In this new series ehospice will be speaking to leaders in the hospice and palliative care sectors, along with individuals who are helping to raise awareness of the important work hospices do. Our first interviewee is Professor Max Watson, an eminent palliative care clinician, author, visiting professor at St Margaret’s Hospice, and the driving force behind Project ECHO in Northern Ireland.
He joined Hospice UK’s clinical team last May as Project ECHO Programme Director, playing a key role in delivering the programme in support of Hospice UK’s five-year strategy. Project ECHO is a lifelong learning and guided practice model that revolutionises medical education and clinical team support. ECHO – which stands for Extension of Community Healthcare Outcomes – was originally developed at the University of New Mexico, in the US.
At the heart of the ECHO model are its hub-and-spoke knowledge-sharing networks. These networks are supported to form ‘communities of practice’ which share knowledge and expertise. A trained facilitator, who is based at a hub, guides their virtual meetings, with the support of a dedicated administration and IT team.
Here he tells us about his role at Hospice UK and his career highlights do date.
What opportunities do you see in your new role at Hospice UK?
There are fantastic opportunities. We are only looking after four per cent of the people who die in the UK, so it is a tiny proportion of in-patients. The majority of people will be dying in hospital, or care homes, and so for us to maximise our impact we need to reach out and work with others in a collaborative way.
The ECHO methodology allows hospices to, for example, reach out to nursing homes and their community support teams, and work with colleagues in old age medicine, frailty management, renal medicine, and cardiology. We have the chance to build these communities which helps us multiply our impact.
What are your goals for the next year or so?
The first set of goals I had for starting to work with Hospice UK was to get us ready to be a training centre, or a superhub. In order to do that we had to start running our own ECHOs, and demonstrate to the Echo Institute that we were in a fit state to be a major training centre.
We have already had interest from more than 50 organisations who want to be trained to become ECHO hubs. We are on track for that, so in a year I hope we will have trained at least 40 hubs across the country. We have developed close collaborative relationships with Highland Hospice in Inverness and St Luke’s Hospice in Sheffield, so we will be able to provide hub training in Scotland, Yorkshire, and London.
What has the impact of ECHO been so far?
The first ECHO in the UK was in the Northern Ireland Hospice for their community palliative care nurses all over the region, nearly 40 nurses. ECHO improved the knowledge of the nurses, and improved self-efficacy. In other words, they became more confident in handling different conversations and clinical scenarios.
With the government, the ECHOs that we ran for them, in our work with optometrists after just nine ECHO sessions the referral patterns of those opticians managing glaucoma and macular degeneration had changed. They were looking after [patients] more, referring less, and the Professor of Ophthalmology was really confident in the care that these opticians could deliver across Northern Ireland.
ECHO allows people to reconnect, to get that support, that knowledge, and that peer-to-peer encouragement.
What do you see for the future of ECHO, both in the UK and around the world?
Around the world ECHO is really taking hold. I was involved in helping to set up an Echo in South India which connects right across India and into Bhutan and Nepal. That ECHO began in February  and it has already had an impact on the lives of more than 200,000 patients.
As a way of linking people and sharing knowledge it has been really good. And the IT involved is so simple now relative to what things used to be, because it is all cloud-based. If a country like India, with all the vagaries of its electric and IT systems can work so effectively with ECHO, it shows the way forward.
In Uruguay, I was involved in helping them link their main palliative care centre hospital in Montevideo with 24 centres across the country, and that has now been running for nearly two years, adding to the consistency in care across the country. My hope for ECHO internationally is that again, it will maximise this very special but limited palliative care resource.
I was in Pakistan a little while ago, met at the airport by my minder with his gun, so the opportunity for me as a westerner helping to deliver palliative care services across the Swatt Valley would be very limited. But with Project ECHO, I can participate from Ireland, in an ECHO which will link in with primary care providers across Pakistan. That is really good for isolated practitioners, it is also really good for me to understand more about local situations.
Within the UK, my hope is that in line with Hospice UK’s strategy, we reach out to more people, to more groups who have not had access to our services, and to link in with others who are delivering palliative care. That across the UK individual hospices will maximise their impact by linking in with care homes, with their community teams and then with their clinical colleagues in the NHS, to improve the care for example of people with frailty, who need a little bit of palliative care, of geriatrics, psychogeriatrics, a little bit of social work, and a little bit of GP input, by building a community of practice to improve the quality of decision-making that can be made for this very challenging growing population.
I hope these communities of practice will spring up across the country and the NHS will see what hospices are providing through Project ECHO and say “we want some of that too.”
Over the course of your career what have your highlights been so far?
I trained in theology and changed to general practice, then went to Nepal, and that had a huge impact. I worked in Nepal for eight years, seeing the real relevance of palliative care in resource-limited countries. I then came back, moved into palliative care and had the privilege of being trained in London and Belfast and working with Dame Cicely Saunders, so I got to spend time at St Christopher’s when she was still present there.
I had the real fortune of teaming up with Dr Caroline Lucas and Dr Andrew Hoy at the Princess Alice Hospice in Esher where I went for training, and they were so supportive of my projects to develop the European Certificate in Palliative Care, and the Palliative Adult Network Guidelines, which then led to the Oxford Handbook of Palliative Care. We took the European Certificate to India, that was translated, and more than 18,000 people have completed it across the world, which is just amazing.
I have been very fortunate in having relationships that have been very supportive and encouraging, and that have allowed me to have a very interesting career in writing, education and reaching out to people.
For more information visit Project ECHO