Analysis iStock
NHS has for it. We are all in this together so why should we not allow all people access to excellent training?’ But despite the obvious benefit to the NHS in terms of preventing more serious complications and relieving day-to-day demands on its services, schemes like this remain the exception rather than the rule. Health Education England (HEE) has a budget of more than £5 billion, but virtually all of that is spent on NHS staff.
Better care sector training could ease NHS workload A pilot scheme is providing nursing home staff with skills in essential procedures. Nick Triggle reports IT SOUNDS so simple the way Health Education Yorkshire and Humber strategic clinical skills adviser Kay Ford describes it. She oversees an NHS-funded training scheme to bring nursing home staff up to speed on a host of fundamental skills from taking blood to preventing pressure ulcers. The scheme was launched after prompting from health colleagues that helping the care sector would also benefit the NHS. Funding was agreed and it was set up. ‘Health professionals brought it to my attention,’ Ms Ford says. ‘They were saying if we could help improve training in care homes it could relieve the pressure on NHS services in terms of fewer visits to A&E, GPs and services such as phlebotomy clinics.’ That was a year ago. So far 500 staff have been trained and another 300 are due to be trained. The programme is still in the process of being evaluated, but already the signs are encouraging. 8
July 2014 | Volume 26 | Number 6
The programme is run by a trainer who visits homes in the area to offer training to care assistants and nurses who want their skills refreshed. They are given the chance to practise the procedures on manikins. As well as learning to turn patients to prevent pressure ulcers and taking blood, staff are taught about catheter care and how to take observations such as blood pressure. Ms Ford says her organisation has always been innovative, but she believes there is no reason why other parts of the NHS should not follow suit. In fact, she suggests they have a duty to do so. ‘They [providers] try to provide training to staff, but have not got the budget the
Health Education England has a budget of more than £5 billion, but virtually all of that is spent on National Health Service staff
Complex conditions Care England, the body that represents providers, believes there needs to be a change in approach. Chair Jane Ashcroft says: ‘The conditions people have are getting more complex and care and nursing homes are expected to do more for their residents. We would like to see the NHS reach out more and support us. ‘Providers recognise the value of good training, it helps us retain and motivate staff but we just do not have the budget the NHS has. It has got particularly difficult in recent years because of the squeeze on the fees councils pay. It means training and numbers suffer unfortunately.’ RCN professional lead for the care of older people Dawne Garrett agrees. ‘The training needs of nursing and care home staff have been largely ignored compared with what happens in the NHS and that is having an impact,’ she says. ‘It is happening at a time when the acuity of illness of care home residents has been increasing because of the ageing population, the drive to keep people in the community and the push to discharge them from hospital quickly. ‘Staff are not always as equipped as they should be. Pressure ulcers and catheters are an issue, but so too are what were once much more unusual needs which are now becoming more common. We are seeing people with tracheostomies and tube feeding in nursing homes and even care homes. Dementia and end of life care can prove challenging as well.’ Ms Garrett acknowledges attempts are being made to improve standards. HEE is drawing up a care certificate for staff working at a healthcare assistant grade across the NHS and social care sectors. The aim is to ensure consistent and high quality NURSING OLDER PEOPLE
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Analysis
Mandatory education needed to encourage end of life conversations
Fair price Association of Directors of Adult Social Services immediate past president Sandie Keene says there is now an acceptance in local government that there needs to be a ‘fair price for care’. ‘This is beginning to be addressed,’ she says. ‘The push for fair prices has seen some of the drop in fees tail off.’ The latest market data from analysts LaingBuisson back this up. In 2013/14 baseline fees paid by councils rose by 1.7%, close to the 1.9% increase in costs that providers reported they faced. However, LaingBuisson pointed out that over the past four years there has been a 5.2% real-terms cut in council-paid fees. But Ms Keene is adamant it is a two-way street. ‘We want to work with providers, but we also need to recognise things are not as bad as has been suggested. The fact remains investment is still being made in the sector and profits are still being made.’
A LARGE STUDY has highlighted significant variation in end of life care across hospitals in England. The National Care of the Dying Audit for Hospitals, published by the Royal College of Physicians (RCP), calls for major improvements to ensure all patients and their carers receive the same standard of care and support. The investigation covered 6,580 people who died in 149 hospitals between May 1 and May 31 2013, and the experiences of 858 bereaved relatives or friends. One of the main findings was a need for better communication between clinicians, patients and carers. According to the audit, doctors and nurses had recognised that most patients (87%) were in the last days of life, but spoke about it with less than half (48%) of those considered capable of having the discussion. From the bereaved relatives’ questionnaire, 76% reported being very involved or fairly involved in decisions about care and treatment, but 24% said they did not feel they were involved in decisions at all. The audit found that training in end of life care was required for nurses in only 28% of trusts. It recommends mandatory training for all staff caring for dying patients, including communication skills training.
Nick Triggle is a freelance writer
Reference Care Quality Commission (2013) The State of Health Care and Adult Social Care in England in 2012/13. www.cqc.org.uk/sites/ default/files/documents/cqc_soc_report_2013_lores2.pdf (Last accessed: June 5 2014.)
NURSING OLDER PEOPLE
Alamy
‘values, behaviours, competencies and skills’ are achieved across the board. It will be launched in March 2015. But she says the demands being placed on homes go beyond the need for training. ‘Nurse staffing ratios are a problem too,’ she says. ‘Resources are too often stretched.’ Evidence presented in the Care Quality Commission’s state of care report, published last autumn, suggests staffing pressures, lack of training and cuts to social care have started to have an effect. It pointed out that overall one in ten people over the age of 75 had experienced an avoidable emergency admission. In care homes people with dementia were particularly vulnerable because they were 30% more likely to be admitted than residents without the condition. What is more, inspections raised safety and care concerns in one fifth of nursing homes and one in ten care homes.
An audit of hospitals in England highlights improvements required when communicating with patients. Louise Hunt reports
RCN long-term conditions adviser Amanda Cheesley, whose remit includes end of life care, says communication skills are an important area for improvement. ‘In many areas, training is focused on treatment and management. It is not necessarily about having the skills to have difficult conversations with patients,’ she says. ‘We need to be equipping nurses with the skills to initiate a frank conversation about what happens at the end, or discuss their choices if a patient raises the question so they can make the most of the time they have left. ‘The level of skill is patchy. There are nurses with absolutely excellent end of life care skills, but some may be reluctant to say: “This is the time to stop treatment. We are probably not going to make a difference now”. Nurses need to be much more comfortable with having that conversation.’ Debriefings She adds that additional training in communication skills could be relatively simple ward-level measures instigated by nurse managers, such as debriefings after a death to discuss if anything could have been done differently. ‘Making end of life care training a priority has to come from the executive team as part of an ethos of respecting patient care,’ says Ms Cheesley, highlighting the example of the Heart of England NHS Foundation Trust, which has recently commissioned end of life care training for all of its 6,000 nurses. And she adds: ‘Every nurse who feels they need additional end of life care skills should have access to training, even if they are not working in places where people are likely to die.’ Louise Hunt is a freelance writer
Find out more To read the RCP audit go to tinyurl.com/ careofdying July 2014 | Volume 26 | Number 6
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9
NHS has for it. We are all in this together so why should we not allow all people access to excellent training?’ But despite the obvious benefit to the NHS in terms of preventing more serious complications and relieving day-to-day demands on its services, schemes like this remain the exception rather than the rule. Health Education England (HEE) has a budget of more than £5 billion, but virtually all of that is spent on NHS staff.
Better care sector training could ease NHS workload A pilot scheme is providing nursing home staff with skills in essential procedures. Nick Triggle reports IT SOUNDS so simple the way Health Education Yorkshire and Humber strategic clinical skills adviser Kay Ford describes it. She oversees an NHS-funded training scheme to bring nursing home staff up to speed on a host of fundamental skills from taking blood to preventing pressure ulcers. The scheme was launched after prompting from health colleagues that helping the care sector would also benefit the NHS. Funding was agreed and it was set up. ‘Health professionals brought it to my attention,’ Ms Ford says. ‘They were saying if we could help improve training in care homes it could relieve the pressure on NHS services in terms of fewer visits to A&E, GPs and services such as phlebotomy clinics.’ That was a year ago. So far 500 staff have been trained and another 300 are due to be trained. The programme is still in the process of being evaluated, but already the signs are encouraging. 8
July 2014 | Volume 26 | Number 6
The programme is run by a trainer who visits homes in the area to offer training to care assistants and nurses who want their skills refreshed. They are given the chance to practise the procedures on manikins. As well as learning to turn patients to prevent pressure ulcers and taking blood, staff are taught about catheter care and how to take observations such as blood pressure. Ms Ford says her organisation has always been innovative, but she believes there is no reason why other parts of the NHS should not follow suit. In fact, she suggests they have a duty to do so. ‘They [providers] try to provide training to staff, but have not got the budget the
Health Education England has a budget of more than £5 billion, but virtually all of that is spent on National Health Service staff
Complex conditions Care England, the body that represents providers, believes there needs to be a change in approach. Chair Jane Ashcroft says: ‘The conditions people have are getting more complex and care and nursing homes are expected to do more for their residents. We would like to see the NHS reach out more and support us. ‘Providers recognise the value of good training, it helps us retain and motivate staff but we just do not have the budget the NHS has. It has got particularly difficult in recent years because of the squeeze on the fees councils pay. It means training and numbers suffer unfortunately.’ RCN professional lead for the care of older people Dawne Garrett agrees. ‘The training needs of nursing and care home staff have been largely ignored compared with what happens in the NHS and that is having an impact,’ she says. ‘It is happening at a time when the acuity of illness of care home residents has been increasing because of the ageing population, the drive to keep people in the community and the push to discharge them from hospital quickly. ‘Staff are not always as equipped as they should be. Pressure ulcers and catheters are an issue, but so too are what were once much more unusual needs which are now becoming more common. We are seeing people with tracheostomies and tube feeding in nursing homes and even care homes. Dementia and end of life care can prove challenging as well.’ Ms Garrett acknowledges attempts are being made to improve standards. HEE is drawing up a care certificate for staff working at a healthcare assistant grade across the NHS and social care sectors. The aim is to ensure consistent and high quality NURSING OLDER PEOPLE
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 19, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Analysis
Mandatory education needed to encourage end of life conversations
Fair price Association of Directors of Adult Social Services immediate past president Sandie Keene says there is now an acceptance in local government that there needs to be a ‘fair price for care’. ‘This is beginning to be addressed,’ she says. ‘The push for fair prices has seen some of the drop in fees tail off.’ The latest market data from analysts LaingBuisson back this up. In 2013/14 baseline fees paid by councils rose by 1.7%, close to the 1.9% increase in costs that providers reported they faced. However, LaingBuisson pointed out that over the past four years there has been a 5.2% real-terms cut in council-paid fees. But Ms Keene is adamant it is a two-way street. ‘We want to work with providers, but we also need to recognise things are not as bad as has been suggested. The fact remains investment is still being made in the sector and profits are still being made.’
A LARGE STUDY has highlighted significant variation in end of life care across hospitals in England. The National Care of the Dying Audit for Hospitals, published by the Royal College of Physicians (RCP), calls for major improvements to ensure all patients and their carers receive the same standard of care and support. The investigation covered 6,580 people who died in 149 hospitals between May 1 and May 31 2013, and the experiences of 858 bereaved relatives or friends. One of the main findings was a need for better communication between clinicians, patients and carers. According to the audit, doctors and nurses had recognised that most patients (87%) were in the last days of life, but spoke about it with less than half (48%) of those considered capable of having the discussion. From the bereaved relatives’ questionnaire, 76% reported being very involved or fairly involved in decisions about care and treatment, but 24% said they did not feel they were involved in decisions at all. The audit found that training in end of life care was required for nurses in only 28% of trusts. It recommends mandatory training for all staff caring for dying patients, including communication skills training.
Nick Triggle is a freelance writer
Reference Care Quality Commission (2013) The State of Health Care and Adult Social Care in England in 2012/13. www.cqc.org.uk/sites/ default/files/documents/cqc_soc_report_2013_lores2.pdf (Last accessed: June 5 2014.)
NURSING OLDER PEOPLE
Alamy
‘values, behaviours, competencies and skills’ are achieved across the board. It will be launched in March 2015. But she says the demands being placed on homes go beyond the need for training. ‘Nurse staffing ratios are a problem too,’ she says. ‘Resources are too often stretched.’ Evidence presented in the Care Quality Commission’s state of care report, published last autumn, suggests staffing pressures, lack of training and cuts to social care have started to have an effect. It pointed out that overall one in ten people over the age of 75 had experienced an avoidable emergency admission. In care homes people with dementia were particularly vulnerable because they were 30% more likely to be admitted than residents without the condition. What is more, inspections raised safety and care concerns in one fifth of nursing homes and one in ten care homes.
An audit of hospitals in England highlights improvements required when communicating with patients. Louise Hunt reports
RCN long-term conditions adviser Amanda Cheesley, whose remit includes end of life care, says communication skills are an important area for improvement. ‘In many areas, training is focused on treatment and management. It is not necessarily about having the skills to have difficult conversations with patients,’ she says. ‘We need to be equipping nurses with the skills to initiate a frank conversation about what happens at the end, or discuss their choices if a patient raises the question so they can make the most of the time they have left. ‘The level of skill is patchy. There are nurses with absolutely excellent end of life care skills, but some may be reluctant to say: “This is the time to stop treatment. We are probably not going to make a difference now”. Nurses need to be much more comfortable with having that conversation.’ Debriefings She adds that additional training in communication skills could be relatively simple ward-level measures instigated by nurse managers, such as debriefings after a death to discuss if anything could have been done differently. ‘Making end of life care training a priority has to come from the executive team as part of an ethos of respecting patient care,’ says Ms Cheesley, highlighting the example of the Heart of England NHS Foundation Trust, which has recently commissioned end of life care training for all of its 6,000 nurses. And she adds: ‘Every nurse who feels they need additional end of life care skills should have access to training, even if they are not working in places where people are likely to die.’ Louise Hunt is a freelance writer
Find out more To read the RCP audit go to tinyurl.com/ careofdying July 2014 | Volume 26 | Number 6
Downloaded from RCNi.com by ${individualUser.displayName} on Nov 19, 2015. For personal use only. No other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
9
