Background The Leeds Teaching Hospitals NHS Trust (LTHT) is a flagship Trust for the NHSIQ ‘Transforming End of Life Care (EoLC) in Acute Hospitals programme’ .

Previous EoLC initiatives had been led by the specialist palliative care team (SPCT) within existing resource supplemented by some non- recurrently funded projects. However, a step change in improved EoLC in this 2000-bedded acute trust required implementation at scale and a corporate approach to sustainability.

Aims To develop a service improvement programme across the organisation to ensure that all patients at LTHT approaching the end of their life are identified and receive the best quality of care with their needs and the needs of their families met appropriately, within available resources.

Method An approach was piloted within two specialties for six months, led by a triumvirate of senior manager, and SPCT lead nurses and clinician. The learning gained from the pilot informed a successful bid to the Care Pathways Programme Board for a corporate EoLC Service Improvement Project, with dedicated project manager support and Trust Board leadership (Medical Director)

Results Stakeholders identified 4 workstreams (Education, Metrics, Interface with community, and Patients and Public Information Needs).

EoLC Project Board formed with senior representatives from across the trust, and with clear communication and accountability back to the Board.

Linkage made with other EoLC initiatives including the engagement of EOLC champions across the Trust.

EOLC process mapping sessions informed the work.

Conclusion In order to implement measurable changes across a large Trust, dedicated project management skills and time are required to ensure momentum and connectivity between inter-related workstreams; to coordinate clinicians across specialties and general practice, and to link into trustwide structures which have the necessary authority and recognition to effect change.

A leadership triumvirate of manager, lead clinician and senior nurse works well.