Workforce development and training: Exploring barriers to a universal approach to end of life care

Healthwatch Staffordshire undertook a project to look into End of Life Care (EoLC) during 2016-17. This was identified as a priority area of focus following a public consultation and was also informed by local intelligence which indicated there were discrepancies in the way EoLC was provided across the county and West Midlands region.

The purpose of the project was to explore the barriers to a consistent, holistic approach to EoLC across Staffordshire, Walsall and Wolverhampton. Three primary areas to research were identified: Advance Care Planning (ACP), Workforce Development and Pre and Post Bereavement Support. This report focuses on Workforce Development and aims to identify the skills and experience of the EoLC workforce, what systems and processes can be put in place for effective multi-disciplinary collaboration, and what training needs to be put in place to help staff do their job effectively.

The study used questionnaires as the main data collection method, sent out to End of Life education trainers in the various hospices and hospitals within Staffordshire, Walsall, and Wolverhampton. This research was led and completed by Engaging Communities Staffordshire (ECS)/Healthwatch Staffordshire, with input and support from Douglas Macmillan Hospice and University Hospitals North Midlands (UHNM). The report also includes an intensive literature review.

The key findings of the study are as follows:

- The palliative workforce is in crisis and requires key changes to survive. The barriers that prevent effective multi-disciplinary collaboration were identified as: difficulty in recruiting and retaining staff, an increasing workload that prevents staff from undertaking training, the cost of training and the lack of resources.

- The current training and development needs to go beyond the basic academic knowledge to include specialist training such as spiritual care training, communication skills training and resilience and stress management training.

- The lack of palliative care staff needs to be dealt with. One mid-term solution could be to merge their workloads with those of generalist staff who have a similar role to specialist palliative care staff to increase efficacy and reduce duplicity.

- The Electronic Palliative Care Co-ordination Systems (EPaCCS) is used to record and share patients’ end of life care preferences. The system has been beneficial overall for EoLC but it is not able to effectively work across sectors to include other organisations (e.g. ambulance services) involved in the care of patients, due to data protection issues and lack of communication.

The report makes three recommendations:

1) Improvements need to be made to the current system (EPaCCS) used to record and disseminate EoL plans to ensure everyone involved in a patient’s care can access the relevant information to enable better joint working.

2) Training should go beyond the academics and theory to include specialist training such as spiritual care training, and should utilise more interactive methods to deliver the training.

3) Enable the release of the workforce for training – for example this could mean using a more effective rota system, using volunteers for non-medical activities.