Developing Generalist Palliative Care Training

1. Developing Generalist Palliative Care Training Helen Dryden Clinical Lead Palliative Care Angus CHP February 2010

2. Today • Define Palliative Care • Consider that palliative care is everyone’s business and everyone’s right • Background to the project • How the project worked • Where are we now- 20 months later?

3. Definition from the World Health Organisation 2002 “….an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness through the prevention and relief of suffering, by means of of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual.”

4. Who can benefit? • People of all ages can benefit from palliative care. • It can help at all stages of the illness from the point of diagnosis, while treatment is in progress, and at the end of life. (Scottish Partnership for Palliative Care)

5. National Picture • Long term conditions & self care • Move to non cancer palliative care • Demographic timebomb • 17 policy documents relating to palliative care in last 7 years • Living & Dying Well Oct 2008

6. Our Local Picture • Clients and carers need access to the best quality palliative care wherever they are, regardless of diagnosis • In 2008- 4558 people died in Tayside- the majority in hospital ( 1280 in Angus) • Nearly 2000 social care officers across Tayside in all settings • Specialist palliative care and District Nursing Services provide training but unable to sustain and cope with large numbers

7. Talking about dying(BBC ICM Poll 2005) • 66% of us haven't discussed how we'd like to die • 62% of us don't want to be artificially fed in a coma • 67% of us wish to die at home • 78% of us would like to be told if we were dying How many of us have told anyone else about our wishes? ICM interviewed a random sample of 1,027 adults aged 16-plus between 1 and 16 July 2005.

8. Death and Dying “I don’t mind dying.  I just don't want to be there when it happens” Spike Milligan

9. Background • Palliative care theory and practice has developed significantly over the last twenty years; however, is has not yet been fully integrated into the core curriculum of interdisciplinary health care providers. • The majority of social and healthcare providers have not received formal education and training in the principles and practices of palliative care.

10. Background • 3 local palliative care services and delivering choice programme had frequent requests for training • Only one dedicated Practice Educator in Tayside- based at Roxburghe- working to capacity • Lack of generalist palliative care education • Discussed at Tayside Pall care Education group • HD arranged meeting with local college and SWD & NHS Tayside rep in Jan 08 • Prepared project brief and developed resources in partnership with:

11. NHS Tayside Palliative Care Strategy: 6 promises Making the most of every day Continuity No symptoms No surprises Customised care Safe Effective care

12. Project objectives: • To develop a training guide, participants handbook and other educational resources to raise awareness of generalist palliative care across Tayside • To prepare and support local trainers to deliver six hours training in palliative care. • To increase staff awareness and understanding of the palliative approach and services available in Tayside

13. Levels of provision • The needs of the majority of people with life- threatening illness can be met by generalists with a basic level of knowledge of palliative care • A minority will need input from specialist palliative care providers i.e. hospices and specialist palliative care teams

14. Five key areas for action: • Assessment and review of palliative and end of life care needs • Planning and delivery of care • Communication and co-ordination • Education, training and workforce development • Implementation and future developments

15. Groundwork • 4 meetings help with small working group- resources developed including evaluation plan • Pilot ran April 2008- (20 people attended) • Due to demand another course provided in Perth Sept 08- (23 people attended + waiting list of 8 people)

16. Trainers’ Main Employer/ Work base (n=43) • Social Work Department 15 • Higher Education College 4 • Care Home 15 • NHS 2 • Other (private care agencies) 7

17. 2 day facilitation skills for trainers • Friday/Monday ½ day facilitation skills then core course content • Practice in small groups all sessions • Take turns of facilitating sessions • Use of work books and trainer guides • Q&A session with course facilitators (Marie Curie & NHS Tayside Specialist pall care staff)

18. Training delivered to date….. • 43 trainers attended 2 day course April + Sep 08-Well evaluated • Over 50 study days (6hrs) have been delivered • Students at Angus College receive introduction to palliative care study day. • Training continues this year in Dundee, Perth & Angus.

20. Staff Attending Training April 08-Dec 09 (n=742)

21. Evaluation • Pre-post for trainers • All trainers & participants submit evaluation forms after each study day • Five focus groups completed • Final report March 09 • External evaluation Dec 09 in press

22. Where are we now? • Up to end Dec 09- trainers trained over 700 staff across Tayside Social care/social work trainers have demonstrated their commitment to further development by attending further training related to palliative care.

23. In Conclusion “Change will not come if we wait for some other person or some other time. We are the ones we’ve been waiting for. We are the change that we seek” Barack Obama (Speech 5th Feb 2008)