The must-read stories and debate in health policy and leadership.

“Everyone expects a conversation about a birth plan and we think the same should hold true for those entering the final phase of their life, too,” said Marie Curie chief nurse Julie Pearce.

Ms Pearce’s comments follow a major review, commissioned by Sir Simon Stevens, which has recommended the NHS invest organise care conversations with patients when they are at the end of their lives.

This might sound obvious to many, but the researchers called on acute medical unit and surgical unit staff to have these conversations not just when a patient could die during their hospital admission, but if they are thought to be in the final 12 months of their life.

The systematic review, done by independent researchers SSQ, found that introducing “patient-centred goals of care conversations” resulted in heightened patient wellbeing, reduced mortality rates and improved staff retention.

Alongside the benefits to staff and patients the review also estimated that such an intervention could save the NHS more than £500m per year and around £3m for individual trusts.

There are clearly multiple benefits to asking patients what they want at the end of their life – most importantly the wellbeing of the patient and their family – but the additional cost savings make the argument hard to ignore.

Opening up

“I’ve been a NHS trust chief executive for 30 years and I’ve never had a conversation like the one we’ve just been through in the last hour and a half.”

This was how David Loughton, CEO of Royal Wolverhampton Trust, summarised the discussion between a dozen NHS trust chief executives brought together by HSJ to discuss the personal and organisational impact of the pandemic. 

He was referring to the openness with which the chiefs in question had shared their feelings about what they had been through emotionally while leading their organisations throughout coronavirus.

Before the pandemic, there would have been a competitive spirit, “my organisation’s doing better than yours”, he said.

“We’ve changed as a group of chief executives”, he claimed. “And I don’t think we will ever go back because of the experience we’ve been through.”

The CEOs were all drawn from HSJ’s list of the service’s top 50 trust chief executives published in March and the full, unedited conversation can be read here.