Harrow Planning And Caring Together (PACT) project: Planning together with care homes residents

Care home residents may be admitted to hospital at the end of life because their wishes are not known or staff feel ill-equipped to engage with advance care planning. This project offered training to care home staff to enable them to do this.

As part of the project, 482 people trained in advance care planning which led to increases in knowledge, skills and confidence around end of life. Fifty-two residents chose to make advance care plans.

One care home became the first nationally to access “Coordinate my Care,” a system which allows shared information about end of life wishes but has significant information governance requirements. Uptake of this across the Harrow Clinical Commissioning Group area rose by 162 per cent within the first two years of the project.

A pilot guide to help care home staff spot and deal with deterioration in accordance with residents’ wishes was also developed. Learning from the project has been spread widely through presentations and publications.

Read a detailed case study about this project at HSJ Solutions


  • Tameside and Glossop Integrated Care Foundation Trust: Tameside and Glossop Digital Health Service – using digital technology to deliver place based care for frail and older people – HIGHLY COMMENDED
  • Buckinghamshire Healthcare Trust: Buckinghamshire Community Hubs
  • Dartford and Gravesham Trust and Guy’s and St Thomas’ FT: POPS: Improving care of older surgical patients
  • Doncaster CCG: Intermediate Care Service: Transforming care to help people stay well at home
  • Kingston Hospital FT: Environments of Care
  • Lancashire Care FT: Zonal engagement and observations practice in older adult mental health inpatients
  • Midlands Partnership FT and University Hospitals of North Midlands Trust: High Intensity Users Service
  • North Staffordshire Combined Healthcare Trust: Rapid Falls Improvement
  • Tameside and Glossop Integrated Care FT: Extensive Care Service
  • Warrington Together: Frailty Hub