: Palliative care

Day 2 of the RCP annual conference included a session on the challenges facing palliative care and how new models and systems can help.

The session opened with Professor Bee Wee, national clinical director for end-of-life care at NHS England and NHS Improvement, who focused on how leadership can improve palliative care.

Professor Wee presented a number of different approaches to leadership, and talked about collaborative leadership of a network of people who are cooperating for the greater good. She highlighted the need to think about leadership as high impact. This requires a shift in the mental model, moving from volume to value. How leaders behave is vital – there has to be a relentless focus on the vision and the strategy and, ‘Our efforts as leaders have to be driven by the people we are serving.’

Professor Wee outlined the IHI framework for improving joy in work. This looks at the elements needed to ensure happy, healthy, productive people. It is vital to ask staff what matters to them. She said: ‘Leaders should be aware of work-related stress and conflicting demands on staff. It is our responsibility to do something about this. If we don’t look after staff, patients will suffer.’

Professor Wee summed up by saying that, ‘Leadership is about being able to trust others and let go, giving them freedom to fail. As physicians, this can represent a big challenge for us. It is about having the courage to be the kind of leader that helps to improve care for the people we serve.’

Dr Amy Proffit, a consultant in palliative medicine and vice president of the Association for Palliative Medicine, then gave a presentation called ‘Palliative care: walking an old path in new shoes’. She talked about the fact that we are all going to die and how vital it is for professionals to get end-of-life care right.

She outlined the beginnings of palliative care as the hospice movement in the 1960s. Today we are facing ‘need explosion’ with not enough palliative physicians to meet that need. The challenge is how we adapt.

Dr Proffit talked about the five priorities of end-of-life care: recognise, communicate, involve, support, and plan/do.

The session closed with Professor Rob George, medical director of St Christopher’s Hospice, who discussed how to manage change when vision is involved.

Prof George talked about lessons learned from St Christopher’s. He summed up the purpose of palliative care as ‘to help people complete their lives well’.

But the challenge is how to provide palliative care at scale. He said the big themes facing palliative care are frailty and multimorbidity. However, it can be very complicated and clinicians have to adapt.

As caseloads grew, St Christopher’s realised that a new programme of approach for frailty was required. This led to ‘age-attuned hospice care’, using the key principle of what matters to older people.

Prof George’s take home message was on change management:

  • if we carry on in the same way the system will explode
  • there are no shortcuts to development if they are to be effective
  • systems don’t take prisoners and the culture has to change – this will not be quick.

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