Aneurin Bevan University Health Board (ABUHB) has taken a collaborative approach to several advance care planning (ACP) /Future Care Planning initiatives/programmes working with primary care, secondary care, care homes and the voluntary sectors. This has been strategically driven by the EOL Care Delivery Plan, the Gwent Palliative Care Strategy (2015-2018) and more recently the ABUHB EOL Board (2018). All projects are directed through the ABUHB ACP work stream with wide membership incl statutory and voluntary sector representation from across ABUHB/Gwent.
Development of ACP Model
ABUHB is passionate about embedding the ethos of ACP into practice and has developed an ACP model aimed at achieving this vision. The model is known as the ACP Triple E model which aims to empower individuals through education to engage with ACP conversations.
The ACP triple e model aims to
- Increase awareness of the benefits of ACP to the public, health and social care professionals and stakeholders
- Improve the ACP knowledge, skills and confidence of health and social care professionals to engage with ACP conversations.
Within the structure of the ACP triple e model, ACP champions are being identified and trained in all areas of practice, empowering them to take ownership of this model to ensure the ACP ethos can be embedded into practice, can be cascaded throughout the UHB and ultimately sustained.
ABUHB have taken the approach of ensuring equitable ACP training is accessible to all within this very large UHB by developing an ACP blended e-learning programme. This provides the minimum ACP education aimed at all health and social care professionals. It also provides the baseline for the ACP champions training programme which is then supported by 2 ACP workshops and communication skills training that includes Sage and Thyme and a 2 day advanced communication skills course, based on Maguire, with role play.
The ACP e-learning is available to all via ESR and learning @wales.
There is foundation and intermediate level :
000NHS Wales-Advance Care Planning Foundation (for up to band 4)
000NHS Wales Advance Care Planning Intermediate (for band 5 and above)
The public awareness element of the ACP model promotes the concepts of Byw Nawr/ Live Now (Dying Matters in Wales). The awareness events include numerous formats including table top stands at hospital sites and in public areas, informal and formal presentations at numerous forums and events. ABUHB have used the feedback from the public engagement to develop merchandise including leaflets and posters and use several formats of sharing information depending on the audience. The bespoke interactive lotto game is particularly successful and generates very meaningful ACP conversations in a variety of settings.
Evaluation of ACP Model
The ACP model has been piloted within the specialities of respiratory and heart failure with the support of R&D. Quantitative and qualitative data has been collected to inform the model’s development and to evaluate its effect on changing practice.
Dissemination of ACP Model
As well as respiratory and heart failure the ACP model is currently being disseminated throughout primary, secondary, care home and voluntary sectors in a structured format. Areas including respiratory, heart failure, mental health, renal, Parkinson’s, frailty, colorectal CRT and CHC have shown particular interest in the ACP Champions Programme to date. District nurses, GPs and practice staff have been involved with our projects and pilots and are also embracing the ACP model.
Within primary care there is a specific initiative providing ACP awareness training across primary care and local authorities. This has been led by the Primary Care & Community Division Professional Development Team with the ACP in Primary Care & Care Homes Project. This has involved delivery of ACP training to residential and nursing homes across the ABUHB/Gwent. There has been significant success with increasing the numbers of ACP’s in place for Residential and Nursing home residents.
Other ACP initiatives/projects
· ACP Scoping Exercise
This was carried out to establish the baseline levels of ACP recording, methods of ACP documentation and information, and IT infrastructure used and available to all providers across ABUHB/Gwent.
· ACP Letter Pilot
This included the development of an ACP letter template for sharing of patients’ future care wishes. Myrddin indicator was added and the new letter category was added to CWS. The ACP template was piloted within 2 localities in Gwent – 2 consultants with 2 community specialist palliative care teams. The audit of this pilot demonstrated both aims were met and the data generated led to further projects
· Special Notes Project
This collaborative project with primary care, OOHs and palliative care resulted in redesign of Out of Hours palliative care special notes. The project improved accessibility and dissemination of the special notes form
· Vision 360 Toolkit Development and Pilot.
A collaborative project (NHS, Macmillan, and Marie Curie), involving Primary Care, Out of Hours and Palliative Care. It included the development of an ACP e-coding template for primary care practices. This was a multi-modal intervention pilot delivered through 6 Gwent GP practices. IT/education/facilitation was provided as well as implementation of the ACP Triple E model for ACP education and facilitation. The pilot showed a significant increase in ACP documentation.
Advance care planning for home health staff: a systematic review. Gleeson A, Noble S, Mann M. BMJ Supportive & Palliative Care 2019; Published Online First: 26 February 2019. doi:10.1136/bmjspcare-2018-001680
ACP Triple E model
Highly Commended at Staff Recognition Awards December 2017
Accepted for oral presentation at All Wales Palliative Care Conference at Gregynog 2017 & 2018
Poster presentation at Chief Nursing Officer Conference May 2018 Cardiff
Poster presentation at R&D Conference June 2018 ABUHB
Poster presentation at 16th World Congress of the European Association for Palliative Care (EAPC) Congress May 2019
Vision 360 Pilot
Oral presentation at APM Supportive and Palliative Care Conference March 2019
Poster presentation at 16th World Congress of the European Association for Palliative Care
(EAPC) Congress May 2019