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First acute hospitals achieve ‘gold standard’ for end of life care


Acute wards in Exeter and Lancaster have become the first in the UK to be recognised for their care for patients nearing the end of their lives by a gold standards framework supported by regulators.

Two wards at Royal Devon and Exeter Hospitals NHS Foundation Trust and one at University Hospitals of Morecambe Bay NHS Foundation Trust are the first to receive the National Gold Standards Framework Centre’s (GSF) quality hallmark award in end of life care.

All three wards were praised for improving the quality of care for all patients towards the end of life and “crucially” for enabling more to live and die at home if they chose.

“Achieving this accreditation is a testament to the hard work and dedication of all the staff”

Em Wilkinson-Brice

Yeo and Yarty wards at Royal Devon and Exeter – oncology and haematology wards, respectively – and Ward 23 at Royal Lancaster Infirmary – a stroke ward – provided evidence of measurable change to the way they organised care and its positive impact on patients, relatives, carers and staff.

Accreditors said they demonstrated early recognition of decline – with more than a third of patients identified as being in the final year of life – offered advance care planning discussions to all and improved communication with GPs, meaning patients were discharged where appropriate.

For example, on Yeo ward, 57% of patients are being identified as in the last year of life, which has helped staff initiative conversations with patients, so care can be planned in line with their wishes.

Em Wilkinson-Brice, chief nurse and chief operating officer at the Royal Devon and Exeter, said: “Achieving this accreditation is a testament to the hard work and dedication of all the staff and end of life teams… who daily provide safe, high quality and compassionate care for our patients.”

Staff from the two hospitals received their awards from Professor Sir Mike Richards, chief inspector of hospitals at the Care Quality Commission, who urged others to follow their example.

“We know that many hospitals struggle to identify patients in the last year of life and consequently find it difficult to coordinate their care adequately,” he said.

“The gold standards framework enables better care for people in the last months of their life,” he said. “These hospitals should be congratulated for leading the way and being exemplars for others to follow.”

The GSF accreditation for acute hospitals is endorsed by the British Geriatric Society, which also took part in the assessment process.

Dr Martin Vernon, the society’s end of life care lead, said the wards’ achievement was a “milestone event”.

“Staff on the wards that have been accredited will feel more empowered to provide the coordinated care this most vulnerable of patient groups require,” he said.

“We hope others will aspire to this standard, as others have in primary care and care homes”

Keri Thomas

Professor Keri Thomas, GSF national clinical director, highlighted that end of life care was “one of the biggest challenges” facing the acute hospital sector.

“By implementing a structured systematic approach – with earlier recognition, improved communication with patients and fellow professionals, and better coordinated care – it is possible to provide a quality of care for people in the final year of life wherever they are,” he said. “We hope others will aspire to this standard, as others have in primary care and care homes.”

The Gold Standards Framework Centre started in 2000 in primary care and now runs GSF programmes in end of life care in all settings.

The two hospitals are among more than 40 to have completed GSF Acute Hospitals Training, a two-year programme aimed at helping generalist frontline staff better recognise patient decline and comply with their preferences.

University Hospitals of Morecambe Bay NHS Foundation Trust

Ward 23 team at the Royal Lancaster Infirmary with their award


Readers' comments (16)

  • Trolling pure and simple

    michael stone | 30-Mar-2015 1:40 pm


    'Hi Ana,

    Even if I knew enough about the situation to write what you wrote:

    ‘Vitriolic comments by any person who will not put a name to them are just, sadly, within my experience a very 'nursey' thing to do.'

    I wouldn't dare to say that (I would 'get slaughtered').

    The LCP failed horribly in some places, because it was being treated 'as a set of rules, into which patients were made to fit' - it was never 'a set of rules', it was a 'framework of sensible options' and [perhaps] a description of treatment which were tried and tested. So the LCP was withdrawn, because the staff using it were not [in some places] well-enough trained.

    It is rather 'odd' that the removal of 'the LCP' has apparently created a lot of 'uncertainty' within the NHS - because none of the law around consent, or mental capacity/incapacity, has changed, and neither has the clinical effectiveness of interventions.

    The LACDP's 'replacement' for the LCP, is a much more theoretically-correct approach [and also more sophisticated] to EoL - but it requires even better training and understanding [than the LCP required] for it to work properly. As the NHS is very cash-strapped, it is not at all obvious that the necessary level of training will be put in place. I pointed that out to the LACDP during its consultation, and I've pointed it out to Bee Wee and others since.

    In my opinion, aside from the person who is dying, the most challenging situation to be in is that of a live-with relative or a 999 paramedic, while the patient is in his/her own home.

    It is also clear [to me, anyway] that it is more challenging to be a nurse involved in EoL, than to be a doctor.

    Not only is there confusion about the Mental Capacity Act (which deals with ‘pseudo consent’ and ‘projection of refusal into future incapacity’) but there is a lot of confusion over the simpler issues around consent from mentally-capable patients. The recent Montgomery case has provoked a fair bit of comment on the BMJ website – there is a series of rapid responses, and since a piece of mine which was posted on March 24, a surgeon in Australia and I have been ‘trading pieces’ over various issues and implications of the court case:

    Montgomery is a strange case: it seems to retrospectively apply the law [about Informed Consent] for England which was implicit in the MCA (an Act of 2005, which is not law in Scotland), to Scotland back in 1999 – so I agree with the comment by Santhanam Sundar (a consultant in Nottingham) that:

    ‘The recent landmark decision in Montgomery v Lanarkshire Health Board has re-defined legally valid, informed consent. (1) (2). Unfortunately, the ruling seems to trample on the defendants’ 'Right to a fair trial'.
    The injuries due to medical negligence occurred in 1 October 1999. But a number of guidelines, books and judgments which were referenced in that ruling were published after the incident in question. It is manifestly unfair to reach a judgment on an action using material published after the event. As a non-expert, I am very perturbed and perplexed that no one seems to take notice of this glaringly obvious unfairness.’

    I had noticed that – it was obvious, as soon as I read the media reports of Montgomery – and it is ‘strange’ (I think the court, was ‘taking advantage of this case, to make clear that ‘medical paternalism is now out – patients make their own chocies’’): but I’ve been sticking to the ‘so what is the law at the moment’ issue, in my own posts.

    You can download the Montgomery Court Ruling (assuming the link posts properly), if anybody wants it, from:

    Unsuitable or offensive?
    michael stone
    michael stone | 30-Mar-2015 2:16 pm

    If you copy the link to the Montgomery case, and then paste it into a browser address bar, it does go to the PDF of the Montgomery ruling.

    Unless I've missed it, Montgomery has still not reached NT - which seems odd, because it has made clear that Informed Consent is the law, and that the 'informing' is a necessary part of obtaining consent.'

    Unsuitable or offensive?

    thank you. both apply!

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  • michael stone

    Anonymous | 30-Mar-2015 2:46 pm

    I am completely baffled by that post - I have no idea, what its point is supposed to be.

    I don't understand why Anonymous has fished out my most recent piece about Montgomery on BMJ, as opposed to the previous series of pieces where I was effectively 'arguing with a doctor in Australia'.

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  • michael stone

    I am wondering why Anonymous didn't chose this article from the BMJ, by Dr Lewis, a retired GP (this has attracted a lot of 'likes' quite quickly):

    Re: Update on the UK law on consent

    Neither Shyan Goh nor Michael Stone need apologise for their keen interest in ethics and Law. Their debate is well-informed, civilised, and is teaching me a lot. Like our NHS, let's keep it public !

    Perhaps it is because unlike the BMJ and Dr Lewis, Anonymous isn't keen on debate ?

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  • can I just say - well done to the hospital wards in the report.
    I think they have been forgotten!

    Unsuitable or offensive? Report this comment

  • michael stone | 31-Mar-2015 2:01 pm

    because I am not keen on you does not mean I am not keen on reasoned debate with experts and others in my profession and anybody else. what a stupid, senseless and insulting deduction you make. it is very rare I would exclude anybody from discussion but you are a total embarrassment! you most recent remark just goes to show how poor your skills of reasoning are! go away and stop wasting everybody's time which would be better spent on patients and informing their care. you are a hindrance! now if you don't mind I am off to a multidisciplinary discussion on palliative care with the real profis. patients, their families and all the different services involved in their care include the TV crew involved in the filming for their documentary. in case you are unaware it is palliative care week to seek to improve the very best drawing from the already very high standards we offer and raise everybody's awareness and offer support and training so that the public also know how best to respond in various facilities and in the community. and no, I do not wish to discuss the subject further with you I also need my time to switch off and enjoy other non related things and recharge my batteries so that patients can benefit from the very best. you totally undermine and underestimate all that healthcare professionals can offer and do to aid and accompany our patients and their entourage and our colleagues and others along the path of the process of dying.

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  • michael stone

    Anonymous | 31-Mar-2015 9:19 pm

    'you totally undermine and underestimate all that healthcare professionals can offer and do to aid and accompany our patients and their entourage and our colleagues and others along the path of the process of dying.'

    Totally untrue - I am not undermining anybody, and I am not underestimating HCPs - that assertion is absolute rubbish !

    I'm saying that EoL is far from perfect, and that HCPs alone will not create better-balanced EoL Care/behaviour, because professionals inevitably fall prey to some 'perspective bias' [as, indeed, does everyone, professional or layman]. Which is nothing like, what you are accusing me of doing.

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