"Wherever I am, health and care staff bring empathy, skills and expertise and give me competent, confident, and compassionate care."

What the citizens of Lancashire and South Cumbria say this means for them

"I need the people who look after me to communicate properly with me and have open and honest conversations."

"Everyone helping and supporting me respects me and treats me with care and compassion."

"I need to know that staff who look after me have the training they need to be able to care for me properly."

"I need to know that people recognise when I am less well and care for me appropriately."

"I have empathic and compassionate staff around me who are confident to talk openly about death and dying. They take a non-judgmental approach and are sensitive to differing cultural and religious practices."

Lancashire and South Cumbria commitments towards making this happen

Enablers and responsibilities

Enabler

• Education standards - e.g. workforce education is provided in accordance with the L&SC end of life care education standards
• Quality assured education - education is delivered by skilled and competent clinicians, facilitators, and educators, e.g. aligned to the standards and guidelines for end of life care facilitators and educators
• Coordination of education - palliative/end of life training centrally coordinated and monitored to ensure accessibility and applicability to all including informal carers and volunteers, e.g. palliative education hubs or hospice education centres
• Sustainable provision - palliative and end of life care education is specifically commissioned, included in service contracts, and seen as a core component of place provision
• Impact on practice - education is evaluated to monitor effectiveness and impact on quality of care, evaluations are used as part of continuous improvement processes
• Mentorship, supervision and coaching - e.g. staff forums focusing on sharing experiences and enablers/ barriers to putting things into practice, clinical and management supervision, access to mentorship and coaching
• Schwartz Rounds - or similar models available that facilitate a safe space and time for staff reflection
• Induction and annual updates - palliative/end of life care training included on staff induction and annual updates with communication skills, equality and diversity, and advance care planning being taught to all roles and disciplines
• Release of staff - staff are paid and released to attend palliative/end of life care training that is considered core to their role e.g. as defined by the L&SC educational standards
• Staff appraisals - mechanisms in place to identify gaps in knowledge, skills and confidence, signposting to available training aligned to core competencies
• Specialist palliative care - delivery of education to generalists is part of their job plan, specialist level education is accessible to support team development
• Palliative care workforce plan - e.g. covering succession planning, recruitment and retention, staff wellbeing and education and training
• Palliative care leadership - e.g. developing leaders education and training, coaching and mentorship, workplace experience, end of life care champions to cascade best practice and inspire and influence the practice of others
• Dementia education - e.g. specific to meeting palliative and end of life care needs, raising awareness of dementia being a life-limiting condition, mental capacity training
• Bereavement support training - to staff and volunteers in recognising and responding to grief and loss and signposting to local support

Commissioner Levers

• Underpinning guidance detailed on page 11-4
• National Specialist Level Palliative & End of Life Care Services Specification (Adults) 5
• Enhanced Health in Care Homes Framework 6
• End of Life Care Education Standards for L&SC 14
•  Standards and guidelines for end of life care facilitators and educators 15
• NHS Continuing Health Care Fast-Track Pathway 18
• Universal Principles for Advance Care Planning 7
• NHS Virtual ward guidance 19
• NHS Chaplaincy guidance 20
• Clinical leadership and peer leadership throughout ICS, ICP and place-based partnerships
• Joint strategic needs assessment
• Dementia Training Standards Framework 21
• Dying Well in Custody Charter 23
• Care committed to me 24
• UK Commission on Bereavement 26
• Standard KPI’s across provider contracts
• Community service contracts
•  Primary care contracts
• Care home contracts
• Hospital contracts
• Hospice (Including children’s hospice) grants
• 3rd sector contracts/grants
• IT contracts
• Domiciliary care contracts
• Lead/joint provider contracts
• Children’s and Young Peoples service contacts
• L&SC palliative education strategy group
• North West Coast learning collaborative

Provider Levers

• Named clinical and board executive lead
• Champion at executive level for learning and development of staff
• Organisational palliative and end of life education strategy
• Place based partnership groups
• Annual audits
• Incident reviews
• Job roles and responsibilities
• Education and training
• End of life care facilitators
• North west anticipatory clinical management planning guidance 9
• Clinical practice summary for palliative care symptoms 11
• L&SC end of life care education standards 14
• Standards and guidelines for end of life care facilitators and educators 15
• Standards and guidelines for the provision of advanced and key level communication skills training programmes 16
• Training and development framework for SAS doctors working in specialist palliative care 17
• Dementia Training Standards Framework 21
• Dying Well in Custody Charter 23
• Care committed to me 24
• EELCA (elearning)

Measurements of success

• Improvement in knowledge, skills, and confidence
• Number and diversity of people reached by training e.g. organisations, roles, ethnicity
• Staff attrition pre and post education and training investment
• Core evaluation from education
• Post event follow-up to evidence changes to practice
• National Audit for Care at the End of Life (NACEL)
• Learner case studies e.g. reflective practice and revalidation
• Staff training passports
• Role specific competency frameworks
• Annual training needs analysis

NB: Baseline measurements should consider skewed data arising due to COVID-19.

Best practice examples

Fylde Coast daily safety huddles for palliative care, end of life and bereavement care services

Scope of coverage: Fylde Coast Hospital, community, and hospice

Lead contacts: Jackie Brunton, lead nurse EOL bereavement care, Blackpool Teaching Hospitals J.Brunton@nhs.net

Brief description: During the challenging times of the pandemic with all its uncertainty and anxiety, we established a daily morning safety support huddle for all teams involved in end of life and bereavement care.  The huddle has been sustained and is attended by palliative care teams across the hospital, community and hospice, end of life and bereavement teams in the acute and community, district nurse lead and chaplaincy.

The huddle provides peer support and a mutually supportive culture with an opportunity to share and concerns and seek any operational support that may be needed for example to assist individual discharge plans, case discussion re shared care etc.

We share good practice, feedback on patients, and have discussions about any system pressures and mutual support that could be provided. The huddle is documented and fed back to all system partners and feeds into the Fylde Coast system meetings including escalating within the operational wider system if required. The rounds are held daily on Microsoft Teams for 15 - 30 minutes with a chair who acts as the management lead for the day.

Outcomes: Teams have found this mutually supportive from a wellbeing perspective and offering mutual aid and different ways of working for example district nurses support to cover community hospice short falls, weekend admissions and planning IPU / out of areas transfers/discharges. More effective use of resources for e.g staff cross cover, discussions. Timely response to escalations and incidents. Opportunity for shared learning and any service improvement / actions needed. Learning and educational opportunity. Clinical supervision.

GP and advanced clinical practitioner workforce development Trinity Hospice

Scope of coverage: Fylde Coast

Lead contact: Dr Gillian Au, medical director g.au@nhs.net

Brief description: Enhancing the local workforce development in palliative and EOLC by training future local GPs.  Applied to HEENW for accreditation to become a host training organisation for pairs of full time 6-month rotational GPSTs giving them experience of working across IPU and community service at the same time as supporting service delivery. Developed the role of the SPC Advanced Clinical Practitioner (ACP) utilising HEE funding streams to enhance the skill mix of our SPC clinical leadership workforce to bridge the gap between CNS and specialty doctor, support seven day working across all services, the medical 1st on call rota, teaching, and supervision to meet the projected palliative and end of life care needs of the future workforce.

Outcomes: Approval as host training site for GPSTs from August 2021. Now welcomed third pair of GPSTs from the Blackpool program. Ensured experienced and effective clinical supervisors. Had excellent feedback and evaluation of the learning experience. Supported the development of their communication skills and EoLC skills and competences. Exposed them to best practice in multidisciplinary patient centred care. GPSTs support direct clinical care and service provision of patients and the first on-call rota. Successfully bid for funding to support the training of six ACPs across the organisation. One physiotherapist ACP who is now leading on the development of our Living Well Service, one paediatric trainee ACP supporting training and developments in our Brian House Children’s hospice services, and four ANPs across our adult services (IPU, hospital and community).

Our learning from our pandemic experience has only served to reinforce the considerable value of the ACP role in realising our mission and service goals, enhancing our effectiveness and responsiveness with the ability to work flexibly across our community, hospital and in-patient unit services where needed. All have undertaken valuable QIPs that have enhanced our service and patient experience. The ACPs have supported seven day working and the medical on-call rota, and in addition to their direct clinical work, our ACPs provide clinical leadership, teaching and supervision to the teams.

Cornea donation and Advance Care Planning (ACP) conversation at Trinity Hospice

Scope of coverage: Starting with Hospice in-patient unit which admits patients from across the Fylde Coast.

Lead contact: ACP Alison Jones

Brief description: Project aim - to normalise conversations with patients within the inpatient unit regarding cornea donation, such discussion to become part of Advanced Care Planning (ACP) with all patients considered medically suitable donors. The aim is not to coerce but merely to inform the patient of the opportunity. Implementation included:

• Staff training
• Networking and advice from National Health Service Blood and Transplant Unit (NHSBT)
• Creation of documentation and referral process
• Coaching and staff peer support in leading such conversations
• Gaining feedback from staff after holding such conversations regarding: how they felt? What went well? What they may do differently in future?
• A patient information leaflet was produced and discussed with patients on admission
• Staff to witness eye retrieval which supported staff in future conversations.

Outcomes: In previous years cornea donation was only carried out at the patient’s request, this was not a routine conversation raised by hospice staff, therefore if the patient did not have knowledge that they were suitable for donation, the opportunity would be missed.

After teaching sessions were held, the project was implemented in July 2021.  Conversation and referral information was captured between July 2021-November 21. Within this time cornea conversation increased by 24% resulting in 21 referrals being made to NHSBT for cornea retrieval after the death of a patient on IPU which resulted in 15 cornea retrievals. This is a very positive start to the project which now requires further reinforcement to achieve our aim that all patients cared for by our IPU, community and hospital services who are eligible to donate their corneas are made aware of this possibility.

End of life core competency and skills framework

Scope of coverage: Blackpool Teaching Hospitals

Lead contact: Lead for project, Victoria Dixon Victoria.dixon2@nhs.net

Brief description: Core competency framework developed to ensure consistent and sufficient level of knowledge and skills in end of life care across all staff groups. Competencies assigned as are relevant to role and scope of practice and attendance at required training recorded on electronic staff record for monitoring of compliance. Training needs analysis and review of educational content reviewed as part of this piece of work

Outcomes: Very recently gone live and therefore no outcomes to measure yet. Will achieve consistency and streamline the education that is provided, avoiding duplication, and enabling key EOL/SPC/Bereavement staff to use resources more efficiently while still providing the required training.

Staff will have the knowledge and skills to provide excellent end of life and bereavement care.

The End of Life Partnership (EOLP)

Scope of coverage: Cheshire West and Cheshire East, North West and national

Lead contact: Salli Jeynes CEO

Brief description: The End of Life Partnership (eolp.co.uk) 

Our vision: Everyone experiences compassionate and personalised end of life care.

Our mission: To educate, innovate and collaborate so that people are empowered to care with confidence and compassion at end of life. We building confidence to care through delivering end of life care education, leadership & innovation, knowledge & informatics and compassionate communities.

Outcomes: Watch our impact video for 2021-22.