David Oliviere, Director of Education, St Christopher’s Hospice, London
Surviving the current economic climate and the need to cement the gaps between provision and professionals with partnerships is ever more pressing. Last month I attended the Montreal Palliative Care Conference with 2,000 people from more than 60 countries. Discussion with colleagues from India, Japan, Australia, as well as numerous European countries, raised for me the question of how we ‘mend the gap’ in palliative care through education.
Education – the key to quality care
The acceleration of the reforms of health and social care services in the UK brings a renewed focus on education and training, with new opportunities to think, re-think and survive in the current economic climate. Ever since the publication of the UK’s first End of Life Care Strategy (2008)1 the emphasis has been on the gaps in providing good end of life care for all: training generalists to address the gaps between palliative care specialists delivering care with those working in non-specialist settings such as care homes, community and other specialties. Education remains the key to good quality care.
The need for integrated care
Over the years we have talked of ‘seamless services’, ‘joined up thinking’ or good ‘co-ordinated care’ but it all boils down to actively mending the gaps relating to service structures (different providers duplicating; delays; geographical inequalities) and professionals (inter-disciplinary working; skill mixes; leadership).
At policy and planning level in the UK there is constant talk of better integration and closing the gap between what is ‘health care’, providing treatment and clinical care, and what is ‘social care’, which is often non-clinical, personal, home-based support with separate management, budgets and personnel. We still need rigorous attention to making best use of time, resources, policies, people and skills through education and workforce planning that promotes integrated care.
Parallel to this, there are important developments in medical and other professional education. ‘Health Education England’ (HEE) is emerging as a national body to oversee education planning. At a more regional and local level, the new Local Education and Training Boards (LETBs) will coordinate the planning and allocation of funding with education providers. My hope is that these changes will give improved opportunities to mend some of the gaps in uncoordinated education planning and provision. For example, providers in the palliative care field continue to duplicate courses on communication skills; advance care planning; medical updates amongst others. Some courses need to be run on a regional basis. There are increasing examples of specialist teams pooling resources, for example, in the field of dementia. It would be interesting to know what structures help or hinder education in other European countries.
Like other education providers in Europe and beyond, at St Christopher’s we are trying to reduce some of the gaps through good education. Our new education programme for 2013, ‘Mend the Gap’, St Christopher’s Education Programme for 2013 focuses on this theme. What is recognised are the pressures and challenges that constrain education: a competency approach can be dry; the economically constrained climate, with funding shortages and less time to release staff for training, is limiting. Yet, we need to continue to ensure that the cement that fills the gaps continues essentially to be education about care with dignity and compassion given with generosity of spirit and innovative leadership.
1. Department of Health. End of Life Care Strategy – promoting high quality care for all adults at the end of life. London: Department of Health, 2008. (The Fourth Annual Report of the End of Life Care Strategy, published in October 2012, is available to download).
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