St Luke’s leads the way in end of life care training

Categories: Education.

St Luke’s Hospice in Plymouth has been running an adapted version of the Six Steps programme for the last 18 months, known as Six Steps +. In that time it has supported 143 staff and 69 organisations representing over 70% of all care homes in the city as well as domiciliary care agencies.

The programme consists of nine workshops focusing on the six steps end of life care pathway, with one devoted specifically to dementia and end of life care. The programme, which received start up funding from Help the Hospices and the The Burdett Trust for Nursing, costs £250 and has proved to be very popular. Care homes that take part send two members of staff who become end of life care champions for their organisation and are expected to attend all the sessions.

Rigorous assessment

Organisations and individuals go through a rigorous assessment process and then have three months to consolidate their learning following the end of the course. During this time they receive practice visits from the cohort lead. They also have to submit their portfolio to the education lead. If they satisfy the course requirements they become accredited with the hospice and this is reviewed each year.

The assessment and accreditation process is robust because it needs to be. If we are giving our brand to an accreditation system then we have to be assured that there is a real commitment by the organisations that the end of life care training of their staff is taken seriously, and end of life care champions receive ongoing support.

The six-step accreditation is now a local quality marker recognised by the local authority and those who achieve it are flagged up in Plymouth’s online public directory. Homes prefer to have a local quality mark linked to their local hospice which families recognise, as an alternative to the national Gold Standard Framework.

Innovations in practice

The programme has led to a number of innovations. One home set up an awareness board, called Life is for Living, which encourages staff, residents and their families to express their wishes. Another produced a bereavement support leaflet. It has also helped forge links between many of the care homes. As one participant put it: “It’s helpful to share experiences with other care homes. We used to see each other as competitors but it’s nice to have a local supportive network now.”


The programme is delivering high quality outcomes. The recent audit demonstrated that: 

  • 96% died at home (compared to 78% last audit)
  • advance care planning has doubled from 22% to 42%
  • unplanned hospital admissions during the last 12 months of life has  fallen from 40% to 23% (only 115 unplanned admissions in total).

Future developments

The education team at St Luke’s were commissioned by Skills for Care to deliver all the education and training materials to support the new Qualifications and Credit Framework (QCF) end of life qualifications. These will be available from Skills for Care by the end of August.

We have also produced a Six Step/QCF mapping tool so that those individuals who wish to can submit their Six Steps portfolio as evidence against some of the national end of life qualifications.

In response to demand to deliver the Six Steps + programme throughout the country we have also developed a Six Steps Train the Trainer programme so that others can deliver the Six Steps + in their area. This programme is needed to ensure that individuals who wish to gain end of life qualifications are taught by ‘occupationally competent’ people in end of life care.

I am really pleased to report that already we have had an excellent response to the programme and our first course is nearly full.

Award finalist

The Six Steps + programme was a finalist in the recent Health Service Journal 2013 Integrated care awards held in London, an achievement we are all really proud of.

A change in culture

The programme has led to a number of innovations within the homes, moving the culture from that of not wishing to talk about end of life care for fear of upsetting residents and their families, to one that encourages people to have end of life conversations. All participants have changed their practice, encouraging staff to talk to residents about expressing their end of life wishes, ensuring ongoing personalised care.

Supportive team

None of the success mentioned in this article could have been achieved without the support of my team and the hospice board who said yes to our ideas and all of our partners in health and social care who have been really supportive. It has been a real team effort and everyone who has taken part in this programme can be proud of their achievements and their continued commitment to providing good end of life care for individuals and their loved ones.

More information about the Six Steps + programme can be found on the St Luke’s website.

Leave a Reply

Your email address will not be published. Required fields are marked *