MARIE CURIE PALLIATIVE CARE INSTITUTE LIVERPOOL, UNIVERSTIY OF LIVERPOOL, UK SERVICE INNOVATION & IMPROVEMENT DIVISION Marie Curie Palliative Care Institute Liverpool (MCPCIL) University of Liverpool, UK Hospital Site Directorate of Specialist Palliative Care 1st Floor Linda McCartney Centre The Royal Liverpool and Broadgreen University Hospitals NHS Trust Prescot Street Liverpool L7 8XP Deborah.murphy@rlbuht.nhs.uk T: +44 (0) 151 706 2274 F: +44 (0) 151 706 5886 KEY PROJECTIS ACROSS THE PORTFOLIO At: January 2013 Marie Curie Palliative Care Institute Liverpool (MCPCIL), University of Liverpool, UK Department of Molecular & Clinical Cancer Medicine University of Liverpool Cancer Research Centre 200 London Rd Liverpool, L3 9TA T: +44 (0) 151 794 8806 Web: www.mcpcil.org.uk Integrated Clinical Sites Marie Curie Palliative Care Institute Liverpool (MCPCIL) University of Liverpool, UK Hospice Site Marie Curie Hospice Liverpool Speke Road Woolton Liverpool L25 8QA j.e.ellershaw@liverpool.ac.uk T: +44 (0) 151 801 1400 Marie Curie Palliative Care Institute Liverpool (MCPCIL) Page 1
CONTENTS Page (s) Introduction 3-5 Institute Mission / Vision / Values 6 Institute Organisational / Operational Structure 7 9 Institute Project / Programme Portfolio 10 Ø Service Innovation & Improvement Key Projects across the portfolio 10 13 Marie Curie Palliative Care Institute Liverpool (MCPCIL) Page 2
INTRODUCTION The Marie Curie Palliative Care Institute Liverpool (MCPCIL), University of Liverpool, UK was formed in 2004. It is a partnership between The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Marie Curie Cancer Care and the University of Liverpool. The Institute aims to make a real and sustained difference to care at the end of life from bedside to policy through service innovation and improvement research and development and knowledge transfer to inform clinical excellence. The Institute has a multiprofessional profile and is under the academic and clinical leadership of Professor John Ellershaw, Professor of Palliative Medicine at the University of Liverpool. Institute personnel hold influential positions nationally and internationally within the field of palliative and end of life care. The Institute sits within the Department of Molecular & Clinical Cancer Medicine and since March 2012 has operated from our new University site within the Cancer Research Centre here in Liverpool. The site was officially opened on 5th November 2012 by Professor Sir Michael Richards, National Clinical Director for Cancer and End of Life Care. The three core partners of the Institute place it in a unique position to attract funding utilising its Department of Health, NHS and charitable affiliations. The Institute s success in securing financial grant support is evident through the growth of its sizeable portfolio which includes support from the European Union, the National Cancer Research Unit (NCRI) and the National Institute for Health research (NIHR) amongst other funders. The Institute promotes a quality research culture where the pursuit of excellence is encouraged and where there is visible strong research leadership and expert management. The research and innovation portfolio grows each year with more than 100 projects undertaken in the first eight years of the Institute s existence. The esteem of key personnel attracts commissions to contribute to some of the most innovative and influential texts within the field of palliative care. The track record of the Institute is one of successfully attracting and delivering a diverse but interrelated portfolio of research activity. Working with an international network of collaborators, the Institute has developed methodological expertise, including ethical complexities in conducting interdisciplinary research in the last hours or days of life, that ideally positions the Institute to address research questions and associated complex issues in this area. The close working of the Institute with its integrated clinical teams, the Directorate of Specialist Palliative Care at the Royal Liverpool and Broadgreen University Hospitals NHS Trust and the Marie Curie Hospice Liverpool enables the rapid and effective transfer of research into clinical practice, thus having a direct influence on those who commission, design, deliver and receive healthcare. This makes a direct and sustained influence on improving care of the dying at the bedside. The Liverpool Care Pathway for the Dying Patient (LCP) Continuous Quality Improvement Programme is a key programme within the Institute portfolio. The sole purpose of the Liverpool Care Pathway for the Dying Patient (LCP) programme is to provide the best possible care for people in the last days or hours of their life. Since the 1990s, the LCP has been developed supported by evidence and research of the highest quality, including a programme of national Marie Curie Palliative Care Institute Liverpool (MCPCIL) Page 3
clinical audit designed to identify areas for clinical and organisational improvement. Eight years after the LCP was first approved as recommended NHS practice, it is now widely used in hospitals across Britain and in at least 21 other countries. Another key programme within the Institute was the OPCARE9 Programme, an international collaboration of nine partner countries with the aim of optimising research for the care of cancer patients in the last days of life. It was funded by a 2.2 million European Union 7th Framework Coordination and Support Action Grant. OPCARE9 systematically investigated current practice across a range of healthcare environments and diverse cultures, in order to reach consensus on optimum care to be delivered at this critical stage of a person s journey. The Institute strives to respond to and to drive the public policy agenda to promote patient choice, dignity and respect through broader societal engagement and working in partnership with local, regional, national and international bodies. Through its various research and quality improvement projects, the Institute aims to promote safe, effective, patient centred, timely, efficient, equitable and measurable care at the end of life. Living and dying well is a core value that informs the work of the Institute, and we believe that good communication, care and compassion are paramount in supporting patients to achieve this goal. Working collaboratively across Europe and beyond has strengthened our commitment and capacity to undertake high quality, robust research, to utilise service innovation and improvement methodology and knowledge transfer to improve care of the dying in the 21st Century. Marie Curie Palliative Care Institute Liverpool (MCPCIL) Page 4
The way we care for the dying reflects the kind of society we have created and live in. At the Institute we recognise the need for research and knowledge transfer that retains a patient and carer focus which promotes practical application rooted in research. We aim to be an international leader for research excellence that makes a difference for the dying on a global basis Professor John Ellershaw Director Marie Curie Palliative Care Institute Liverpool (MCPCIL) We believe the Institute is uniquely placed to drive up the quality of care of the dying by inspiring, supporting and truly empowering patients, carers and healthcare workers and commissioners so that a good death in our society is the norm not the exception Deborah Murphy Associate Director Marie Curie Palliative Care Institute Liverpool (MCPCIL) The Institute has developed a dynamic program of research focused on care at the end of life and is making international change through collaborative research and practice Their collaborative strategy has created a broad knowledge base and real change in end of life care across the UK and internationally Professor Susan Block Chair, Department of Psychosocial Oncology and Palliative care Dana Farber Cancer Institute Professor at Department of Medicine and Psychiatry, Harvard Medical School Marie Curie Palliative Care Institute Liverpool (MCPCIL) Page 5
MARIE CURIE PALLIATIVE CARE INSTITUTE LIVERPOOL - MISSION VISION VALUES Our Mission The Institute s mission is to be a centre of excellence and an international leader in care of the dying from bedside to policy through service innovation, research and development and knowledge transfer. It enables clinical excellence that makes a real and sustained difference to dying people and their relatives and carers, in order to influence those who shape and deliver healthcare for the dying on a global basis. Our Vision The Institute s vision is to be an international leader, a collaborative partner and a centre of research excellence for care of the dying. It aims to facilitate and support those who want to make a local, national or international difference to drive up quality for care of the dying. Our Values 1. Patient Focus: We must make a real and sustained difference at the bedside for dying patients and their carers. 2. Subject Focus: We recognise the need to use collective expertise in developing the most appropriate service innovation, research and development, and knowledge transfer and evaluation methodologies. This will enable us to retain a patient and carer focus, balancing practical application with robust investigation in care of the dying. 3. Transparency: We are an Institute that values people first and to achieve our mission we must engage those who shape and deliver healthcare across international boundaries. We aim to report success and failure and always seek the opinion of people outside of our Institute. 4. Collaboration: We recognise that to achieve our mission we must collaborate within our Institute and with external collaborative partners to earn and preserve the trust of those we aim to support, locally, nationally and internationally Strategic Priorities Ø Service Innovation that drives up sustained quality and productivity. Ø Research and Development that makes a difference to patient care. Ø Knowledge transfer rooted in research excellence. Ø Clinical excellence in care of the dying. Ø International collaboration. Lay Summary Our aim at the Institute is to be a recognised centre which improves the care of the dying, locally, nationally and internationally. This is mainly done through research, training and also finding new ways to help doctors and nurses to provide the best care possible and improve care for patients, their families and loved ones. We work with other experts on studies that give us strong and reliable evidence. This evidence tells us about the best way to care for and support patients and their families at the end of life. It also shows us what changes will be needed within our health care to support doctors and nurses to provide better car Marie Curie Palliative Care Institute Liverpool (MCPCIL) Page 6
MARIE CURIE PALLIATIVE CARE INSTITUTE LIVERPOOL ORGANISATIONAL STRUCTURE Operational Structure across the Institute portfolio The Institute sits within the Department of Molecular & Clinical Cancer Medicine and since March 2012 has operated from our new University site within the Cancer Research Centre here in Liverpool. The Institute engages with the two clinical sites the Directorate of Specialist Palliative Care at the Royal Liverpool and Broadgreen University Hospitals NHS Trust and the Marie Curie Hospice Liverpool to drive up the quality for care of the dying from bedside to policy. The Institute is currently engaged in over 50 projects based within 4 divisions Service Innovation and Improvement Division Strategic Lead: Deborah Murphy Operational Lead: Maureen Gambles The Service Innovation and Improvement Division comprises of programmes, projects and activities that drive up quality for care of the dying through service redesign, evaluation, innovation, service improvement and culture change. The Liverpool Care Pathway for the Dying Patient (LCP) Continuous Quality Improvement Programme which is internationally acclaimed for promoting high quality of care for the last hours or days of life sits within this division. The Service Innovation and Improvement Division aims to put innovation and research into action by applying proven quality improvement tools and technologies and assessing progress through systematic measurement. Research and Development Division Strategic Lead: Prof John Ellershaw Lead: Stephen Mason The Research and Development Division focuses its expertise on the care of dying patients. Through the innovative application of established research methodologies, the division seeks to make a real and sustained difference to care at the bedside, whilst influencing local, national and international policy. The breadth of the division's research engages both basic and applied healthcare science in the drive to improve the care delivered to the dying patient and their family. Business Development and Support Lead: Jane Dowson The Business Development and Support Division is responsible for operationalising the MCPCIL strategy. This includes securing and managing financial and personnel resources, planning business continuity and ensuring that the deployment of its resources meets the needs of its stakeholders and partners. It is also responsible for ensuring that dissemination of its activities reaches appropriate target audiences, communicating information and news from its diverse portfolio though its website as well as other media. Marie Curie Palliative Care Institute Liverpool (MCPCIL) Page 7
Learning and Teaching Division Lead: Anita Roberts The Learning and Teaching Division drives the knowledge transfer agenda, leading the way in providing training for clinicians and other allied healthcare professionals in various aspects of palliative and end of life care. The Institutes has a unique position in undertaking pioneering research as well as having clinical and teaching roles. This combined approach enhances the reputation of the Institute and helps to attract a growing number of participants from across the UK and overseas to access the high quality professional courses it offers. Over 1000 participants every year from across the UK and overseas attend a wide range of academic and continuing professional development learning opportunities we provide. MCPCIL is the University of Liverpool s lead for medical education for palliative medicine and a recent national Voices survey of bereaved relatives in England identified the care from doctors in Merseyside amongst the highest standard in the country. The Institute is a core member of the European Association for Palliative Care (EAPC) medical education steering group, leading on two important curriculum projects, structured as task forces. Our Masters programme in the Ethics of Cancer and Palliative Care is an exciting and unique joint venture uniting academic, clinical and practical expertise with Keele University and is the only such course of its type across the world. The Institute has a unique position in undertaking pioneering research into palliative care and educational and knowledge transfer approaches that is rotted in research excellence. This combined approach enhances the reputation of the Institute and helps to attract a growing number of participants to access the high quality professional courses that continue to grow in demand. Marie Curie Palliative Care Institute Liverpool (MCPCIL) Page 8
MARIE CURIE PALLIATIVE CARE INSTITUTE LIVERPOOL OPERATIONAL STRUCTURE Partnership Board Institute Strategy Group (ISG) Institute Management Group (IMG) Service Innovation & Improvement Division Research & Development Division Business Development & Support Division Learning & Teaching Division Directorate of Specialist palliative Care RLBUHT Marie Curie Hospice Liverpool Marie Curie Palliative Care Institute Liverpool (MCPCIL) Page 9
MARIE CURIE PALLIATIVE CARE INSTITUTE LIVERPOOL - PROJECT PORTFOLIO FOUR STAGES 1 = Initiation one page protocol accepted 2 = Planning full protocol being written 3 = Implementation project / work in progress 4 = Closure outputs, dissemination & final report STAGE SI PROJECT REFERENCE BRIEF OUTLINE OF KEY PROJECT 1 SI - 015 LCP E learning programme To determine a joint approach to LCP elearning tool that could be translated across other clinical areas as a web link 2 SI 004 Advanced Care planning Advanced Care Planning programme - to determine the process towards a robust ACP Programme building on the learning across our local health economy to determine best practice / process and transferability of learning 3 SI 001 LCP Continuous quality Improvement Programme UK 3 SI 002 LCP Continuous quality Improvement Programme International 3 SI 006 Development & evaluation of an International educational toolkit to underpin the LCP 3 SI 008 Releasing time to care: Innovation of senior nursing roles across palliative care services 3 SI 011 Living Community Presence Care of the Dying Volunteers (CODV) 3 SI 012 The Liverpool End of Life Care Partnership Joint Programme EolC Case Managers Supportive Discharge Academic Palliative Care Unit (APCU) The coordination of the LCP Continuous quality Improvement Programme UK The coordination of the LCP Continuous quality Improvement Programme International To Develop & evaluation of an International educational toolkit to underpin the LCP continuous Quality Improvement Programme To support 3 secondments within Service Innovation & Improvement from the Specialist Palliative Care clinical service and enhance the learning and leadership potential of the individuals and the services To support the dying patient and their family in the last hours or days of life with a trained care of the dying volunteer (CODV) at the bedside to create a living community presence This innovative project brings the Royal Liverpool and Broadgreen University Hospital NHS Trust and Marie Curie cancer Care in partnership to drive up the quality of care for our patients to enable them to live well and die well in the place of their choice. 3 SI 014 Rapid Discharge Home to Die Care Pathway To design / implement / disseminate and sustain a rapid discharge plan to enable a dying patient to be discharged home as a matter of urgency. Marie Curie Palliative Care Institute Liverpool (MCPCIL) Page 10
STAGE SI PROJECT REFERENCE BRIEF OUTLINE OF KEY PROJECT 3 SI 016 Supporting best care of the Dying To determine a model of best practice for care in the last hours or days of life for a dying person in prison in the Prison Service 3 SI 017 LCP Electronic document To determine an electronic version of the LCP core document that could be translated across other clinical areas as a web link and test out partnership working with company KODIT re data management into the future 3 SI 018 Development of Supportive guidance for new personnel / young researchers 3 SI - 019 Excellence in Care of the Dying : learning from the patent story, relative narrative To determine supportive / reflective / mentorship programme to support our personnel in SI Division that could be disseminated across the MCPCIL To determine clinical excellence through the learning of a bereaved relative / cares concerns - learning from the patient story the relative narrative 3 SI 020 TRANSFORM Programme Led by the End of Life Care Programme we are one of 25 first wave Trusts driving a quality improvement programme for end of life care in the hospital environment. 3 SI - 022 Enhanced Strategic Public & policy engagement programme 4 SI 010 Experience of nurses caring for patients with learning disabilities in hospital setting: a pilot study To determine a public policy engagement strategy in support of the Institute core business To determine the knowledge base of healthcare professional in the care of those with learning disabilities at the end of life & develop a healthcare professional supportive information leaflet Marie Curie Palliative Care Institute Liverpool (MCPCIL) Page 11