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End of life care

Our work on end of life care (EoLC) has been driven by our commitment to implement the workforce related recommendations in the ‘One Chance to Get it Right’ publication, produced by the Leadership Alliance for the Care of Dying People in June 2014.

This coalition of 21 members from across the healthcare sector, including HEE, was commissioned in 2013 by the Department of Health to produce a system-wide written response to the Independent Panel Review of the Liverpool Care Pathway led by Baroness Neuberger.

The Leadership Alliance set out its vision of what good care in the last days to hours should include in One Chance to Get it Right, in the form of five Priorities for Care of the Dying Person. These are:

  1. the possibility that a person may die within the coming days and hours is recognised and communicated clearly, decisions about care are made in accordance with the person’s needs and wishes, and these are reviewed and revised regularly
  2. sensitive communication takes place between staff and the person who is dying and those important to them
  3. the dying person, and those identified as important to them, are involved in decisions about treatment and care
  4. the people important to the dying person are listened to and their needs are respected
  5. care is tailored to the individual and delivered with compassion – with an individual care plan in place.

End of Life Care Core Skills Education and Training Framework – developed in partnership by Health Education England, Skills for Health and Skills for Care – supports the provision of high-quality, person centred care for terminal patients and their families.

The framework classifies key skills and knowledge into three tiers, ranging from general end of life care awareness to the in-depth knowledge needed to care for and support an individual approaching the end of their life, and their family. It describes core skills and knowledge that are common and transferable across services. Enabling greater consistency in the training and assessment of end of life care core skills and knowledge.

Employers can use the framework to identify key skills and knowledge for roles and teams; conduct training needs analysis; and plan, design and commission training.

One of our commitments in the One Chance to Get it Right document was to conduct research into the development and evaluation of education and training methods and programmes which addressed uncertainty and communication when caring for the dying.

Given the wealth of guidance, tools and education and training materials being used by NHS staff, HEE commissioned The Democratic Society to review the efficacy of existing education and training resources on end of life care for the NHS workforce in March 2015.

The review was a deep dive exercise to establish what types of education and training resources help deliver high quality care for the dying. Research was comprised of both quantitative and qualitative methods: a survey focused on frontline NHS staff and qualitatively a series of focus groups across England; interviews with health experts from professional bodies and two national workshops aim at NHS and social care professionals.

The review completed its research phase in July 2015 and has now produced a report for HEE. The review has informed HEE’s local action plan, which will promote and embed those education and training resources which drive high quality outcomes for staff and patients.

The One Chance to Get It Right document was a system wide response to the Liverpool Care Pathway Review and HEE’s approach to implementation at a national level is to collaborate with partner ALBs, namely NHS England and Public Health England, on end of life care wherever possible and integrate outputs from workstreams to ensure the system supports a holistic approach to end of life care.

HEE is a member of The National Palliative and End of Life Care Partnership, made up of statutory bodies including NHS England, the Association of Adult Social Services, charities and groups representing patients and professionals. Visit the partnership website for more information on its work.

This partnership has developed a framework for action in making palliative and end of life care a priority at local level ‘Ambitions for Palliative and End of Life Care: A national framework for local action 2015-2020’, which is aimed at local health and social care and community leaders. Published in August 2015, it builds on the Department of Health’s 2008 Strategy for End of Life Care and responds to an increased emphasis on local decision making in the delivery of palliative and end of life care services since the introduction of the Health and Social Care Act 2012.

As part of the Ambitions Partnership, a new End of Life Care (EoLC) Knowledge Hub has been launched which acts as a ‘one stop shop’ for palliative and EoLC information. This hub provides anyone involved in the commissioning or provision of palliative and end of life care with a quick and easy way to source information, including helpful tools and resources to drive delivery of the Ambitions for Palliative and End of Life Care – a national framework for local action.

Expansion of the Ambitions website was commissioned by NHS England and taken forward by the National Council for Palliative Care, one of the Ambitions partners.

A cross-sector stakeholder group was established to oversee the transition of national documents, leaflets, booklets, policies and educational resources. Decisions made were based on validity, reliability, value and relevance to the Ambitions framework.

Early next year, professionals will be able to submit resources they would like to see available on the knowledge hub for assessment against robust criteria to ensure the site remains current and appropriate for users.

Since the publication of the strategy, good progress has been made in end of life care but there is still much more that needs to be done. Research by Hospice UK and the National Council for Palliative Care, carried out last year showed that only around four in ten (43%) Health and Wellbeing Boards in England include the needs of dying people in their key strategies that shape health and social care services. This is why HEE will implement the One Chance to Get It Right and review recommendations through a local action plan, so that employers are clear about workforce development and continuing personal development needs of NHS staff.

End of Life Care for All (e-ELCA) is an e-learning programme that aims to enhance the training and education of health and social care staff and volunteers involved in delivering end of life care.

The programme was commissioned by the Department of Health and developed by HEE e-Learning for Healthcare (e-LfH), in partnership with the Association for Palliative Medicine of Great Britain and Ireland, to support the implementation of the Department of Health’s 2008 national End of Life Care Strategy.

Accessibility has been a key driver when developing e-ELCA to enable those working in end of life care to improve their confidence and expertise through high quality learning, in whichever setting they happen to work in. The sessions are regularly reviewed by experts to ensure they are up to date and reflect current good practice.

The sessions also have a high degree of flexibility built in, allowing learners and trainers to undertake learning to suit the lifestyle and pace of the intended learner. Learners and trainers can choose the sessions that are relevant with no set timeframe for completion. Each session lasts only 20-30 minutes and can be dipped in and out of as required. e-ELCA should ideally be used as part of blended learning with support from trainers or mentors and peer group working, however it can also be used individually through any computer with internet access.

Free access is available for NHS staff, hospice workers and social care staff in England. A small number of selected sessions are also freely available to volunteers, clerical and administrative staff on an open access website

With the aim of increasing the use of e-ELCA, a number of focus groups were conducted and an online survey developed to identify what systems organisations would ideally have in place to support learners, their mentors and those providing education and training programmes.

Adult social care employers registered with the national minimum data set for social care can access e-ELCA. If you would like to register with the NMDS-SC to receive the user registration code, visit the national minimum data set for social care website.

Mapping of the e-ELCA modules to the end of life qualifications units is now available below. There are 14 units which form the core of the qualifications and the e-ELCA modules identified can support learning for each unit as specified. Employers registered with the national minimum data set for social care will have access to a user registration code. The code will enable each of their individual employees to self-register for access to e-ELCA on the e-Learning for Healthcare website.

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