NACEL Quality Improvement
Case Studies
Explore a selection of detailed case studies featuring quality improvement projects shared by organisations.
Barts Health NHS Trust - Staff Training for Improved Care at the End of Life Outcomes
At Whipps Cross Hospital, more than 40 EOLC Champions, nurses, HCAs and AHPs were supported to lead improvements in end of life care across all wards. NACEL data guided priority areas and ensured changes were targeted and meaningful.
Patient and family stories were incorporated into staff education, with bereaved relatives’ experiences developed into training videos used for reflective learning and to reinforce the human impact of care.
End of Life Care Champions were trained in Quality Improvement methods, co‑designed ward‑level solutions and embedded compassionate care practices, including pain‑assessment prompts and bereavement‑story‑based training, helping ensure consistent dignity, symptom control and cultural sensitivity.
The project also moved from a top‑down model to a frontline‑led, data‑driven approach, supported by the EOLC Facilitator, Quality Improvement Matron and Quality Improvement team.
East Lancashire Hospitals NHS Trust - Improving End of Life Care and Bereavement Services
The project focused on strengthening End of Life Care and bereavement support within East Lancashire Hospitals NHS Trust (ELHT) for the 2025 – 2026 period. The project aimed to enhance the quality, consistency, and compassion of care delivered to patients approaching the end of life and to improve support for their families and carers.
A key driver for the initiative was the Trust’s performance in the NACEL. Historically the Trust ranked well below the national average for many of the audit measures.
The Newcastle upon Tyne Hospital NHS Foundation Trust - Palliative Care 24/7 Out of Hours Consultant Support: A Pilot
Until July 2024, out-of-hours support for patients in a Newcastle Upon Tyne Hospital or in the Newcastle community was via a local ‘Hospice Advice Line’ which for many years has been provided on a non-commissioned basis by two non-NHS hospice organisations.
There were recognised risks associated with this, including concerns about stability and sustainability of the service and acknowledgement of changes in the complexities of palliative care need in our patient group, particularly those having care under tertiary services (e.g. those awaiting heart and lung transplantation). These patients were benefiting from palliative care with specialist insights in-hours and we were concerned that this was not always the case out of hours, creating a disparity.
In July 2024, to work toward the availability of equitable care both in and out of hours, the trust began a nine-month pilot project in which the seven palliative care consultants provided out of hours support to all prescribing clinicians across Newcastle.
University College London Hospitals NHS Foundation Trust - Implementing a Joint Strategy to Provide Equitable Care at the End of Life
NACEL data highlighted opportunities for improvement in religion and ethnicity recording, and spiritual assessments.
The aim was to address disparities in care by strengthening how staff recognise and respond to individual patient needs. Key areas of improvement included:
Improving the accuracy and completeness of recording patient ethnicity and
religion.
Embedding routine spiritual needs assessments into clinical practice.
Providing targeted teaching to staff on Do Not Attempt Cardio-Pulmonary
Resuscitation (DNACPR) and Treatment Escalation Plan discussions to ensure
these conversations are personalised, including cultural and faith considerations.
Providing more equitable bereavement support for families.
University Hospital of Derby and Burton NHS Foundation Trust - System Working and Collaborative Transparency on Improvement Needs
The project aimed to strengthen Advance Care Planning through the ReSPECT process. Internal audit findings and national audit insights highlighted gaps in staff and patient understanding and the need for more consistent, high‑quality planning.
To address this, the End of Life Team led a programme of work that combined structured improvement activity with collaboration across multiple professional groups and system partners. This included working with:
The Resuscitation Team;
The Equality, Diversity and Inclusion Team (to improve protected
characteristic data and support targeted community engagement);
Consultants holding ICB roles (to align Trust activity with Derbyshire and Staffordshire priorities and support the rollout of digital ReSPECT to ensure consistent practice across organisations).
This integrated approach reinforced that improving Advance Care Planning is a shared responsibility across the Trust and wider system, not solely the remit of specialist palliative care.
Dorset County Hospital NHS Foundation Trust - Personalised Care and Support Planning
To enhance and improve the training and education offered, and to enable an increase in the number of staff receiving teaching, Dorset County Hospital created the End‑of‑Life Support Worker role to work alongside the End‑of‑Life Facilitator.
Over the past year, Dorset County Hospital has reviewed and updated its end‑of‑life care plan to include more detailed guidance on hydration, nutrition, diabetes and Parkinson’s at the end of life, as well as expanded sections on support for families. The updated plan was initially introduced on two wards, supported by both classroom‑based and one‑to‑one teaching, with minor adjustments made in response to feedback.
The new care plan is now being rolled out across the hospital.
Harrogate and District NHS Foundation Trust - Specialist Palliative Care Provision
Palliative and End of Life Care work plan focused on enhancing generalist palliative and end of life care across the locality through:
Development and implementation of evidence‑based guidelines
Coordination and delivery of palliative and end of life care education
Leading the Harrogate and District Foundation Trust end of life care strategy
Active participation in locality, Integrated Care Board and regional palliative and end of life care strategic groups