Why The Last 1000 Days?

Despite the hard work of caring staff, patients, particularly older people, get ‘stuck’ in hospitals, and the systems and silos in healthcare conspire to make this worse. This booklet is about the most valuable currency in healthcare – patients’ time. It would be fair to say that a significant proportion of people who get stuck in the health care system are in the last 1000 days of their life, so they are the very people who do not have time to waste.  

By focussing on the last 1000 days, our aim is to help draw attention to where time is wasted, what could be done differently and to share some examples of successes. Time really is the key; if you are against the clock, trying to get several things actioned, looking at when various services are open, competing for theatre slots, investigation times or outpatients appointments, there is rarely enough time. On the other hand if you, or one of yours, is waiting for any of the above it’s very easy to lose precious days.

However much we individually agree with the last 1000 days philosophy, nothing changes unless someone changes it. It’s very easy to think you can’t make a difference to a system, an organisation or a healthcare culture, and true you possibly won’t impact the whole system in one go. The thing is, big changes – cultural shifts – all start somewhere, usually by one person, and then the next, making a start with a small change to something they have influence over. All it takes is for each of us to be brave enough to make a stand about the things that matter to us.

The TODAY model has been created to help you to make that stand. 

About the Authors

Professor Brian Dolan, OBE

FRSA, MSc(Oxon), MSc(Nurs), RMN, RGN

Brian is the originator of #Last1000days and #EndPJparalysis.

He is Honorary Professor of Leadership in Healthcare at University of Salford, Manchester and Visiting Professor of Nursing at Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford.

In the 2019 New Year’s Honours List Brian was awarded an OBE ‘For Services to Nursing and Emergency Care

Brian has a 30+ year career in various nursing, leadership, academic and consulting roles focusing on system redesign, culture change and patient flow.

He is Director of Health Service 360 and works in New Zealand (where he is Director of Service Improvement in Canterbury District Health Board), the UK and Australia.’.

Lynda Holt


Lynda is CEO of Health Service 360, and a champion for brave leaders and difference makers.

Lynda has a background in emergency care, an NHS career spanning two decades with extensive leadership experience at organisation and national level.

She has supported health organisations to make tangible change through empowering people and focusing on patient experience.

Lynda’s work is steeped in neuroscience, and for the last 18 years she has helped people to have the impact they want through their work.

Lynda’s work is steeped in neuroscience, and for the last 18 years she has helped people to have the impact they want through their work.

This involves courage, doing what you believe in, and getting out of your own way.

Lynda has written a number of books on mindset, leadership and business development; she has been featured on radio, TV and in industry magazines.

What is 1000 Days

The Last 1000 Days is a vehicle for drawing attention to patients’ time. It is widely recognised that the elderly, the chronically ill, and those with life limiting conditions are the same people who spend the most time in healthcare settings. These are the very people who have the least time to waste.

The Last 1000 days concept has been developed to help draw attention to where & how time is wasted, to reinforce the positioning of patient’s time as the most important currency in health care and to create a sense of urgency.

By creating a sense of urgency, we prioritise what can be done, what’s in the way and what needs to be different. Making an issue out of the Last 1000 Days is important because it galvanises us to act. It creates a cause, a thing we can all get behind and a common language for change that we can share.

Of course, creating models and talking about things doesn’t change them, but raising awareness, giving people a compelling reason to change and the tools to make a difference does enable change to happen. As nurses, doctors, therapists or other people involved in the patient’s journey through the health system, we strive to do the best by patients on a daily basis. Sometimes we fall short because we are paying attention to the wrong thing – the system and processes we are used to, the way things are currently done and the time scales we have come to accept. By putting patients’ time at the centre of everything, by making it our most important currency, we create a new value system that enables us to pay attention to different things – the things that may get in the way of the care we want to give.

Two examples of this are #EndPJparalysis and #Red2Green. These will be discussed and used as examples as we showcase the TODAY model.

#EndPJparalysis (originated by Professor Brian Dolan 2016) is a simple concept that encourages patient to get up, dressed and moving while in hospital. Thus preventing complications of being immobile, including chest infections, muscle degeneration, clotting; as well as shifting patient’s perceptions ‘I’m sick’ to ‘I’m getting better’

#Red2Green (originated by Dr Ian Sturgess 2007) makes visible any delays in the patient’s journey through the system, identifies fixes and values patients’ time by not wasting it. Each is a compelling story that connects us to doing the right thing for patients, valuing their time and in doing so valuing staff time too.