Palliative Care Training for Care Staff in England

There is no single mandatory palliative care course for care staff in England. Instead, NICE sets out what good care for dying adults looks like, NHS England expects local health systems to have a workforce with the right knowledge, and the Skills for Care training guide lists end of life care as additional training that should align to the national Core Skills Education and Training Framework. So palliative care training for care staff is largely a matter of matching your training to the people you support and showing that staff are competent.

This guide covers England. It explains what palliative and end of life care mean, what the main sources say about training, what a sensible programme should include, and where free learning is available.

What palliative and end of life care mean

NHS England describes palliative and end of life care as care that helps people "live well in the last years, months, weeks, days and hours of their life", with support tailored to the individual. It applies to people of all ages and to those living with multiple complex conditions, not only people with cancer or people in their final days. That matters for training: a care assistant in a residential or home care service may support someone for months or years of advancing illness before the last days begin.

What the main sources say about training

None of the bodies we checked sets a required course length or renewal date for palliative care training. What they do say is summarised below.

The statutory guidance is for England and applies to integrated care boards, which it says must commission palliative care under section 3(1) of the NHS Act 2006 (as amended). The Skills for Care guide sets out what employers should consider, and it separates training that is usually required by law from training an employer or commissioner decides is essential.

The national skills framework

The End of Life Care Core Skills Education and Training Framework was first published in 2017. According to Skills for Health, it was commissioned by Health Education England and developed with Skills for Health and Skills for Care. It describes common skills for delivering end of life care to adults across health and adult social care, and it is meant to inform training programmes, job descriptions and commissioning. Skills for Health says the Department of Health and Social Care has commissioned Skills for Care to review it, that the page now calls it the End of Life Care Core Capabilities Framework, and that a draft has been consulted on. Check the current version before you build a programme around it.

What palliative care training should cover

NICE NG31 is aimed at the last days of life, but its headings make a useful skeleton for training. Each of these areas appears in the guideline:

• Recognising the last days. Gathering information about the person's needs and clinical signs, and monitoring for change at least every 24 hours (1.1.6). The guideline also reminds staff that improvement can happen, so a person may be stabilising rather than deteriorating (1.1.3).
• Communication. Establishing the person's communication needs and preferences, discussing prognosis honestly while "avoiding false optimism", and exploring advance statements, advance decisions to refuse treatment and lasting power of attorney (1.2.1 to 1.2.5).
• Shared decision-making and care planning. An individualised care plan covering goals, preferred setting, symptom preferences and post-death care needs, shared with the person, their family and the care team (1.3.5, 1.3.6).
• Hydration and mouth care. Supporting drinking where the person wishes and is able, with frequent mouth and lip care (1.4.1, 1.4.2).
• Symptom management. Pain, breathlessness, nausea, anxiety, agitation and noisy respiratory secretions, with a reminder to seek specialist palliative care advice if symptoms do not improve promptly (1.5.9).
• Anticipatory prescribing. Medicines prescribed in advance for likely symptoms, reviewed as needs change and monitored at least daily (1.6).

Care staff do not make prescribing decisions, but they do notice symptoms, report them and support the person's wishes, so they need to understand what these steps are and why they happen.

Medicines at the end of life

CQC's guidance on end of life care planning and medicines optimisation in adult social care describes anticipatory medicines as injectable medicines prescribed for a named person before a clinical need arises. It says these need personalised administration directions from the prescriber, that authorisation sheets should be time-limited and state how many doses can be given before the prescriber must review (usually three), and that records must show each dose given. It also says anticipatory medicines should be given by suitably trained individuals, and that nurses using syringe drivers should be trained and competent before using them. Care workers who are not nurses should know who is authorised to do what in their service, and what to do out of hours: CQC says the care plan should make clear who to contact for help, including out of hours.

Advance care planning, DNACPR and the Mental Capacity Act

CQC's themed work on DNACPR decisions (page last updated 12 May 2022) is a useful reality check. It says good training should give professionals the knowledge, skills and confidence for advance care planning conversations. It found that most staff said they had the training they needed, but CQC was concerned they did not always have the necessary knowledge or skills, and that most training had not been evaluated. One advocate quoted by CQC said that "a lot of the staff think they know about the Mental Capacity Act, but don't have the depth of understanding they need." For employers, the lesson is to test understanding, not just record attendance.

Free e-learning

End of Life Care for All (e-ELCA) is described on a Health Education England page as an e-learning programme to enhance the training and education of health and social care staff. The page says sessions last 20 to 30 minutes each, and that free access is available for NHS staff, hospice workers and social care staff in England. It also says adult social care employers registered with the national minimum data set for social care can obtain a registration code for their staff. The page is hosted by Health Education England and may predate later changes, so check the current access route before relying on it.

A simple plan for care providers

• Map your service. Work out who you support who may be nearing the end of life and which roles are involved.
• Choose content from the framework. Align end of life care training to the Core Skills framework, as the Skills for Care guide suggests.
• Cover medicines separately. Anyone supporting anticipatory medicines needs role-specific competence.
• Assess understanding. Use scenarios on communication, capacity and care planning.
• Record it. Add the topic to your training matrix and link it to supervision and appraisal, which is where Regulation 18 puts competence.
• Support staff too. CQC treats a lack of support for family, friends, carers and staff after a death as a sign of poor end of life care.

Frequently asked questions

Is palliative care training mandatory for care staff in England?

No source we checked makes one named course mandatory for all care staff. CQC expects staff to be trained and competent for the care they provide, and Skills for Care lists end of life care as additional training for roles that need it.

How often should end of life care training be refreshed?

The Skills for Care guide gives no refresher period for end of life care. Set your own interval in the light of staff roles and review it through supervision and appraisal.

Who can give anticipatory medicines?

CQC says they should be given by suitably trained individuals, with directions from the prescriber. Follow your own medicines policy and the prescriber's instructions.

Does NICE NG31 cover children?

No. NG31 is about care of dying adults. Children's and young people's palliative care follows separate guidance.

Closing thoughts

Good palliative care training is practical and person-centred. Match it to the roles you have, anchor it to the national framework, assess understanding and keep records you can show an inspector. You can browse more professional development topics in our CPD hub, and read our guide to CQC Regulation 17: good governance for how records and oversight fit together.

This article is general information, not clinical, regulatory or compliance advice. Always follow the clinical guidance and prescriber instructions for the person you support, and check requirements with your regulator and commissioner.