Background: Hospitalisation during the last weeks of life when there is no medical need or desire to be there is distressing and expensive. This study sought palliative care initiatives which may avoid or shorten hospital stay at the end of life and analysed their success in terms reducing bed days. Methods: Part 1 included a search of literature in PubMed and Google Scholar between 2013 and 2018, an examination of governmental and organisational publications plus discussions with external and co-author experts regarding other sources. This initial sweep sought to identify and categorise relevant palliative care initiatives. In Part 2, we looked for publications providing data on hospital admissions and bed days for each category. Results: A total of 1252 abstracts were reviewed, resulting in ten broad classes being identified. Further screening revealed 50 relevant publications describing a range of multi-component initiatives. Studies were generally small and retrospective. Most researchers claim their service delivered benefits. In descending frequency, benefits identified were support in the community, integrated care, out-of-hours telephone advice, care home education and telemedicine. Nurses and hospices were central to many initiatives. Barriers and factors underpinning success were rarely addressed. Conclusions: A wide range of initiatives have been introduced to improve end-of-life experiences. Formal evidence supporting their effectiveness in reducing inappropriate/non-beneficial hospital bed days was generally limited or absent.

IntroductionThe inclusion of leadership within the General Medical Council Outcomes has encouraged UK medical schools to incorporate leadership into curricula, although it is often delivered in classroom environments. In order to illustrate to our clinical students that leadership skills are useful irrespective of positional authority, the University of Buckingham Medical School has developed a week-long programme illustrating the impact that junior and trainee doctors can have on the National Health Service environment (in a week).MethodsStudents received lectures on leadership principles and conducted focus groups and 1 min interviews to assess the values at Milton Keynes University Hospital (MKUH). Students collated the responses, and all MKUH staff, including the executive board, were invited to hear the feedback.Findings and conclusionsThe students concluded that a review of the hospital’s values was required and the executive board committed to a review which has been completed, with the values redefined and reworded. At the end of the week, 92.3% of students felt their perspective had been broadened and some reported feeling empowered by the impact that a weeks’ work could achieve. This short course has illustrated that an active approach to leadership can demonstrate to students that leadership is not just for those in positions of responsibility and change can be achieved by anyone with ambition.

No abstract

As part of the Department of Health initiative – £30 million funding for children's palliative care in 2010/11, Children's Hospices UK successfully submitted a proposal with Help the Hospices relating to Care Quality Commission (CQC) registration and compliance with the statutory Essential Standards of Quality and Safety.The project ran between December 2010 and March 2011 developing guidance and best practice examples for hospice services in England.The project assisted children's and adult hospice services by providing information to:▶Inform future development and planning of services to ensure best practice▶Identify current services and gaps in current compliance▶Work with our partner ‘Help the Hospices’ to share project outputs and support the transition agenda between children's and adult services.The project required a mixed methodology to ensure effective delivery of the project objectives. Methodologies employed included an online questionnaire, stakeholder visits and interviews, delivery of three educational workshops, academic review of compliance techniques and partnership working with stakeholders to complete exemplar compliance assessments.The project enabled a number of outputs and analysis and these were shared with member organisations via the extranet services of both Children's Hospices UK and Help the Hospices.Outputs included:▶Establishment of information relating to registered activities across hospice services▶Provision of educational workshops led by the CQC in relation to compliance, inspection and the Judgement Framework▶The development of a ‘Compliance Toolkit’ providing information and advice relating to meeting the Essential Standards including exemplar compliance assessments▶Partnership with ‘Help the Hospices’ to further improve transition for life limited young people by understanding the population of children and young people with palliative care needs who will be moving to adult services.The presentation will focus on some of the learning from this joint venture and consider next steps.

No abstract