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Understanding how the UK’s healthcare workforce can provide high quality care to older people: Dunhill Medical Trust
Following the publication of the Francis Report with its recommendations for a more integrated approach to staff training to improve older patient care, Dunhill Medical Trust initiated a review into current training within the NHS, to find out whether, with an ageing population to care for, NHS staff have the necessary training to deliver the required specialist health care to older patients. The results from the research would empower staff working in health and social care to improve patient experience by effectively measuring, and acting upon people’s feedback
Picker’s trusted expertise in carrying out in-depth reviews through interviews with stakeholders, staff and patients meant that it would be possible to examine the current education and training landscape, identify potential deficiencies in education or training, and assess the impact this had on the care of older people. The research would provide credible evidence to encourage improvement in this area of health and social care, and so maximise the impact and reach of new thinking.
The research involved three components: a knowledge audit involving desk research and telephone interviews with eight stakeholders; qualitative telephone interviews with 41 health and social care staff; and a systematic review. A patient and public involvement (PPI) advisory group was set up and played an important role throughout the project.
Interviews with stakeholders and staff shed light on the current education and training landscape, as well as key knowledge and skills that staff require, and that should be incorporated in the planning and designing of education and training programmes. The systematic review consolidated the evidence of education and training programmes that have been implemented with staff, and directly or indirectly measured the impact on older people’s care.
The key findings of the review allied closely with the Picker Principles for person centered care: it found that for older patient care to have good clinical outcomes there needs to be continual training across organisations and sectors, so that patients receive effective treatment by professionals they can trust. In many cases this relies on continuity of care and smooth transitions between departments as well as emotional support, empathy and respect by staff who are fully trained in the necessary care competencies in geriatric medicine, including knowledge of mental capacity, delirium, and frailty.
Picker’s systematic review revealed that training was haphazard at best, and that there were no integrated training programmes to equip staff to better look after older patients. If training did exist, then its impact was usually not measured, but where it had been assessed, it revealed that staff training was the key intervention into improved patient experiences and clinical outcomes.
The review exposed a gap in training for older patient care that went right back to Medical School level: some undergraduate medical courses included only five weeks of ‘care for the elderly’ in a five-year curriculum. And once graduate students are working within the NHS, then training programmes between sectors and organisations differed widely. Lack of resources and lack of motivation (for example no financial incentives) were real barriers to education and training.
When staff were able to acquire skills and knowledge it was immensely beneficial and instilled confidence in their ability to perform their duties. However, once core training requirements were fulfilled, there was a lack of consistency and quality control over continuing education.
Staff felt that ‘siloed’ working between different sectors and specialisms was particularly problematic in care of older people. As individuals age, their care needs may change, requiring more support arising from complex physical and mental health conditions. As such, caring for older people is multifaceted and having the skills and knowledge to assess and manage the multi-system nature of ‘geriatric syndromes’, as well as potential polypharmacy, is essential – in other words a more holistic approach is needed.
The findings suggest that, as with other professions, there needs to be continuing professional development built into the system. Staff need to have access to knowledge and information, coupled with a positive and supportive culture where training is rewarded. To achieve this, it may be that internal organisational barriers need to be taken down.
Picker’s report findings are the first step in understanding how the health and social care workforce can be equipped to provide high quality care to older people. Care providers and regulatory bodies now need to put these findings into practice, and make a real difference to the lives of older people who need to be treated within the NHS. The success of this survey underlines the fundamental essence of Picker: the delivery of credible evidence that allows maximum impact and reach for new thinking and innovation – in this case for health and social care for the elderly within the NHS.
As a result of the report the Dunhill Medical Trust, amongst a range of other actions, now sponsor a new category at the annual British Medical Journal Awards which celebrates excellent team-based and person centred care for older people. In addition to this it will be working with UK medical schools and faculties of health and social care to identify and celebrate education and training initiatives which embody the principles of excellent person centred care and individuals who are playing their part to develop a healthcare culture which is underpinned by kindness, empathy and dignity.
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