development of a knowledge and skills framework for...

Quality Education for a Healthier Scotland

Development of a Knowledge and SkillsFramework for Palliative and End of Life Care for the Health and Social Services Workforce

WorkshopPalliative and End of Life care


Aims of workshop

• To raise awareness of the Knowledge and Skills fFramework for Palliative and End of Life Care for the health and social services workforce.

• To reflect and consider your role and learning needs within the context of palliative and end of life care.


Knowledge and Skills

Framework

Health and Social Services Workforce in

Scotland

Palliative and End of Life Care


Palliative and End of life Care in Scotland

• 40,000 0f 54,000 people who die each year need palliative care.

• However, 11,000 people miss out on that care

• People receive 90% of their care at home/homely setting in the last 6 months of life

• Between 50-75% of people express a preference to die at home – yet only 25% do.


A Growing Challenge

• Ageing population – over 75s due to increase by 85% by 2039

• People dying by 2037 to increase by 12% to 62,000

• Increasing complexity – nearly 2/3rd of people over 60 have a long term condition

• 40% of people aged 75 or over living with two or more long term conditions

• The shift from acute care to community – increase in demand to die at home?

• Less resources available to meet the challenge


A Growing Challenge

8 out of 10 people who die have needs that could be met through palliative care

Next 20 years – estimated demand for health and social care services will increase by 20-30%


Strategic Framework for Action onPalliative End of Life Care

Vision

By 2021, everyone in Scotland who needs palliative care will have access to it

Meeting the Challenge


Strategic Framework for Action on Palliative Care and End of Life Care

Collaboration and Co-operation


The Strategic framework identifies 10 commitments with one commitment specifically focused on education, learning and training:

“We will support the workforce by commissioning NHS Education for Scotland and the Scottish Social Services Council to develop a new palliative and end of life care Educational Framework. This will address the needs of the whole workforce and will be focused on fostering an integrated and collaborative approach to educational provision.”

• A workforce that feels adequately trained and supported to provide the palliative and end of life care that is needed.

• All health and care workers require an appropriate level of knowledge and skill in palliative care and end of life to match level of involvement with people with P&EoLC needs


Aim/ Purpose of Education Framework

• Identify the knowledge and skills required by all workers who might come in to contact with people who have palliative and end of life care needs.

• The framework describes the key domains that are integral to palliative care in all health and social care settings and outlines the associated knowledge and skills required by all health and social service workers.


Definition of Palliative Care

Framework underpinned by WHO definitions of palliative care for adults and children.

Palliative care includes, but is not limited to the end of life and is

“ an approach that improves the quality of life of adults, babies and children and their parents, families and carers when they are facing problems associated with life- limiting conditions. It works through early identification, assessment and treatment of pain and other physical, psychological, social or spiritual problems”.


Who provides care?

Palliative care is provided by a range of health and social care sectors and informally by families, carers, friends and communities.


Development of the Framework

NES appointed 3 Practice Development Co-ordinators(PEC)

The PEC’s are in place to support the development and implementation of the framework .

• WEST (base Glasgow) : Elizabeth Sanchez-Vivar

• NORTH (base Dundee) : Jane Andrew

• SOUTH/EAST (base Edinburgh) : Elaine Colville


Communication Pathway for Development and Governance Monitoring

National Implementation Advisory Group(Scot Govt, Heath, Social Services, stakeholders )

↕

Education Advisory Group( NES, SSSC, External stakeholders)

↕

Project Team(NES,SSSC)

↕

NHS and Social Care Workforce


Development of Framework – Phase 1

• In fostering an integrated and collaborative approach to workforce learning and development, we consulted widely with health and social service workers, experts in palliative and end of life care, educators and other partners who helped us develop, review and refine the framework.

Evidence gathered through:

• scoping existing palliative and end of life care education and development provision;

• a rapid review of literature and mapping of existing palliative and end of life care competency and capability frameworks;

• focus groups held with health and social service workforce; and

• a NES/SSSC survey of the palliative and end of life care learning needs of the health and social service workforce.

• The framework structure and content was then shared at regional and cross-sector levels. Expert groups, health and social service workers, educators and other partners reviewed the content and provided feedback which was used to revise the framework. The revised framework was then disseminated through an on-line consultation. Responses from the health and social service workforce and other key stakeholders informed refinement of finalised the framework


Phase1 : Development

Framework Development

and Production

CONSTRUCTION OF DRAFT

FRAMEWORK CONTENT

ENGAGEMENT WITH

STAKEHOLDERS

CONSULTATION WITH

STAKEHOLDERS

REVIEW OF THE DRAFT

FRAMEWORK

REVISION OF THE DRAFT

FRAMEWORK


Structure of Framework

The framework has three interrelated components:

• Principles of the framework

• Domains - associated knowledge and skills

• Levels - of knowledge and skills


DO

MA

IN 1

Fun

dam

enta

l of

Palli

ativ

e C

are

K &

S

DO

MA

IN 2

Co

mm

un

icat

ion

& C

on

vers

atio

n K

&S

DO

MA

IN 3

Loss

, Gri

ef a

nd

Be

reav

eme

nt

K &

S

DO

MA

IN 4

Car

e P

lan

nin

g &

Del

iver

y K

&S

Person-centered

Care

National Care

Standards

Human Rights

UNDERPINNING

PRINCIPLES

LEVEL Expert

LEVEL Enhanced

LEVEL Skilled

LEVEL Informed

DO

MA

IN 5

C

are

Last

Day

s o

f Li

fe K

&S

Knowledge and Skills Development Frameworkfor Health and Social Care Workforce in Scotland


Underpinning Principles

Three sets of principles which promote a person-centred, outcomes focused, human rights based approach to palliative and end of life care. These principles are at the centre of the integration of health and social care and wider public service reform.

• World Health Organisation Definitions of Palliative Care. Palliative care is internationally recognised as a basic human right, promoting person-centred care.

• The PANEL Principles (Participation, Accountability, Non-discrimination and Equality, Empowerment and Legality). These principles underpin a human rights based approach which empowers people to know and claim their rights.

• The National Care Standards Principles are integral to the standards which outline what everyone in Scotland can expect when using health and social care services, and how providers of care should deliver and improve services. These are based on a human rights approach underpinned by the PANEL principles


Domain Themes

• Fundamentals of palliative care

• Communication and conversations

• Loss, grief and bereavement

• Care planning and delivery

• Care in the last days of life


Loss, Grief &Bereavement

Communication&

Conversations

Fundamentals Of

Palliative Care

Care Planning

Care in last days of Life

Knowledge and skill Domains


Knowledge and Skill Domains (I)

Domain 1: Fundamentals of palliative care

• This domain includes the underpinning principles and philosophy of a palliative care approach, and incorporates elements essential to the development and improvement of palliative and end of life care service provision.

Domain 2: Communication and conversations

• Effective communication and conversations are integral to the provision of palliative and end of life care and support. Workers need to be able to have effective conversations with people who may be experiencing distress and uncertainty, to provide support and share decision making. Good communication is also essential to enable effective teamwork, in and across teams.

Domain 3: Loss, grief and bereavement

• Dealing with loss, grief and bereavement for the person, their family and carers, and the workforce who provide care and support for them, is integral to palliative and end of life care provision. This domain acknowledges the potential impact of living and working with loss and recognises the importance of appropriate support for self and others.


Domain 4: Care planning and deliveryThis domain outlines the importance of working in partnership with the person, their family and carers to promote participation, choice and control, and address their personal outcomes and holistic needs. This involves taking a proactive approach to care; anticipating, assessing and responding in a timely way to incorporate their needs, personal outcomes and choices. This takes account of changing needs, deterioration and uncertainty.

Domain 5: Care in the last days of lifeThis domain focuses on care in the last days and hours of life when the team caring for the person agree that death is expected within hours to days, and a natural death is occurring with all possible reversible causes having been considered

Knowledge and Skill Domains (II)


Levels of Knowledge and Skills (I)

Knowledge and skills

Within each domain, there are four levels of knowledge and skills. These outline what workers need to know and do, depending upon their degree of involvement in palliative and end of life care, and their role responsibilities in the care and support of people with palliative and end of life care needs, their families and carers. Some of the knowledge and skills are integral to all health and social care, and in the framework, are applied in the context of palliative and end of life care.

• Informed level outlines the knowledge and skills required by all health and social service workers in relation to palliative and end of life care.

• Skilled level outlines the knowledge and skills required by health and social service workers who by virtue of their role and level of responsibility regularly provide care and support to people with palliative and end of life care needs, their families and carers.


Enhanced level outlines the knowledge and skills required by health and social service workers who by virtue of their role and level of responsibility provide, co-ordinate and manage the care and support of people with palliative and end of life care needs, their families and carers.

Expert level outlines the knowledge and skills required by health and social service workers who by virtue of their role and level of responsibility play an expert specialist role in the care and support of people with palliative and end of life care needs, their families and carers.

Levels of Knowledge and Skills (II)


Levels of knowledge and Skills

• The levels of knowledge and skills required by workers may differ across the five domains depending on their degree of involvement and role responsibilities.

• Knowledge and skills at each level are incremental, in that, the depth and breadth of knowledge required, and the complexity of related skills associated with each domain increases at each level.

• A worker at enhanced level within a domain will therefore have the knowledge and skills at the preceding levels. This enables the framework to be used in a flexible way enabling workers to develop their knowledge and skills at different levels.

• The framework does not specify particular roles in relation to the corresponding knowledge and skills levels, and the levels are not defined by profession or seniority in an organisation or sector.

• Rather, individual workers and their employers are best placed to interpret and apply the content and aspirations of the framework to their roles


Ongoing and Future developmentPhase 2

• National Knowledge and Skills Development Framework PEOLC Launch (provisionally) April 2017

• National and Regional Engagement for Implementation with Health and Social Care Partnerships, Independent, Third and Education Sector Work Force

• National and Regional Engagement for Evaluation and Impact Assessment

• Continuous Regional Engagement with Health and Social Care Partnerships, Independent, Third, Education sector work force (identify educational need, gaps, resources, access to education/training)

• Review, update and collate existing educational resources (nationally , regionally and internal)


Community of Practice : Palliative Care Education

The Project development can be accessed through the following link:

www.knowledge.scot.nhs.uk/pceducation.aspx

http://www.knowledge.scot.nhs.uk/pceducation.aspx


References

• Scottish Partnership for Palliative Care. Grasping the nettle. What action can we take to improve palliative and end of life care in Scotland? Edinburgh: Scottish Partnership for Palliative Care; 2015. Available from: Available from: http://www.parliament.scot/S4_HealthandSportCommittee/Inquiries/PCA_Grasping-the-Nettle_SPPC.pdf

• The Scottish Government. Strategic framework for action on palliative and end of life care. 2016-2021. Edinburgh: The Scottish Government; 2015. Available from: http://www.gov.scot/Topics/Health/Quality-Improvement-Performance/peolc/SFA

• Skills for Care. National occupation standards. Available from: http://www.skillsforcare.org.uk/Standards-legislation/National-Occupational-Standards/National-Occupational-Standards.aspx

• World Health Organisation. WHO definitions of palliative care. Available from: http://www.who.int/cancer/palliative/definition/en/

• Scottish Human Rights Commission. Scotland’s national action plan for human rights 2013-2017. Edinburgh: Scottish Human Rights Commission; 2013.

• Healthcare Improvement Scotland. National care standards principles. Available from: http://www.healthcareimprovement

http://www.skillsforcare.org.uk/Standards-legislation/National-Occupational-Standards/National-Occupational-Standards.aspx

http://www.healthcareimprovement/


1. What do you consider to be your role in Palliative and End of Life Care?

2. Considering your role as a HCSW and involvement with people who have Palliative and End of Life Care needs, what do you feel your learning needs are?

3. How do you see yourself interacting with this framework?

4. What Is the key learning that you will be taking away from today’s session?

Discussion and Reflection

development of a knowledge and skills framework for...

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