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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