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Nurses to get communication skills training in Welsh palliative care plan

NHS Wales nurses delivering palliative care are to receive improved training plus better people support and end of life communication skills.

The expectations of staff nursing the terminally ill have been set out by the Welsh government.

The “Delivering End of Life Care” plan sets out to improve how people in Wales will be supported and cared for at the end of their lives.

The Welsh government wants sector staff working for NHS Wales and its partners to make palliative care consistently good across the country.

Central to its plans are ensuring that professionals and families work together to plan for the end of life, and that people are well-supported, wherever they choose to die.

The plan specifically aims to:

  • improve training for health professionals delivering end of life care in the community
  • develop the skills required to support people wherever they choose to die
  • improve communication skills to enable discussions about the end of life with individuals and their families
  • seek the opinions of individuals about their care to feed back and ensure continuous improvement in end of life care.
  • The proposals build on the achievements of the Palliative Care Implementation Board.

These include ensuring every health board can access specialist palliative care 24 hours a day, seven days a week, delivering education programmes for GPs and nursing home staff and ensuring care pathways put the viewpoints of the patient and their relative at the centre of care.

Health minster Mark Drakeford said that maintaining an individual’s dignity in their last days of life is vital.

This can be achieved, he said, by having open and honest chats about the end of life and providing support to people and their families to plan for the end of life.

Mr Drakeford added: “How well we care for our dying reflects how we care as a society. Inequalities at the end of life are as unacceptable as inequalities in life.”

Simon Jones, Head of Policy and Public Affairs for Marie Curie Cancer Care in Wales, said: “As an organisation, we welcome the Welsh Government’s plan on palliative care in Wales.

“We are particularly pleased with the emphasis on providing palliative care via integrated working between the NHS, local government and third sector providers, which will allow terminally ill patients easier access to the care they need.

Susan Morris, General Manager for Macmillan Cancer Support in Wales, said: “Macmillan welcomes the Welsh Government’s new End of Life Care Delivery Plan, the first comprehensive strategy on end of life care in Wales.

“We hope that this plan will lead to an improvement in the quality and consistency of palliative and end of life care across Wales.”

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Readers' comments (3)

  • michael stone

    'Central to its plans are ensuring that professionals and families work together to plan for the end of life'

    Good - I keep nagging all and sundry about this: my current terminology involves 'replacing the MDT approach with the Core Care team concept' (CCT = everyone who while an EoL patient is at home, can in theory talk to each other and to the patient: so CCT = GP, live-with 'relatives' and regularly-attending District Nurses).

    Then you tell the CCT 'Talk to each other - or else it can get horribly confused !' and you tell everyone outside the CCT (999) 'anyone in the CCT understands this better than you do - believe the person'.

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  • michael stone

    I’m in a good mood so far today, by my standards.

    First I get an e-mail from the Nat EoL Team, which makes me think I’m making progress with my campaign to stop the English NHS from writing in its guidance ‘a verbal refusal of cardiopulmonary resuscitation is not legally binding’ (which is nonsense, legally, ethically and logically – it is an absurdity, the promulgation of which, should make anyone with a brain cry !).

    Then I read this one, making me suspect that Wales has moved towards my Core Care Team idea, for end-of-life at home. This is the theory, and operation, for my CCT concept, very briefly:

    WHY IT IS NEEDED

    I would claim, that the nature of the discussions when EoL patients are at home, is so complex, chaotic and ‘implicit’, that a process-based approach to record-keeping is so doomed to either incompleteness, or to ambiguity and therefore the potential to mislead, that instead the primary reliance must be the distinction between ‘the people who are involved with the patient in an ongoing way’ and those who are not.

    Basically – ‘you needed to be there, to properly understand it’.

    The MDT concept, does not do that: the MDT concept introduces a primary division, between professionals and laymen.

    The CCT concept, by contrast, introduces a primary division, between those people, lay or professional, who have been able to talk to the patient and to each other on an ongoing basis, and everyone who is outside of the CCT group.

    HOW IT WORKS

    The way the MDT ‘concept’ works, is fairly well understood by clinicians in theory, even if in practice implementation is variable. So I will concentrate on the ‘mechanism’ implied by the CCT concept. It basically only involves a few ‘directives’, with the members of the CCT being told to follow these principles, and to create for each patient and live-with relatives (LWRs), on an ad hoc basis, ‘whatever works best for you as a group’ (this does not exclude things such as EPaCCS – it merely relegates the significance of such formalised records):

    1) Everyone in the CCT, and the patient, must attempt to keep talking to each other, sufficiently that nobody is deprived of any information that person would ‘reasonably need to know’ – so the stress is on ‘keep talking to each other, as openly as possible, because if you don’t talk, then confusion and false assumptions can easily be the result’.

    2) This does not preclude record-keeping, but it downgrades written records to a status secondary to an explanation of a record, given by anyone within the CCT who says ‘that actually means ….’. So, the second implication is that everyone outside of the CCT, has to be instructed to believe what anyone within the CCT is saying, as the default position: paramedics must be told to believe what LWRs are telling them, even if the information is not supported by records (because a patient-relative conversation, can have taken place but not yet been recorded: there is also an issue, in that currently the NHS seems determined to only allow specified professionals to up-date records, and you cannot write something down in real-time, if you are not present !).

    3) The professionals must, if they think a relative has done, or said, something ‘strange, confusing or wrong’, ask the relative why it was done or said. And the professionals must tell the LWRs ‘to ask us to explain why we are doing things, that seem wrong or inappropriate to you’ (see Note 1).

    COMMENT: A downside of the process-based behaviour, the approach currently taken by the NHS to cover this area, is that it inherently promotes confusion – because there is no way that patients and relatives can be familiar with ‘the process’. The CCT concept, forces everyone to talk to each other, and to develop within the CCT a ‘process’ which will work for the group as a whole, on a case-by-case basis – inherently, that makes everyone discuss and understand ‘the process’.

    SECOND COMMENT: The MDT approach, separates clinicians and (for VoD design) other professionals, from patients and relatives, and consequently things such as EoL guidance and CPR/VoD policies are written by groups of, usually, only professionals. Also, hospital-based clinicians, perhaps because hospitals are inherently more ‘structured’ than primary healthcare, seem to be writing guidance which then ‘bleeds out into primary settings’: so hospital-based nurses and doctors, are formulating the behaviour sets for EoL patients who are in their own homes. Within a hospital, doctors and nurses are always present, and should be able to successfully implement ‘a known process’ – but EoL at home, should have a belief and behaviour set which is being designed by the people involved: by GPs, patients, LWRs, DNs and paramedics. The CCT concept, if adopted, would promote that change to the way guidance is created.

    I’ll have to track down this Welsh guidance, and/or its author(s).

    Unsuitable or offensive?

  • michael stone

    I have e-mailed NHS Wales, and scanned through their 'policy statement' - I couldn't actually find out 'how they plan to make things change', as opposed to 'what we think needs to change'.

    Anyway, I've sent my proposal, to Wales - I await with interest, but no expectation, to see if a comment is forthcoming.

    I get a bit grumpy, when i keep reading 'we need to be more inclusive of patients and their relatives' but nobody proposes a MECHANISM FOR CHANGE - ditto, I get very vexed by 'clinicians have a duty to speak up' without making sure that speaking up will not lead to being victimised.

    I get grumpy about lots of things !

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