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Case Study – NHS Nottingham City and the University of Nottingham

Competence-based training boosts skills and confidence in clinical practice for End of Life Care (EoLC)

NHS Nottingham City and the University of Nottingham use competencies to support staff development for End of Life Care (EoLC).

As part of its aim to embrace the health and social care integration agenda, NHS Nottingham City evaluated the skills of its workforce. The Trust is following a competency-based approach for the development of clinical staff, Allied Health Professionals, and support staff who work with patients with EoLC needs in primary care settings.

Competences are grouped by skill level to ensure that the right staff are competent in End of Life Care for the roles the Trust expects them to deliver. The ‘Competency Matrix’ allows staff to monitor and evidence their End of Life Care activity alongside their KSF reviews.


  • Participants have increased their competence and confidence in clinical practice
  • Supports NHS Nottingham City actions to meet the national End of Life Care Strategy
  • Applicable across all local care providers – NHS, independent and third sector
  • Supports a multidisciplinary approach to End of Life Care
  • Programmes suitable for level 1 and level 2 staff and above working across all areas of Health and Social Care delivery
  • Training facilitates individual action planning for participants to translate learning into their clinical environments
  • Linking to competences ensures staff have the right skills that are patient-centred

“One of the key advantages of running competence-based training in this way, with a diverse range of health professionals, has been developing partnership working across organisations providing End of Life Care.

We have seen shared learning and an appetite for a closer partnership approach to End of Life Care delivery across health and social care as a result.”

Becky Chady, Lecturer Palliative and End of Life Care, University of Nottingham

How we helped

The Trust started to review job descriptions to ensure staff are appropriately skilled according to their level of ‘exposure’ to providing End of Life Care, and to formulate education and training programmes to upskill the workforce.

End of Life Care Competences and Common Core Principles developed by Skills for Health and Skills for Care were used as a starting point for all job descriptions and the resulting training framework.

Having carried out a skills gap analysis that informed a competency matrix, the Trust prioritised employees who would benefit from tailored training programmes to upskill and extend knowledge. As an initial step, it delivered multi-level training targeted at 100 care home staff in Nottingham, addressing issues such as pain management and the use of syringe drivers.

The Trust also devised training for new recruits around use of a community-based information plan, which embeds communication competencies in a half-day course. This has been made available to colleagues from the voluntary sector, and in future care home staff will also benefit.

The Trust worked with the University of Nottingham to devise a unique pilot programme ‘Improving the End of Life Care Experience’ which is a generic introduction for staff across all health and social care settings.

Supporting multi-disciplinary learning

A specific three-day learning event was completed by 66 staff during the pilot, with participants including registered and non-registered allied health care staff, community matrons and nurses, health and social care workers, care support workers, and agency staff. The course content was directly linked to the End of Life Care Core Competencies, and introduces participants to issues such as diagnosing dying, recognising loss and distress, and ethical principles.

The early evaluation suggests significant changes to competence and confidence in clinical practice, and feedback from the first three courses has been extremely positive.

Participants felt they had developed skills that are easily transferred to practice and gained a good insight into other care institutions’ views and practices regarding End of Life Care.

As the Sector Skills Council for all health sector employers, we support the NHS, independent, and the third sector organisations. Since 2002 we’ve been working with employers to get the right people, with the right skills, in the right place at the right time. We are the authoritative voice on skills issues for the health sector and offer proven workforce solutions and tools – with the expertise and experience to use them effectively.