Quality statement 15: Workforce – training

Quality statement

Health and social care workers have the knowledge, skills and attitudes necessary to be competent to provide high-quality care and support for people approaching the end of life and their families and carers.

Quality measure

Measures from End of life care strategy: quality markers and measures for end of life care (Department of Health 2009).

See also quality measures and national indicators for further information.

Structure:

a) Evidence of local arrangements to ensure that health and social care workers receive training appropriate to their role incorporating dealing with loss, grief and bereavement, and basic aspects of spiritual care, common to people of all faiths and none.

b) Evidence of local arrangements to ensure that training is informed by current legislation, national competences and good practice guidelines, where available.

c) Evidence of local arrangements to ensure that training is followed up with the use of competences as part of appraisals and professional development plans for health and social care workers to ensure that appropriate knowledge, skills and attitudes are embedded into practice and kept up to date.

Outcome:

a) Improved patient safety relating to end of life care treatment.

b) Health and social care workers who come into contact with people approaching the end of life and/or their families and carers feel confident and supported in caring for this group.

See the overview for overarching outcomes.

What the quality statement means for each audience

Service providers ensure that systems are in place to provide and assure education for all health and social care workers appropriate to their role. This should enable them to develop the knowledge, skills and attitudes necessary to be competent to provide high-quality care for people approaching the end of life and their families and carers.

Health and social care workers participate in appropriate training and engage in evaluation and supervision to ensure they have the knowledge, skills and attitudes necessary to be competent to provide high-quality care for people approaching the end of life and their families and carers.

Commissioners ensure they commission services that provide and assure education for all health and social care workers appropriate to their role. This should enable them to develop the knowledge, skills and attitudes necessary to be competent to provide high-quality care for people approaching the end of life and their families and carers.

People approaching the end of life and their families and carers are cared for and supported by staff with the knowledge, skills and attitudes needed to provide high-quality care.

Source guidance

Department of Health quality markers and measures for end of life care top ten quality marker for providers 8; and markers and measures 1.32, 1.33, 1.35, 1.37, 1.38, 1.39, 2.9, 3.3, 3.15, 3.16, 4.10, 5.9, 5.10, 6.9, 6.10, 7.8, 8.8, 9.5 and 10.3.

NHS National End of Life Care Programme draft Spiritual support and bereavement care quality markers and measures for end of life care: bereavement care 4 and spiritual support 4.

NICE cancer service guidance key recommendation 20 and recommendations 8.11 and 8.13.

Data source

Structure:

a) Local data collection. The National care of the dying audit – hospitals may be relevant.

b) Local data collection.

c) Local data collection.

Outcome:

a) Local data collection. The NHS Outcomes Framework 2011/12 indicators 5a – patient safety incident reporting, 5b – severity of harm, 5c – number of similar incidents, 5.4 – incidence of medication errors causing serious harm (not specific to end of life care).

b) Local data collection.

Definitions

The term 'workers' includes paid staff and volunteers.

Training includes formal, accredited training as well as informal or locally provided training. The level of education required for individual workers will depend on their role.

Guidance on workforce training requirements in different settings is available from the source references. Broadly, these recommend the following:

  • Curriculum content relating to end of life care contained within pre-registration and undergraduate education for health and social care.

  • Training programmes within hospitals, community settings, care homes, ambulance services and other health and social care settings including specialist palliative care services.

  • Taking into account communication skills (including issues around loss, grief and bereavement), spiritual care, assessment and care planning, advance care planning, and symptom management as they apply to end of life care.

  • Particular account should be taken of the training needs of those workers involved in discussing end of life issues with patients, families and carers.

  • Specialist palliative care services to act as an educational resource for training generalist palliative care in the community, including GP practices, district nursing services, care homes and community hospitals, and acute hospitals and other services.

  • Medical and district/community nursing out-of-hours workers should be competent in providing general palliative care, including symptom management, the use of syringe drivers, assessment of need, communication skills and providing support both to the patient and to carers in relation to 'do not attempt cardiopulmonary resuscitation' orders (also 'do not attempt resuscitation' orders), and advance decisions.

High-quality care and support is safe, effective and delivers a positive experience for people approaching the end of life and their families and carers.

Strategies for developing the workforce may include the use of End of Life Care for All (e-ELCA) (e-learning resource commissioned by Department of Health) in conjunction with face to face teaching, work-based learning and peer education.

Training needs within other appropriate settings not specified above, such as homeless hostels and prisons, should also be considered.

Examples of staff competencies in spiritual care are available from Marie Curie Cancer Care spiritual and religious care competencies for specialist palliative care. These outline four different competency levels for staff working in all areas of care, both specialist and non-specialist.