A need to improve education to implement best practice in end of life care (EOLC) was identified across the local health and care sector in Shropshire. Discussions between the key stakeholders: Joint Training, Severn Hospice, as the local leader in EOLC, and the End of Life (EOL) commissioner at Shropshire Clinical Commissioning Group (SCCG) identified that an accredited learning pathway would provide the best outcomes for staff and people being supported at EOL. This led to a new learning programme being developed.
The programme draws upon NICE Quality Standards:
- QS13: Care for adults approaching the end of life. This quality standard covers care for adults (aged 18 and over) who are approaching the end of their life. This includes people who are likely to die within 12 months, people with advanced, progressive, incurable conditions and people with life-threatening acute conditions. It also covers support for their families and carers. It includes care provided by health and social care staff in all settings. It describes high-quality care in priority areas for improvement.
- QS144: Covers the clinical care of adults (aged 18+) who are dying, during the last 2 to 3 days of life. It describes high-quality care in priority areas for improvement.
Aims and objectives
Aim: To develop new partnerships to achieve best practice in EOLC through the provision of new education programmes.
- Support the implementation of the End of Life Strategy (2008) and NICE Quality Standards;
- End of life care for adults (QS13) November 2011
- Care of dying adults in the last days of life (QS144) March 2017 to enhance knowledge, develop skills and promote positive attitudes and behaviours at the End of Life.
- Person centred values, dignity and choice will be our corner stone.
- Raise awareness of the EOLC pathway to enable learners to better support people approaching EOL and improve the experience at EOL for people in Shropshire.
- Create a system-wide approach.
- Develop and deliver an accredited learning programme to meet the learning outcomes identified in the End of Life Skills for Care Qualification Credit Framework CQF at level 2, 3 and 5 using a multi-agency approach.
- Introduce learners to the hospice environment to challenge perceptions and overcome barriers to best practice at EOL.
- Develop knowledge and understanding of the complex and sensitive nature of EOLC and its application in the wider care and health sector by providing learning opportunities:
- In “forgotten communities” i.e. areas of rural isolation.
- To address specific EOL challenges e.g. palliative management in Chronic Obstructive Pulmonary Disease (COPD).
- Providing a conference experience in Shropshire: 'Advanced Care Planning (ACP) in Non-Malignant Conditions – Sharing Good Practice'.
- Improve communication with people when distressed via SAGE & THYME communication workshops.
- Facilitate relationships across acute, community and the hospice sector.
Reasons for implementing your project
As of 2015, the population in Shropshire was 311,380. More people live in rural areas than urban areas. The 2011 census showed that Shropshire has a higher percentage of over 65-year olds than the national average. The 2011 census also showed 44% of residents over 50 in the West Midlands compared to a national average of 36.4%. The area has a higher rate of deaths than births. The catchment area includes numerous health and care providers in Shropshire, Telford and Wrekin hospice and the local acute hospital.
A need for improved education to implement best practice in End of Life Care (EOLC) was identified across the care and health sector. Evaluation comments and feedback from discussions from Joint Training events initiated conversations with the Seven Hospice and End of Life Commissioner. This confirmed the education need, inspiring the progression of this work.
The Joint Training team at Shropshire Council approached the Severn Hospice as the recognised leader of EOLC provision and education in our local community. Discussions identified that an accredited learning pathway would provide the best outcomes for staff and people being supported at EOL.
- The End of Life Commissioner for Shropshire CCG (SCCG) is a key stakeholder, consulted and involved from the outset – priority for SCCG was a nationally-recognised accredited learning route.
- Severn Hospice is a recognised local leader in EOLC. It was engaged as a partner in identifying and prioritising learning need and developing and delivering the learning programmes
- The role of health and care providers in Shropshire was important in ensuring that the learning programme is accessible to the sector.
- Skills for Care and Health Education England in financially supporting the programme to enhance the experience of EOLC for the citizens of Shropshire.
How did you implement the project
Firstly, we needed to identify lead staff, who were knowledgeable, skilled and passionate about the subject to take the work forward. The joint training lead for accredited programmes and the lecturer/practitioner for the Severn Hospice were tasked with developing the programme. The Level 2 City & Guilds accredited course was the starting point, later developing Level 3 and 5.
The programme is now complimented by a range of EOLC learning options. This has been informed by NICE guidance and quality standards, Gold Standards Framework (GSF) and local policy. It aims to familiarise workers from different roles and settings with guidance, standards and a common language in a meaningful way to inform practice. The project began in 2013 and continues to date.
Key steps for the programme lead included:
- Develop learner resources and learner workbooks for evidence of learning for City & Guilds assessment and certification.
- Deliver training packages and mentoring sessions.
- Liaise with the county training assessment centre for assessment and certification of learner portfolios.
- Review priorities and identify new areas of development.
Challenges addressed include:
- Embarking on a new way of working and a new partnership - full engagement gained from the outset.
- Address the emotional impact on learners - care in structuring the learning to ensure the opportunity to explore this e.g. 2 tutors at each session.
- Schedule the programme to ensure that it is attractive to the sector – realistic as to time frames for learner feedback, mentoring and completion of portfolios.
- Schedule short training sessions to maximise attendance e.g. afternoons and provision of training in local community venues.
- Keep to time frames for each element of the programme.
- Develop credibility in a new area of learning for joint training by working in partnership with the Severn Hospice and developing our credibility as a proactive partnership in delivering training to national standards in EOLC.
- Measure the value of learning longer term, via an annual interactive recognition and evaluation event.
- Staff time in ongoing consultation.
- Tutor hours for development and delivery.
- Assessment costs for accredited awards & certificates.
- Venue and refreshments.
- Management costs to manage the completion of bids and project delivery within agreed timescales.
To date, the service has been funded via various streams as below:
- SCCG £4000 in 2013 - accredited learning route for EOLC.
- Skills for Care Innovation Award £15,172 in 2013-14 City & Guilds accredited route, for care sector levels 2 and 3.
- Health Education West Midlands (HEWM) £68,952 from 2014 through to 2018/19.
- Reduced rural isolation; raised profile/demystified the role of the hospice as a residential provider, day and hospice at home service.
- Brought together workers from fragmented provider services to learn together; improving responses at EOL promoting a consistent approach.
- Supported choice at EOL.
- Provided City and Guilds accredited programmes.
- Provided training for nurses/health professionals in “forgotten communities” on specific topics; e.g. COPD.
- Provide advanced care planning conference; non-malignant disease.
- Increased knowledge/understanding in staff, trainers and assessors.
- Attracted learners from across the sector - acute hospital, community hospital, hospice, housing, residential care and domiciliary settings, from a variety of work roles
- Total learners to date = 477 (see supporting info)
- Up skilling of learners, progression to bigger awards/certificates
- Service improvement, changing and improved practice demonstrated via evaluations
- Value for money; conference allocation = £5000. Cost per learner = £36.76 per day. No charges to learners to date for participation.
- Assessment Centre achieved “direct claims status” for all programmes recognising the high standard of learner portfolios.
Cost / savings:
Accurate cost savings are difficult to identify due to the fragmented provision of services. Severn Hospice has 24 beds, 4 out of 5 patients supported at home. Day hospice attendances during 2016-17 = 3497. For each £1 received from NHS, Severn Hospice delivers £3 worth of care. Our rural county depends on knowledgeable and skilled community health and care services staff to support people at EOL, supporting choice and NHS savings in keeping people at home longer. This frees up valuable hospital beds and supports demands of the projected local population demographics.
This proactive approach to learning used the NICE guidance and quality standard. Also the Gold Standard Framework (GSF) recognised across Shropshire. The GSF provides a common language, and planned system of care in consultation with family and patient, alongside the coordination across the health and sector to deliver EOLC. This supported the sector in Shropshire to anticipate and meet the needs of people at end of life before needs occur.
Enhanced by the promotion of individual EOLC plans and advanced directives, our annual recognition and evaluation event is one way we identify and evidence what the programme has meant to staff, patients or service users. Improved relationships across sectors means that colleagues can support each other to deliver the best care outcomes possible.
Key learning points
- Ensure “buy in” from community leaders / senior manager’s e.g. local hospice, commissioners.
- Identify required outcomes from these leaders.
- Link to a nationally recognised learning agenda.
- Identify partner organisations to work with.
- Identify lead staff, knowledgeable, skilled and passionate about the subject to take the work forward.
- Develop a quality, consistent standard of training.
- Share the vision of what we aim to achieve with provider services and their staff in a meaningful and practical way.
- Engage positively with all providers including those from rural communities.
- Be prepared to meet providers half way i.e. provide training in local, easily accessible venues e.g. community hospital / community centre at times consistent with staff availability.
- Do what you say you are going to do, be realistic, build your credibility on strong foundations and proven achievements.
- Be proactive in keeping on stakeholders radar.
- Respond positively to evaluation comments and recommendations.
- Robust administrative processes are needed to support coordination of the learning programmes for both staff and learners.
- Recognise and plan for the potential emotional impact on learners.