Quality statement 16: Workforce planning
Generalist and specialist services providing care for people approaching the end of life and their families and carers have a multidisciplinary workforce sufficient in number and skill mix to provide high-quality care and support.
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: Evidence of local service specification(s) that explicitly include generalist and specialist end of life care services in order to provide a multidisciplinary workforce to meet the needs of the local population identified in local needs assessment(s).
Outcome: See the overview for overarching outcomes.
Service providers (generalist or specialist) ensure that systems are in place to provide a multidisciplinary workforce sufficient in number and skill mix to provide high-quality care and support to people approaching the end of life and their families and carers.
Health and social care professionals work as part of a multidisciplinary workforce that provides high-quality care and support to people approaching the end of life and their families and carers.
Commissioners ensure they commission generalist and specialist palliative care services with a multidisciplinary workforce sufficient to provide high-quality care and support to people approaching the end of life and their families and carers.
People approaching the end of life and their families and carers receive high-quality care and support because there is enough staff with the right skills to meet their needs.
Department of Health quality markers and measures for end of life care 1.3, 1.20, 1.22 and 1.36.
NICE cancer service guidance key recommendation 19 and recommendations 8.22 and 8.24.
Structure: Local data collection.
The National Council for Palliative Care undertakes a workforce survey looking at staff working in palliative care in a variety of settings.
The terms 'generalist' and 'specialist' in relation to end of life care are defined on page 7). Broadly, generalist services include GPs, district nurses and general ward doctors and nurses. Specialist services deliver specialist palliative care, by palliative medicine physicians, clinical nurse specialists or specialist allied health professionals, for example, speech and language therapists. Specialists outside of palliative medicine may also be part of the multidisciplinary team, for example nephrologists, neurologists, cardiologists and geriatricians.
High-quality care and support is safe and effective and delivers a positive experience for patients, families and carers.
The End of life care strategy from the Department of Health recommends appropriate provision of essential services to meet the needs of the local population. These services include, but are not limited to:
nursing services (including visiting and rapid response services)
personal care services
access to pharmacy services
access to equipment
specialist palliative care.
NICE cancer service guidance recommends the following composition for specialist palliative care teams:
palliative medicine consultants
palliative care nurse specialists
a team secretary/administrator.
Furthermore, it recommends a range of expertise provided by:
chaplains/spiritual care givers
professionals able to deliver psychological support equivalent to level 3 of the psychological support service model (see topic 5, psychological support services).
This expertise may be provided by named individuals on a full-time, part-time or regular sessional basis.
In Consultant physicians working with patients, the Royal College of Physicians recommends between 1.56 and 2.00 whole-time equivalent (WTE) consultants in palliative medicine per 250,000 population. Service requirements for specialist palliative care are detailed in quality statement 10.
The Department of Health document NHS chaplaincy: meeting the religious and spiritual needs of patients and staff, recommends the following for adequate chaplaincy provision:
Every 35 beds = 1 unit of chaplaincy-spiritual care.
Every 500 WTE staff = 1 unit of chaplaincy-spiritual care.
Each unit of chaplaincy-spiritual care is deemed to last for 3.5 hours. These units are intended to cover the general responsibilities of the healthcare chaplain – additional units are required for specific responsibilities.
Services should be efficiently coordinated in accordance with quality statement 8 on coordinated care, to ensure that multidisciplinary input does not become burdensome to people approaching the end of life and their families and carers or services themselves.