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Achieving Gold in End of Life Care

It’s now 10 years since the Gold Standards Framework in End of Life Care was launched. Maggie Stobbart-Rowlands explores the benefits it can have on residents, care providers and the wider health economy.

When Otto Frederick Rohwedder started selling sliced bread to his customers in Davenport, Iowa, in 1928, it was hailed as a huge step forward in domestic life. When you think about, it really wasn’t rocket science, but was one of those genius moments that married two simple things – a loaf of bread and a machine to cut it – to create something which improves our quality of life.

Improving the quality of life in a care home needn’t be a job for rocket scientists either. In fact, while the impact is far greater than that of sliced bread, the ‘magic’ required really is not much more sophisticated. It does require a framework, commitment and dedication. But the rewards are potentially great.

The National Gold Standards Framework (GSF) in End of Life Care recently celebrated a decade of delivering its Care Homes Training Programme at a parliamentary reception hosted by former Care Services Minister, Paul Burstow MP. Rather than resting on its laurels, the GSF Centre took the opportunity to launch a number of new, flexible ways in which care homes can benefit from the ten years of experience it has gleaned, working with more than 2,500 across the UK. During that time, more than a million care home residents and their families have felt the benefit of improved care, in line with their preferences, and almost a quarter of a million care home staff have enjoyed a sustained boost to their confidence, a new set of skills and a sense of satisfaction in being able to deliver the care their residents want and deserve.

Many care homes feel daunted at the prospect of undertaking an end of life care training programme, fearing it will involve considerable increased work and issues they are reluctant to tackle. But, this is where the sliced bread analogy comes in. Break down the GSF Care Homes programme into its simple core elements (or slices, if you prefer) and the fear factor can quickly be dissipated.

Identify, assess, plan

Identify, assess, plan. Now, that doesn’t sound too taxing does it? But those are the three core elements on which the GSF programme is built. By implementing them, with the help of a portfolio of resources and tools, those 2,500 homes that have completed the training have undergone a transformation, not just for the residents and their families but for the staff and indeed the local health economy.

The vast majority of GSF accredited homes (up to 200 apply for accreditation every year and around 100 are being reaccredited annually too) endeavour to start the process within days of a new resident’s admission. By instigating open lines of communication at the earliest possible opportunity, staff are immediately creating a sense of trust with residents and their family upon which they can build throughout the resident’s time in the home.

These conversations form the basis of an Advance Care Plan which will inform how the resident wishes to be cared for and where. This helps both parties feel more empowered and drastically increases the chances of avoiding crises. It also means that for the vast majority of care home residents who express a preference to be cared for in their care home, their wishes are met and their care is planned, right up until the end of their lives. GSF accredited homes have demonstrated a halving of avoidable hospital admissions and doubled the number of residents dying in the home rather than in hospital. This has the added benefit of relieving pressure on over-stretched hospitals and reducing costs for the local healthy economy.

GSF accredited care homes are a hallmark of excellence in the area, recognised by the Care Quality Commission, NHS Choices, commissioners and other indications of quality provision, endorsed by all of the major care home organisations and the National Skills Academy for Social Care – providing relatives with the assurance they crave when looking for a home.

Breaking down the barriers

Recognising that there are barriers to participating in its full programme, most notably cost and time, the GSF Centre has responded with a variety of more accessible and economical ways of engaging.

The GSF Centre has been piloting a Silver Foundation level programme, with homes in Nottingham and Northampton with great success. This version of the programme is designed for homes that are keen to start adopting the GSF principles but don’t yet feel ready to attempt the whole Premium Gold Programme. A number of the homes in the Nottingham phase are now moving on to the full Gold programme.

The original Premium Gold Programme is built around six workshops and has now been developed to include a filmed version to support the cascading of training throughout the whole home. Six months after completing the training, giving time to embed the new practices, homes can apply for accreditation. This process involves rigorous assessment against 20 standards, using objective independent assessors. The award is valid for three years, before the home must apply for reaccreditation.

Compassionate care is achievable

The Care Quality Commission’s Chief Inspector of Adult Social Care, Andrea Sutcliffe, said recently, ‘Making sure care homes are places I would be happy for my mum, or anybody else’s mum or loved one, to call home depends on them providing services that are safe, caring, effective, responsive and well-led. By being creative and focusing on continuous improvement and innovation, staff and managers can deliver good and outstanding care, which everyone has the right to expect.

‘Over the past 10 years, the work of the National Gold Standards Framework Centre has helped to raise standards of care for many thousands of people in the final stages of their life, which we know is so important. Schemes like the Gold Standards Framework show that the delivery of high-quality and compassionate care is achievable.’

Achieving a Gold Standard in end of life care for all residents is not only achievable, but flexible too. Planning a person’s care from the time they come into a care home right up until the end of their life will help them and their family to have comfort that their wishes will be followed at all times. This has the added benefit of avoiding unnecessary hospital admissions, meaning care homes can also help to reduce pressure on the NHS.

Maggie Stobbart-Rowlands is Gold Standards Framework Lead Nurse at the Gold Standard Framework Centre. Email:

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