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National End of Life Care Programme

Claire Henry
National Programme Director
National End of Life Care Programme

At some point in his or her career, almost every nurse is going to be involved in the care of someone nearing the end of their life. Of course, some nurses choose to specialise in those relatively small areas of nursing that centre around helping the patient towards a dignified death, involving the provision of palliative care.

For much of the nursing workforce, however, contact with those who are dying is more sporadic. As is the case with practice nurses, they are likely to be just one member of a multidisciplinary team, possibly spread across secondary and tertiary care, voluntary sector hospices, social care and even specialist housing.

The Department of Health's (DH) National End of Life Care Strategy, published last summer (2008), recognised that with such a broad range of professionals involved in some way in caring for those at the end of their life, "a cultural shift in attitude and behaviour" had to be achieved across the health and social care workforce.

June 2009 saw the launch of Common core competences and principles for health and social care workers working with adults at the end of life. The document, which places the core competences required by up to 2.5m health and social care staff into four groupings, is a response to a call-to-arms in the national strategy.

It said: "There is widespread agreement on the importance of workforce development to the overall success of this End of Life Care Strategy and an acknowledgement that there are deficiencies in the knowledge, skills, attitudes and behaviours of staff groups who come into frequent contact with people at the end of their lives. The focus, therefore, relates more to training and development issues across all the statutory and independent sectors involved in end-of-life care services, than on an expansion in the workforce."

The four core groups of competences are:

  • Communication skills.
  • Assessment and care planning.
  • Symptom management, maintaining comfort and wellbeing.
  • Advance care planning.

They are accompanied by seven principles, which emphasise the need for end-of-life care that responds to the needs and wishes of the individual and his or her family. The principles also emphasise the imperative for interagency working and that workers should have the support they need to develop the knowledge, skills and attitudes that allow them to deliver high-quality end-of-life care. Often, that includes the patient remaining at home to die or as close to death as possible.

In this way, the competences and principles emphasise the crucial role of the local GP surgery and their relationships with community nursing teams and social care. This also makes clear how the document meshes with the recent guide around end-of-life care in the Transforming Community Services: Ambition, Action, Achievement series.

That guide, Transforming End of Life Care, emerged from Health Minister Lord Darzi's Next Stage Review of the NHS. It also emphasises the importance of effective health and care partnerships. The guide says better teamwork should ensure improved co-ordination at all stages of the patient pathway. The competences and principles are intended to support workforce development and training across all relevant professional and staff groups at all levels and in all care settings.

It is obvious that with practice nurses having contact with so many patients nearing the end of their lives, their loved ones and a range of professionals, such as allied health professionals, social care professionals and district nurses, you can make a real difference to the quality of end-of-life care.

The core competences represent the first of a three-strand workforce development programme. A suite of e-learning resources developed by e-Learning for Healthcare will be launched in January, with a communications skills programme to follow later in 2010. That additional communications programme – despite the skill being covered in the competences published last month – shows just how vital a component of end-of-life care  good communication is.

For the full core competences document visit the NEOLCP website at: or to order a copy email:
To download the Transforming End of Life Care guide visit: