Developing end of life care practice

Developing end of life care practice:
A guide to workforce development to support social care and health workers
to apply the common core principles and competences for end of life care.

Contents
1.

Overview

2.

End of life care practice scenario: Using the framework at Cedar Lodge

3.

A framework of competences, values & knowledge
3.1
3.2

Assessment and care planning

3.3

Advance care planning

3.4

Symptom management: maintaining comfort and wellbeing

3.5
4.

Communication skills

Overarching knowledge and values

Appendix End of life care core competences, values & knowledge: links between health and
social care QCF units and social care induction standards.

Acknowledgements
Skills for Care greatly values the work of Melissa Balman that has enabled this publication.
Melissa worked closely with Marie Lovell of Skills for Care’s policy team.
Marie, and Marc Lyall of Skills for Health’s policy team and Glenis Freemen of the National End
of Life Care Programme, also gratefully acknowledge the following contributors:
ƒ
Helen Bennett, Children’s Hospices UK
ƒ
Angie Glew, Breakthrough Consulting
ƒ
Karen Hendry, Leeds Teaching Hospital Trust
ƒ
Margaret Holloway, National End of Life Care Programme
ƒ
Katie Lindsay, National End of Life Care Programme
ƒ
Stephen Lock, Department of Health
ƒ
Eleanor Sherwen, National End of Life Care Programme
ƒ
Tes Smith, National End of Life Care Programme
ƒ
Lucy Sutton, NHS South Central
ƒ
Bee Wee, National End of Life Care Programme
ƒ
Jo Wilson, Heatherwood and Wexham Park Hospitals Trust

Developing end of life care practice: a guide to workforce development to support social care and health workers to apply the
common core principles and competences for end of life care
Jointly published by:
Skills for Care, West Gate, 6 Grace Street, Leeds LS1 2RP www.skillsforcare.org.uk
Skills for Health, 2nd Floor, Goldsmiths House, Broad Plain, Bristol BS2 0JP www.skillsforhealth.org.uk
National End of Life Care Programme, 3rd Floor, St John’s House, East Street, Leicester LE1 6NB www.endoflifecareforadults.nhs.uk
© Skills for Care / Skills for Health / National End of Life Care Programme, 2012
Published date: February 2012 Review date: February 2014
Skills for Care reference no. DS 029 National End of Life Care Programme reference no. PB0018 B0212
Copies of this work may be made for non-commercial distribution to aid social care and health workforce development. Any other copying
requires the permission of the publishers.
Skills for Care is the employer-led strategic body for workforce development in social care for adults in England. It is part of the sector skills
council, Skills for Care and Development.
Skills for Health is the sector skills council for all health employers—both NHS and independent.
The National End of Life Care Programme works with health and social care services across all sectors in England to improve end of life care
for adults by implementing the Department of Health’s End of Life Care Strategy.
This work was researched and compiled by Melissa Balman, working to a commission from the publishers. It was funded by the National
End of Life Care Programme.
Bibliographic reference data for Harvard-style author/date referencing system:
Short reference: SfC/SfH/NEoLCP 2012
Long reference: Skills for Care, Skills for Health, National End of Life Care Programme, Developing end of life care practice: a guide to
workforce development to support social care and health workers to apply the common core principles and competences for end of life care,
(2012) www.skillsforcare.org.uk www.skillsforhealth.org.uk www.endoflifecareforadults.nhs.uk

1. Overview
This guidance has been developed to ensure that
workers involved in supporting someone who is at
the end of their life are properly trained to be able to
undertake their work effectively and appropriately.
It should be read alongside the Common core
competences and principles for health and social
care workers working with adults at the end of life,
published in 2009 by Skills for Care, Skills for Health,
the Nat ional E nd of L ife Car e P rogramme an d t he
Department of Health (available on all their websites).
The principles and competences in that publication
remain current, but in this guide there are some
additions to the competences in order to reflect
emerging understanding of the importance of issues
related to spirituality (understood as widely as
possible) and bereavement. The sequence of some of
the 2009 material has been altered in this guide, too.
These changes follow consultation with people who
have been using the 2009 material.
This guide completely replaces the 2010 A framework
of National Occupational Standards to support
common core principles for health and social care
workers working with adults at the end of life,
published by the same organisations as this present
guide.
Each section gives an explanation of the area of work,
and includes important links to further information
and resources. There is also a ‘practice scenario’ to
show how the competences are connected, and how
they can be used to help in developing services and
in ensuring that workers are appropriately trained and
skilled.

Supporting people at the end of
life
The common core principles for end
of life care published in 2009 are:
1. Choices and priorities of the
individual are at the centre of
planning and delivery.
2. Effective, straightforward, senstive
and open communication between
individuals, families, friends and
workers underpins all planning and
activity. Communication reflects an
understanding of the significance of
each individual’s beliefs and needs.
3. Delivery through close multidisciplinary and interagency
working.
4. Individuals, families and friends are
well informed about the range of
options and resources available
to them to be involved with care
planning.
5. Care is delivered in a sensitive,
person-centred way, taking account
of circumstances,wishes and
priorities of the individual, family and
friends.
6. Care and support are available to
anyone affected by the end of life
and death of an individual.
7. Workers are supported to develop
knowledge, skills and attitudes.
Workers take responsibility for,
and recognise the importance
of, their continuing professional
development.

Overarching values
& knowledge

Communication
skills

Advance c are
planning

High quality
person-centred
end of life care
Symptom
Assessment & c areHigh quality
management: comfort
planning person-centred end
& wellbeing

of life care

End of life core competences and national occupational standards
National Occupational Standards (NOS)
describe performance as the outputs from a
person's work. They focus on what the person
needs to be able to do, as well as what they
must know and understand to work effectively.
They are designed to allow workers to be
assessed against them. Health and social
care NOS are relevant to many people who
work within the health and social care sectors.
They apply across the National Health Service,
local government, and independent sector
organisations both private and voluntary.
NOS describe performance (what a person
does), the performance criteria (the national
standard they should achieve) and the
underpinning knowledge and understanding
required to undertake that particular function.

To become competent, a worker needs to have
developed the appropriate skills (the ability to
undertake specific activities in an appropriate
and professional manner, using experience and
judgement to ensure high quality performance);
values (the beliefs and ideals shared within a
culture, about what is desirable and good); and
knowledge (relevant to the area of work).
The competences described in this document
should be used alongside occupation-specific
competences, standards or capabilities. In
many instances they will overlap, although there
will be times that the end of life competences
and knowledge are additional.

Core competences for effective delivery of end of life care
The Department of Health’s 2008 End of Life Care Strategy, which this document supports, sets
out what adults reaching the end of their lives, and their carers*, can expect from the services
provided to them. The National Institute for Clinical Excellence (NICE) draft End of Life Care Quality
Standard, published for consultation in the spring of 2011 and due for final publication in the
autumn of 2011, emphasises these expectations. The key points are summarised below.
1. A diagnosis that is arrived at as quickly as
possible, with information about prognosis
and treatment options explained sensitively,
appropriately and in a jargon-free way.
2. Information that is provided as and when it
is needed, in a format that is appropriate to
their needs and abilities.
3. Regular assessment and care planning
that includes discussion about current
and future care, is person-centred, and
takes account of practical, physical,
psychological, spiritual, social and religious
needs and preferences.

9. Care and support that meets practical,
physical, psychological, spiritual, social
and religious needs and maximises
independence and social participation for
as long as is possible.
10. In the event of an unexpected crisis,
prompt, safe and effective urgent care; at
whatever time of day or night it is needed,
appropriate to their needs and preferences.
11. Safe and timely transfers if they need to
be moved, so that they receive care in the
place most appropriate to their needs and
preferences.

4. Support for carers and family members
including children, recognising the impact
of bereavement upon them.

12. Specialist palliative care when it is needed,
and that takes account of needs and
preferences.

5. Care and support delivered seamlessly, by
multidisciplinary teams working together to
meet identified needs.

13. Timely identification of the last days
of life, and care delivered at that time
that is individualised to their needs and
preferences and ensures access to, and
administration of, prescribed medication.

6. Care and support that is delivered by
practitioners who understand the person’s
current medical condition, care plan and
preferences.
7. Care and support that is delivered by
workers who are competent, have the
appropriate knowledge and have the right
skills and attitudes needed to provide safe
and effective care for people approaching
the end of life.
8. Care and support that is available when
it is needed, and at home if that is their
preference.

14. Sensitive communication with carers and
families who are newly bereaved, with
timely verification and certification of death,
information including details of any possible
coroner involvement, and practical support
appropriate to their needs and preferences.
15. Emotional and bereavement support
appropriate to their needs and preferences,
for people closely affected by a death.
* ‘Carer’ is used throughout to mean family and friends who
provide care, as distinct from social care and health workers.

Important connections
End of Life Care for All (e-ELCA) is an e-learning
package developed to support the 2008
End of Life Care Strategy. It was developed
by a partnership between the National End
of Life Care programme, the Department of
Health, the Association of Palliative Medicine
and e-Learning for Healthcare. Four core
modules for health and social care workers
were launched in 2010 (advance care planning,
assessment, communication skills and
symptom management including comfort and
wellbeing); as well as an introductory module
and one on integrating learning. Following
positive feedback, three more modules are now
available:
ƒ

Social care related – supporting people
to live and die well, palliative care social
work, as assessment support and care
planning, hospital social work, end of life
care in homes and domiciliary care setting

ƒ

Bereavement

ƒ

Spirituality.

The integrating learning module includes
condition-specific end of life care scenarios,
critical situations, differing scenarios around
dying (e.g. as a prisoner, as a homeless
person), and care after death (‘last offices’). It
also includes frameworks and tools such as
DNACPR (‘Do not attempt cardio pulmonary
resuscitation’), and the framework for advanced
kidney disease. Curriculum workbooks to
support e-learning and learning pathways
covering primary care, social care and
secondary care are also available.

All the NOS in the Skills for Health database
are mapped against and indicatively linked to
the NHS Knowledge and Skills Framework
(KSF) dimensions. A worker can use evidence
demonstrating competence against NOS as
evidence he or she is meeting their NHS KSF
profile.
The Qualifications and Credit Framework
(QCF) has recently been launched to replace
the former NVQ framework. Units within it
can be linked to the competences, values
and knowledge described here. QCF units,
which are informed by national occupational
standards, include some units specifically
developed to support end of life care.
Social work training is currently being
reviewed, and it is proposed that the NOS for
social work be replaced by a ‘capabilities
framework’, which can also be linked to the
end of life competences.

Getting the most from the guidance
End of life care is the responsibility of a wide
range of professions and occupational groups,
working in a range of settings, undertaking
a range of activities in co-ordinated and
person-centred ways. This means that there
can be no one single way to map the end of
life competences against the requirements
for each of these groups. Working in a truly
person-centred way also means that the
responsive, flexible and sensitive approaches
taken by workers responding to changing
needs results in the expectations placed upon
workers changing over time. So an individual
practitioner may need to be performing at
different levels, undertaking different activities at
different times.
This document has been produced to
help guide people in thinking about the
competences needed at the different points of
the individual’s journey. It is intended not just
for front line workers, but also for those people
engaged in commissioning, developing and
managing those services, including workforce
development leads and trainers.

Information in this document can be used in
many ways, including to:
ƒ
Support discussions as part of
supervision
ƒ

Identify individual learning needs

ƒ

Shape training provision

ƒ

Influence workforce development plans

ƒ

Inform service development

ƒ

Shape job descriptions

ƒ

Influence commissioning

ƒ

Influence policy discussions

ƒ

Enable individuals and their carers to
increase their understanding of what
services and support they can expect.

The next sections outline some of the ways
people undertaking specific tasks might find
this guidance helpful. For many people, their
jobs will incorporate several of these areas.

Commissioning
People commissioning services should ensure
that workers delivering the care they have
commissioned have appropriate training and
support, and can demonstrate the necessary
competences.
This can be achieved by developing a
commissioning strategy that includes
purchasing services with:
ƒ

Flexibility and choice, enabling individuals
and their carers to be properly cared for
and supported as their situations change

ƒ

ƒ

Appropriate underpinning workforce
development and training programmes to
ensure that all workers have the required
skills, values and knowledge to deliver
personalised and sensitive end of life care
services
Workforce training and development
programmes that incorporate the
perspectives of people who use services
and of carers, and that promote
collaboration across agencies.

Strategic leadership and management
Sustained leadership and drive are needed both
nationally and locally to ensure that appropriate
actions are taken to support workforce and
service development in end of life care. Part of
the function of leadership and management is
to ensure that the services provided achieve the
standards set by the end of life principles and
competences.
This guidance can be used to consider how to
plan and deliver services, and the training and
support provided to employees. This includes
ensuring that systems are in place to identify and
provide for the support needs of those working
with people at the end of their lives.
The end of life care competences can be used
to ensure services are consistent with what
individuals and carers say they want, delivering
personalised and flexible support. They can help
in achieving better quality care, and contribute
to meeting the Care Quality Commission (CQC)
performance indicators and support employers in
commissioning and delivering training.
The guidance can be used to:
ƒ

ƒ

Monitor and improve services, taking into
account the views and experiences of the
people who use end of life care services

ƒ

Work with independent and voluntary
sector partners, as well as people who
use services and carers, to develop a
local workforce development strategy with
a focus on raising knowledge and skill
levels and providing career development
opportunities

ƒ

Foster a common approach to end of life
care across teams and organisations

ƒ

Provide a framework for workforce
development, embedding the competences
in performance management, and support
new ways of working

ƒ

Ensure workers have the skills and support
they need to work to the competences and
principles.

ƒ

Design job roles, tasks and job
descriptions.

ƒ

Commission learning that enables workers
to deliver high quality end of life care.

ƒ

Link identified end of life care learning
needs to the worker’s own occupational
standards and training requirements
Contribute to organisational discussions
about workforce planning for end of life
care.

Provide benchmarks for best practice
and service improvement, embedding
the principles in corporate policies and
governance frameworks

Line management and supervision
Line managers have a particular responsibility
to ensure that each worker for whom they are
responsible is properly equipped and supported
to deliver high quality end of life care. This
guidance can be used to help:
ƒ
ƒ

Identify learning and support needs related
to working with a specific individual
Discuss and agree personal development
plans

ƒ

Direct health and social care service delivery
Workers in health and social care, across both
the public and independent sectors, all need
training and support to ensure they are able to
communicate and work effectively with people
who are dying and with their carers. This
guidance can help to increase job satisfaction
by helping both paid and volunteer
workers to meet individuals’ and carers’ needs
and expectations.

ƒ

Discuss the skills and knowledge needed
with supervisors and/or line managers
to ensure shared understanding of the
implications for the worker’s job role and
working practice

ƒ

Challenge practice which is not consistent
with the principles and the underpinning
competences, values and knowledge.

The guidance can be used to:
ƒ

Identify skills gaps and support needs
and ensure that these are met through
personal and team development plans

Educators, trainers, workforce development managers
The end of life core competences should be
an integral part of all education, training and
support for those working in, or aspiring to
work in, health or social care in settings or
circumstances where they may be dealing with
people at the end of their life. Education and
training providers should consider reviewing
training in relation to end of life care.
End of life care competences, values and
knowledge underpinning the principles can:
ƒ

ƒ

Help shape units of learning to be
included in the Qualifications and Credit
Framework.
Develop undergraduate and postgraduate
training and assessment programmes.

ƒ

Design in-service training and assessment
programmes.

ƒ

Provide shared and agreed benchmarks
of best practice.

ƒ

Address what people who use end of life
services say they want from health and
social care providers.

ƒ

Reflect what employers want their
workforces to be able to do.

ƒ

Provide a framework to assess end of life
care skills and competences.

ƒ

Support the commissioning of education
and training to address workforce
development needs.

Useful resources
www.dh.gov.uk
For a range of relevant documents including:
ƒ

Common core competences and principles for health and social care workers working with
adults at the end of life (July 2009) This is also on the sites of the publishers of this present
guide.

ƒ

End of Life Care Strategy (July 2008)

ƒ

The NHS Knowledge and Skills Framework (NHS KSF) and the Development Review Process
(October 2004).

ƒ

End of Life Care Strategy Quality Markers and measures for end of life care (June 2009)

www.e-lfh.org.uk/projects/e-elca
This site contains all of the e-learning sessions that have been developed to support the End of
Life Care strategy, and is freely available. It is intended to be of use to all practitioners concerned
with end of life care.
www.endoflifecareforall.org.uk
This site contains a subsection of the e-learning sessions developed for end of life care in e-ELCA.
There are 12 basic sessions which are available on an open access basis.
www.education.gov.uk
Hosts the draft recommendations of the Social Work Reform Board, including Building a safe and
confident future: One year on. Overarching professional standards for social workers in England
(December 2010).
www.healthcareworkforce.nhs.uk
This site provides a range of tools for those working in the health care sector, including a Six Step
Methodology to Integrated Workforce Planning and a Guide to Workforce Planning for Service
Commissioners.
www.nice.org.uk
The National Institute for Health and Clinical Excellence has just completed a consultation on the
draft quality standard for ‘End of Life Care for Adults’. The final standard should be available from
autumn 2011.
More resources on the next page

Useful resources, continued
www.endoflifecareforadults.nhs.uk
This site includes a wide range of resources, some of which are also available on other sites
included here. Guidance linked to specific competence areas is listed at the end of the relevant
chapters.
ƒ
ƒ
ƒ

National End of Life Care Programme – Information for commissioning end of life care
The route to success in end of life care – achieving quality for people with learning disabilities
Care towards the end of life for people with dementia: an online resource guide

The National End of Life Care programme has also launched a series of publications under the
‘Route to Success’ banner, looking at end of life care in specific service areas:
ƒ
Acute hospitals www.endoflifecareforadults.nhs.uk/publications/route-to-success-acute-hospitals
ƒ
Hostels & homelessness www.endoflifecareforadults.nhs.uk/publications/rts-hostels
ƒ
Learning disabilities www.endoflifecareforadults.nhs.uk/publications/route-to-success-people-with-learning-disabilities
ƒ
Residential care www.endoflifecareforadults.nhs.uk/publications/route-to-success-care-homes
www.skillsforcare.org.uk
This is the skills sector council for people working in social care. Its site includes the following
useful documents.
End of Life Care Knowledge Set (revised 2010)
http://www.skillsforcare.org.uk/qualifications_and_training/N_V_Q/knowledge_sets/end_of_life_care.aspx

End of Life Care Learning and Development Pathway (2009) This includes mapping against
health and social care NVQs and NOS, as well as suggesting performance levels for particular
roles.
http://www.skillsforcare.org.uk/workforce_strategy/new_types_of_worker/prevention/NToW41.aspx

Is it that time already? (2009) Video produced with Housing 21 to accompany their EOL guide for
workers in extra care housing schemes
www.skillsforcare.org.uk/qualifications_and_training/qualificationsandcreditframeworkQCF/what_is_changing.aspx

For details of the four QCF units developed to support end of life care.
www.skillsforcare.org.uk/qualifications_and_training/qualificationsandcreditframeworkQCF/supporting_materials.aspx

Two scenarios illustrating how QCF units can contribute to development of EoL workers (level 2 in
residential care and level 3 in domiciliary).
The workforce strategy section of this site includes material on ‘workforce redesign’ about the
workforce dimensions of service transformation.
www.skillsforhealth.org.uk
This is the skills sector council for people working in health care. The site includes full versions of
the healthcare NOS.

An end of life care practice scenario:
Using the framework at Cedar Lodge
Alec is an 87 year-old widower living at Cedar
Lodge, a residential care home. He has lived
in the home for the past two years, and during
that time has had the same key worker, Amana.
In total there are ten care workers and four
domestic workers in the unit Alec lives in, plus
additional agency workers.
Alec’s three children are all regular visitors to the
home.
He has recently been diagnosed with renal
failure, and his life expectancy is only a couple
of months without dialysis. In the past Alec has
made it clear that when his “time comes” he
wants to be able to stay at Cedar Lodge, and
“go quietly”. He has stated that she does not
want any treatment that will prolong his life. This
means he has chosen not to accept dialysis.
A planning meeting, involving Alec, his family,
and health and social care workers has taken
place, and a care and support plan has been
put in place to help Alec to live comfortably at
Cedar Lodge. This has included a discussion,
led by Alec, about his wishes. He has made
it clear that he does not want any medical
intervention to prolong his life, and this has
been recorded in an ’advance care plan’. Alec’s
two daughters are supportive but his son,
Martin, has difficulty accepting the decision.

As well as input from his GP, Alec will be
receiving regular support from specialist
nurses to manage his symptoms and keep him
comfortable. Day-to-day care and support will
continue to be provided by Cedar Lodge care
workers. Alec’s daughters and Martin will spend
time with their father each day.
This is the first time since she began working
at the home that Sue has been closely involved
with someone who is dying, and she is both
upset and anxious about caring properly for
Alec.
As the home manager, and Amana’s line
manager, Maggie is responsible for ensuring
that Amana is properly trained and supported
so that Alec’s needs and the needs of his family
are properly addressed.
In discussion with her manager, Amana talks
about her concerns, her feelings, and what she
sees as the gaps in her expertise.

Cedar Lodge: key issues identified by Amana and Maggie
Amana (Key worker)

Maggie (Manager)

Action

Issue: Alec is becoming very tired, spending more time resting. His skin is very fragile and the risk of skin
breakdown has increased significantly.
Amana is an experienced and
qualified care worker, but she
and her colleagues need to
be highly skilled in managing
Alec’s skin so that it does
not break down causing him
additional distress.

Maggie wants to make
sure that Amana has some
additional training in this area
so she feels confident and is
able to take proper care of
Alec’s skin.
Maggie will ensure that all other
members of the team are able
to provide support consistent
with this.

Maggie plans to work alongside Amana to demonstrate
good skin care. This will give her the opportunity to
observe Amana, and to demonstrate best practice. In
doing this she will be able to reassure Amana about her
practice. Maggie will also talk to the nurse specialists, to
find out if there are any particular creams or equipment
that will benefit Alec, or if they have any other advice.

Issue: Alec understands that he is going to die. He needs to be able to talk to people about how he feels and what
he wants to happen. Alec and Amana have a strong relationship, and Alec has made it clear that he does not
want to have lots of new people around him at this stage of his life.
Amana is worried that Alec
may ask her questions that she
cannot answer. Although the
nurses who will be visiting him
regularly could answer Alec’s
questions, Alec may well feel
more comfortable talking to
Amana.

Maggie also recognises that
the team will need to be
supported, and will look for
ways to make sure that this
happens.

Maggie knows that Amana
needs some additional training
to help her dealing with the
Amana is also apprehensive
questions Alec may ask, and
about talking to Alec about his the things he wants to talk
dying. She feels upset herself, about. Maggie realises that the
and is anxious about how she
level of communication skills
will cope.
that Amana will need may be
above the level for which she is
The other members of Amana’s
currently trained.
team are also fond of Alec, and
Amana is concerned that they Some of the support &
are all properly supported.
development that Amana
needs is very practical, and
Maggie expects that by talking
to the doctors and nurses
involved in Alec’s care the
information about the progress
of his condition will be relatively
easy to gain.
Maggie herself has done
bereavement counselling so will
be able to offer some guidance,
but she is aware that Amana
will need further training.

Maggie is aware of the importance of acknowledging
and trying to meet Alec’s spiritual needs. (Overarching
value A talks about practice that “...acknowledges the
significance of spiritual, emotional and religious needs
and support.”). She talks to Amana about this, and
reassures Amana that she can talk to her if she feels
upset whilst working with Alec. She plans to ensure that
she makes time available for this.
In order to give Amana more practical support she has
been on the e-ELCA website and has found several
helpful communication sessions, as well as a Spirituality
module. Although Amana is very busy, and unlikely
to complete these units in the short term, she has
suggested that she should look at them. By making time
to discuss with Amana what she has learnt through the
e-learning afterwards, Maggie can help Amana deepen
her learning and apply this to Alec’s situation. In addition
to the Spirituality module, she plans to build these
into Amana’s development programme. Maggie has
identified the following e-ELCA units:
ƒ

Communication: information giving

ƒ

Social care: Supporting people to live & die well

ƒ

End of life care in homes and domiciliary care
settings.

Cedar Lodge: key issues identified by Amana and Maggie
Amana (Key worker)

Maggie (Manager)

Action

Issue: Alec’s son, Martin, feels that his father should accept treatment to prolong his life. This is a cause of distress
to Alec, and has led to friction between Martin and his sisters. Martin had also challenged workers at the
home, suggesting that it is their job to get his father to change his mind.
Maggie is very worried about
this situation, and is particularly
concerned about Amana’s
ability to deal with it. On
balance she feels that this is
not something Amana should
be responsible for, and that she
should speak to Martin herself.
Amana is also very concerned
She decides that Amana needs
about how this is affecting
to be able to speak to Martin
Alec’s two daughters, who are
in a calm and positive way,
being distracted from spending
butt od irecth imfi rmly to more
time with their father, and have
senior workers who will work
to manage Martin and his
with him to help him come to
views. She knows that Alec
terms with his father’s decision.
has recorded his wishes in an
Maggie recognises that
advance care plan (ACP) but
she is a little unsure about what ’advance care plans‘ and ’care
plans‘ can be easily confused,
this means.
and that it is important for
everyone to have a good
understanding of the difference.
She thinks that if Amana is
confident about this, it will help
her when talking to Martin.
Having already been
challenged by Alec’s son,
Amana is really worried about
further encounters. She does
not know what to say to
Martin, and has noticed how
this upsets Alec.

Maggie discusses Amana’s responses the next time this
happens, and tells her to refer Martin to the senior on
duty. Maggie is going to talk to all of the workers, so that
everyone is clear about this.
Maggie and Amana also discuss Alec’s right to make
his own decision, and the importance of his being
supported by the team. Maggie, the senior team and
Amana will all look at the eELCA module: Dealing with
challenging relatives.
They discuss how they will work with all of the family,
with reference to the end of life underpinning value
“practice that acknowledges the differences and
conflicts that may arise between the individual, their
friends and family when making decisions; and is
sensitive in helping all those concerned to reach a
positive resolution.”
Maggie has checked the e-ELCA website and seen that
there are several ACP modules. At this stage she plans
to look through these herself, and to use this information
to offer a short session with Amana and other workers,
explaining what an ACP is and discussing how this will
affect decisions about Alec as his disease proceeds.

Issue: Alec is in renal failure. No one else at Cedar Lodge has had renal failure in recent years, so there is very little
understanding of the condition.
Amana feels that she needs
to have some knowledge
about renal failure and what to
expect. She thinks that this will
help her in her work, and will
be useful when she is talking
to Alec and to his son and
daughters.

Maggie recognises that this is
important for herself as well as
for Amana.

The specialist nurses have left some leaflets, which all
workers will be asked to look at. Maggie has also found
a relevant e-learning module (condition-specific case
study: End-stage renal failure). She plans to undertake
the module herself, and support Amana through doing it.
Amana has offered to brief other members of the team
on the contents as part of her development.

Wider workforce development issues for Cedar Lodge identified by Maggie
Issue

Workforce development solution

Although death and dying are
relatively frequent events at Cedar
Lodge, workers had had very little
training in this area. This is partly
a funding problem, the funding
that they have been able to
attract has been linked to national
qualifications such as NVQs and
not one-off training programmes.

Maggie has decided to undertake a mapping exercise, to see how the end of life
competences, knowledge and values link to the current QCF units [see appendix in
this present guide]. She is hoping to find connections so that workers undertaking
funded training can also have some end of life training. Once she has done this she
will approach the training organisations that she works will and look at how they can
integrate end of life care into their training modules. She will also look at the e-learning
units to see how these can be integrated into learning opportunities. To help her in
her thinking Maggie has looked at the new qualifications options for those working in
residential care, particularly the level two diploma on the Skills for Care website.
She has already noticed some useful connections, for example:
End of life competence – communication skills
QCF end of life specific units:
ƒ
HSC 3035 support individuals who are bereaved
ƒ
HSC 3048 support individuals at the end of life
QCF mandatory unit: SHC 31 Promote communication in health, social care or
children’s and young people’s settings
QCF optional unit: HSC 3029 Support individuals with specific communication
needs.
She is also thinking about undertaking a similar exercise next time their induction
programme is reviewed.

Amana has immediate needs with
regard to her work with Alec, but
she has very little time in which
to undertake further training to
support her practice.

In the short term Maggie has identified some e-learning modules that Amana can
access, and has offered some practical support in the workplace. However, thinking
about this has led Maggie to conclude that everyone working at Cedar Lodge needs
a better understanding of working with people who are dying. She therefore plans to
look in more detail at the e-learning units and identify some that she see as core to
the work of the home. She will then build these into individual workers’ development
plans, and commission or deliver some specific training sessions around these. She
will integrate this with the more formal qualifications training that workers undertake,
providing a range of blended learning opportunities for people.

Many of the people who live at
Cedar Lodge may have clear
ideas about how they wish to
die, including what kinds of
treatments, if any, they wish to
have. Maggie realises that some
residents may choose to begin
these difficult and important
conversations with the workers
they know and trust. She
therefore realises that she needs
to introduce some training, and
provide information, so that
workers are prepared should such
a conversation arise.

This is seen as a priority for Maggie. She decides to talk to the trainers based at her
local hospice for advice, and potentially to work with them to develop and introductory
programme for all workers at the home. She wants some training for everyone,
including domestic workers, as she knows that residents will talk to the people they
trust and get along with, whatever their role. She also plans to talk to the specialist
nurses, to find out what protocols are already in place, so that workers at Cedar Lodge
can work in a multidisciplinary way with colleagues from all backgrounds.

Maggie has spent some time
looking at the end of life care
competences, knowledge and
values, and thinks that these need
to inform future appointments.

The senior staff team have set aside one of their meetings to look at these in detail.
From this they will consider:
ƒ
ƒ

reviewing their person specifications
looking at ways to ensure that workers are properly supported and enabled to
develop the skills and knowledge that are important in delivering end of life care.

3.

A framework of competences, values & knowledge

3.1 Communication skills
Being able to work with people in a sensitive and insightful way, demonstrating a good
understanding of the factors that can affect the quality and method of the interaction, is the basis
of sound practice. For all of the competences listed below, practitioners should take account of
the many factors that affect communication. These include:
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ
ƒ

Sensory impairments
intellectual ability
Language
Culture
Religion or similar beliefs, if any
Age, in particular when working with young family members and children
Levels of spiritual wellbeing and distress.

Good communication matters in every aspect of health and social care; the competences
described below are of particular importance when working with people at the end of life.

Competences
A Communicate with a range of people on a
range of matters in a form that is appropriate
to them and the situation.
B Develop and maintain communication with
peopleab outd ifficultan dcomp lexmat tersor
situations related to end of life care.
C Present information in a range of formats,
including written and verbal, as appropriate
to the circumstances.
D Listen to individuals, their families and friends
about their concerns related to the end of life
and provide information and support.

E Work with individuals, their families and
friends in a sensitive and flexible manner,
demonstrating awareness of the impact
of death, dying and bereavement, and
recognising that their priorities and ability to
communicate may vary over time.
F Work with colleagues to share information
appropriately, taking account of issues of
confidentiality, to ensure that individuals
receive the best possible care. Ensure that
information is clear, and non-jargonistic, so
that it can be fully understood by others.

Communication skills – Useful resources
www.act.org.uk
GP workbook
Although targeted at general practitioners this book includes really helpful guidance about
communicating with children, young people and adults.
Talking about end of life care: right conversations, right people, right time
This draws on the experience of a number of pilot sites to illustrate the importance of good
communication, with the right people, at the right time, to a positive experience for patients. It also
shows how good training and workforce development can be used to underpin good practice.
The Disability Distress Assessment Tool (DisDAT)
A tool produced by a partnership of organisations in the North East, to record the ways in which
individuals with learning disabilities that affect their communication skills communicate distress and
contentment. The tool was developed to support people with learning disabilities who have life-limiting
conditions.
This site contains all of the e-learning suites that have been developed to support the End of Life Care
Strategy, and is freely available. It is intended to be of use to all practitioners concerned with end of life
care. Details of modules can be found in the useful links in the Overview section of this document.
www.scie.org.uk
Dignity in Care factsheet: communication
Part of Scie’s Dignity in Care research and best practice programme; this is a useful poster outlining key
ways to ensure good communication with individuals.
www.winstonswish.org.uk
Winston’s wish specialises in working with children and young people with terminally ill parents. The site
has lots of helpful guidance about how to help children who have lost a parent or who have a parent with
a terminal illness.

3.2 Assessment and care planning
Care plans (sometimes called support plans)
document the aspirations, goals and priorities
of the individual, and describe how they will be
achieved, monitored and reviewed. They should
be developed with the individual, and, where
appropriate, their carers. They are plans for care
in the present and the future, and are subject
to regular review and change. Assessing and
maximising the individual’s capacity (the ability
to make a decision about a particular issue at
the time it needs to be made, or to consent to
a specific act) are essential aspects of the care
planning process.
Care plans can be made on behalf of a person
who lacks capacity, by involving those people
closest to them (family, friends, carers,
professionals) and taking account of any
‘advance decisions’ or ‘advance care plans’
that have been made. If an individual lacks the
capacity to make decisions, the processes
required by the Mental Capacity Act (2005)
should be followed to ensure that the

individual’s best interests are pursued
(see Capacity, care planning and advance care
planning document in resources at the end of
this section).
Care plans differ from advance care plans
because advance care plans are drawn up in
anticipation of future loss of mental capacity,
to be used when the individual can no longer
actively contribute to the care planning process
(see the advance care planning section in this
guide) They can then be used to help with
decisions to be taken at that time.
In some situations, where a carer provides a
high proportion of the individual’s care, a carers’
assessment should be undertaken; this is the
responsibility of the local authority.
Assessment and care planning are ongoing
processes, incorporated in a cyclical process
that includes the delivery of the plan (see
Symptom Management, Maintaining Comfort
and Wellbeing).

assess: by dialogue with
relevant people

review: id entify wh en
circumstances or priorities
change

Assessment
planning and
delivery cycle

monitor: continuous
feedback from the individual
and relevant people

act: provide care as agreed
in the care plan, working in
partnership with the individual
and others

High quality, person-centred care
planning and delivery matters in every
aspect of health and social care; the
competences described (next page) are
of particular importance when working
with people at the end of life.

Competences
A Understand the range of assessment tools
and ways of gat hering in formation an d t heir
advantages and disadvantages.
B Assess pain and other symptoms using
assessment tools, pain history, appropriate
physical examination and relevant
investigation.
C Undertake/contribute to multi¬disciplinary
assessment and information sharing.
D Ensure that all assessments are holistic,
including:
ƒ background Information
ƒ current physical health and prognosis.
ƒ social and/or occupational wellbeing

ƒ religious and/or spiritual wellbeing
(recognising the differences between
these two concepts and the person’s
ability to maintain their preferred variations
of their outward practice, such as prayer
habits, diet, dress, etc.)
ƒ culture and lifestyle aspirations, goals and
priorities
ƒ risk and risk management
ƒ the needs of families and friends, including
carers’ assessments, and including
children and young people.
E Regularly review assessments to take
account of changing needs, priorities and
wishes, and ensure information about
changes is properly recorded.

ƒ psychological and emotional wellbeing
Useful resources for assessment & care planning
www.carersuk.org/help-and-advice/practical-help/care-and-support/carers-assessment
For further information about carers’ assessments.
www.dh.gov.uk
End of life care and personalised care planning (information sheet 8). One in a series of factsheets
to support people working with individuals with long term conditions.
Capacity, care planning and advance care planning in life limiting illness: A Guide for Health and
Social Care Staff
Gives clear guidance on the differences between care planning and advance care planning, as
well as explaining the impact of loss of mental capacity and how to ensure that an individual’s best
interests are maintained.

More assessment & care planning resources on next page

Useful resources continued
Holistic common assessment of supportive and palliative care needs for adults requiring end of life
care
Step by step guide to undertaking holistic assessments to support care planning and delivery
The differences between general care planning and decisions made in advance
A succinct chart that describes the differences between care planning, advance care planning,
advance decision to refuse treatment and DNACPR (‘Do not attempt cardio pulmonary
resuscitation’). The chart included guides practitioners through the legal aspects of each, describes
who is responsible for what and outline key actions to be taken.
This site contains all of the e-learning suites that have been developed to support the End of Life
Care Strategy, and is freely available. It is intended to be of use to all practitioners concerned with
end of life care. Details of modules can be found in the useful links in the Overview section of this
document.
www.winstonswish.org.uk
Winston’s wish specialises in working with children and young people with terminally ill parents. The
site has lots of helpful guidance about how to help children who have lost a parent or who have a
parent with a terminal illness.

3.3 Advance care planning
Advance care planning is a voluntary process of discussion and review to help an individual who
has capacity to anticipate how their condition may affect them in the future, and if they wish, set
on record their choices about care, treatment and/or decisions to refuse treatment in specific
circumstances. It is undertaken at a time when the individual has capacity, to be used if that
capacity is later lost. It is not the same as a care plan (see Assessment and Care Planning section)
but should be used by professionals and families to review and update care plans if and when the
individual no longer has the intellectual capacity to make decisions for themselves.
Competences
A Demonstrate awareness and understanding
of advance care planning, and the times at
which it would be appropriate.
B Demonstrate awareness and understanding
of the legal status and implications of
the advance care planning process; in
accordance with the provisions of the Mental
Capacity Act.
C Demonstrate awareness and understanding
of the impact of culture and religion (or
similar belief, if any) upon the choices people
make.
D Show understanding of informed consent
andd emonstratet heab ilityt ogives ufficient
information in an appropriate manner.
E Use effective communication skills when
having advance care planning discussions as
part of ongoing assessment and intervention.

F Work sensitively with families and friends
to support them as the individual decides
upon their preferences and wishes during
the advance care planning process.
Recognise the potential for conflicts arising
from different religious, cultural or lifestyle
perspectives and work with those
involved to reach agreement.
G Where appropriate, ensure that the wishes
of the individual, as described in an advance
care planning statement, are shared (with
permission) with other workers.
H When appropriate, know what the advance
care planning statement contains, and how
this will impact upon an individual’s care
delivery.

Useful resources for advance care planning
Advance Decisions To Refuse Treatment: A Guide for Health and Social Care Professionals
A guide to help health and social care professionals understand and implement the new law
relating to advance decisions to refuse treatment (ADRT) contained in the Mental Capacity Act
2005.
Capacity, care planning and advance care planning in life limiting illness: A Guide for Health and
Social Care Staff
Gives clear guidance on the differences between care planning and advance care planning, as
well as explaining the impact of loss of mental capacity and how to ensure that an individual’s best
interests are maintained.
Planning For Your Future Care : A Guide
A guide written for patients and people who use services, explaining what advance care planning
means, and how, if they wish they can talk to people about making an advance care plan.
The differences between general care planning and decisions made in advance
A succinct chart that describes the differences between care planning, advance care planning,
advance decision to refuse treatment and DNACPR (‘Do not attempt cardio pulmonary
resuscitation’). The chart includes guides practitioners through the legal aspects of each, describes
who is responsible for what and outline key actions to be taken.
Care strategy, and is freely available. It is intended to be of use to all practitioners concerned with
document.
www.scie.org.uk/publications/dementia/decisions/advance.asp
Advance Care Planning Part of the Dementia Gateway series, but a clear description that is of use
in a range of situations.
www.westonhospicecare.org.uk/wiki/?page=advance_planning
Many hospices have information and pro formas to support discussions and produce advance
care plans. This website contains an explanation of advance care panning, a form for individuals to
use, and a form to help others who are making decisions on behalf of someone else.

3.4 Symptom management: maintaining comfort and wellbeing
The responsibility that a practitioner has in ensuring the wellbeing of individuals depends upon
their particular role and expertise. For a social worker or social care practitioner the focus is likely
to be on managing care and support. Workers who are more medically-based may, for example,
have responsibility more for symptom management. However, there is significant overlap,
and maintaining the physical and spiritual comfort and wellbeing of an individual is a shared
responsibility, delivered through the appropriate multi-disciplinary partnership.
Maximising an individual’s wellbeing means looking at all of their concerns and goals, and
working to manage and achieve these in accordance with their wishes (see Assessment and care
planning). It incorporates far more than dealing only with medical concerns. Maintaining comfort
and wellbeing may include, among other things, spiritual and emotional wellbeing, the ability to
participate in activities that are important to the individual, or being at home.
High quality, person-centred service provision matters in every aspect of health and social care;
the competences described below are of particular importance when working with people at the
end of life.

Competences
A Be aware that symptoms have many causes,
including t he d isease it self, it s t reatment, a
concurrent disorder (including depression or
anxiety) or other psychological or practical
issues.
B Understand the significance of the
individual’s own perception of their
symptoms to any intervention.
C Understand that the underlying causes of a
symptom will have an impact upon how care
should be delivered.
D Understand the range of therapeutic options
available, in cluding d rugs, h ormone t herapy,
physical therapies, counselling or other
psychological interventions, complementary
therapies, surgery, community or practical
support.

E In partnerships with others, including the
individual, their family and friends, develop an
end of life care plan which balances disease
specific treatment with other interventions
and support that meets the needs of the
individual.
F In partnership with others, implement,
monitor and review the end of life care plan.
G Understand the cultural and religious (or
similar belief) issues that may impact on
symptom management. Recognise the
potential for conflicts between individuals
and family members, arising from different
religious, cultural or lifestyle perspectives
and work with those involved to reach
agreement.

Useful resources for symptom management
Care strategy, and is freely available. It is intended to be of use to all practitioners concerned with
document.
www.scie.org.uk
Dignity in Care factsheet: pain management in practice
Part of Scie’s Dignity in Care research and best practice programme; this is a useful poster outlining
key ways to recognise and support people who are in pain.

3.5 Overarching knowledge and values
At the heart of all practice, practitioners in whatever role need to have a good understanding of the
underpinning knowledge needed to work with people at the end of their lives. They need also to
work in ways that contribute to maximising the physical, spiritual and emotional wellbeing of those
for whom they are caring. Social care and health professionals working with people at the end of life
are bound by their own codes of practice or ethics, but in addition the knowledge and values below
are related directly to end of life care.
Knowledge
In the context of end of life care, understanding
and knowledge of:

ƒ

The impact of one’s own beliefs on
practice.

ƒ

One’s own professional/role boundaries.

ƒ

ƒ

Legal and ethical issues – adherence to
legislation and advisory guidance, for
example:

The impact of the individual’s culture and
beliefs, including any religious beliefs, on
treatment both before and after death.

ƒ

Where appropriate to role, the
responsibilities of caring for the person
after death.

ƒ

Approaches to risk assessment,
management and taking.

- DNACPR (‘Do not attempt cardiopulmonary resuscitation’)

ƒ

Theories of change, loss and bereavement
and how these impact upon people.

ƒ

Professional codes of practice or conduct
and their impact on practice.

ƒ

Social models of care and person-centred
approaches.

ƒ

The role and contribution of other workers
and organisations to the individual’s care,
and to leadership and innovation.

- The Mental Capacity Act
- The Mental Health Act
- Advance Decisions to Refuse Treatments

Values
Practice that:
A Is person-centred, recognising the
circumstances, concerns, goals, beliefs
and culture of the individual, their family and
friends, and acknowledges the significance
of spiritual, emotional and religious needs
and support.
B Acknowledges the differences and conflicts
that may arise between the individual,
their friends and family when making
decisions; and is sensitive in helping all those
concerned to reach a positive resolution.

D Demonstrates awareness of the importance
of con tributing t o evalu ation an d ch ange of
services, participating as appropriate, and
of involving the people who use them in that
process.
E Recognises and takes responsibility for one’s
own learning and continuing professional
development, and contributes to the learning
of others.

C Is sensitive to the support needs of family
and friends, including children and young
people, both as part of end of life care and
following bereavement.
Useful resources
www.dh.gov.uk/publications
Bereavement care services: a synthesis of the literature (Jan 2011)
Spirituality Care at the End of Life a systematic review of the literature (Jan 2011)
For a wide range of information, guidance and links to other useful sites.
www.endoflifecareforadults.nhs.uk/publications/guidance-for-staff-responsible-for-careafter-death
For guidance to help workers responsible for care after death.
Care strategy, and is freely available. It is intended to be of use to all workers concerned with end
of life care.
The suites include condition-specific end of life scenarios, critical situations and differing scenarios
around dying, for example as a prisoner and as a homeless person, as well as care after death
(also known as ‘last offices’) and various frameworks and tools such as DNACPR and the
framework for advanced kidney disease.

Appendix End of life care core competences values & knowledge:
links between health and social care QCF units and social
care induction standards
The following pages link the end of life care
core competences, values and knowledge to
the social care Common Induction Standards
and to health and social care (HSC) QCF units.
It provides a framework for trainers or those
involved with commissioning and developing
training to work across the two sets of
competences making logical connections. It is
not an exhaustive list, and as new QCF units are
developed there will be other units that could be
connected.
There are a small number of units that are
specific to end of life care; these are in shaded
cells in the tables.
Under each standard are the units that relate
most closely to end of life care, and the
numbers in the brackets refer to the specific
criteria within that unit that link to the end of life
care competences.
By looking for the links between end of life care
training an d d evelopment an d ot her HS C u nits,
people developing programmes (whether or not
leading to a qualification) will be able to:
1. Ensure that the required end of life care
training is included in the curriculum.

2. Demonstrate that workers are competent
across the relevant aspects of end of life care
as well as their more generic learning.
3. Ensure that end of life care training is
delivered in a way that incorporates HSC
units and enables workers to demonstrate
their learning towards achieving those units.
Employers and those commissioning training
will be able to “pick and mix” to ensure that
employees have the right range of training and
development for their circumstances.
For example, by looking at the end of life
competences, a manager in a residential
home for older people may realise that it is
important that all workers are comfortable about
responding to a resident who wants to talk
about the fact that they are dying. Therefore,
when creating an induction programme she
may want to ensure that everyone has some
understanding of communicating with people
who are dying; so one of the communication
sessions is designed to cover this topic.

Communication skills
A
B
C
D
E

F

Communicate with a range of people on a range of matters in a form that is appropriate to
them and the situation.
Develop and maintain communication with people about difficult and complex matters or
situtions related to end of life care.
Present information in a range of formats, including written and verbal, as appropriate to the
circumstances.
Listen to individuals, their families and friends about their concerns related to the end of life
and provide information and support.
Work with individuals, their families and friends in a sensitive and flexible manner,
demonstrating awareness of the impact of death, dying and bereavement, and recognising
that their priorities and ability to communicate may vary over time.
Work with colleagues to share information appropriately, taking account of issues of
confidentiality, to ensure that individuals receive the best possible care. Ensure that
information is clear, and non-jargonistic, so that it can be fully understood by others.

Common Induction Standards

QCF level 2

QCF level 3

STANDARD 1 ROLE OF HEALTH &
SOCIAL CARE WORKER

HSC 2022 CONTRIBUTE TO THE
CARE OF A DECEASED PERSON

HSC 3035 SUPPORT INDIVIDUALS
WHO ARE BEREAVED

3. The importance of working in
partnership with others(.1)

2. Be able to contribute to supporting
those who are close to the individual(.2)

3. Be able to support individuals to
express their responses to loss (.1.2)

STANDARD 3 CO MMUNICATE
EFFECTIVELY

HSC028 HANDLE INFORMATION
IN HEALTH AND S OCIAL CARE
SETTINGS

AT THE END OF LIFE

1. Importance of effective
communication in the work setting
(.1.2.3)

3. Be able to handle information
in accor dance with agreed ways of
working (.1.2)

2.Meeting the communication and
language needs, wishes and preferences SHC21 INTRODUCTION TO
of individuals (.1.2)
COMMUNICATION IN HEALTH,
SOCIAL CARE OR CHILDREN’S AND
3.Overcoming difficulties in promoting
YOUNG PEOPLE’S SETTINGS
communication (.1.2.3.4)
1. Understand why communication is
important in the work setting (.1.2.3.)
2. Be able to meet the
communication and language needs,
wishes and preferences of individuals
(.1.2.3.)
3.Be able to reduce the barriers to

4. Be able to provide support to
individuals and key people during end
of life (.1.2.4.6)
5. Understand how to address
sensitive issues in relation to end of life
care (.1)
HSC3029 SUPPORT INDIVIDUALS
WITH SPECIFIC COMMUNICATION
NEEDS
1.Understand specific
communication n eeds an d factors
affecting them (.1.2.3.4.5.6)
2.Be able to contribute to
establishing t he n ature of s pecific
communication needs of individuals
and ways to address them (.1.2.3)
3.Be able to interact with individuals
using their preferred communication
(.1.2.3.4)
4.Be able to promote
communication between individuals
and others (.1.2.3.4)


QCF level 2

QCF level 3

SSOP2.2 SUPPORT
EFFECTIVE COMMUNICATION
WITH INDIVIDUALS WITH A
SENSORY LOSS

HSC038 PROMOTE GOOD
PRACTICE IN HANDLING
INFORMATION IN HEALTH AND
SOCIAL CARE SETTINGS

1.Know different methods that
can support communication with
individuals with sensory loss (.1.2.3)

2.Be ab le t o imp lement good p ractice in
handling information (.1)

2.Be able to use different methods of
communication with individuals with
sensory loss (.1.2.3)
3. Understand how the environment
impacts on communication with
individuals with sensory loss (.1.2)
4.Be able to utilise the environment
for effective commu nication wit h
individuals with sensory loss (.1)

HSC 3038 WORK IN
PARTNERSHIP WITH FAMILIES TO
SUPPORT INDIVIDUALS
2. Be able to establish and maintain
positive relationships with families (.1)
5. Be able to exchange and record
information about partnership working with
families
7. Be able to provide feedback about
support for families
SHC31 PROMOTE
COMMUNICATION IN HEALTH,SOCIAL
CARE OR CHILDREN’S AND YOUNG
PEOPLE’S SETTINGS
1. Understand why effective
communication is important in the work
setting (.1.2.)
2.Be able to meet the communication and
language needs, wishes and preferences
of individuals (.1.2.3.4)
3. Be able to overcome barriers to
communication (.1.2.3.4.)
SSOP3.2 PROMOTE EFFECTIVE
COMMUNICATION WITH INDIVIDUALS
WITH SENSORY LOSS
1.Understand the importance of effective
two way communication (.1.2.3)
3. Be able to support the individual with

Assessment and care planning
A
B
C
D

E

Understand the range of assessment tools and ways of gathering information and their
advantages and disadvantages.
Assess pain and other symptoms using assessment tools, pain history, appropriate physical
examination and relevant investigation.
Undertake/contribute to multi¬disciplinary assessment and information sharing.
Ensure that all assessments are holistic, including
ƒ
Background information
ƒ
Current physical health and prognosis.
ƒ
Social and/or occupational wellbeing
ƒ
Psychological and emotional wellbeing
ƒ
Religious and/or spiritual wellbeing (recognising the differences between these two
concepts and the person’s ability to maintain their preferred variations of their outward
practice, such as prayer habits, diet, dress, etc.)
ƒ
Culture and lifestyle aspirations, goals and priorities
ƒ
Risk and risk management
ƒ
The needs of families and friends, including carers’ assessments, and including children and
young people.
Regularly review assessments to take account of changing needs, priorities and wishes, and
ensure information about changes is properly recorded.


QCF level 2

QCF level 3

SOCIAL CARE WORKER

HSC2022 CONTRIBUTE TO THE

WHO ARE BEREAVED


2. Be able to contribute to supporting
those who are close to the individual (.2)

express their responses to loss (.1.2)

EFFECTIVELY

HSC025 THE ROLE OF THE HEALTH
AND SOCIAL CARE WORKER

(.1.2.3)

3. Be able to work in partnership with
others (.1.2.4)

5.Understand the role of specialist
agencies in supporting individuals who
are bereaved (.2)

HSC026 IMPLEMENT PERSON
CENTRED APPROACHES IN
language needs, wishes and preferences HEALTH & SOCIAL CARE
1.Understand person-centred
approaches for care and support (.1.2.3)
2.Be able to work in a person-centred
way (.1.2)

HSC036 PROMOTE PERSONCENTRED APPROACHES IN
HEALTH AND SOCIAL CARE
1.Understand the application of
person-centred approaches in health
and social care (.1)
way (.1.2.3)

5.Be able to support the individual’s right 5.Be able to support the individual’s
right to make choices (.3)
to make choices (.2.3)

STANDARD 4 EQUALITY &
INCLUSION
2.Provide inclusive support (.2)
STANDARD 7 PERSON-CENTRED
SUPPORT
1.Promote person-centred values in
everyday work (.1.2)
2. Working in a person-centred way
(.1.2.3)
5. Supporting an individual’s rights to
make choices (.1)

QCF level 2
IN HEALTH AND SOCIAL CARE
SETTINGS
1.Understand the need for secure
handling of information in health and
social care settings (.1.2)
2. Know how to access support for
3. Be able to handle information in
accordance with agreed ways of
working (.1.2)

6.Promoting spiritual and emotional well- HSC2003 PROVIDE SUPPORT TO
MANAGE PAIN AND DISCOMFORT
being (.1.2.3)
2.Be able to assist in minimising
individual’s pain or discomfort (.1.2)
3. Be able to monitor, record and report
on the management of individuals’ pain
or discomfort (.1.2.3)

QCF level 3
HSC035 PROMOTE GOOD
PRACTICE IN HANDL ING
INFORMATION IN HEAL TH AND
2.Be able to implement good practice
in handling information (.1.3)
HSC 3020 FACILITATE
PERSON-CENTRED ASSESSMENT,
PLANNING, IMPLEMENTATION
AND REVIEW
1.Understand the principles of personcentred assessment and care planning
(.1.2.3)
2.Be able to facilitate person-centred
assessment (.1.2.3.4.5)
3.Be able to contribute to the planning
of care or support (.4)
4.Be able to support the
implementation of care plans(.3)
5.Be able to monitor care plans (.1.2.3)
6.Be able to facilitate a review of
care plans and their implementation
(.1.2.3.4.5)
NEEDS
6.Be able to review an individual’s
communication needs and the support
provided to address them (.1.2.3)
HSC3038 WORK IN PARTNERSHIP
WITH FAMILIES TO SUPPORT
INDIVIDUALS
4.Be able to work with families to
access support in their role as carers
(.1)
5.Be able to exchange and record
information about partnership work
with families (.1.2)
6.Be able to provide feedback about
support for families (.1.2.3.4)

Advance care planning
A
B
C
D
E
F

G
H

Demonstrate awareness and understanding of advance care planning, and the times at which
it would be appropriate.
Demonstrate awareness and understanding of the legal status and implications of the advance
care planning process; in accordance with the provisions of the Mental Capacity Act.
Demonstrate awareness and understanding of the impact of culture and religion (or similar
belief, if any) upon the choices people make.
Show understanding of informed consent and demonstrate the ability to give sufficient
information in an appropriate manner.
Use effective communication skills when having advance care planning discussions as part of
ongoing assessment and intervention.
Work sensitively with families and friends to support them as the individual decides upon their
preferences and wishes during the advance care planning process. Recognise the potential fo
conflicts arising from different religious, cultural or lifestyle perspectives and work with those
involved to reach agreement.
Where appropriate, ensure that the wishes of the individual, as described in an advance care
planning statement, are shared (with permission) with other workers.
When appropriate, know what the advance care planning statement contains, and how this w
impact upon an individual’s care delivery.
QCF level 2

QCF level 3

SOCIAL CARE WORKER



others (.1.2.3)

EFFECTIVELY

HSC 026 IMPLEMENT PERSONCENTRED APPROACHES IN

AT THE END OF LIFE
1.Understand the requirements of
legislation and agreed ways of working
to protect the rights of individuals at
the end of life (.1.2)


(.1.2.3)

approaches for care and support
(.1.2.3.4)

language needs, wishes and preferences 2. Be able to work in a person-centred
way (.1.2)

3.Be able to establish consent when
providing care or support (.1.2)
5. Be able to support the individual’s
right to make choices (.1.2)

2.Understand factors affecting end of
life care (.1.2.3.4)
3.Understand advance care planning
in relation to end of life care (.1.2.3.4)
4.Be able to provide support to
of life care (.1.2.3.4.6)
5.Understand how to address
sensitive issues in relation to end of life
care (.1.3.4)
8.Be able to support individuals
through the process of dying (.1.2.3)
9.Be able to take action following the
death of individuals (.1.2)

SUPPORT
(.1.2.3)
make choices (.1)

QCF level 2
SETTINGS

QCF level 3

1.Understand the need for secure
handling of information in health and

HSC036 PROMOTE PERSONCENTRED APPROACHES IN
and social care (.1.2)

2. Know how to access support for

way (.1.2.3)

3. Be able to handle information in
6.Promoting spiritual and emotional wellaccordance with agreed ways of
being (.1.2.3)
working (.1.2)

3.Be able to establish consent when
4.Be able to implement and promote
active participation (.2.3)
5.Be able to support the individual’s
right to make choices (.1.2.3.4)
6.Be able to promote individual’s wellbeing (.1.4)
HSC 038 PROMOTE GOOD
PRACTICE IN HANDL ING
INFORMATION IN HEAL TH AND
1.Understand requirements for
handling information in health and
2.Be able to implement good practice
in handling information (.1.2.3)
HSC 3020 FACILITATE
AND REVIEW
(.1.2.3)
of care or support (.1.2.3.4)
6. Be able to facilitate a review of
(.1.2.3.4.5.6)


QCF level 2

QCF level 3
NEEDS
3. Be able to interact with individuals
using their preferred communication
(.4)
5.know how to support the use of
communication technology and aids
(.1.2.3)
DURING A PERIOD OF CHANGE
1.Understand reasons for and
responses to change
positive relationships with families (.3)
3.Be able to plan shared approaches
to the care and support of individuals
with families (.1.2.3.4.5)
information about partnership work

Symptom management: maintaining comfort and wellbeing
A

Be aware that symptoms have many causes, including the disease itself, its treatment, a
concurrent disorder (including depression or anxiety) or other psychological or practical issues.
B
Understand the significance of the individual’s own perception of their symptoms to any
intervention.
C Un
derstandt hatt heu nderlyingcau ses ofas ymptomwillh avean imp actu ponh owcar es hould
be delivered.
D
Understand the range of therapeutic options available, including drugs, hormone therapy,
physical therapies, counselling or other psychological interventions, complementary therapies,
surgery, community or practical support.
E

F
G

In partnerships with others, including the individual, their family and friends, develop an end of life
care plan which balances disease specific treatment with other interventions and support that
meets the needs of the individual.
In partnership with others, implement, monitor and review the end of life care plan.
Understand the cultural and religious (or similar belief) issues that may impact on symptom
management. Recognise the potential for conflicts between individuals and family members,
arising from different religious, cultural or lifestyle perspectives and work with those involved to
reach agreement.


QCF level 2

QCF level 3

AT THE END OF LIFE
life care (.1.4)
approaches for care and support (.1.2.3) 4.Be able to provide support to
EFFECTIVELY
of life care (.5)
way (.1.2)
5.Be able to support the individual’s right
through the process of dying (.2.3)
(.1.2.3)
to make choices (.2.3)
HSC036 PROMOTE PERSON2.Meeting the communication and
6.Be able to promote individuals’
language needs, wishes and preferences well-being (.1.2)
HSC2003 PROVIDE SUPPORT TO
1.Understand approaches to managing and social care (.1)
pain and discomfort (.1.2.3)
2. B e ab le t o as sist in min imising
way (.1.2.3)
individuals’ pain or discomfort
(.1.2.3.4.5)
right to make choices (.3)
6.Be able to promote individual’s wellon the management of individuals’ pain
being (.2.4)
SOCIAL CARE WORKER

HSC026 IMPLEMENT PERSON
HEALTH & SOCIAL CARE


QCF level 2

SUPPORT

HSC2030 PROVIDE SUPPORT FOR
SLEEP


1.Understand the importance of sleep
(.1.2.3)

(.1.2.3)
make choices (.1)
6.Promoting spiritual and emotional
well-being (.1.2.3)

QCF level 3
HSC 3020 FACILITATE
AND REVIEW
(.1.2.3)
of care or support (.4)
4.Be able to support the
implementation of care plans(.3)
6.Be able to facilitate a review of
(.1.2.3.4.5)
INDIVIDUALS
1.Understand partnership working with
families (.1.2.3.4)
3.Be able to plan shared approaches
to the care and support of individuals
within families (.1.3.5)
information about partnership working

Overarching values and knowledge
Knowledge
In the context of end of life care, understanding and knowledge of:
ƒ

One’s own professional/role boundaries.

ƒ

Legal and ethical issues – adherence to legislation and advisory guidance, for example:
ƒ
ƒ
ƒ
ƒ

The Mental Capacity Act
The Mental Health Act
Advance Decisions to Refuse Treatments
DNACPR (‘Do not attempt cardio pulmonary resuscitation’)

ƒ

Professional codes of practice or conduct and their impact on practice.

ƒ

The role and contribution of other workers and organisations to the individual’s care, and to
leadership and innovation.

ƒ

The impact of one’s own beliefs on practice.

ƒ

The impact of the individual’s culture and beliefs, including any religious beliefs, on treatment
both before and after death.

ƒ

Where appropriate to role, the responsibilities of caring for the person after death.

ƒ

Approaches to risk assessment, management and taking.

ƒ

Theories of change, loss and bereavement and how these impact upon people.

ƒ

Social models of care and person-centred approaches.

Values
Practice that:
A

Is person-centred, recognising the circumstances, concerns, goals, beliefs and culture of
the individual, their family and friends, and acknowledges the significance of spiritual,
emotional and religious needs and support.

B

Acknowledges the differences and conflicts that may arise between the individual, their
friends and family when making decisions; and is sensitive in helping all those concerned to
reach a positive resolution.

C

Is sensitive to the support needs of family and friends, including children and young people,
both as part of end of life care and following bereavement.

E

Demonstrates awareness of the importance of contributing to evaluation and change of
services, participating as appropriate, and of involving the people who use them in that
process.

F

Recognises and takes responsibility for one’s own learning and continuing professional
development, and contributes to the learning of others.


QCF level 2

QCF level 3

SOCIAL CARE WORKER

HSC 2022 CONTRIBUTE TO THE

1.Responsibilities and limits of your
relationship with an individual (.1.2)

1.Know the factors that affect how
1. Understand the effects of
individuals are cared for after death (.1.2) bereavement on individuals (.1.2)

2.working in ways that are agreed with
your employer (.1.2.3)

2.Be able to contribute to supporting
those who are close to the individual
(.1.2.3.4)

2. Understand the principles for
supporting individuals who are
bereaved (.1.2.3)

3. Be able to contribute to preparing
deceased individuals prior to transfer
(.1.2)

express their responses to loss (.1.2.)

partnership with others (.1.2.3)
STANDARD 2 PERSONAL
DEVELOPMENT
1.Competence in your own work role
within the sector (.1.2.3)

4. Be able to contribute to transferring
deceased individuals(.1.2)

WHO ARE BEREAVED

4. Be able to support individuals who
are bereaved (.1.2.3.4.5.6)

4. Producing a personal development
plan( 1.2.3)

5.Understand the role of specialist
HSC024 PRINCIPLES OF
agencies in supporting individuals
SAFEGUARDING AND PROTECTION who are bereaved (.2)
IN HEALTH & SOCIAL CARE
HSC 3048 SUPPORT
2.Know how to respond to suspected or INDIVIDUALS AT THE END OF
LIFE
alledged abuse (.1.2.3)

5.Using learning opportunities and
reflective practice to contribute to
personal development (.1.2.3.4)

3. Understand the national and local
context of safeguarding and protection
from abuse (.1.2.3.4)

EFFECTIVELY
4. Understand principles and practice
relating to confidentiality (1.2.3.4.)

4. Understand ways to reduce the
likelihood of abuse (.1)

STANDARD 4 EQUALITY AND
INCLUSION


1.The value and the importance of
equality and inclusions (.1.2.3.4)

1. Understand working relationships in
health and social care (.1.2)

2. Providing inclusive support (1.2.3.)

2. Be able to work in ways that are
agreed with the employer (.1.2.3)

2.Reflective practice (.1.2)
3.Evaluating own performance (.1.2.3)

3. Access information, advice and
support about equality and inclusion
(.1.2)
STANDARD 5 PRINCIPLES FOR
IMPLEMENTING DUTY OF CARE
1. Understand how duty of care
contributes to safe practice (1.2.)
2.Know how to address dilemmas that
may arise between an individual’s rights
and the duty of care (.1.2.3)

5. Know how to recogniseand report
unsafe practices (.1.2.3)

others (.1.2.3)
HSC026 IMPLEMENT PERSONCENTRED APPROACHES IN
approaches for care and support
(.1.2.3.4)
2. Be able to work in a person-centred
way (.1.2)
5. Be able to support the individual’s
right to make choices (.1.2)

1.Understand the requirements
of legislation and agreed ways
of working t o p rotect t he rights of
individuals at the end of life (.1.2)
life care (.1.2.3.4)
3.Understand advance care
planning in relation to end of life care
(.1.2.3.4)
4.Be able to provide support to
of life care (.1.2.3.4.6)
5.Understand how to address
sensitive issues in relation to end of
life care (.1.3.4)
through the process of dying (.1.2.3)
9.Be able to take action following the
death of individuals (.1.2)

SUPPORT
everyday work (.1.2.3)
(.1.2.3.4)
make choices (.1.2.3)
6.Promoting spiritual and emotional
well-being (.1.2.3)

QCF level 2

QCF level 3

HSC027 CONTRIBUTE TO HEALTH
AND SAFETY IN HEALTH AND
SOCIAL CARE

HSC036 PROMOTE PERSON
CENTERED APPROACHES IN

1.Understand own responsibilities, and
the responsibilities of others, relating
to health and safety in the work setting
(.1.2.3.4.5)

person-centred approaches in
health and social care (.1.2)

HSC2003 PROVIDE SUPPORT TO
1.Understand approaches to managing
pain and discomfort (.1)
on the management of individuals’ pain
HSC 2030 PROVIDE SUPPORT FOR
SLEEP
3.Be able to assist an individual to sleep
(.1.2)

2,.Be able to work in a person-centred
way (.1.2.3)
3. Be able to establish consent when
right to make choices (.1.2.3.4)
6.Be able to promote individual’s wellbeing (.3.4)
7.Understand the role of risk
assessment in enabling a personcentred approach (,1.2.3)

HSC037 PROMOTE AND
SHC21 INTRODUCTION TO
IMPLEMENT HEALTH AND SAFETY
1.Understand own responsibilities, and
the responsibilities of others, relating to
4.Be able to apply principles and
health and safety (.1.2.3.4)
practices relating to confidentiality at
2.Be able to carry out own
work (.1.2.3.4)
responsibilities for health and safety
(.1.2.3.4.5.6)
SSOP2.2 SUPPORT EFFECTIVE
HSC 038 PROMOTE GOOD
COMMUNICATION WITH
PRACTICE IN HANDLING
INDIVIDUALS WITH A SENSORY
INFORMATION IN HEALTH AND
LOSS
2.Be able to use different methods of
1.Understand requirements for
communication with individuals with
handling information in health and social
sensory loss (.4)
care settings (.1.2)
3.Understand how the environment
3. be able to support others to handle
impacts on communication with
information (.1.2)
HSC 3020 FACILITATE PERSON4. Be able to utilise the environment for
CENTRED ASSESSMENT,
effective communication with individuals
PLANNING, IMPLEMENTATION AND
with sensory loss (.1.2.3)
REVIEW
(.1.2.3)


QCF level 2

QCF level 3

DURING A PERIOD OF CHANGE
1.Understand reasons for and responses
to change (.1.2.3)
INDIVIDUALS
1.Understand partnership working with
families (.2.3.4)
positive relationships with families (.1.3)
3.Be able to plan shared approaches to
the care and support of individuals with
families (.3)
7.be able to provide feedback about
support for families(.2.3)
SHC31 PROMOTE
4. Be able to apply principles and
practices relating to confidentiality
(.1.2.3)
SSOP3.2 PROMOTE EFFECTIVE
COMMUNICATION WITH
INDIVIDUALS WITH SENSORY LOSS
2.Understand different methods that
can support communication with
4. Evaluate the effectiveness of
methods of communication used to
support an individual with sensory loss
(.1.2.3.4.5)

Developing end of life care practice

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