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Sunday 21 July 2019
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clinical team

Supportive care in care homes

The ‘Six Steps to Success Programme’ is a workshop style training programme developed by the Greater Manchester and Cheshire Cancer Network, the Merseyside and Cheshire Cancer Network and the Cumbria and Lancashire End of Life Care Network with support from the National End of Life Care Programme.

It enables care homes to implement the structured organisational change required to deliver the best end of life care. The leadership Alliance for the Care of Dying People (2014) stated that all clinicians involved in the care of the dying patients and their relatives or carers should have a specific standard set and the need to develop training resources or programmes for continuing professional development was highlighted as well as improving the confidence of care home staff to make end of life care decisions based on patient preference and choice and improve the quality of care provided.

The Team now comprises of a Lead Facilitator and End of Life Care Trainers. The Team continue to deliver education and support to 32 (two Homes have closed since the programme was first introduced) nursing/residential homes across Salford in relation to end of life care issues. Every home has been given the opportunity to attend formal education sessions; all 32 homes have engaged and are at various points of learning within the programme.

Since November the Team have implemented a  one to one coaching model; in that they work alongside the nurses and carers in the care home setting at the point of need as well formal education and training. Coaching is gaining momentum in many organisations and is seen to enable the highest form of learning. Literature suggests that coaching can lead to increased staff confidence and motivation, and can change traditional cultures and behaviours and increase the skills and competence of staff.

The service aims to:

  • Provide a coordinated facility to guide, support and advise care home staff (at the point of need), enabling them to anticipate, plan and deliver optimal, culturally sensitive end if life care for individual residents.
  • Work collaboratively with other services, e.g. district nurses, GPs and hospital palliative care services to expedite safe and appropriate rapid or fast-track discharges for care home residents nearing the end of life from hospital to care home.
  • Develop supportive working relationships between care home staff, Salford Care Homes Practice, (plus other GPs), district nurses, community Macmillan nurses, social care, safeguarding and continuing healthcare and other service providers by co-ordinating ‘joined up’ working and ensuring timely and appropriate referrals to and from other services.
  • Maintain strong integration with the hospital and community specialist palliative care teams to ensure the appropriate use of end of life care documentation, e.g. uDNACPR, individualised end of life care plan, EPaCCS, statement of intent.
  • Sustain the commitment to six steps formal workshop education programme as well as the support and expectations visits.
  • Ensure appropriate on-going relevant data collection to inform performance monitoring and improved patient outcomes.
  • Increase clinical support for care home staff to maintain residents wishes to remain in the home by supporting the implementation of mortality review meetings.
  • Support nursing home staff to manage residents symptoms at the end of life, including safe administration of end of life care medication, in collaboration with GPs and district nurses when necessary.
  • Contribute to ensuring that an equitable standard of healthcare is delivered to all Salford residents by supporting care home staff to deliver a high standard of end of life care using the tools and processes available in community, hospital and hospice settings, e.g. Advance Care Planning (EPaCCS), End of Life Care Plan and Royal’s Alliance Bereavement Model.
  • Disseminate and embed national guidance, clinical and quality standards in how end of life care is delivered locally, across the region and nationally.


The End of life care homes team, as part of the wider Salford Royal Palliative Care Service received a CQC rating of ‘outstanding’ from its inspection of community and hospital end of life care in January 2015.

Further information

  • Visit the elca site
  • Download the leaflet Care and support in the last days of life - see below
  • Contact Anne Mitchell or Marie Roberts on 0161 206 1868 Lead end of life care facilitators – for care homes

Available documents

application/pdfCare and support in the last days of life (1.63MB)Download
 Review: April 2020