What is the challenge your project is going to address and how does it connect to the theme of 'How can we improve across system boundaries?​

The Care Home population on the Fylde coast exceeds 3,800 residents in 99 care homes, many, if not most, of whom are in their last 1000 days of life. The NHS describes good end of life care as “helping you live as well as possible until you die, and then allow you to die with dignity”. Sadly this frequently does not happen and many residents do not die in their preferred place as they have not had discussions about their preferences. Residents often deteriorate faster when spending time in hospital rather than their usual place of care and people, including care home residents, who wait more than eight hours in an Emergency Department before admission to an inpatient bed are at greater risk of death within 30 days. The challenge is to improve cross boundary working to prevent avoidable admissions and enable residents to stay where they wish to spend their remaining days.

What does your project aim to achieve?

The goal of this programme is to give our people, primarily residents in our local care homes, the ‘Gift of Time’. This refers to how we, in the health and social care system, can support a person to spend their precious time as they wish, harm free, in their last 1000 days. Focusing on this concept, the programme will further build upon the partnership with our residents, system partners and the community to improve services and enable patients to be in the place they live longer. Along with a quality improvement coach, social and health partners care homes staff and residents, we will deliver improvements to further reduce unnecessary time residents spend in emergency healthcare settings in their last 1000 days of life.

This programme is currently still in a learning phase and the goal is to scale up the impact and number of residents it reaches.

How will the project be delivered?

Blackpool Teaching Hospital are currently in the second learning, or ‘Understand’, phase of the Last 1000 Days collaborative, working closely with 10 care homes. Prior to the start of phase 3 we aim to fully evaluate this programme in order to understand how we can spread and sustain this programme of work on a much larger scale, increasing the number of residents lives improved.

An improvement coach to increase culture, capabilities and structures needed for learning and embed improvement.

How is your project going to share learning?

This programme of work is already shared with our local social and health partners, it has been presented at the international EndPJparalysis Global Summit and in 1922, won the prestigious Health Service Journal ‘Best use of integrated partnership working in patient safety’ award for reducing falls in the target care homes by 70 per cent as well as reducing attendances to emergency departments by  73%.

The proposal to evaluate and publish this work in both peer reviewed and popular health and care journals would give another opportunity share this work more widely in addition to impacting a larger number of residents on the Fylde coast.

As part of the Lancashire and South Cumbria integrated care system any programme learning and progress will be shared.