Training Needs Analysis Report

Report
  • 1. Communication skills for end of life care Training for health and social care staff Talking Needs Action Training Needs Analysis: The pilot sites report their findings for end of life care communication skills
  • 2. Contents Acknowledgements Executive summary 1. Introduction 2. Background 3. Taking a needs-based approach 4. Identifying providers 5. The TNA itself 6. Engagement 7. Findings 8. What did the pilot sites get out of the TNA? 9. Getting results 10. Good practice identified through the TNA 11. Next steps for pilots 12. References 2 3 6 8 9 10 10 11 12 15 16 19 21 21 Appendices i Tools to support assessment and planning ii Scope 22 27 Glossary 29 Acknowledgements With thanks to the 12 pilot sites that have participated in this project and have shared their findings and experiences with the national programme. Special thanks to Jill Banks Howe and Linda Nelson at the University of Teesside for their support in developing the questionnaires for the training needs analysis. 2
  • 3. Executive summary Purpose and scope of this report This report provides the first round of feedback from a training needs analysis (TNA) pilot project, set up to support the development of communication skills training for all those working in end of life care (EoLC). It provides some early outcomes and learning from 12 pilot sites around the country, each of which carried out its own local workforce TNA. We hope these initial findings will be useful to other organisations planning to carry out a TNA themselves, or to support the development of EoLC training plans. A series of ‘top tips’ are summarised in the document. The report is also aimed at strategic health authorities, education commissioners and providers, health and social services commissioners and service providers, health and social care staff and their managers. 3 This project has been run by the National End of Life Care Programme (NEoLCP) in partnership with Connected©, the national communication skills training programme for cancer services. Context and background The health and social care EoLC workforce is employed by a wide range of organisations in a variety of settings. Competence in communication underpins all good quality EoLC. It is essential that health and social care staff can have open and effective conversations with people, their families and carers about death and dying and the issues surrounding it. This ensures that service users are well supported, their wishes can be properly discussed and personal care plans put in place. The End of Life Care Strategy1 has identified communication as one of the four competence areas that cut across all levels of
  • 4. practice. It recognises the skills that already exist in the workforce and aims to build on these to make sure that all staff have the ability to deliver quality care for everyone. Training and education are not the only ways to develop skills. Workplace learning opportunities through experience, role models and mentoring are very important. Appraisal and continuing professional development are also vital. There are cost benefits to having a competent workforce that has timely and appropriate conversations with people at the end of life: individuals’ needs will be identified promptly, resulting in the right care at the right time and avoiding unnecessary interventions – making best use of staff time and resources. Key findings • The majority of health and social care staff are involved in EoLC. Staff time spent working in this area varies, depending on the setting and their role • Most have received some basic, generic communication skills training • Most believe they would benefit from further training to address the challenging demands of conversations with people approaching the end of life • Provision of intermediate and advanced training is limited. There is specific need for more advanced training aimed at staff caring for non-cancer patients • Social care staff, particularly those working for private organisations, have more limited access to EoLC training than health care staff • Service providers and staff are not always aware of local training options • There is often misunderstanding about the term ‘end of life care’. Many staff do not appreciate their role in its delivery and therefore don’t understand the relevance of EoLC training • Co-ordination of training across local areas is often poor, with examples of course duplication and gaps. Benefits of a TNA The TNA has provided pilots with a better understanding of the workforce engaged in EoLC, the existing competences and training currently available. This supports a strategic approach to workforce development. Wide partnership engagement has enabled a more co-ordinated approach and the TNA has provided a structure for ongoing monitoring of competences and for evaluating the impact of training. The TNA process has had the additional benefit of raising awareness of EoLC and identifying enthusiasm for training. It has supported culture change – getting death and dying onto the agenda for the whole EoLC workforce. The pilots have established structures that facilitate effective multidisciplinary, multi-agency and interdisciplinary working across organisational boundaries. These will support ongoing workforce development in EoLC as well as providing a forum for future joint working in other areas. Lessons learned – summary of key good practice tips (full details in report) For commissioners • Specify the outcomes and quality standards of education and training that are required for commissioning and risk management. Commission according to identified workforce need, include staff caring for both cancer and non-cancer patients • Specify the necessary skills, attitudes and training required for the workforce in service agreements and contracts. 4
  • 5. For educators • Align training with workforce need, accommodate individuals’ requirements, apply adult learning principles, encourage joint working and collaboration. For service providers • Align workforce development with corporate business strategies, governance systems, existing frameworks and clinical pathways. Link the cost benefits of a competent workforce to training proposals and embed relevant competences in recruitment/appraisal systems. For staff managers • Provide opportunities to develop competences in the workplace through mentoring, example and team support. Ensure person specifications and job descriptions describe the necessary communication competences accurately. For individual staff • Take personal responsibility for reviewing, renewing and enhancing the competences, knowledge and skill required for your role in EoLC. Next steps The TNA has provided the pilot sites with an information base to support development of training and education that will meet the needs of their local workforce. It will then be important to monitor the delivery and uptake of training and to evaluate its impact on business objectives, the service user experience, staff confidence and competence. The final project report and findings will be published early in 2011. 5 “We found that the majority of staff within care homes had received little communication skills training and now, recognising that communicating with people at the end of life is a skill gap, are very keen to attend training.” Anil Garcia, project manager, Mount Vernon, Essex
  • 6. 1. Introduction - Why do a TNA and what are its aims? “Ensuring that health and social care staff at all levels have the necessary knowledge, skills and attitudes related to the care of dying people will be critical to the success of improving end of life care.” End of Life Care Strategy 2008 People approaching the end of life often require a complex mix of health and social care services, which are provided across a wide range of sectors and organisations including hospitals, care homes, hospices and their own homes. Many people – including clinical and nonclinical staff, family and friends, palliative and non-palliative staff – provide this care. However, because it often forms only part of the non-palliative role, these particular workers may not be trained in the identification, delivery and discussion of EoLC. Workforce competence in communication underpins all good quality EoLC. While generic communication skills are important in all settings, there are particular challenges involved in communicating with people at the end of life. By building on existing workforce skills and training, we aim to provide health and social care staff with the skills and confidence they need to have open and effective conversations with people, their families and carers about death and the issues surrounding it. In this way service users’ wishes can be discussed and care plans put in place. Good communication contributes significantly to quality of care and there is sound evidence to show that training can improve competence in communication. As well as improving service quality there are inherent cost benefits in developing a Leeds: St Gemma’s Hospice "Most staff acknowledged that the communication skills training they had received did not focus specifically on end of life care and felt they would like further training to support them in their role." Sally Coppock, advanced nurse practitioner, St Gemma's Hospice competent workforce that identifies patients early and is able to initiate timely and appropriate conversations. Needs will be identified promptly, avoiding unnecessary interventions and making best use of staff time. Better communication between staff, individuals and their carers will improve coordination of services and facilitate best use of resources. Cost savings could also be made through improved planning of training programmes, ensuring that duplication is avoided. A properly trained workforce is likely to have higher morale and job satisfaction – resulting in less staff attrition. The English health and social care workforce in EoLC is estimated to be around 2.5 million. The communication skills pilot project, of which the TNA is a part, was established to support development of communication 6
  • 7. competences in this workforce, building on and enhancing their existing skills. The NEoLCP is working on this project in partnership with Connected©, the national communication skills training programme for cancer services. Twelve pilot sites have been set up across the country2. They were asked to assess existing workforce competences, then use the results of their assessment to determine the training required. Using this needs-based approach, the first step was for each pilot site to carry out a TNA. The purpose of this report is to highlight some of the early TNA findings and to suggest how these can be used to develop best practice in other locations. We hope that it will be useful to organisations that are planning to carry out a TNA themselves or to support the development of their training plans. It highlights the rationale behind the TNA project and the processes used, as well as detailing the key findings from and benefits to the pilot sites. This report is relevant to all those with an interest in EoLC, particularly: • Strategic health authorities’ workforce development leads • Local education commissioners • Commissioners of local health and social care services • Education providers including higher education institutes, further education institutes and specialist education providers • Local service providers • Health and social care staff and their managers. Further analysis of the pilot site findings will be included in the final project report, which will be published early in 2011. 7 Lancashire and South Cumbria Cancer Network "Staff working in critical care, renal medicine and stroke services initiate and respond to difficult end of life conversations. They need the knowledge and skills to provide support, care and information for this vulnerable group of people and their care givers." Jayne McGurran, senior communication skills development trainer, Lancashire and South Cumbria Cancer Network
  • 8. 2. Background: the three foundation projects Three foundation projects have been set up to progress The National End of Life Care Strategy’s vision for workforce development. Communication skills Twelve pilot sites across England were established in September 2009. Their aim is to explore training need, develop local training for EoLC and so inform good practice for future training and education. The pilot sites are: • Berkshire East Community Health Services • Dorset Cancer Network • East of England Cancer Networks (Mount Vernon, Anglia, Essex) • NHS West Essex • Greater Manchester and Cheshire Cancer Network • North East London Cancer Network • South East London Cancer Network • St Gemma’s Hospice, Leeds • University of Teesside • LOROS Hospice (Leicestershire and Rutland) • St Luke’s Hospice, Plymouth • Lancashire and South Cumbria Cancer Network. Common core competences Skills for Health and Skills for Care identified the common core competences and principles for EoLC, which were published in June 20093. These provide a framework to support The National End of Life Care strategy, specifying the principles and competences that form the common foundation for the EoLC workforce in health and social care. A framework of national occupational standards was subsequently published in January 20104, which specified the core standards that underpin the competency framework. A knowledge set for EoLC is also available which specifies the learning outcomes for the five key areas of competence as identified in the common core competences, including communication. The common core competences for communication skills, their related national occupational standards and the knowledge sets have formed the basis of the TNA (see appendix i for background information). e-ELCA A suite of free e-learning sessions launched in January 2010 by the programme and its partners includes a core module on communication skills for EoLC. Workers in many health and social care agencies are able to access the resource at www.e-elca.org.uk. The sessions are intended to support a variety of learning approaches, including experiential and face-to-face. The curriculum for e-learning is also aligned to the common core competences (see appendix i). 8
  • 9. 3. Taking a needs-based approach As well as analysing training needs at an individual level, the process must consider the links to both functional and organisational objectives. “We have found this project extremely valuable; the data collected have provided us with excellent evidence to support our current communication skills education provision and have given us significant insight into how this provision may be successfully developed for the future end of life care workforce.” Sharon de Caestecker, head of education, LOROS The TNA process supports: • Development of a training resource plan • Procurement of needs-based education and training • Planning of associated training activities • Procurement of services provided by a competent workforce. Why do a TNA? TNA is the process by which training and development needs are identified. The purpose is to outline how organisational objectives will be realised through the development of workforce competences. Once the need is identified, a resource plan can be agreed and the appropriate training delivered. Assessment of its impact will then inform business objectives. This needs-based approach supports the development of a competent workforce, avoiding unnecessary or duplicated training. Identify the competences required for the workforce Training Needs Analysis Identify service providers and assess workforce competences Determine business objectives Needs-based approach Implement training Identify current training and education Develop/commission training Benchmark against competences Identify training need 9 Monitor and evaluate impact of training Training resource plan
  • 10. Dorset Cancer Network 4. Identifying providers 5. The TNA itself The first step for the pilots was to identify the health and social care services expected to deliver EoLC and all local education and training providers in their area. Dorset broadened its scope to include nineteen sectors that may have some contact with people at the end of life. These included fire and ambulance services, the police, solicitors and military bodies. 5.1 Methods There are a range of data collection methods available, which include: • Interviews • Group discussions • Focus groups • Questionnaires and surveys • Job analysis, including review of job descriptions. “The global to specific approach of our scoping proved a useful methodology since it enabled us to get an overall sense of what communication skills training was being provided throughout Dorset, across all sectors.” Annie Raven-Vause, project lead, Dorset 5.2 Objectives • To identify the existing competences in the EoLC workforce • To identify the current training provision • To match the current skills against the recommended competences • To identify any shortfall. 5.3 TNA approach Pilot sites selected the objectives and approach that best met local requirements. The programme worked with Teesside University, using guidance from NHS Connecting for Health5,6, and in consultation with the pilots to develop three separate questionnaires - for employers, employees and training providers. These templates could be modified to reflect local need and ten pilot sites made some amendments to them. 10
  • 11. The majority of sites used survey questionnaires as the basis for the TNA but several supplemented these with focus groups for particular sectors, eg training providers. Most questionnaires were completed independently by individuals – sometimes following a presentation – while others were completed by a researcher during telephone interviews. Questionnaires were delivered to respondents by hand, sent by post or electronically and a few sites developed their own online versions (Plymouth, LOROS, Dorset). Most pilots surveyed employer organisations, employee representatives and training providers. Essex made the decision to target only employers and training providers. Some pilots tailored their approach to specific staff groups. Leicestershire and Rutland Hospices (LOROS), for example, targeted volunteer staff separately and developed a customised information sheet, while Leeds tailored its data collection methods for each staff group. 6. Engagement “There are a huge number of employing agencies of various types concerned with delivering end of life care and one of the challenges of this study has been to ensure that we have sufficient responses from a range of employers to give representative findings.” Tonia Dawson, nurse director, Anglia Cancer Network Response rates varied between pilots, sectors and settings. Pilots achieved more responses by actively marketing the questionnaires through briefing events, engaging managers to promote the TNA with their staff and tailoring their questionnaires or collection methods to target specific groups. Repeat mailouts and telephone follow-up of nonresponders also achieved higher rates and 11 East of England provided an opportunity to complete the questionnaire by telephone. For example, Mount Vernon got good results from employers by repeating emails and carrying out phone or face-to-face interviews, achieving 59 percent response rates in primary care, 35 percent in acute care and 23 percent in care homes. In general, response rates were lower from social care employees. This highlighted the importance of making language appropriate and relevant to the sector and of involving social care partners in the projects from the outset. Response rates were higher from training providers. For example, 66 percent of training provider questionnaires were returned in Anglia, 58 percent in Leeds and 54 percent in Mount Vernon. In Lancashire and South Cumbria the response rate from training providers was lower but, by holding a focus group, they successfully supplemented their findings with additional qualitative information.
  • 12. 7. Findings Main findings • The majority of health and social care staff are involved in EoLC • Most have received some basic, generic communication skills training • Most believe they would benefit from further training to address the challenging demands of conversations with people approaching the end of life • Provision of intermediate and advanced training is limited, with a particular need for more advanced training aimed at staff caring for non-cancer patients • In many areas there is a lack of awareness of available training • Co-ordination is often poor, with examples of course duplication and some gaps • Access to EoLC training is generally more limited for social care staff than health care staff • Often staff did not appreciate their role in EoLC, or the relevance of specialised training in this area. 7.1 End of life care workforce – the details The results confirmed that most of the health and social care workforce is engaged in delivery of EoLC. For example, 92 percent of St Luke’s respondents and 52 percent in Dorset – which surveyed a wider range of sectors – had conversations with people about death and dying. This highlights the fact that many occupations and staff groups have some engagement with EoLC. The proportion engaged in EoLC varied depending on the sector. In Leeds, for Leicestershire and Rutland Hospices (LOROS) example, 60 percent of the voluntary staff and 100 percent of acute sector staff said they had some involvement, while in Essex 77 percent of nursing, care home and domiciliary care staff were engaged in this area. The amount of time staff spent in EoLC varied, depending on their roles. Anglia found this ranged between 20 and 100 percent of staff time overall. Community nursing teams and critical care workers surveyed in Leeds spent 20 to 40 percent of their time caring for people at the end of life. The majority of critical care workers in Lancashire and South Cumbria also spent around the same amount of their time in EoLC, while the majority of stroke service staff in Lancashire and South Cumbria reported less than 20 percent engagement. The TNA uncovered a frequent misunderstanding of the term ‘end of life care’ – with employees not appreciating their role in delivery of such care and the relevance of EoLC training to them. 7.2 Training provision – the details A range of organisations provides communication skills training: higher education institutes (HEIs); further education institutes (FEIs); in-house local service 12
  • 13. providers; hospices and occasionally independent organisations. Specialist palliative care staff, working in hospices or the acute sector, provide most of the communication skills training for EoLC. Most pilot sites found a range of local courses available at basic or basic/intermediate level for health workers, some of which were specific to EoLC. Provision of intermediate and advanced level courses is more limited, with few opportunities outside the Connected© training programme for cancer services. There were, however, some examples of more extensive provision. For example, LOROS found that a wide range of communication skills courses – including some academically accredited ones – were available to most staff. Basic communication skills training for social care workers is generally provided through induction or NVQ courses. The surveys suggest that social care staff, particularly those working for private agencies, may have more limited access to EoLC communication skills training than those working in health. In Essex, however, which is responding to the shift towards supporting people to die at home, the important role of domiciliary care workers has been recognised and plans are in place to develop specialist domiciliary care workforce skills. Most trainers held a teaching qualification and many had undertaken the Connected© Advanced Communication Skills Training (ACST) course. Some of those teaching at advanced level felt they would benefit from additional training. The TNAs suggest that service providers are not always aware of local training opportunities for staff and there may be limited co-ordination in the local planning of courses with examples of content overlap, duplication and some gaps. In general, there appears to be a lack of training co-ordination across the different sectors and disciplines. 13 “If more people choose to die at home, domiciliary care agencies have an important role to play in end of life care. Targeting these agencies – and ensuring the workforce has the opportunity to develop the skills they need – will contribute to the success of the national strategy.” Carol O’Leary, Macmillan nurse director, Essex Cancer Network There were, however, some examples of good practice. Essex found evidence of collaborative working between service providers, who commissioned training from each other. 7.3 Competences – the details The results show that most health and social care workers involved in EoLC have received some basic, generic communication skills training but may not have received any training specific to EoLC. In particular, social care staff were less likely to have received EoLC communication skills training. Very few respondents outside the cancer multidisciplinary teams had advanced training. Communication is a core skill specified in the common induction standards for social care
  • 14. and the majority of these respondents had attended basic courses. The Care Standards Act 2000 requires 50 percent of care home staff to be trained to NVQ level 2 or above in health and social care, which includes a unit on communication skills. However, care home, domiciliary staff and employers often recognised a need for more. Those employed by private agencies may not have had the same access to core skills training. There were some examples of a more skilled workforce. Essex found many care home staff had received training specific to EoLC and 57 percent of LOROS employee respondents said they had received some. Of these, 17 percent had completed ACST and another 24 percent had received other training. These courses, mainly provided by the hospice, included counselling, palliative care and bereavement. Most health and social care staff assessed themselves as competent in EoLC communication but felt that they would benefit from additional training. LOROS found that 50 percent of those who assessed themselves as competent had received some relevant training. In Leeds, qualified nurses working in nursing homes and care officers working in residential homes felt competent in discussing advance care planning and undertaking holistic needs assessments, but were less confident in supporting bereaved and distressed relatives. The Leeds TNA indicated that care workers, especially ancillary staff, may have overestimated their competence in some areas owing to a lack of understanding of the criteria and skill set required for their role. This would need further investigation. The difficulty of selfassessing competence was also recognised by Teesside University and Dorset. 7.4 Training need – the details The majority of staff felt they had the opportunity to identify their training needs via their appraisal with their line manager. Although most have core competences in generic communication, relatively few have had specific training. There was some variation between settings, with residential care home staff and domiciliary staff identifying most training need. Most sites identified a gap in advanced level training for EoLC for health and social care staff who were not eligible for the Connected© ACST. As well as a need for more advanced training generally, this highlights the importance of access to competency-based, advanced level training for appropriate staff caring for non-cancer patients. Many employees felt that they would benefit from additional tailored training, particularly in breaking bad news, managing complex needs, bereavement support, bereavement counselling, holistic needs assessment, advance care planning, cognitive behavioural therapy and informed consent. Most also recognised the need for ongoing learning and development. “The TNA findings have helped to identify the target audience and required level of communication skills training within our region. We can now utilise this information to develop programmes and workshops to meet these needs, which can only enhance the care currently delivered to individuals at the end of their life.” Linda Nelson, principal lecturer, Teesside University 14
  • 15. 8. What did the pilot sites get out of the TNA? 8.1 Benefits for workforce development • A more strategic approach that addresses the competences required • A better understanding of the EoLC workforce, its existing competences, the training currently provided and the future training need • An informed platform on which to base training plans and sound rationale for decision-making North East London and South East London Cancer Networks 7.5 Top tips to improve access to training • Provide a range of training styles to accommodate a diverse workforce • Apply adult teaching principles for learning and development that place a level of trust and responsibility on the individual • Consider timing and venues to facilitate access for all staff groups • Make information about training widely available • Use available funding resources to optimise learning opportunities for all • Take account of high staff turnover and its impact on costs and capacity • Consider the literacy and language needs of staff with English as a second language. • Resource issues were identified to inform training plans • Better engagement with stakeholders, improving co-ordination of training • A structure to monitor workforce competences and evaluate training impact. 8.2 Wider benefits • TNA raises awareness of EoLC, communication skills and training need • TNA puts death and dying onto the agenda for the whole EoLC workforce • New relationships and structures have established effective multidisciplinary, multiagency and interdisciplinary working across organisational boundaries • Knowledge gained from this TNA can support development of other EoLC skills, such as advance care planning • The commitment to staff development has the potential to improve staff morale and the feeling of being valued – better staff retention and associated cost savings are a long-term benefit of this • TNA contributes to the development of a learning culture, enabling faster, more effective implementation of training • TNA provides an opportunity to address users’ communication needs. 15
  • 16. 9. Getting results Top tips for a TNA 1. Allow adequate time for thorough planning and preparation 2. Match the level of enquiry to organisational needs and set a realistic scope and timeframe 3. Consider the use of sampling and making projections based on workforce numbers 4. Involve representatives from all stakeholders in consultation and planning to improve engagement and data quality across sectors 5. Customise questionnaires, using language and terminology specific to each sector. Keep questions simple and focused, basing them on the core competences and taking into account that literacy and language issues can be barriers 6. If relevant, take advantage of the opportunity to incorporate other EoLC competences in the TNA 7. Pilot questionnaires with all staff groups to reduce incomplete and inaccurate data 8. Use online surveys to easily collate and analyse data but be aware that some staff have limited computer access and IT skills 9. Consider telephone surveys for employers and training organisations. They also help to clarify questions 10. Improve response rates by marketing the TNA beforehand and following up non-responders. Greater Manchester and Cheshire Cancer Network 9.1 Preparation • It is difficult to survey such a wide range of staff groups and organisations. The level of enquiry should identify and reflect organisational needs, with a realistic scope and timeframe agreed beforehand • Social care, in particular, features large numbers of - often small - providers, which may include private and third sector employers, as well as local authorities. There is often a very mobile workforce. It is important to appreciate that getting contact information may be difficult and timeconsuming. Databases may be out of date. The Care Quality Commission website7 proved to be a useful source of contact details for all care homes and home care services by local authority region • Where further investment in training is planned, consider statistical and numerical goals when using questionnaires. The required response rates or the percentage of the workforce surveyed, for example, should be carefully considered in advance • Consider incorporating other EoLC competences in the TNA if appropriate 16
  • 17. acquired from scoping • Similarly, consider selection of a crosssection of care providers and concentrate on a smaller number but with more depth of investigation, using questionnaires, interviews or focus groups as appropriate. 9.4 Engagement • Improved engagement with managers and organisations can be expected if the TNA has minimal impact on ‘business as usual’ • Targeted marketing and presentations to groups of staff helped to increase response rates. Most sites found that raising awareness and interest in training resulted in a better understanding of local need • Projections of training needs can be made through a combination of comprehensive scoping of health and social care providers, quantifying the workforce according to staff groups, and a survey or interviews with a representative sample of the workforce • Plan how you will communicate results, defining channels and audience • Delivery and uptake of training must be monitored and evaluated. This should include its impact on business objectives, staff confidence/competence and how this links to the user experience. 9.2 Targeting • Consider customising questionnaires/ approaches for specific staff groups • Telephone surveys can be useful, especially for employer and training provider organisations. Queries can be addressed more easily and an instant response is received. 9.3 Sampling • It may not be necessary to capture data from all employees. More meaningful information may be gained by targeting specific staff by group, level or setting, using tailored approaches. Projections can then be made based on workforce data 17 • Response rates are improved by good communication; in particular, ensuring people know the ‘format’ for the method (eg interview or group discussion), the time it will take, the purpose of the TNA and the intended use of the data collected • Involving representatives from all stakeholder groups in consultation and planning is likely to improve engagement across all sectors and achieve higher response rates • Pilot sites that included social care representation on their planning teams and those that sought support from their regional Skills for Care representatives found it easier to identify social care providers and to engage with this sector • Personal approach methods such as interviews, while more time intensive, usually provided better responses than more passive approaches, such as sending out a questionnaire • If response rates are low, there is potential for bias and care should be taken in interpretation of the findings. 9.5 Questionnaires • Keep questionnaires simple and be clear
  • 18. about the questions that need answering. Keep the focus as narrow as possible • Use the agreed competences as the basis for the TNA • The language used in invitation letters and questionnaires is paramount. Terminology and priorities are very different between the health and social care sectors. Take this into account to avoid alienating people • Literacy and language can be a barrier for some staff attempting to complete questionnaires • Piloting of questionnaires with a full range of staff groups is essential to reduce incomplete and inaccurate data • Online questionnaires did not improve response rates but were useful for data analysis and capture • Not all staff have access to computers in the workplace – particularly in care homes. IT literacy was also found to be an issue for some so consider whether electronic or paper questionnaires are more appropriate • The pilot schemes found it hard to determine the training levels required by the employees surveyed. Consider incorporating questions on staff role and exposure to EoLC to tackle this. 9.6 Care required • If using questionnaires, it can be difficult to identify the competences being addressed in training programmes – especially as communication skills training is often embedded within other courses and may not be specific to EoLC • Self-assessment of competences can be unreliable. The TNA found evidence of overreporting and under-reporting • Benchmarking of training against competences does not take account of the quality and effectiveness of the training or value for money. “The TNA process has improved engagement across a range of organisations and provided a good platform for future working.” Paula Hine, education and development manager, St Luke's Hospice Plymouth: St Luke’s Hospice 18
  • 19. impact on staff confidence/competence. Link workforce development to patient experience • Specify the necessary skills, attitudes and training required for the workforce in service agreements and contracts • Oversee the commissioning of training at a sector or regional level and ensure clarity of responsibility for co-ordination of local provision. Aim to provide a comprehensive range of suitable courses with appropriate capacity, avoiding unnecessary duplication Berkshire East Community Health Services pilot 10. Good practice identified through the TNA The TNA results have identified some important ways to improve practice. 10.1 For commissioners • Align workforce development plans with organisational objectives and strategies • Incorporate project benefits and expected outcomes into wider project, resource and implementation plans • Align workforce competences with governance systems around patient safety and risk management • Specify the outcomes and quality standards that are required for commissioning and risk management. Select training that has evidence of effectiveness, uses recognised methodologies and offers value for money • Commission appropriate communication skills training for staff caring for both cancer and non-cancer patients. 10.2 For educators • Align training with the common core competences and the identified needs of the local workforce • Accommodate individual training requirements, in terms of both knowledge and preferred learning style, according to accepted training principles. Apply adult learning approaches that are based on mutual trust, respect, personal responsibility and experience • Work collaboratively with other local providers to ensure that the range of training provided is responsive to changing needs, co-ordinated and comprehensive • Market what is on offer to both health and social care sectors and provide directories of all local training and education • Design training for minimum impact on continuity of service delivery • Identify both the cost benefits and the service benefits of training • Link workforce development to patient experience to capture the benefits of training • Determine the return on investment by developing evaluation criteria to assess the • Provide appropriate support to all those delivering courses 19
  • 20. • Encourage joint training across specialities and sectors as this has the potential to reinforce the value of multidisciplinary working • Consider supplementing the current core generic communication skills training with an introduction to EoLC conversations or scenarios • Use the e-ELCA (End of Life Care for All) e-learning sessions to supplement generic communication skills programmes for EoLC. 10.3 For service providers • Align workforce development with corporate business plans and strategies • Align workforce development with existing frameworks and link to clinical pathways • Align workforce competences with governance systems around patient safety and risk management • Link cost benefits of a competent workforce to training proposals and corporate business objectives • Take account of the costs of backfilling staff absence when planning training and development • Embed EoLC communication competences in human resources and organisational development plans for recruitment and appraisal • Align job descriptions and personal specifications for the EoLC workforce to the Knowledge and Skills Framework (KSF) or the Common Induction Standards for communication • Create good data collection and record keeping systems - they are essential to monitor training and staff competences 10.4 For staff managers • Align workforce development with corporate business plans and strategies • Create good data collection and record keeping systems – they are essential to monitor training and staff competences • Ensure job descriptions and personal specifications accurately describe communication competences required for the role • Include communication skills in all health and social care staff appraisals and incorporate into continuing professional development • Provide the opportunity to develop communication competences in the workplace through mentoring, example and team support. 10.5 For individual staff • Take personal responsibility for reviewing, renewing and enhancing the competences, knowledge and skill required for your role in EoLC • Measure individual role specifications against the common core competences, principles and the underlying national occupational standards to identify the competences required • Use your appraisal and personal development plans to identify training needs. "Feedback from some employers was that literacy and language could have been a barrier to completing the TNA forms, particularly for those in more junior roles." Sally Coppock, advanced nurse practitioner, St Gemma's Hospice • Link workforce development to patient experience in order to capture the benefits of training. 20
  • 21. 11. Next steps for pilots The TNA has provided the pilot sites with an information base to support development of training and education that will meet the needs of their local workforce. It will be important to monitor the delivery and uptake of training and to evaluate its impact on business objectives, staff confidence and competence, and on the user experience. Please contact the national programme at info@endoflifecare.nhs.uk for more information, or if you would like to have copies of the questionnaires used by the pilot sites. Teesside University 12. References 1. National End of Life Care Strategy. Department of Health, 2008 5. EDT 3 – standard - training needs analysis. NHS Connecting for Health 2. Developing skills: talking about end of life care. National End of Life Care Programme/Connected©, 2010 6. ETD 3 – guidance – training needs analysis. NHS Connecting for Health 3. Common core competences and principles: a guide for health and social care workers working with adults at the end of life. NEoLCP/DH/Skills for Health/Skills for Care, 2009 7. Care Quality Commission website http://www.cqc.org.uk/findcareservices.cfm 4. A framework of national occupational standards to support common core competences and principles: a guide for health and social care workers working with adults at end of life. NEoLCP/DH/Skills for Health/Skills for Care, 2010 Case studies highlighting the pilot sites' work will be posted on the National End of Life Care Programme’s website, www.endoflifecareforadults.nhs.uk, as they become available. A summary of this report is available from the publications section of the programme’s website. 21
  • 22. Appendices Appendix i: Tools to support assessment and planning 1. Common core competences and principles: a guide for health and social care workers working with adults at the end of life (NEoLCP/DH/Skills for Health/Skills for Care, 2009) Extract The competences for communication (a) In relation to EoLC, communicate with a range of people on a range of matters in a form that is appropriate to them and the situation (b) Develop and maintain communication with people about difficult and complex matters or situations related to EoLC (c) Present information in a range of formats, including written and verbal, as appropriate to the circumstances (d) Listen to individuals, their families and friends about their concerns related to the end of life and provide information and support (e) Work with individuals, their families and friends in a sensitive and flexible manner, demonstrating awareness of the impact of death, dying and bereavement, and recognising that their priorities and ability to communicate may vary over time. Principle 2 Effective, straightforward, sensitive and open communication between individuals, families, friends and workers underpins all planning and activity. Communication reflects an understanding of the significance of each individual’s beliefs and needs. Link to the guidance: http://www.endoflifecareforadults.nhs.uk/publications/corecompetencesguide 2. A framework of national occupational standards to support common core competences and principles for health and social care workers working with adults at the end of life (NEoLCP/DH/Skills for Health/Skills for Care, 2010) Extract National occupational standards (NOS) identified as relevant for ALL health and social care staff who communicate with people at the end of life. Assistant level HSC21 Communicate with and complete records for individuals Practitioner level HSC31 Promote effective communication with, for and about individuals HSC366 Support individuals to represent own needs and wishes at decision-making forums HSC368 Present individuals’ needs and preferences 22
  • 23. Advanced practitioner level HSC41 Use and develop methods and systems to communicate, record and report CHS48 Communicate significant news to individuals HSC366 Support individuals to represent own needs and wishes at decision-making forums HSC368 Present individuals’ needs and preferences Download guidance from: http://www.endoflifecareforadults.nhs.uk/publications/corecompetencesframework Search tools Other NOS may be relevant for specific staff roles or settings and a search tool is available at https://tools.skillsforhealth.org.uk Additional online tools to support identification and application of NOS are available on the Skills for Health website at www.skillsforhealth.org.uk 3. Knowledge set for end of life care (revised edition, Skills for Care, 2010) Section 2: Communication EoLC common core competences (key themes) 2.1 Communication principles Learning outcomes 2.1.1 Understand the importance of communicating, reporting and recording effectively in the care environment 2.1.2 Understand the need for positive and effective communication with the individual who is considering the end of their life 2.1.3 Understand the importance of listening to what an individual is saying to you, to ensure individuals feel valued and fully involved in the decision-making process about their care 2.1.4 Recognise that the individual’s feelings and behaviour will often be linked directly to their illness and the need to communicate about it 2.1.5 Understand that the individual’s body language is often a key indicator in what they are communicating 2.1.6 Understand principles and practices relating to confidentiality 2.2 The professional 2.2.1 Understand that significant news should normally only be relationship - roles communicated by a senior member of staff - however, this should and responsibilities not limit your communication with individuals 2.2.2 Be aware of the boundaries of your role, know how to communicate this to others 2.2.3 Know what is an appropriate professional relationship with an individual, based on trust and honesty within the constraints of your job role 2.2.4 Know how to develop a professional working relationship with friends and family members in order to support them 2.2.5 Be aware of other sources of support for individuals. For example, when considering spiritual or pastoral needs, offer to contact a minister or other faith leader if appropriate 2.2.6 Understand your level of responsibility and when to refer to a more appropriate person for information 23
  • 24. 2.3 Providing 2.3.1 Recognise that more informed individuals are more empowered accurate and people relevant information 2.3.2 Understand that individuals need access to good quality and comprehensive information, as and when they want it 2.3.3 Have knowledge of local services appropriate for the individual 2.3.4 Be aware of how to provide information about services and support networks that are available to individuals, their families and friends 2.3.5 Know how to offer written (or alternatively formatted) information and ensure it is in a language and format appropriate to the person receiving it 2.4 Recording 2.4.1 Know the importance of recording and communicating any practices significant conversations with an appropriate level of detail 2.4.2 Distinguish between subjective and objective language, fact and opinion 2.4.3 Know what constitutes clear, objective statements in care plans, reports, daily logs, handover reports, etc 2.4.4 Understand the importance of using appropriate language and avoid the use of negative statements and language when describing a person approaching the end of life 2.5 Supporting the 2.5.1 Have an understanding of a person-centred approach to support individual and their and care for individuals who are at the end of life family and friends 2.5.2 Understand the need to support and work with family and friends of the individual 2.5.3 Know how to ensure family members are supported from diagnosis to the end of the individual’s life and beyond 2.5.4 Understand the importance of involving family members in the decision-making process (within agreed limits or if the care plan names them) Link to the guidance: http://www.skillsforcare.org.uk/developing_skills/knowledge_sets/end_of_life_care.aspx 4. Common induction standards (Skills for Care, 2005) Standards for people entering the social care workforce and those changing roles or employers within social care. They are designed to be met within 12 weeks of starting employment. Standard 3 Communicate effectively Main areas Outcomes 1. Importance of effective communication in the work setting 1.1 1.2 1.3 Additional information Be aware of the different reasons why people communicate Understand how communication affects relationships in the work setting Know why it is important to observe an individual’s reactions when communicating with them 24
  • 25. Main areas Outcomes 2. Meeting the communication and language needs, wishes and preferences of individuals 2.1 Know how to establish an individual’s communication and language needs, wishes and preferences Communication methods 2.2 Understand a range of include: communication methods and styles • non-verbal that could help meet an individual’s communication including: communication needs, wishes and • eye contact preferences • touch • physical gestures • body language • behaviour • verbal communication including: • vocabulary • linguistic tone • pitch. Communication may include signs, symbols, pictures, writing, objects of reference, human and technical aids, eye contact and touch. May include a personal audit 3.1 Recognise barriers to effective of your own written and communication communication needs 3.2 Be aware of ways to reduce barriers Eg culture, religion, health issues, sensory impairment to effective communication 3.3 Know how to check communication has been understood to minimise misunderstandings when communicating Services may include: 3.4 Be aware of sources of information • translation and support or services to enable • interpreting services more effective communication • speech and language services • advocacy services 4.1 Understand what confidentiality means in your work role 4.2 Be aware of ways to maintain confidentiality in day to day communication 4.3 Be aware of situations where information normally considered to be confidential might need to be passed on 4.4 Explain how, when and from whom to seek advice about confidentiality 3. Overcoming difficulties in promoting communication 4. Understand principles and practices relating to confidentiality Additional information Link to further details about common induction standards: http://www.skillsforcare.org.uk/entry_to_social_care/common_induction_standards/common_ind uction_standards.aspx 25
  • 26. 5. e-ELCA (End of Life Care for All) Communication skills curriculum Core competences In relation to EoLC, communicate with a range of people on a range of matters in a form that is appropriate to them and the situation e-ELCA sessions • Importance of good communication • Principles of communication • Communicating with ill people • Talking with ill people: consider the surrounding environment • Culture and language in communication • Information giving • Breaking bad news Develop and maintain communication with people about difficult and complex matters or situations related to EoLC • “Am I dying?” “How long have I got?” - handling difficult questions • “Please don’t tell my husband….” - managing collusion • “I don’t believe you, I’m not ready to die!” - managing denial • “What will it be like?” - talking about the dying process • “Why can’t I stay here?” “I don’t want to stay here” when preferred place of care cannot be met • “I’m not lovable anymore....” - discussing intimacy • “Why me?” - discussing spiritual distress • Silence: the withdrawn patient • Distress: the crying patient • Request for organ and tissue donation • Request for euthanasia Present information in a range • Face-to-face communication of formats, including written • Telephone communication and verbal, as appropriate to the • Written communication circumstances Listen to individuals, their families and friends about their concerns related to EoLC, and provide information and support • • • • Work with individuals, their families and friends in a sensitive and flexible manner, demonstrating awareness of the impact of death, dying and bereavement and recognising that their priorities and ability to communicate may vary over time • • • • • Understanding and using empathy Skills that facilitate good communication Dealing with challenging relatives Challenging communication with colleagues Legal and ethical issues embedded in communication Things that block good communication Self-awareness in communication Communicating with non-English speaking patients Communicating with people with speech and hearing difficulties • Communicating with children and young people • Discussing ‘do not attempt CPR’ decisions • Discussing food and fluids Link to e-ELCA website: http://www.e-elca.org.uk 26
  • 27. Appendix ii: Scope Pilot Health care Social care Anglia (EoE) Acute hospitals (10) Community hospitals (8) Hospices (6) GPs (315) Nursing homes (165) Care homes (625) Domiciliary agencies (308) Nursing agencies (138) East Berkshire Community care nursing teams (2) Community outpatients service (1) Community hospital (1) Hospice (1) Allied health professionals teams (2) Ambulance service (1) Long term conditions team (1) Nursing care homes (21) Residential care homes (10) Domiciliary and Nursing agencies (5) Local Authority (1) Learning disabilities team (1) Essex (EoE) Acute trusts (3) Hospices (6) PCTs (3) Private residential care homes (25) Voluntary sector residential homes (3) Private nursing homes (3) Voluntary sector nursing homes (3) Dual registered private homes (4) Dual registered voluntary sector homes (1) Private domiciliary/ home care services ( 3) Local authorities (3) Dorset Acute Trusts (6) Mental health/PCT/community services (12) Hospices (5) GPs (145) Private hospitals (2) Nursing & domiciliary agencies (39) Nursing & registered care homes (123) Local authorities (10) Lancs and South Cumbria Stroke network - acute hospitals (7) Critical Care - acute hospitals (4) Renal Medicine - acute hospitals (5) Blackpool Council (10) Lancashire social care teams (6) Cumbria social care services Cumbria social care - independent sector NHS Acute Hospitals (7) Social care education providers (2) Council education providers (2) Leeds Acute trust (3 wards) Community healthcare service (1) Residential care homes (5) Nursing care homes (4) NHS acute trust (1) NHS community trust (1) Hospices (1) Help the hospices (1) LOROS Acute trust (1) PCTs (2) Community health service (2) Hospice (1) District/community hospitals (10) City/county/district councils (10) Phase 1 Acute hospitals (4) Tertiary centre (1) Hospices (4) PCT (provider services) (3) GP practices (20) Phase 1 Nursing care homes (30) Care care homes (15) Manchester Private, independent and voluntary care organisations (TBC) Other Training providers University (3) Acute trusts (9) Hospices (3) Local authority (3) PCT (1) Other (1) Patients (5) Patient focus group (1) Volunteer group (1) Technical support team (1) University (2) Acute trust (1) Hospices (1) Local authority (social care) (1) PCT (1) Other (1) University (1) Acute trusts (3) Hospices (3) Local authority (1) PCT (1) Fire & ambulance (2) Police & coroners (6) Prisons (4) Armed services (1) Accountants & finance (2) Solicitors (7) Religious & faith communities (12) Funeral directors (16) Voluntary sector (186) Hospice volunteers (TBC) Ambulance service (1) Cancer network (1) Education providers (9) East Midlands Deanery Clinical education centres at hospitals and in-house providers (TBC)) Universities (4) FEI (20) Adult education (TBC) Distance learning (TBC) Phase 1 University (5) Acute trusts (4) Hospices (3) Local authority (TBC) Other (2) Phase 2 Phase 2 Phase 2 Nursing care homes (TBC) Acute Hospitals (10) Hospices (5) Care care homes (TBC) PCT (provider services) (5) GP practices (TBC) University (as phase 1) Acute trusts (10) Hospices (3) Local authority (TBC) Mount Vernon (EoE) Secondary care teams (31) Primary care (54) Hospice (3) Nursing care homes (64) Local authority (11) Residential care homes (197) Mental health trusts (8) Prisons (2) Education/training providers (24) Plymouth Acute trust (1) PCTs (2) GP practices (64) Hospice service (1) Adult social services (2) Care agencies (12) Nursing & residential care homes (170) Charity/volunteer employees (48) Ambulance services (1) FEI (5) Universities (1) Local authority (2) Hospices (1) PCT (1) Other (16) Teesside NHS & primary care trusts (16) GPs (192) Hospices (5) Nursing homes (7) Social services (33) Prison services (4) Ambulance trusts (2) University trainer (2) In-house trainer (3) Charity trainer (1) Unknown (2) North East and South East London Cancer Networks used existing data from the Marie Curie Delivering Choice Programme 2008. 27 28
  • 28. Glossary Cancer Network Thirty cancer networks across England co-ordinate the planning, commissioning and delivery of cancer services Care Quality Commission The health and social care regulator for England Care Standards Act The Care Standards Act 2000 established a major regulatory framework for social care Common induction Standards for people entering the social care workforce and standards those changing roles or employers within social care. Designed to be met within 12 weeks of starting employment Competence A statement describing the behaviour, knowledge and values expected of workers to fulfil a specific role competently © (ACST) Connected Connected© is the national training programme in advanced communication skills developed for senior health professionals working with cancer patients Continuing Professional A process to maintain, develop and enhance skills, knowledge Development (CPD) and competence in order to improve performance at work e-ELCA (End of Life Care for A programme providing national, quality assured online training All) modules to support health and social care staff working in end of life care End of Life Care (EoLC) All elements of support to people approaching the end of their lives. It encompasses the management of all symptoms, including pain, and provides psychological, social, spiritual and practical support Knowledge and Skills The NHS Knowledge and Skills Framework defines and describes Framework (KSF) the knowledge and skills that NHS staff need to apply in their work in order to deliver quality services Knowledge set for end of The knowledge set for EoLC describes the minimum key learning life care outcomes that are required to deliver on the EoLC competences within social care NVQ National Vocational Qualifications: work-based awards for National occupational standards that are achieved through assessment and training National Occupational National occupational standards describe performance (the skills), Standard (NOS) the performance criteria (what they should achieve) and the underpinning knowledge required to undertake a particular function Palliative care A comprehensive approach to the physical, social, psychological and spiritual needs of people with progressive illness Personal Development Plan A personal development plan sets out the identified learning and (PDP) training activities that support staff development, so the job can be undertaken effectively. This is routinely reviewed during staff appraisal Skills for Care The Sector Skills Council for the UK social care sector Skills for Health The Sector Skills Council for the UK health sector Training needs analysis (TNA) TNA is the process by which training and development needs are identified 29
  • 29. Crown Copyright 2010 Edited and designed by: www.furnercommunications.co.uk www.endoflifecareforadults.nhs.uk
Description
The pilot sites report their findings for end of life care communication skills 22 September 2010 - National End of Life Care Programme This report provides the first round…