The pilot sites report their findings for end of life care communication skills 22 September 2010 - National End of Life Care Programme This report provides the first round of feedback from a training needs analysis (TNA) pilot project, set up to support the development of communication skills training for all those working in end of life care. It provides some early outcomes and learning from 12 pilot sites around the country, each of which carried out its own local workforce TNA. We hope these initial findings will be useful to other organisations planning to carry out a TNA themselves, or to support the development of EoLC training plans. A series of 'top tips' are summarised in the document. Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013

1. Communication skills for end of life care
Training for health and social care staff
Talking Needs Action
Training Needs Analysis:
The pilot sites report their findings for
end of life care communication skills
Summary report

2. Summary report
Purpose and scope of this
report
This report provides the first round of
feedback from a training needs analysis (TNA)
pilot project, set up to support the
development of communication skills training
for all those working in end of life care (EoLC).
It provides some early outcomes and learning
from 12 pilot sites around the country, each of
which carried out its own local workforce
TNA. We hope these initial findings will be
useful to other organisations planning to carry
out a TNA themselves, or to support the
development of EoLC training plans.
The TNA contributes to improved training
provision for EoLC and supports the
development of a skilled and confident
workforce. This report is relevant to all those
involved in or with an interest in EoLC and will
be particularly relevant for:
• Strategic health authorities’ workforce
development teams
• Local education commissioners
• Commissioners of local health and social
care services
• Education providers including higher
education institutes, further education
institutes and specialist education providers
• Local service providers
• Health and social care staff and their
managers.
This project has been run by the National End
of Life Care Programme (NEoLCP) in
partnership with Connected©, the national
communication skills training programme for
cancer services.

3. Context and background
The health and social care workforce involved
in EoLC is extensive and is employed by a
wide range of employers in a variety of
settings. Workforce competence in
communication underpins all good quality
EoLC. It is essential that health and social care
staff can have open and effective
conversations with people, their families and
carers about death and dying and the issues
surrounding it. In this way, service users are
well supported, their wishes can be properly
discussed and personalised care plans can be
put in place.
Learning is a life-long process based upon
individual interest, motivation, need, values
and competences. The Department of
Health End of Life Care Strategy 20081 has
identified communication as one of the four
competency areas that cut across all levels of
practice. It recognises the communication skills
that already exist in the workforce and aims to
build on these to make sure that all staff have
the ability to deliver quality care for everyone.
Formal training and education are not the only
ways that people develop skills and the
opportunity to learn in the workplace through
experience, role models and mentoring should
be recognised. The maintenance and
development of skills are a continuous
dynamic process that can be supported by
appraisal and continuing professional
development.
There are cost benefits to having a competent
workforce that can initiate timely and
appropriate conversations with people at the
end of life: individuals’ needs will be identified
promptly, resulting in the right care at the
right time and avoiding unnecessary
interventions – making best use of staff time
and resources.
The TNA, by identifying existing workforce
competences and training need, supports the
development of appropriately qualified staff
who can deliver high quality care wherever it
is provided.
Key TNA findings
• The majority of health and social care staff
are involved in EoLC. The proportion of
staff time involved in EoLC varies,
depending on the setting and the staff role
• Most have received some basic, generic
communication skills training
• Most believe they would benefit from
further training to address the challenging
demands of conversations with people
approaching the end of life
• Communication skills training is provided
by a range of organisations including
universities, colleges, in-house local service
providers, hospices and independent
organisations. Specialist palliative care staff
provide most EoLC communication skills
training
• Provision of intermediate and advanced
training is limited

4. • There is a need for more competencybased advanced level training in general
and, in particular, improved access for staff
who don't care for cancer patients
Top tips for a TNA
1. Allow adequate time for thorough
planning and preparation
• Social care staff, particularly those working
for private organisations, have more limited
access to EoLC training than health care
staff
2. Match the level of enquiry to
organisational needs and set a realistic
scope and timeframe
• Service providers and staff are not always
aware of local training opportunities
3. If the scope of the TNA is large,
consider using a representative sample
of employees and employers
• There was a frequent misunderstanding
about the term ‘end of life care’ with staff
not appreciating their role in its delivery
and, therefore, not understanding the
relevance of EoLC training
4. Involving representatives from all
partners in consultation and
planning will improve engagement
across sectors and improve the quality
of data collected
• Co-ordination of training across local areas
is often poor, with examples of course
duplication and gaps.
Benefits of a TNA
The pilots found that the TNA has provided
them with a better understanding of the
workforce engaged in EoLC, the existing
competences and the training currently
available. This supports a strategic approach
to workforce development. Wide stakeholder
engagement has enabled a more co-ordinated
approach to training and education and the
TNA has provided a structure for ongoing
monitoring of competences and for evaluating
the impact of training.
The TNA process has had the additional
benefit of raising awareness of EoLC and has
identified enthusiasm for training. It has
supported culture change – getting death and
dying onto the agenda for the whole EoLC
workforce. The pilots have established project
structures that facilitate effective
multidisciplinary, multi-agency and
interdisciplinary working across organisational
boundaries, and these will support ongoing
development and provide a forum for future
joint working in other areas.
5. Customise questionnaires, using
language and terminology specific for
each sector. Keep questions simple and
focused, basing them on the core
competences2 and taking into account
that literacy and language issues can be
barriers
6. If relevant, take advantage of the
opportunity to incorporate other EoLC
competences in the TNA
7. Piloting of questionnaires with all staff
groups is essential to reduce incomplete
and inaccurate data
8. Online surveys may not improve
response rates but are useful for
collation and analysis of data. Be
aware that some staff groups have
limited access to computers and may
have limited IT skills
9. Telephone surveys can be useful for
employers and training organisations
10. Improve response rates by marketing
the TNA and following up nonresponders.

5. • Commission appropriate communication
skills training and education, matched to
need for staff caring for both cancer and
non-cancer patients.
For educators
• Align training with the common core
competences and the identified needs of
the local workforce
Lessons learned – key good
practice tips
For commissioners
• Align workforce development plans with
both organisational strategies and clinical
governance systems for patient safety and
risk management. Incorporate the expected
outcomes, the cost and service benefits
into wider project, resource and
implementation plans
• Specify the outcomes and quality standards
of education and training that are required
for commissioning and for risk
management. Select training that has
evidence of effectiveness, uses recognised
methodologies and offers value for money
• Accommodate individual training
requirements, in terms of both knowledge
and preferred learning style, according to
accepted training principles. Apply adult
learning approaches that are based on
mutual trust, respect, personal
responsibility and experience
• Work collaboratively with other local
providers to ensure that the range of
training provided is responsive to changing
needs, co-ordinated, comprehensive and
well marketed
• Encourage joint training across specialities
and sectors as this has the potential to
reinforce the value of multidisciplinary
working
• Consider supplementing the current core
generic communication skills training with
an introduction to EoLC conversations or
scenarios and make use of the e-ELCA3
(End of Life Care for All) e-learning
modules.
For service providers
• Determine the return on investment by
developing evaluation criteria to assess the
impact on staff confidence and
competence and linking workforce
development to patient experience
• Align workforce development with
corporate business strategies, governance
systems, existing frameworks and clinical
pathways
• Specify the necessary skills, attitudes and
training required for the workforce in
service agreements and contracts
• Link cost benefits of a competent
workforce to training proposals and
corporate business objectives
• Oversee the commissioning of training at a
sector or regional level and ensure clarity of
responsibility for co-ordination of local
provision
• Embed EoLC communication competences
in human resources and organisational
development plans for recruitment and
appraisal

6. • Create good data collection and record
keeping systems - they are essential to
monitor training and staff competences
• Use your appraisal and personal
development plans to identify training
needs.
• Link workforce development to patient
experience in order to capture the benefits
of training.
Next steps
For managers of staff
• Job descriptions and personal specifications
should accurately describe communication
competences required for the role
• Include communication skills in all
appraisals of health and social care staff
and incorporate them into continuing
professional development
• Provide the opportunity to develop
communication competences in the
workplace through mentoring, example
and team support.
For individuals
• Take personal responsibility for reviewing,
renewing and enhancing the competences,
knowledge and skill required for your role
in EoLC
• Measure individual role specifications
against the common core competences,
principles and the underlying national
occupational standards to identify the
competences required
The TNA has provided the pilot sites with an
information base to support development of
training and education that will meet the
needs of their local workforce. It will now be
important to monitor the delivery and uptake
of training and to evaluate its impact on
business objectives, the service user
experience, staff confidence and competence.
The final report for the communication skills
pilot project will be published early in 2011.
References
1. http://www.dh.gov.uk/en/
Publicationsandstatistics/Publications/
PublicationsPolicyAndGuidance/DH_086277
2. http://www.endoflifecareforadults.nhs.uk/
education-and-training/corecompetences
3. http://www.e-lfh.org.uk/projects/
e-elca/index.html
The full TNA report is available online at:
http://www.endoflifecareforadults.nhs.uk/
publications/talking-needs-action

7. Crown Copyright 2010
Edited and designed by: www.furnercommunications.co.uk
www.endoflifecareforadults.nhs.uk