Clinical Commissioning Groups collaborate to improve End of Life Care (EoLC) provision, to support the national Department of Health End of Life Care Strategy

As part of a range of measures to improve services to patients, South Worcestershire Clinical Commissioning Group (now merged with Herefordshire and Worcestershire Clinical Commissioning Group) commissioned our team to carry out a workforce skills review for South Worcestershire and two neighbouring CCGs to assess whether frontline services across the county met the requirements of the Department of Health’s End of Life Care Strategy (EoLC).

The challenge

The EoLC Strategy states that wherever possible people should be able to spend their last days in the place of their choosing. This has led to an increasing number of people who say they would prefer to get this support in their own homes.

The CCGs wanted to ensure that all integrated staff teams across the county had the skills and training to meet this challenge, and asked Skills for Health, the UK Sector Skills Council for the health sector, to review their workforce’s skills. The review included health and care trusts (specifically the Integrated Community Teams) along with other staff delivering EoLC services, including social care colleagues and hospice staff.

The aims were to assess the current competences and identify future competences required for EoLC Services across the three CCGs; to identify any skills gaps, and to develop a competence framework for the workforces that provide those services.

How we helped

Functional Analysis – we used the National End of Life Care patient pathway as the overarching quality framework. They held workshops involving frontline staff and partner organisations to look at the processes – who is involved and what they do – along with the skills and knowledge that are required, and the local challenges. It was essential to involve the staff who deliver EoLC in the community to understand what skills were required to meet the needs of patients, and increasingly, their carers and families.

Skills Mix Review – using service, workforce, and finance information and data, we analysed how the service should be configured to meet local needs

Role Redesign – we established the specific competences needed for each role, identifying the skill levels required for high quality and productive delivery of service functions.

The outcomes

We delivered a Competence Framework for each CCG, listing the functions and competences that are needed to deliver the National EoLC pathway. This will enable the local CCGs to accurately specify the detailed competences required for EoLC when commissioning services. It will also ensure that training and education are accurately tailored and targeted to the right staff and that it will meet any specific skills gaps and be more cost-effective.

For the frontline Care, Trust, and Hospice services, the review has provided a relevant skills framework that can be used by individuals and teams, and at the service level, in appraisals, staff supervision, and when planning training.

The workshop approach added value to the project as it enabled a great variety of staff views, experience, and comments to be gathered. It gave participants the opportunity to discuss with colleagues and partners how their services were delivered and how they could be improved and revealed local challenges, such as concerns about having the cultural knowledge to deal with diverse communities, and the problems for both staff and patients in rural areas. Staff felt as though they were part of the review and engaged with this approach.

“Skills for Health have been very supportive throughout the process of workforce planning and responsive to our needs and wishes. They have provided us with detailed reports as per the specification. They are willing to go the extra mile to ensure we are satisfied with the quality and content of reports.”

Debbie Westwood, Senior Programme Lead, South Worcestershire Clinical

We made several recommendations to the three CCGs as a result of the review, including:

• advanced communications training for all those involved in EoLC, to help them deliver sometimes difficult messages to patients, their carers, and families
• more regular, scheduled clinical supervision for community staff, to allow them to talk about what can be difficult and challenging experiences
• training in assessing the cultural and spiritual needs of patients nearing the end of their life, as well as facilitating care after death, because many staff felt unsure of how to do this
• future HR and personnel practice for EoLC staff to be underpinned by the Role Templates and associated competences that specify the required skills and knowledge to deliver quality EoLC in the community.

As a direct result of the analysis and review, South Worcestershire CCG is assessing existing training across the county to ensure it reflects the EoLC findings, meets current staff needs, and is targeted at the most appropriate staff. It is also looking into other training requirements.

The CCGs are working with partners to assess other findings to ensure they continually review the quality of care in meeting the growing EoLC challenge.

As the Sector Skills Council for Health, we help health sector employers across the UK optimise the potential of their workforce. Our proven solutions address not just improved productivity but also the quality of health and healthcare.