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									                    Barnet Primary Care Trust

                   NHS Contract for the Provision of

           Training and Development in End of Life Care for

             North Central London Care Homes Workforce




           INVITATION TO TENDER



Return completed ITT
Referenced: NCL EOLC CH ITT

To:
Mark Watson, Eolc CCI Board Co-ordinator,
North Central London End of Life Care
Collaborative Commissioning Initiative
Bullimore House
Finchley Memorial Hospital
London N12 0JE

By: 28TH January 2010 by 1.00pm
                                                                                North Central London


                                                                                              End of Life Care
                                                                          Collaborative Commissioning Initiative
                                                                                               Bullimore House
                                                                                     Finchley Memorial Hospital
                                                                                               London N12 0JE
                                                                                          Phone: 020 8349 7556
                                                                                             Fax: 020 8349 7552




Dear Sir/Madam


Re: Training and Development in End of Life Care for North Central London Care Homes Workforce


Offers are invited subject to the terms of this letter and also to the Terms of Offer (document no.2) for
the supply, in accordance with the NHS Terms and Conditions of Contract, Supplementary
Conditions of Contract and Additional Supplementary Conditions of Contract, of the goods and/or
services detailed in the Specification (document no.4).

This Invitation to Offer package comprises the following documents (if any of these documents are
missing please contact me immediately):
Document no.1        Covering letter
Document no.2        Evaluation and scoring criteria
Document no.3        Terms of Offer
Document no.4        Specification
Document no.5        Form of Offer
I would like to draw your attention to the following important points when completing and submitting
your offer:
1. All offers must be written in English and, where applicable, in ink.
2. All offers must be accompanied by the signed Form of Offer. This must not be amended in any
   way.
3. All offers must be submitted in a plain sealed envelope bearing the following reference NCL EOLC
   CH ITT. The envelope must not identify the name of your company.
4. The envelope containing your offer must be returned to the Contact Point: Mark Watson detailed
on the covering page, no later than 1 pm on 28th January 2010.
I must also draw your attention to the enclosed Form of Offer where all the requirements for
completing and submitting an offer can be found. Failure to comply with these instructions may
result in your offer being rejected.
I hope that this clarifies matters, but please contact me if there is anything you wish to discuss.
Yours faithfully

Mireille

Mireille Hayden
End of Life Care Collaborative Commissioning Lead
                                   EVALUATION AND SCORING CRITERIA



Evaluation criteria

Tenders will be evaluated against the following evaluation criteria



Criteria                                                              Weight

Topic Specific experience

Specialist knowledge in End of Life Care                              20

Experience of working with care homes                                 10

Project Management Experience
Training and Development Experience

Experience of managing the successful delivery of training            18
projects

Demonstration of skills and capacity to undertake the work:           10
       clear leadership of work
       adequate qualifications and experience of the team

Specific proposals for how the work will be undertaken                14

Innovation / value added                                              6

Total Quality                                                         80

Price

Transparent cost element and value for money                          20

Total                                                                 100
                          EVALUATION AND SCORING CRITERIA




Scoring system

      Number of                        Definition for scoring ‘Quality’
       Points

          0       Fails to provide evidence of their ability to meet the requirements

          1       Evidences limited ability to meet some but not all of the requirements

          2       Evidences limited ability to meet all requirements

          3       Provides good evidence of the ability to meet all the requirements.

          4       Provides good evidence of the ability to meet all the requirements and
                  exceeds them in some of areas.

          5       Provides good evidence of the ability to meet all the requirements and
                  exceeds them in the majority of areas.
                                           TERMS OF OFFER



Terms of Offer
General notes

Barnet PCT is making this invitation on behalf of North Central London End of Life Care Collaborative
Commissioning Initiative. Offers are invited for the supply of training and development in End of Life
Care for the North Central London Care Homes Workforce.

This is a one off contract starting March 2010.

1. Information and confidentiality
1.1    Information that is supplied to offerors as part of the procurement exercise is supplied in good
       faith. However, offerors must satisfy themselves as to the accuracy of such information and
       no responsibility is accepted for any loss or damage of whatever kind or howsoever caused
       arising from the use by the offerors of such information, unless such information has been
       supplied fraudulently.
1.2    All information supplied to offerors by the PCT in connection with this procurement exercise
       shall be regarded as confidential. By submitting an offer the offeror agrees to be bound by the
       obligation to preserve the confidentiality of all such information.
1.3    This invitation and its accompanying documents shall remain the property of the PCT and
       must be returned on demand.

2.     Freedom of Information Act 2000
2.1    The Freedom of Information Act 2000 (FOIA) applies to the PCT.
2.2    Offerors should be aware of the PCTs obligations and responsibilities under the FOIA to
       disclose, on request, recorded information held by the PCT. Information provided by offerors
       in connection with this procurement exercise, or with any Contract that may be awarded as a
       result of this exercise, may therefore have to be disclosed by the PCT in response to such a
       request, unless the PCT decides that one of the statutory exemptions under the FOIA applies.
       The PCT may also include certain information in the publication scheme which it maintains
       under the FOIA.
2.3    In certain circumstances, and in accordance with the Code of Practice issued under section
       45 of the FOIA or the Environmental Information Regulations 2004, the PCT may consider it
       appropriate to ask offerors for their views as to the release of any information before a
       decision on how to respond to a request is made. In dealing with requests for information
       under the FOIA, the PCT must comply with a strict timetable and the PCT would, therefore,
       expect a timely response to any such consultation within five working days.
2.4    If offerors provide any information to the PCT in connection with this procurement exercise, or
       with any Contract that may be awarded as a result of this exercise, which is confidential in
       nature and which an offeror wishes to be held in confidence, then offerors must clearly identify
       in their offer documentation the information to which offerors consider a duty of confidentiality
       applies. Offerors must give a clear indication which material is to be considered confidential
       and why you consider it to be so, along with the time period for which it will remain
       confidential in nature. The use of blanket protective markings such as “commercial in
       confidence” will no longer be appropriate. In addition, marking any material as “confidential” or
       equivalent should not be taken to mean that the PCT accepts any duty of confidentiality by
      virtue of such marking. Please note that even where an offeror has indicated that information
      is confidential, the PCT may be required to disclose it under the FOIA if a request is received.

2.5   The PCT cannot accept that trivial information or information which by its very nature cannot
      be regarded as confidential should be subject to any obligation of confidence.

2.6   In certain circumstances where information has not been provided in confidence, the PCT
      may still wish to consult with offerors about the application of any other exemption such as
      that relating to disclosure that will prejudice the commercial interests of any party.

2.7   The decision as to which information will be disclosed is reserved to the PCT, notwithstanding
      any consultation with you.

3. Prices
3.1   Prices stated must remain open for acceptance until 90 days from the closing date for the
      receipt of offers.
3.2   Prices must be firm (i.e. not subject to variation) .

4. Offer documentation and submission
4.1   Offers will be submitted for all services.
4.2   The services offered should be strictly in accordance with the Specification document.
      Alternative services may be offered but all differences between such items and the
      Specification must be indicated in detail in the Offer Schedule.
4.3   Offers must comprise:
      •    An Offer Schedule
      •    The Form of Offer
      •    Details of the offeror‟s ability, if any, to trade electronically
      •    Confirmation that any information previously supplied to the PCT in connection with the
           offer is still accurate and is incorporated by reference into the offer.
4.4   The Form of Offer must be signed by an authorised signatory: in the case of a partnership, by
      a partner for and on behalf of the firm; in the case of a limited company, by an officer duly
      authorised, the designation of the officer being stated.
4.5   The Form of Offer and accompanying documents must be completed in full. Any offer may be
      rejected which:
      •     contains gaps, omissions or obvious errors; or
      •     contains amendments which have not been initialled by the authorised signatory; or
      •     is received after the closing time.
4.6   For help in completing the Form of Offer please contact for queries.
4.7   Offers must be written in English and submitted in a plain sealed envelope which does not
      identify the offeror. The envelope should bear the address label enclosed herewith and arrive
      at that address no later than 1.00pm on 28th January 2010.

5. Contract award criteria
5.1   The contract will be awarded on the basis of the most economically advantageous offer
      judged on price, quality, delivery performance, risk and overall cost effectiveness. These
      factors are not listed in any particular order of importance.
6. Contract monitoring
6.1   The PCT is committed to helping improve the efficiency of contracted suppliers through
      sharing information on performance measurement. The criteria for measuring performance
      shall be agreed with the supplier/s and formally documented. It is possible that measurement
      criteria will develop during the term of the contract - this will also be documented following
      agreement with the supplier/s.
NHS Contract for Provision - Specification
   Training and Development in End of Life Care for

     North Central London Care Homes Workforce
                                                  SPECIFICATION




INTRODUCTION
End of life care involves care to all those with any advanced, progressive, incurable illness, enabling
each individual to live as well as possible until they die. It enables the supportive and palliative care
needs of both patient and family to be identified and met throughout the last phase of life and into
bereavement. It includes management of pain and other symptoms and provision of psychological,
social, spiritual and practical support.

A workforce that is skilled and confident in the provision of palliative and end of life care underpins the
development of reliable, responsible and sustainable services for those patients with life-limiting disease.



CONTEXT AND DRIVERS
The National End of Life Care Strategy (July 2008) outlined the shift needed within the health and social
care workforce in terms of attitude and behaviour relating to end of life care. It acknowledged the
deficiencies in knowledge, skills, attitudes and behaviour of staff groups who come into frequent contact
with people at the end of their lives. It recognised the care home staff as an important section of this
workforce needing upskilling with significant numbers having unmet training needs and outlined a
minimum level of skills and knowledge.

With the Strategy came the release of additional resources to implement changes including workforce
and development monies to facilitate the improvement of End of Life Care for local health economies.
The North Central London End of Life Care Collaborative Commissioning Initiative (NCL Eolc CCI)
agreed to pool these funds to ensure an efficient delivery of one of its core objectives:

Focus on improving End of Life Care understanding; skills; and confidence of nursing/care home staff

 Illustrated in figure one are the vital steps to establishing the strategy and plans for developing the skills
and knowledge of this target professional group.




We would like to acknowledge South East London’s comprehensive Education Strategy as supportive information for the
development of this specification.
Figure 1: Cycle for skills and knowledge development




The Department of Health has undertaken some work to define the core principles and competencies
required by staff groups when they deliver end of life care: Skills for Health and Skills for Care in
collaboration with the NHS End of Life Care Programme developed „Common core competences and
principles for health and social care workers working with adults at the end of life’ launched in June
2009.this document can be accessed via the national End of Life Care Programme website at:
http://www.endoflifecare.nhs.uk).

The document sets out and has detailed dimensions relating to four competency areas, namely:
 Communication skills
 Assessment and care planning
 Symptom management
 Advance Care Planning

The detailed dimensions relating to these competency areas can be found in Appendix 1.

The document also suggests seven overarching principles that should be applied to these competency
areas and describes these principles in detail. The overarching principles are:
    The choices and priorities of the individual are at the centre of all end-of-life care planning and
       delivery
    Effective, straightforward, sensitive and open communication between individuals, families,
       friends and workers underpins all planning and activity
    High quality end-of-life care is delivered through close multidisciplinary and inter-agency working
    Individuals, their families and friends are well informed about the range of options and resources
       available to them to enable them to be involved in the planning, developing and evaluating of
       end-of-life care plans and services
         Care is delivered in a sensitive, person-centred way that takes account of the individual, their
          family and friends
         Care and support are available to, and continue for, anyone affected by the end of life, and death,
          of the individual
         Workers are supported to develop knowledge; skills and attitudes that enable them to initiate and
          deliver high quality end-of-life care or, where appropriate, to seek advice and guidance from other
          colleagues. Workers recognise the importance of their continuing professional development, and
          take responsibility for it.

The document includes summary case studies from the pilot sites to illustrate how the core
competencies and principles can be applied in practice and to describe any lessons learnt through the
testing.

The national End of Life Care Strategy suggests that consideration should be given as to how these four
competency areas are broken down to reflect the knowledge, skills and attitudes required to undertake
each of the roles described within the end of life care pathway; as illustrated in figure two.

Figure 2: The End of Life Care Pathway
Source: End of Life Care Strategy: Promoting high quality care for all adults at the end of life (July 2008)




Please note that this pathway includes, and the end of life care strategy recommends, the use of
the three nationally recognised End of Life Care tools:
 The Gold Standards Framework; currently for primary care and care home settings and a method to
   ensure good coordination of multidisciplinary team care for end of life care patients
 The Preferred Priorities for Care tool or similar advance care planning tool; to enable documentation
   of patients’ preferences and choices; and
 The Liverpool Care Pathway, to facilitate appropriate good care in the last days of life.
THE CONTEXT WITHIN NORTH CENTRAL LONDON

North Central London has a total of 143 care homes which cover older age and/or dementia (see
appendix 2 for details).

A programme of implementation of the Gold Standard Framework (GSF) has been in place across the
sector and 45 (31%) of care homes have been or are part of this programme (See table 1).

The aims of the GSF Care Homes programme are to:
        Improve the quality of care provided for all residents from admission to the home
        Improve the collaboration with GPs, primary care teams and specialists
        Reduce the number of inappropriate hospital admissions in the final stage of life, enabling
          more to die with dignity in the home, if that is their wish.

Table 1: North Central London Care Homes

PCT          Total       With Nursing   Care Homes on GSF Programme   With Nursing
Barnet       62          20             24   (39%)                    9
Camden       9           3              5    (56%)                    2
Enfield      45          11             5    (11%)                    3
Haringey     18          3              5    (28%)                    1
Islington    8           8              6    (75%)                    6
Total        143         45             45   (31%)                    21


In addition a 1 day EOLC foundation course for health care assistants has been rolled out 4 times in the
past year and some informal training has been carried out in-house in some homes.

Specific work has also been taken forward in NHS Barnet to specify the skills and competences required
by all providers in delivering end of life care. The outcome of this work is a set of competencies and
behavioural indicators which are listed in appendix 3.

Additional training opportunities
The Department of Health has set up an e-learning for End of Life Care project (ELCA), designed to
support the implementation of the workforce development aims within the national End of Life Care
Strategy.

The project will deliver accessible, easily digestible e-learning materials for the four core competency
areas identified in the End of Life Care Strategy and as described in section 1.1.3. Namely;
communication skills, assessment and care planning, symptom management, and advance care
planning.

These sessions are intended to complement and support a variety of learning experiences; including
experiential and face-to-face learning. They enable those who are new to this area of care giving to gain
some basic knowledge; encouraging them to take this further, whilst others can build on prior learning.
The programme will consist of approximately 180 e-learning sessions, all written by subject matter
specialists and experts in their particular field and extensively peer reviewed. Each session will be
around 20 minutes in length and will incorporate self-assessment tools, audio and video clips, and case
studies. A whole module will be devoted to presenting the learner with a variety of clinical scenarios,
drawn from real-life situations, to integrate and consolidate learning.

It is anticipated that all health and social care workers plus those in the voluntary sector will be able to
access ELCA via the e-Learning for Healthcare website at http://www.e-lfh.org.uk by January 2010.
If available within these timescales, this development will support the delivery of the training programme
and needs to be considered as an additional resource in the training programme.
SPECIFICATION OF WORK

The North Central London Collaborative Commissioning Initiative is seeking proposals for a training
programme for care homes across North Central London from either a single provider, partnership or
consortia to enhance End of Life Care understanding; skills; and confidence of nursing/care home staff.

Benefits of this project
   End of Life Care in care homes delivered by staff with appropriate levels of competence
   Reduction of avoidable hospital admissions
   Increase of patients dying in preferred place of care

Programme outline

We envisage this programme being delivered in house with a whole systems approach:
 train the trainers approach for senior staff (management and senior nursing) to ensure sustainability
  and embedding; and
 basic end of life care skills and knowledge training for Health Care Assistants and junior nurses/staff.

Priority should be given to nursing and residential homes with the highest level of hospital deaths.

Courses should cover the knowledge, skills and attitudes required to deliver all aspects of the pathway of
care. From our learning in the delivery of HCA End of Life Care training in care homes we recommend
strong emphasis be made on communication skills and addressing personal, organisational and cultural
attitudes to death, dying and bereavement as well as the use of experiential learning methods.

Due to capacity and resource limitations, we recommend the use of “off the shelf” end of life care training
packages as a cost effective approach. Providers will also need to build in e-learning opportunities into
the training programme to support sustainability.

Whilst we remain clear about the quality of the training and the requirements around outcomes, we are
flexible with our vision and open to alternative ways of delivery.

Measurable outcomes
Number and type of care homes represented on the training programme
Number and type of staff trained – i.e. Registered Nurse, HCA or other
Increase in End of Life Care knowledge, skills, attitudes and confidence of care home staff
Increase in the proportion of resident deaths taking place in the care home
Reduction in crisis hospital admissions


Timescales for implementation

Submission of proposals
Proposals in response to this specification should be submitted by 1pm of 28th January 2009. It is
anticipated that interviews with short-listed organisations will take place on 10th February 2010.

Implementation/planning is expected to start end of March 2010 with training courses delivered
after April 2010.

Proposals submitted should include:
    Examples of relevant experience;
      A description of the proposed programme of work, from set up through to evaluation; with
       timescales
      A description of the proposed training plan including delivery and evaluation
      A description of how the considerations listed below will be addressed
      A description of the skills and experience of the team to be allocated to the work;
      A description of the proposed approach to stakeholder engagement
      A description of project management and reporting arrangements;
      Costings for each element of the work; and
      Contact details for 2 referees.

Additional considerations:

The training provider should refer to the core competencies and principles outlined above as well as
NHS Barnet‟s Eolc competencies and behavioural indicators (see Appendix 3), in determining the
educational programme, course curricula, outcomes and in designing course material.

Providers should ensure that their courses include both didactic and transformative learning methods as
well as practice education where possible.

Providers need to ensure sustainability and self-sufficiency of the care homes in their learning and
development beyond completion of support provided through this contract.

Providers will need to take into account attitudes to training needs in care homes (i.e. training needs are
not always prioritised in care homes), staff turn-over and level of skills. Providers will be responsible for
ensuring greatest uptake and dissemination.

Providers will need to take into account the learning from the implementation of GSF in Care homes and
current HCA Eolc training programme.

Providers will need to consider how they ensure equality of uptake of the training across the sector given
the difference in numbers of care homes in each borough.


CONTRACT VALUE
The contract value will be in the range of £60,000 to £80,000 (including all costs: expenses, VAT…)
Appendix 1
 Extract from ‘Common core competences and principles for health and social care workers
                    working with adults at the end of life’ (DoH, 2009)
Appendix 2
                    Care homes in North Central London by PCT (incl CQC rating and GSF)

               Non-GSF GSF
Residential
Nursing



Barnet

                                 CSCI                           Residential Total (42)             1448
              Name                       Capacity Postcode
                                 stars                                                    CSCI
                                                                        Name                      Capacity Postcode
          Acacia Lodge            2        32     N12 9TB                                 stars
Amonet Residential Care Home      2        12      N3 1SL      Abbey Ravenscroft Park      2        50     EN5 4ND
          Apthorp Lodge           2        108    N11 1EQ     Appletree Court Care Home    2        77     HA8 0AX
Ashfield Residential Care Home    3        15     N12 9EE      Arkley Nursing Home, The    3        60     EN5 3LJ
      Athenaeum House             2        21     N20 9AH      Candle Court Care Home      2        93     NW2 2TD
       Catherine Lodge            2        39     N12 8RP      Carlton Court Care Home     n/a      81     EN5 2SQ
     Church Walk House            2        42     NW2 2TJ          Elmstead House          3        50     NW4 3TH
                                                   NW11        Fernbank Nursing Home       1        34     N3 1AB
      Clara Nehab House           2        25
                                                    0DA             Hadley Lawns           2        44     EN5 4QE
           Clore Manor            2        72     NW4 1EH     Heathgrove Lodge Nursing                      NW11
                                                                                           1        36
  Clovelly House Residential                                           Home                                  8NA
                                  3        39     N12 9PN
           Home Ltd                                               Henry Nihill House       3        30     HA8 9PU
Conifers Residential Home, The    n/a      24     N20 8AE             Kenwood              1        32     N12 8HG
            Courtlands            2        11     EN5 1ED      Lady Sarah Cohen House      1        120    N11 3ND
          Dellfield Court         2        40     N3 2DY        Lansdowne Care Home        2        92     NW2 1TU
 Dr French Memorial Home Ltd      2        30     N12 7NN    Lewis W Hammerson Memorial
                                                                                           1        68     N2 0BE
                                                   NW11                Home
  Eastside House Rest Home        2        16
                                                    0BA             Magnolia Court         2        54     NW2 2LH
  Eleanor Palmer Trust Home       3        32     EN5 2UR          Osmond House            2        49     N2 0BG
  Ella & Ridley Jacobs House      2        48     NW4 4EB                                                   NW11
                                                                        Sage               2        61
  Elmhurst Residential Home       3        30     N12 7DP                                                    9AL
           Friary Lodge           2        15     N20 0NN                                                   NW11
                                                                Sonesta Nursing Home       2        32
          Grace House             2        10     N12 8EU                                                    8DP
           Grange, The            2        28     N12 8SP            Springdene            3        56     N20 9AT
           Hilton Lodge           n/a      13     N12 9HB      The Cedars Care Centre      2        45     EN5 1SB
 Kingsdowne Residential Home      3        18     EN5 5PU         Nursing Total (20)               1164
      Leo Baeck House             2        43     N2 9BQ
           Limes, The             2        26     N12 9HA             Total (62)                   2612
Meadowside Residential Home       2        68     N12 7DY
            Merrivale             1        56     HA8 0BT
       Nazareth House             3        89     N2 0RU
            Northwood             2        17     EN5 1RZ
      Orchard Avenue 10           1         3     N20 0JA
   Paulmay Dementia Care          3         8     N3 2DE
    Rosa Freedman Centre          2        18     NW2 1AJ
  Roseacres Residential Care
                                  2        43     N20 9DZ
           Home
            Rosetrees             2        55     N11 3ND
 Roseview Residential Homes       2        10     EN4 8HP
          Rubens House            2        51     N3 2NB
          Seaforth Lodge          n/a      21     N11 3EX
  Sir Thomas Lipton Memorial
                                  n/a      24     N14 5HE
            Home
          St Margarets`           3        44     NW3 7UN
                                                   NW11
          Sunridge Court          2        46
                                                    8PT
          Sydmar Lodge            2        57     HA8 9QH
       Woodside Home              3        49     N20 0EH
Camden

                                CSCI                                                       CSCI
             Name                       Capacity Postcode              Name                        Capacity Postcode
                                stars                                                      stars
           Branch Hill           2        50     NW3 7LS       Ash Court Care Centre        2        62     NW5 2PD
       Compton Lodge             2        34     NW3 3BX          Rathmore House            2        20     NW3 3EL
      Ingestre Road (12)         2        48     NW5 1UX     St John`s Wood Care Centre     2        100    NW8 0HJ
           Kay Court             2        54     NW3 7AJ         Nursing Total (3)                   182
          Spring Grove           3        46     NW3 6DH
       Wellesley Road            2        48     NW5 4PN              Total (9)                      462
     Residential Total (6)                280



Enfield

                                CSCI                                                       CSCI
             Name                       Capacity Postcode              Name                        Capacity Postcode
                                stars                                                      stars
           Abbeydale             2        21     N13 4AJ     Albany Park Nursing Home       2        43     EN3 5UJ
       Amberley House            2        16     N13 4BJ            Conifers The            2        30     N13 4BS
       Anastasia Lodge           3        29     N21 3AE           Edwina House             2        22     N13 4RJ
       Autumn Gardens            n/a      40     N14 4QB    Elizabeth Lodge Nursing Home    2        87     N21 1PN
          Avon Lodge             2        36     EN1 4PD     Honeysuckle House Nursing
                                                                                            2        32     N13 5HY
          Bridge House           2        37     EN2 9HT              Home
       Bullsmoor Lodge           2        48     EN3 6TE       Hugh Myddelton House         1        47     N14 5QR
Camden Lodge Residential Care                                  Murrayfield Care Home        2        74     N18 2DF
                                 2        24     N22 8QX
          Home                                                      Nairn House             2        61     EN1 4TR
          Cedar House            1        17     EN1 2PP    Southgate Beaumont Nursing
                                                                                            1        52     N14 7DJ
       Clay Hill House           2        60     EN2 9JA               Home
    Coppice Wood Lodge           2        38     N11 1LX      Stamford Nursing Centre       2        90     N18 1SU
          Devon House            1        14     N14 4HA    Wellington Park Nursing Home    2        33     EN1 2PL
       Eastbrook House           1        43     N9 8DA          Nursing Total (11)                  571
          Eliza House            2        26     EN1 3QX
            Elmhurst             2        14     EN1 1NE             Total (45)                     1522
          Fern Lodge             2        20     N21 3NX
           Five Oaks             2        44     EN4 0JT
          Green Trees            2        16     EN4 0EY
 High Trees Residential Care
                                 3        12     EN2 9AA
           Home
          Hollies, The           2        19     N13 4AB
          Holly House            3        16     EN1 2PT
       Lime Trees, The           2        15     N11 1RG
      Minchenden Lodge           3        25     N14 6DD
  Parkside Residential Home               24     EN1 2EU
       Parkview House            2        45     N9 7RQ
        Reardon Court            2        36     N21 3BH
  Roseview Residential Home      2        14     N11 1RE
           Springview            3        58     EN2 7BL
     St Catherine`s Home         1        16     EN3 4AJ
   St Theresa`s Rest Home        2        23     EN1 2JN
    Sunbridge Care Centre        2        43     N9 7PZ
          Trent Lodge            2        16     EN2 6TZ
      Woodberry Grove            2        26     EN1 2PW
           Woodlands             2        20     N13 4AB
    Residential Total (34)                951
Haringey

                                    CSCI                                                                 CSCI
            Name                             Capacity Postcode                    Name                           Capacity Postcode
                                    stars                                                                stars
    Alexandra Park Home              1         15          N10 2JS     Newstead Nursing Home              1        36        N6 4AL
      Broadwater Lodge               2         45        N17 6NN     Osbourne Grove Nursing Home          2        32        N4 3EL
       Brownlow House                2         24          N10 3LR     Priscilla Wakefield House          2        112       N15 4PL
          Cranwood                   2         34          N10 3JA        Nursing Total (3)                        180
 Ernest Dene Residential Care
                                     2         33          N10 2JX
           Home
                                                                                Total (18)                         605
        Fer View, The                3             6     N11 2ED
     Mary Feilding Guild             3         43          N6 4DP
        Meadow, The                  2         40          N10 1PL
        Morriss House                2         25          N8 8EP
      Nightingale House              2             9     N22 7UE
       Peregrine House               2         35        N15 5RE
       Red House, The                2         35          N15 3PJ
   Spring Lane Care Home             3         63        N10 3PA
         Stirling Park               2             6     N22 5BN
         Woodlands                   1         12          N8 9BP
    Residential Total (15)                     425



Islington



                                                                          CSCI
                                      Name                                                    Capacity               Postcode
                                                                          stars
                           Bridgeside Lodge Care Centre                     3                      64                    N1 7RY
                                 Cheverton Lodge                            2                      52                   N19 3AY
                          Highbury New Park Care Home                       2                      53                    N5 2DS
                           Highgate Nursing Home (The)                      3                      55                    N6 5LX
                             Lennox House Care Home                         1                      87                    N7 7DS
                           Muriel Street Resource Centre                    2                      60                    N1 0TH
                             St Anne`s Nursing Home                         2                      50                    N7 7DL
                                   The Infirmary                            3                      10               EC1M 6AN
                                Total (Nursing) (8)                                                431
Appendix 3
      End of Life Care competencies and behavioural indicators – NHS Barnet

                                          Communication

Effectively communicates, both in writing and verbally. Adapts style of communication, to suit the
situation and the people being addressed. Gives clear messages, and ensures patients, families,
carers, and other external agencies are aware of what is happening. Explains complex issues,
making them easy to understand. Ensures that important messages are communicated and
understood by the listener.

Positive Indicators
 Introduces self when meeting with people for the first time
 Speaks to patients in a warm friendly manner
 Asks clear, simple, relevant questions to establish the condition of the patient
 Actively listens by giving eye contact, nodding, and summarising what has been said
 Empathic when listening to people who are upset
 Is confident having „difficult‟ conversations with patients
 Adjusts communicating style based on non verbal cues of the patient / family / carer
 Can explain the reality of a situation constructively and supportively
 Uses direct, unambiguous language
 Explains to the patient what they are doing and why
 Does not make assumptions about what the patient has been told
 Clearly explains the illness or prognosis and explains a course of action
 Clarifies the patient‟s / family‟s understanding by asking questions
 Welcomes questions from patients / families / carers
 Answers questions honestly and openly, completely and accurately
 Presents facts calmly and clearly
 Repeats or rephrases information to help patients / families / carers to understand
 Uses direct, concise communication to negotiate on behalf of the patient
 Clearly explains the patient‟s situation to colleagues
 Sufficient information is provided on patient assessment and referral forms in order that informed
   decisions can be made
 Records accurate patient information on patient on medical notes
 Does not invade the space of the patient
 Uses open body language
 Explores non verbal cues with patient / family
 Looks at the patient when speaking with them

Negative Indicators
 Adopts an authoritarian style when speaking with patients / families / colleagues
 Does not communicate or document work undertaken, causing duplication of work
 Talks around an issue rather than use clear language to describe the situation
 Communication style uses unhelpful language or tone that can cause distress
 Explains at a pace that is too fast for patients / families / carers
 Interrupts the patient, does not listen to patients or respond to their questions
 Does not ask questions to help clarify understanding
 Is abrupt and shows annoyance
 Provides vague information on written documents
                                           SPECIFICATION



                                      Emotional Intelligence

Monitors own and others‟ feelings and emotions, and uses this information to guide their thinking and
action and respond accordingly. Adopts a positive attitude and approach to their role and manages
every situation according to need.

Positive Indicators
 Aware of own strengths and weaknesses
 Aware of impact on others
 Manages and displays emotion appropriately without losing control of the situation
 Can tailor own actions depending on the needs of the patient
 Can see issues from the perspective of others
 Engages people through the use of conversation
 Is calm and measured when others around them are not
 Knows how to influence others positively
 Responds to unhelpful behaviour of patients/families/carers in an appropriate way
 Responds to challenges from patient/family/carer constructively
 Has the confidence and the courage to use the words „death‟ and „dying‟
 Refers to others when dealing with situations they are not experienced in
 Able to cross professional boundaries – can express views and challenge other staff
 Does not support inappropriate actions and takes steps to resolve
 Has open discussions with colleagues, being honest about feelings and capabilities
 Knows when they need support / advice from others and asks for it

Negative Indicators

   Fails to recognise the dynamic between physical, emotional, psychological and social issues
    when dealing with patients/families/carers
   Allows time pressures to drive behaviour inappropriately
   Lacks self awareness
   Displays an inappropriate desire to be in control
   Avoids conflict
   Becomes aggressive and loud if does not get their own way
   Autocratic in style – unapproachable
   Follows procedures robotically rather than dealing with the patient‟s needs
   Allows preconceptions from personal experience to drive how they deal with patients
   Inability to step back from personal experience when dealing with patients
   Labels patients/families/carers as „difficult‟ and treats accordingly
   Does not engage in friendly conversation with patient or peers
   Becomes defensive and argumentative when patients ask questions
   Lacks empathy
   Has difficulty telling a patient they are dying
   Does not admit when they don‟t know or when they are wrong
   Does not seek help when it is appropriate to do so
                                            SPECIFICATION



                                          Patient Focused

Focuses on the patient and provides a high quality service that is tailored to meet their individual
needs. Ensures the patient‟s needs, views and concerns are clearly identified and responded to. Has
the best interest of the patient at the forefront of all actions.

Positive Indicators
 Is patient-centred when communicating with families and healthcare professionals
 Listens to the wishes of the patient, and what the patient wants to achieve before they die and
   helps them achieve that where possible
 Understands what it means for the patient to die in their place of choice, what this will involve and
   can explain this clearly
 Displays a willingness to spend time with the patient exploring their concerns
 Displays a warm and friendly caring manner when dealing with patients
 Identifies different ways of working to best help the patient
 Apologises when necessary
 Avoids making assumptions about the patients needs
 Assesses the care and support needed by the patient to improve their quality of life
 Provides a clear care plan that has been worked through with the patient
 Spends time speaking about what is on offer regarding the provision of care and explains all
   options available in a way that is easy to understand
 Manages the expectations of the patient
 Takes account of the patient‟s experience of living as well as the quality of their dying
 Allows the patient to develop ideas of how their care can progress
 Manages the transition between making someone better and helping them towards the end of
   their life with dignity, comfort and respect
 Does not bow to pressure from others regarding the needs of the patient when it is not in the best
   interests of the patient
 Keeps in touch with the patient and responds to their calls
 Provides continuity of care by following up issues and getting back to the patient

Negative Indicators
 Fails to turn up to appointments made with patient
 Does not review the patient‟s care schedule
 Focuses on processes and procedures and not the specific needs of the patient
 Imposes own views rather than listen to the patient
 Inflexible approach to dealing with patient needs /issues / concerns
 Avoids spending time with the patient listening to their concerns
 Argues with the patient and dissuades them from following a course of action
 Rushes the patient
 Gives information to patients regardless of whether it‟s in their best interest
 Gives patients false hope and makes promises that can‟t be kept
 Lacks attention to detail when identifying patient deterioration
 Avoids contact with the patient when end of life is approaching
                                           SPECIFICATION



                                      Family / Carer Focused

Establishes and maintains relationships with the families and carers of patients. Provides appropriate
information during the end of life care process, and supports them throughout, including after the
patient has died.

Positive Indicators
 Introduces the team to the family / carers to build rapport
 Give the family / carers a point of contact
 Shows interest in the patient‟s family and carers as well as the patient
 Asks questions to understand the family / carers
 Conducts meetings and makes time with family / carers and involves them in decisions
 Recognises family / carer‟s level of knowledge and adapts input accordingly
 Manages the anxiety of families / carers by thorough explanations and listening to their concerns
 Give the family / carers time to ask questions and express thoughts and feelings
 Keep the family / carers informed and explains what is happening
 Always greets the family and carers when meeting with them
 Suggest agencies that might assist the family / carers with their needs
 Is aware of the differing needs of family members and carers
 Supportively challenges families / carers offering information and advice to clarify the situation
 Advises families / carers on action taken
 Enables the family / carers to interact with the patient
 Informs the family / carers how they can best assist the patient
 Works in partnership with patient, family and carers when agreeing care plans
 Explains what happens after death to family / carer and possible effects
 Asks questions regarding the welfare of the family / carer after the death of the patient
 Arranges respite care for the carer

Negative Indicators
 Focuses on the task not the people involved
 Makes decisions without involving the patient, family or carers
 Does not interact with, or provide support to, the family / carers
 Does not know how to talk with the family / carers
 Does not allow the family / carers to express themselves or their concerns
 Family / carers are not updated, or given information and are „kept out of the loop‟
                                           SPECIFICATION



                                  Respect for Culture and Beliefs

Awareness and understanding of the differing culture and beliefs of the patient and their families and
carers. Respects the cultural needs / expectations of the patient / family and considers these when
providing patient care. Is non discriminatory in the delivery of care


Positive indicators
 Understands different religious and cultural beliefs about dying
 Considers cultural issues when communicating, and discussing death with the patient / family
 Uses appropriate language
 Establishes how the patient wishes to be addressed
 Has received, and applies, training regarding religious and cultural differences
 Has awareness of different holidays / religious festivals
 Asks questions to understand cultural norms
 Understands the complexity between cultural and legal / medical requirements
 Adapts style to meet the cultural needs of the patient / family
 Uses interpreters where appropriate to enhance communication and with the patient / family
 Discusses the patients holistic needs – spiritual, religious and cultural
 Makes decisions about the patient based on evidence and not assumptions about them
 Can gauge the cultural needs of the patient/family/carer and respond appropriately
 Does not allow own views on death to impact negatively on the care provided to the patient


 Negative Indicators
 Does not pick up on subtle cultural differences
 Does not understand different cultural norms
 Allows own values and beliefs about death to take priority over the patients and allows these
   beliefs to drive the treatment provided to patients
 Believes in pro longing life at all costs, irrespective of the effect on the patient
 Does not attempt to understand when the patient / family / carer has a different accent
 Does not alter speed or clarity of communication when someone is having difficulty understanding
   them



                                      Personal Responsibility

Takes personal responsibility for making things happen and achieving results. Displays commitment
and conscientiousness. Acts with integrity. Readily accepts responsibility for addressing problems
and shows determination for the successful delivery of end of life care.

Positive Indicators
 Takes responsibility for their actions and performance in the role
 Is punctual in attending appointments and meetings
 Manages workload to ensure they have time to visit patients where necessary
 Keeps up to date with paperwork
 Follows up referrals promptly
 Fully engages in the task that needs doing
                                          SPECIFICATION



   Consults colleagues when they don‟t know how to deal with a patient‟s symptoms, without
    abdicating responsibility for taking forward actions for the patient
   Can work without supervision where appropriate
   Involves other services appropriately
   Adopts a proactive approach to completing the workload
   Will see a task through to the end
   Observes colleagues in order to learn from them
   High lights poor practice to the appropriate managers
   Challenges inappropriate behaviour
   Challenges colleagues if care plans are not followed accurately
   Admits if they get it wrong or if they do not know something
   Addresses any knowledge gaps identified by speaking with others
   Attends meetings to keep themselves up to date with information
   Conducts own research if faced with an unfamiliar issue
   Delivers an effective service despite a heavy workload

Negative Indicators
 Avoids work they do not like doing
 „Cherry picks‟ the patients they want to deal with
 Delegates patients to others instead of addressing needs themselves
 Does not update their knowledge of the patient
 Relies on colleagues rather than use their own knowledge
 Refers patients on inappropriately
 Allows the pressure of time to stop them discussing issues with the patient
 Does not follow up on cases, or follow through on issues raised / commitments made
 Does not seek clarification on issues when needed
 Gets behind with paperwork
 Fails to seek assistance to the detriment of the patient
 Reluctant to take responsibility for the transfer needs of patients, between departments
 Performs to the minimum standard
 Performs tasks at a slow pace

                                    Partnership/Team Working

Develops strong working relationships internally and externally to achieve common goals. Breaks
down barriers between groups and involves others in discussions and decisions. Creates working
partnerships inside and outside of the organisation.

Positive Indicators
 Treats colleagues as equals and respects their views of the patient
 Creates a team culture between care professionals involved with the patient
 Has a good understanding of how the whole care provision system works, the differing roles
   within it and what services other teams can provide
 Creates a partnership between patients, families/carers and care professionals
 Contacts / refers to other organisations where necessary
 Liaises with the multi-disciplinary team and is inclusive of all colleagues
 Liaises with other care professionals and shares information with all relevant parties
 Liaises with GP‟s, where necessary, to update them of changes to the patient
 Willing to conduct multi agency visits to enhance the care provided
                                           SPECIFICATION



   Involves other care professionals in the planning of patient care
   Information shared between care providers is descriptive and accurate
   Accessible and responsive when contacted by other service providers
   Shares own experience and knowledge with colleagues
   Explains how information will be used and who it will be shared with
   Does not duplicate records
   Constructive when challenging colleagues
   Supports colleagues appropriately when being challenged by patients
   Knows who to refer to when addressing the patients needs
   Provides feedback to the team of what action has been taken
   Provides support to colleagues
   Trusts colleagues / other care professionals to do their job

Negative Indicators
 Does not liaise with the wider care provision team
 Does not provide feedback to colleagues
 Does not seek assistance when needed
 Views other service providers as a threat
 Has difficulty acting on others‟ suggestions / knowledge
 Is unaware of how to contact other relevant parties in the provision of services
 Does not communicate with other care professionals
 Is unaware of aspects of the patient‟s needs as does not speak with other colleagues involved
   with the provision of care
 Does not recognise or utilise the skills of other care professionals
 Does not provide information requested by other teams / colleagues
 Does not respond to questions from other departments
 Expects other services to address issues
 Insufficient information is completed on assessment forms for others to be able to make an
   informed decision


                                        Maximising Potential

Actively supports and encourages self development and the development of others in order that end
of life care is provided to the highest standard. Ensures all service providers achieve these
Standards. Values the need for training and understands the importance of the feedback process.

Positive Indicators
 Demonstrates good techniques and provides clear explanations when teaching others
 Clearly explains practice to less qualified peers and helps others to develop
 Enables and encourages junior staff to reflect on their performance
 Makes time to reflect on own performance and adjusts behaviour accordingly
 Reflects on each case in order to learn
 Keeps up to date regarding knowledge and skills and attends study days, mandatory and non
   mandatory training improve own performance
 Uses the internet/ intranet / reads journals / latest research to keep skills and knowledge current
 Implements newly learned information / training into the workplace
 Identifies learning experiences and uses this learning to inform future experiences
 Creates a learning environment by talking through issues
                                            SPECIFICATION



   Uses clinical support group to reflect upon and enhance performance
   Gives feedback to colleagues / peers
   Accepts feedback from colleagues/patients/families
   Obtains feedback from families / carers on performance
   Views feedback as essential for professional development
   Adapts behaviour / practice on receipt of feedback
   Identifies skills / knowledge gaps and addresses these
   Discusses mistakes as a team in order to develop learning
   Is a mentor to less experienced staff


Negative Indicators
 Prefers to use old techniques even when they have received updated training
 Does not use clinical supervision group to reflect on performance
 Does not develop their professional knowledge
 Lacks awareness of their own training needs
 Has not attended recent training to update
 Views training as unimportant and does not attend training / study days
 Does not reflect on experiences to develop understanding/learning
 Unaware of own development needs
 Receives poor feedback from patient
 Does not seek or offer peer support
 Feels criticised by feedback and becomes defensive
 Does not accept feedback and views feedback as a weakness
 Requires additional supervision due to a lack of training


                                      Preparation and Planning

Prepares themselves by gathering information and managing workload efficiently and maintains
effective records. Plans and organises activities to ensure resources are used efficiently to provide
effective end of life care.

Positive Indicators
 Prioritises workload
 Gathers as much information to assess where the patient is physically, medically and emotionally
   to help build a picture before they see the patient
 Assesses what is needed when first seeing the patient
 Speaks with the patient to establish spiritual and cultural needs
 Checks the patient‟s medical record is up to date, reads them carefully and speaks with the
   patient to clarify where necessary
 Gathers information, reviews medical notes, speaks to other care providers
 Clarifies when referrals are made by asking questions to find out what has already been done /
   offered
 Provides detailed information in order that assessment decisions can be made
 Accurately collates information and keeps all documents up to date
 Is resourceful and organises appropriate action to assist the patient‟s care needs
 Checks the patient‟s medical box is properly equipped
 Ensures the appropriate care package is in place
                                           SPECIFICATION



Negative Indicators
 Fails to ask for resources required by the patient until it is too late
 Selects a diagnosis or a course of action without first receiving all of the information
 Has not read the medical notes before meeting the patient
 Fails to review the patient notes and speak with others previously involved with the patient
 Ignores the referral notes provided
 Does not make an accurate assessment of the situation because of a lack of information

                              Problem Solving and Decision Making

Identifies problems, and gathers information from a variety of sources. Analyses information, and
generates options to make effective decisions. Makes decisions that fit with the provision of end of
life care.

Positive Indicators
 Has a clear management plan for the way forward
 Is aware of the bigger picture and the options available to the patients care needs
 Plans ahead for possible eventualities and anticipates problems and communicates these to the
   relevant parties
 Provides timely and proactive interventions when planning
 Acts on the information provided
 Uses own initiative when faced with challenges
 Willing to try new ideas and approaches
 Is innovative when solving problems and can improvise when necessary
 Deals with complex issues head on
 Thinks outside of the box – considers all of the options available
 Communicates with the team to gain information to help identify solutions
 Discusses solutions with relevant parties
 Does not make assumptions that lead to inappropriate conclusions
 Explores all of the options with the patient – not just the easiest
 Offers different care solutions to patients
 Uses own experience to inform the situation positively
 Recognises best practice to identify ways to improve service delivery

Negative Indicators
 Fails to identify issues
 Fails to plan ahead or consider eventualities
 Does not take a big picture approach to patient care
 Avoids fully exploring all avenues of treatment or the options available
 Only uses own experience to inform decisions or identify solutions
 Does not respond quickly enough to referrals from consultants
 Refers problems on rather than addressing them themselves
 Indecisive and seeks reassurance on their clinical practice
 Only identify simplistic solutions – takes a text book approach rather than dealing with the
   individual case
 Sees simple rather than complex solutions
 Makes assumptions based on experience inappropriately
 Creates „crises‟ by failing to plan for eventualities
                                                SPECIFICATION



                        Knowledge of Role and the Provision of End of Life Care

    Instils confidence in patients by demonstrating a good clinical understanding of the provision of end
    of life care. Understands the principles of good palliative care and common procedures and follows
    the correct methodologies and procedures.

    Positive Indicators
     Has a good knowledge of theory, practice, legislation and procedures for end of life care and
       articulates this
     Good knowledge of anatomy and physiology
     Understands psychological theories and the impact on the patient and family of dealing with death
     Follows protocols and correct methodology / procedures
     Has a knowledge of the provision of care and resources (including voluntary) available to patients
       / families
     Clearly explains the service‟s position, protocols and practices and issues relating to after care /
       medical help / counsellors
     Gives sound, accurate answers to clinical questions
     Knows who to involve / consult regarding specific patient care and the services needed
     Refers appropriately
     Knows where and how to source equipment
     Is aware of what other service providers can and can‟t do
     Has up to date information regarding the patient‟s medical background and
     Understands different medical conditions involved in end of life care
     Accurately updates patient‟s notes
     Can judge the deterioration of a patient and take appropriate action
     Identifies the mental capacity of the patient appropriately
     Checks medication being used to treat the patient
     Thorough understanding of drug administration
     Has up to date knowledge regarding symptoms and control of pain
     Can discuss the ethics of some medications and practices and explains to patients the rationale
       behind different treatments
     Recognises symptoms and the necessary medication to deal with them and initiates change of
       medication when appropriate
     Understands the effect the drugs have on the patient
     Knowledge of issues that affect people who are bed ridden
     Recognises the signs of when a patient is approaching death
     Knowledge of emergency first aid
     Risk assesses the different techniques used with the movement of patients and establishes ways
       to alleviate patient discomfort
     Can correctly use a syringe driver
     Can confidently use a computer to effectively complete records / paperwork



    Negative Indicators
   Does not follow guidelines or protocols
   Has become de-skilled
   Needs help to perform basic tasks
   Lacks confidence due to a lack of knowledge
                                              SPECIFICATION



   Can‟t resolve simple administrative problems
   Lacks awareness of accountability
   Has no depth of knowledge or out of date knowledge
   Unaware of other services available to the patient/family/carer
   Does not complete assessment / decision support tools sufficiently
   Needs supervision when performing tasks
   Has incomplete knowledge of what their role requires
   Does not communicate the full range of services to the patient
   Incorrect procedures are used which result in a breakdown of service delivery
   Out of date drugs knowledge
   Cannot explain why a course of action is inappropriate
   Prescribes treatment that is not appropriate
   Doesn‟t know how to operate a syringe drive
   Has insufficient knowledge regarding symptom control
   Fails to recognise when a patient is deteriorating
   Does not recognise the approach of death in patients
   Fails to recognise when medication is not working
   Does not use the computer to enhance work performance
   Is not computer literate and is reluctant to use I.T systems
   Does not complete computerised documentation up keep it up to date
                                          Form of Offer

NHS Contract for the Provision of training and Development in End of Life
Care for the North Central London Care Homes Workforce
[insert name of offeror] („the Offeror‟) of [insert address of offeror]

Agrees:
1.1     That this offer and any contracts arising from it shall be subject to the Terms of Offer, the NHS
        Terms and Conditions of Contract and Supplementary Conditions of Contract and all other
        terms (if any) issued with the Invitation to Offer; and
1.2     to supply the goods and/or services in respect of which its offer is accepted (if any) to the
        exact quality, sort and price specified in the Offer Schedule in such quantities, to such extent
        and at such times and locations as ordered; and
1.3     that this offer is made in good faith and that the Offeror has not fixed or adjusted the amount
        of the offer by or in accordance with any agreement or arrangement with any other person.
        The Offeror certifies that it has not and undertakes that it will not:
          •     communicate to any person other than the person inviting these offers the amount
                or approximate amount of the offer, except where the disclosure, in confidence, of
                the approximate amount of the offer was necessary to obtain quotations required
                for the preparation of the offer, for insurance purposes or for a contract guarantee
                bond;
          •     enter into any arrangement or agreement with any other person that he or the other
                person(s) shall refrain from making an offer or as to the amount of any offer to be
                submitted.



Dated this [insert day] day of [insert month and year]


Name (print)


Signature


Title



The Form of Offer must be signed by an authorised signatory: in the case of a partnership, by a
partner for and on behalf of the firm; in the case of a limited company, by an officer duly authorised,
the designation of the officer being stated.

								
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