Promoting access to, and use of, specialist palliative care services by BME communities: A community engagement project

Transcription

1 Promoting access to, and use of, specialist palliative care services by BME communities: A community engagement project Report to Sue Ryder Hospice Apprenticeship Project Steering Group Summary Report August 2012

2 Contents 1.0 Introduction Background/Context Project Aims/Methodology Findings Impact & Benefits of the Project Recommendations References 19 Positive contribution to community regeneration, development and social mobility Successfully raised awareness of end of life and palliative care services amongst the Black Minority Ethnic (BME) community Developed new and sustain able relationships within the wider community to facilitate and assist in the in the process of information dissemination

3 1.0 Introduction The publication of the End of Life Care Strategy in 2008 (Department of Health (DH), 2008) raised the profile of end of life care in England and signalled the need to coordinate and plan its delivery in order to ensure that all individuals would have a choice about where they are cared for and die. This Report is a summary of an evaluation of a community engagement project undertaken by Sue Ryder to raise awareness of specialist palliative care services and to develop culturally appropriate care for people from Black and Minority Ethnic (BME) communities aiming to promote equity of access and utilisation. Engagement activities and the development of Apprenticeships were used to create better relationships with BME communities and to provide a demonstration project to inform future services delivered across the Charity. A copy of the full evaluation report is available from Sue Ryder. The Report, which is aimed at the Project Steering Group and those within the Charity responsible for strategic service developments, draws on the range of data generated during the Project (October 2009-July 2012) to identify its outcomes and to offer some guidance to inform future decision making. In addition, as palliative and end of life care are provided in a variety of organisational settings, the findings will also be relevant to commissioners, other specialist palliative care service providers and the range of health and social care professionals involved in the delivery of the palliative and end of life care pathway as current patterns of care are reformed and services are redesigned to improve the quality of care and ensure best use of financial resources. 1

4 2.0 Background/Context In 2009, the Sue Ryder Apprentice Project, based in the Bradford and Airedale District, was awarded Department of Health (DH) funding for three years. Through the implementation of a community engagement project, the Project aimed to achieve: Increased access and referrals to palliative and end of life care for Black and Minority Ethnic (BME) people Improved palliative and end of life care services by making them more culturally appropriate for BME people Involvement of BME people in the delivery of palliative and end of life care services Better relationships between BME communities and palliative and end of life care service providers. Key performance indicators for the Project were identified as: Forging and strengthening new partnerships with the BME community locally Raising the profile of Sue Ryder locally with the BME community Addressing under-representation of BME people as service users and staff Increasing opportunities for local BME people to access training and employment within health and social care services Providing opportunities for host services to develop staff Local and national targets were also identified to monitor progress of the Project throughout the funding period (Section 5.4). The Project aimed to achieve these indicators by funding a part-time Project Coordinator and through the phased recruitment of ten apprentices, who met specific language requirements, to undertake community engagement activities. During their period of appointment, the Apprentices were trained to NVQ level 2 in Health and Social Care (now Diploma in Health and Social Care). In order to develop their knowledge and skills, the Apprentices undertook placements with Sue Ryder Manorlands In-patient Unit, Day Therapy Unit and Specialist Palliative Care Community Team, as well as with one of two Bradford District Care Trust community nursing teams and the Hospice at Home team. The Apprentices also worked, in collaboration with the Project Co-ordinator, within the BME communities undertaking community engagement initiatives to raise awareness of specialist palliative care and services. To identify the impact of the Project, the Steering Group commissioned an independent evaluation of the Sue Ryder Apprentice Project by the University of Bradford. Evaluation of the Project was required driven by strategic and operational needs for improved provision of palliative and end of life care for people from BME groups. The Apprentice Project, initially locally based, also aimed to develop a national replicable model. This Summary Report provides an evaluation of the Project for the period October 2009-July It should be acknowledged that the evaluation project did not commence until April 2010 by University of Bradford resulting in incomplete data for the period October 2009-May A brief overview of the Project methodology and key findings are provided below. Full details can be found in Section 6.0 of the full evaluation report available from Sue Ryder. 2

5 3.0 Project Approach/ Methodology The Sue Ryder Apprentice Project was evaluated at different levels utilising Return on Investment (ROI) methodology (Phillips, 2003). The ROI framework was used to demonstrate the effectiveness of the Project by defining the levels of evaluation, the types of data collected, the sequence of collection and the approximate timing. This enabled a chain of impact to be demonstrated whereby the reaction and satisfaction with the induction and training programme were identified (level 1), skills and knowledge learned (level 2) were applied on the job (level 3) to produce business impact (level 4). A return on investment calculation of cost (level 5) was not undertaken as this was represented by the grant awarded. Instead, the impact of the Project was demonstrable through the number of new patient referrals from the BME community achieved during the Project (using the baseline of 5 referrals in 2007 as identified in Project grant application). The evaluation drew on a number of data sources including: Post-programme Questionnaires (level 1) Placement specific action plans and associated progress monitoring reports (level 2) Feedback reports from action learning groups (level 2) Focus group and individual interviews from Apprentices (levels 1& 3) Focus group interview from service/placement providers (level 1& 3) Referral data from service(s) (Level 4) Individual interviews with Service Managers and Project Co-ordinator (level 4) Documentary analysis of Steering Group Minutes and Project Co-ordinator Reports (level 3 & 4) 3

6 4.0 Findings Following confirmation of DH funding from October 2009, a Project Co-ordinator was appointed (0.8 whole time equivalent (wte) initially then 1.0 wte) and a Steering Group was formed. 4.1 Level 1: Reaction, Satisfaction and Planned Action of the Apprentices, Mentors and Service Managers The Project appointed one Project Coordinator, sixteen Apprentices and one Administrator. Four Apprentices were recruited in March 2010 and an additional two in September A phased recruitment of Apprentices was then undertaken during as Apprentices left and placement capacity was released. Following appointment, Apprentices undertook an induction programme. This included mandatory training, an NVQ preparation programme and a two-day Introduction to Palliative Care Course. Level 1 evaluation measured the reaction and satisfaction of the Apprentices to the NVQ preparation and Palliative Care course alongside identifying their plans to apply what they had learned. Apprentices rated the NVQ preparation and palliative care programmes as 5/5 for importance, relevance and perceived utility for developing health and social care skills, understanding the philosophy and practices of palliative care, and the role of palliative and end of life care services. Interview data confirm that all Apprentices were very satisfied with the content of the Induction, NVQ and Palliative Care programmes. Placements were evaluated at three months by Service Managers and Mentors. Each placement rated 5/5 for importance and relevance. At the start of the Project, concern had been raised about the utility of a three month placement solely with the community specialist palliative care service. Whilst the placement was viewed as offering significant learning opportunities in terms of observing the co-ordination of palliative and end of life care, attending Gold Standards Framework meetings, team working and communication with clients and their carers, the Apprentices opportunities to achieve the range of skills required to complete the NVQ units were considered limited. In order to address this, it had been agreed that Apprentices would undertake a shared learning placement between the Hospice Day Therapy Unit and the community specialist palliative care team. This shared placement was evaluated positively by placement Mentors and Apprentices. 4.2 Level 2: Evaluation of Learning Experiences Apprentices rotated through four placements during their year-long apprenticeship including: In-patient unit Sue Ryder Manorlands Hospice Specialist Community Team/Day Therapy Unit - Manorlands Hospice District Nursing Team Bradford District Care Trust Hospice at Home Team Bradford District Care Trust Normally, they were recruited to work for 30 hours per week and spent the equivalent of half-day/week working alongside the Project Co-ordinator on community engagement activities. In addition, the Apprentices met weekly with the Project Coordinator to share their experiences, identify further training needs and, at regular intervals, receive feedback from the NVQ assessor. 4

7 Feedback indicates that, when working in their allocated placement, Apprentices were negotiating and planning with their Mentors and the Project Co-ordinator to identify learning opportunities to meet the Project needs and key performance indicators, alongside achievement of the NVQ units and awards. The learning experiences identified enabled the Apprentices to develop their knowledge and skills and, where appropriate, apply their learning about palliative and end of life care. Data identify that the Apprentices were making significant progress to achieve the NVQ award. Feedback also highlights that, occasionally, Apprentices experienced personal distress when caring for dying patients. Individual clinical supervision sessions were made available once/month with the Sue Ryder Education Lead to provide additional support. All Apprentices accessed this supervision finding it beneficial. Apprentices had allocated time to participate in community engagement activities in collaboration with the Project Co-ordinator. These activities offered learning experiences to educate and inform the BME community, in their community language, about health risks and health promotion, for example at Health MOT clinics, alongside providing information about palliative/end of life care and Manorlands Hospice. In addition to the Apprentice and local community engagement activities discussed above, Mentors from across the placement providers also identified individual learning opportunities from their work with the Apprentices and the Project. These learning opportunities are reported to have developed their level of cultural awareness and cultural competence when caring for people from BME communities and, when shared, also resulted in enhancing inclusivity within their practice or service. These experiences were identified by one Mentor as: significant opportunities for raising my own level and organisational awareness to initiate discussions within services which can lead to inclusivity..and better..more individualised care.. (Mentor) 4.3 Level 3: Application and Implementation of Learning Working alongside their Mentors, the Apprentices experiences included providing direct care to people with palliative/end of life care needs. They participated in health MOT clinics, undertaking body mass index (BMI) and blood pressure monitoring, and providing health education advice for local BME community groups. In addition, the Apprentices utilised these activities to inform the BME community about specialist palliative care and Manorlands Hospice. Furthermore, Apprentices supported community groups on visits to the Hospice, overcoming language barriers to explain about the services available and responding to questions. These visits were described by the Apprentices as significant opportunities to break down barriers between BME communities and Manorlands Hospice and to enhance confidence in the specialist palliative care services. The activities of the Project Co-ordinator included several strands: Project co-ordination, monitoring and reporting Recruitment for Apprentice posts the Project developed a bespoke, locally based recruitment strategy. This approach proved very successful in attracting interest in the posts from the local community with requisite language skills and offers a potential model for maximising recruitment from all communities. This also offers an organisational learning opportunity to inform the Charity s advertising/recruitment strategy and ethnicity monitoring 5

8 of job applicants and employees. As a result of the Project, these areas have been identified as requiring further development by the Project Co-ordinator and the Charity s Human Resource department. Supporting/Engaging Apprentices the Project Co-ordinator held weekly meetings with all Apprentices; undertook individual monthly reviews with Apprentice and Mentor, updated training plans, involved Apprentices in community engagement activities as detailed below. Community engagement o Within Keighley and District the Project delivered 45 information dissemination events and participated in fundraising activities with beneficiaries including Sue Ryder Manorlands, Sue Ryder Wheatfields, Marie Curie Cancer Care and the Pakistan Flood Appeal. A successful Schools Project has been initiated on two occasions in collaboration with the Day Therapy Unit and a further Schools Project is planned. o Within Manorlands collaboration with key staff and departments was undertaken to share learning from the Project and involve key staff in community engagement activities o Within Sue Ryder liaison with the Charity s Human Resource and Public Relations departments was undertaken to encourage learning from, and publicity for, the Project activities o To national palliative care audience journal article publications and conference presentations were undertaken 4.4 Level 4: Impact Given the positive feedback and experiences of Apprentices and placement providers, it was proposed that underspend for the financial year 2009/10 would enable the Project to provide two additional apprenticeships to the original 10 indicated in the bid application. At July 2012, the Project had exceeded this target and had appointed 16 Apprentices, one administrator and one Project Co-ordinator. Level 4 evaluation also focused on evidencing achievement of the key target outcomes (Section 5.4) and performance indicators for the Project: Forging and strengthening new partnerships with the BME community locally The process of recruiting the Apprentices has helped to develop sustainable relationships with community centres, job centres, religious and cultural centres, voluntary sector professionals and individuals within the local BME communities. The establishment of working relationships with other local healthcare providers to secure work placements in palliative and end of life care has also helped to strengthen relationships with those organisations. The benefits reported for the placement providers include:- 1) Overcoming language barriers 2) Raising cultural awareness and developing cultural competence of staff to enhance inclusivity of services 3) Improving working relationships between the different teams/organisations. 4) Staff development from a mentoring perspective. 5) Engaging with 'hard to reach' groups through Health MOT clinics provided at community group locations/venues 6) Clarity regarding referral criteria to specialist palliative care services enabling appropriate and timely discussions with patients and their carers regarding referral to be made and reducing heath inequalities 6

9 Raising the profile of Sue Ryder Care locally with the BME community Significant effort and progress has been made to identify and develop opportunities to inform and engage with the BME people and communities in Keighley and District. To date, it is reported that over 840 people have attended community engagement events organised or supported by the Project. These events, delivered in community languages, aimed to break down cultural and language barriers and to raise awareness of specialist palliative care services. In addition, via the business and community contacts developed, the Project assisted in fundraising initiatives and charitable events for Sue Ryder, Marie Curie Cancer Care and the Pakistan Flood Appeal. These engagement activities extended the reach of Sue Ryder Manorlands and the Charity to people who would not have previously engaged with, or known about, the services. A Directory of Key Contacts for local businesses, community groups and organisations could be formalised for distribution within Manorlands and the Charity to develop these engagement opportunities and sustain these community relationships. Opportunities for all staff working within the Hospice to engage with the activities created by the Project should be examined. Addressing under-representation of BME people as service users and staff An increase in the number of new patient referrals to Sue Ryder Manorlands specialist palliative care services for people from BME communities has been achieved. A total of 33 people have taken up the offer of help with meeting their palliative and end of life care needs during the period May 2010-July 2012.This exceeds the target of 10 set for Project and indicates improvements in awareness, access to, and utilisation of specialist palliative care services with opportunities to reduce health inequalities for BME people and their families/carers. Following the appointment of one Apprentice to a Health Care Support Worker role within the Charity, the limitations of the Charity s current processes for monitoring the ethnic profile of job applicants and staff emerged. In addition, attempts to collect data relating to the ethnic profile of people referred to individual Sue Ryder Hospices revealed inconsistent practices across the Charity. An opportunity, therefore, exists for the Charity to engage with, and learn from, the Project to develop consistent monitoring practices for the ethnic profiles of staff and service users. This would enable both an accurate picture of the impact of the Project to be demonstrated and the Charity to achieve accurate data for ethnic monitoring. Increasing opportunities for local BME people to access training and employment within health and social care services The Project has successfully recruited one Project Co-ordinator, sixteen Apprentices and one administrator. These included 4 men, 13 women, local, unemployed at the time of appointment, people from the community in Keighley and District with the requisite language skills. The Apprentice posts attracted significant interest with up to 146 people requesting recruitment packs and between people submitting applications on each recruitment occasion. The award/training profile achieved during the Project is: MSc Health and Social Care Management 1 NVQ Level 2 Health and Social Care 6 Diploma in Health and Social Care (current) 3 NVQ Level 3 1 NVQ Level 3 (current) 2 Safe Handling of Medicines 8 QCF Level 2 Dementia Awareness 4 7

10 Diploma in Management Level 3 1 Diploma in Fundraising Level 3 (current) 1 Non-completion 3 (Secured alternative employment, entered higher education, moved to Ireland) Four Apprentices and the Project Co-ordinator remain in post whilst 12 Apprentices have successfully used the experiences and opportunities of the Apprenticeship to identify their career ambitions, develop their self-confidence and secure employment or further study. Two Apprentices applied for, and were appointed, as Healthcare Support Workers at Sue Ryder Manorlands. Seven Apprentices have continued in roles within health and social care services following completion of their Apprenticeship. One Apprentice will commence a nursing programme in September 2012 and three Apprentices are submitting applications for entry in nursing. These appointments, employment and award successes are viewed as very positive outcomes for the Project contributing to the achievement of the key performance indicators and exemplified in the journey of one of the Apprentices Farah : Farah is a 22 year old woman of Pakistani origin. She applied for an Apprentice role in July Previous employment included telesales at a local mail order company and working as an administrative assistant. Farah had no healthcare experience when she commenced her apprenticeship in September Following enrolment on NVQ level 2 Health and Social Care, Farah s first placement was at the Hospice in-patient unit. Farah received very positive feedback from her mentor, the team and patients for her work. When a vacancy arose for a Healthcare Support Worker within the in-patient unit Farah applied and was recruited. Farah left her apprenticeship in January 2011 and continued with the NVQ level 2 award, completing this in March Subsequently, Farah enrolled for the NVQ level 3 award in order to apply for a Nursing degree programme via UCAS. Farah also enrolled at the Open College to achieve the requirements for maths and science to enter nursing - successfully completing these in March and May Farah was interviewed for nursing at a local University and will commence this programme in September At her exit interview, Farah said: The Project has helped me in many areas..i ve grown up really. When I left school I knew it was a mistake but there was no-one to guide me. The Project has helped me achieve..all the things I thought I could never do..the certificates have my name on them. It s been fantastic really. We ve all gained something. Manorlands staff have taken the time to help me. The Project has helped us to move back into education or employment. I ve completed my NVQ3 and I ve been accepted for nursing in September mum and dad are really proud of me.. (Exit interview, Apprentice female). Enhanced self-confidence, personal and career aspirations were evident in exit interviews with all Apprentices. A typical comment was: The past year I ve been learning about myself, learning about others, learning about holistic care. I will never forget this experience. Palliative care is very difficult to deal with. Throughout this journey I have been surrounded by people who care and support me. I was seeing regular body bags and 8

11 funeral directors. That was hard. Providing direct care was nerve wrecking. I haven t given up. I wanted to carry on and achieve the NVQ2. My main objective now is NVQ3. I want to do a degree..that s my target. I m going to work with an organisation caring for people with mental health issues. I ve enjoyed it and its been sad at times.. (Exit interview, Apprentice, male). Apprenticeships, therefore, offer a potentially successful model for recruiting hard to reach groups into training and employment within specialist palliative care and health and social care services. Providing opportunities for host services to develop staff Benefits were reported by Teams participating in the Project including raising cultural awareness and developing the cultural competence of team members. Other opportunities were introduced to develop staff within host services. These include establishing cultural awareness training and redesigning the Charity s Equality and Diversity training. The Project Co-ordinator worked alongside host services and departments to develop action plans for forging and strengthening partnerships with the local BME community and the Asian business sector in Keighley and District. The Project also created an opportunity for one volunteer to work alongside the Project Co-ordinator to introduce a Schools Project. Opportunities for staff development are also evident in everyday practice: The Hospice has cared for more Asian people and it has recruited young Asian staff members as Healthcare Support Workers. This has been helpful and challenging. Innate prejudices and practices are being discussed. It s helped us to reflect on specific instances of our everyday practice with new eyes and examine our relationships. It s early days but the opportunities for this to influence across the Charity. It s starting to impact on how the Charity thinks.. (Steering Group Member) Finally, opportunities for learning from the Project to change the Charity s recruitment and ethnic monitoring practices have been identified. 9

12 5.0 Impact/Benefit of Project Final evaluation of the Project indicates the significant impact and benefits which have been made including: 5.1 For Sue Ryder Manorlands and the Charity: Corporate social responsibility: this refers to the contribution an organisation makes to the health and sustainability of its local community (Kings Fund, 2006a) An increase in the number of new patient referrals to Sue Ryder Manorlands specialist palliative care services for people from BME communities. A total of 33 people have taken up the offer of help with meeting their palliative and end of life care needs during the period May 2010-July 2012.This exceeds the target of 10 set for Project and indicates improvements in awareness, access to, and utilisation of specialist palliative care services with opportunities to reduce health inequalities for BME people and their families/carers. Engagement with over 840 people from local BME communities providing information in their community language to address misconceptions and raise awareness of specialist palliative care and services aiming to reduce inequalities in access and utilisation of services. Introduction of a Schools Project to promote awareness of, and engagement with, local specialist palliative care services from a young age, contribute to the diversity curriculum delivered within Schools and promote opportunities for inter-generational activities through an arts project with people referred to the Day Therapy Unit. To date, this new initiative has been delivered on two occasions receiving very positive evaluation from the School s teachers and students, and Day Therapy Unit patients. A further Schools Project is planned. Enhanced communication within and across services has been achieved through the delivery of direct patient care with Apprentices and participation in community engagement activities, resulting in benefits for the wider community. Specialist palliative care services were more accessible as language barriers were overcome, and opportunities to overcome barriers to entry relating to religious/ cultural practices have enhanced confidence in the specialist services. Providing opportunities for social mobility (Department of Work and Pensions (DWP), 2007). Of the 18 people employed by the Project, nine Apprentices and one Administrator have moved to full- or part-time employment including two who have been appointed as Healthcare Support Workers at Sue Ryder Manorlands In-patient Unit. Two people left their Apprenticeship to undertake further study within higher education, one Apprentice moved to Ireland and four Apprentices are continuing with their Apprenticeship. The Project Coordinator also remains in post. All reported a very positive experience during their Apprenticeship. The Apprenticeships offer a potential model for recruiting from hard to reach groups, those communities which services have found it difficult to reach out to or to contact using existing recruitment techniques (Brackertz, 2007), as well as assisting them to move into permanent employment or further study. The Apprenticeships have benefitted both the individual and the local community where unemployment benefit claimants in Keighley have shown a 0.3% point increase and Bradford West has shown the biggest percentage point increase nationally at 1.6% points on the year to July 2012 (ONS, 2012). Furthermore, the Apprenticeships have encouraged participants to identify their future career aspirations. Four 10

13 Apprentices are pursuing entry into nursing as a career. Sue Ryder Manorlands and the Charity have, therefore, raised their profile as a local employer of choice in relation to the recruitment and training of previously unemployed people with specific language skills and for supporting social mobility (DWP, 2007). Establishing wide ranging community engagement activities and forming new relationships with community groups, local Mosque representatives, business leaders/owners. These activities have provided opportunities to raise awareness and dispel misconceptions about specialist palliative care and local health services. Opportunities for future business relationships with local organisations are being considered including joint sponsorship of a Religious Festival calendar developed by the Project Co-ordinator and circulated to local businesses, schools, University and within Sue Ryder Manorlands. Feedback to the Project Co-ordinator indicates that the Calendar has been instrumental in raising awareness of religious festivals and enhancing knowledge about their significance across the community, influencing planning of events to avoid coinciding with major religious festivals and initiating discussions about additional religions for inclusion in future years. Enhancing cultural awareness and competence of health professionals through action leaning groups, a redesigned in-house diversity training programme and informal discussions within, and across, teams and services. This learning provides opportunities for wider workforce development and organisational learning across the Charity. The Project has, to date, engaged particularly with specific teams and key individuals within the Hospice and Charity who have expressed enhanced cultural awareness and competence. The challenge for Sue Ryder Manorlands and the Charity going forward includes organisational commitment to, and engagement with, the Project to learn from the successes of the Project incorporating that learning into organisational recruitment strategies, sustainable workforce development and everyday working practices to benefit service users and carers. Organisational motivation, which recognises the Charity s wider position and role within its local communities and concern that the workforce should reflect the diversity of its local populations, has been identified as a key condition for home-grown workforce strategies to be effective (Kings Fund, 2006a). Skill supply Recognition of the challenges to deliver the End of Life Care Strategy and commitment to diversifying Sue Ryder Manorlands workforce, both to reflect the local population and service requirements/expectations, has enabled Manorlands to initiate a successful community engagement programme and Apprenticeship Framework for workforce recruitment and development which could contribute to a wider Charity Grow your own initiative (Kings Fund, 2006a). Attracting and successfully recruiting a Project Co-ordinator and 16 Apprentices from the local community into work within specialist palliative care, and health and social care. In addition, 1 Administrator was recruited. The Project Co-ordinator and four apprentices remain in post. Recruitment to these posts has provided opportunities for cross-directorate working, challenging current practices and stimulating wider thinking within Sue Ryder Manorlands and across the Charity Recruiting people from the local community who have received training in the occupations on which Sue Ryder is dependent. This has promoted diversity in the workforce (roles, age, gender and ethnicity). 11

14 An inflow of new skills, including language skills and cultural awareness, has been achieved which can be cascaded through the existing workforce Creating and implementing a successful Apprentice Framework and developing an infrastructure with local training providers, primary and specialist palliative care services to recruit and support Apprentices and to maximise success of the Apprenticeships. The Framework developed is reflective of national guidelines for good practice (Warwick IER 2010) and has provided an effective way of meeting current and future skills demand. Achieving an optimum fit between the skills of the Apprentices and the needs of the workplace by being able to shape the Apprentices approaches to the work and Sue Ryder Recruitment and retention The development of a recruitment strategy by the Project Co-ordinator which, when implemented, attracted significant interest in the Apprenticeship posts from local people with requisite language skills. This strategy offers potential learning for the Charity and other organisations to attract applicants and recruit from all members of the community, including those considered to be hard to reach by usual Charity recruitment strategies. The Apprenticeships provided a means of recruiting 17 people from the local community by being able to offer a fixed term contract of one year, pay above the national minimum wage, and a period of training leading to a nationally recognised qualification. Opportunities to retain Apprentices as part of the permanent workforce when vacancies arose. Whilst Apprenticeships were offered as fixed-term one year contracts, two Apprentices applied for and were successful in being offered permanent employment as Healthcare Support Workers at Sue Ryder Manorlands, when vacancies arose. This demonstrates commitment and loyalty to the organisation which provided training and employment opportunities. Motivation and reward Raising awareness of the cultural aspects of practice and service delivery across Manorlands thorough cross department working. The Project Coordinator has also contributed to redesigning the in-house diversity training programme. Evaluation data suggest that this has served to motivate attendees within Sue Ryder Manorlands to discuss their level of awareness about diverse cultures, assess their competence to meet patients needs and to consider how their practice/service might be enhanced to break down barriers for the diverse populations served. 5.2 The impact and benefits for the Project Co-ordinator and Apprentices include: A local employment opportunity contributing to the development of culturally appropriate specialist palliative care services in an area of increasing unemployment (ONS, 2012). Employment and training opportunities for 18 people, including the Project Co-ordinator, which resulted in the development of new knowledge and skills related to specialist palliative care, and achievement of a nationally recognised qualification to enhance future employment possibilities and career options. Support to move into further permanent employment or education for 12 people including 7 who have continued their employment within health and/or social care services. 12

15 Support to identify career aspirations and achieve social mobility, including four Apprentices who are pursuing nursing careers 5.3 The impact and benefits for the participating services include: Enhanced team working between specialist palliative care and district nursing services that provided placements and Mentors to support the Apprentices to achieve NVQ/Diploma in Health and Social Care award and experience in palliative and end of life care. Closer team working, resulting from participation in the Project activities, enabled misconceptions about healthcare services to be addressed at community engagement events helping to improve confidence in, and use of, services by the local community and reduce health inequalities Clarity regarding referral criteria for specialist palliative care services for all people with palliative and end of life care needs. This awareness by district nursing teams facilitated informed discussions with patients and their families about services and the promotion of equity of access to, and timely utilisation of, services reducing health inequalities A number of individual, service and patient benefits resulting from a team s engagement with the Apprentices and the Project. In particular, overcoming language barriers and identifying opportunities to engage with BME communities enabled services to provide health education, personalised assessment and culturally sensitive care, facilitating timely and appropriate referrals to specialist palliative care services. Opportunities to reflect on and develop the cultural awareness and competence of individuals and teams, resulted in overcoming barriers to the use of services through enhanced culturally sensitive, appropriate practice and service delivery for the BME community. 5.4 Progress with Local and National Target Outcomes (at July 2012) Local and national targets were identified in the Project grant application to monitor progress of the Project throughout the funding period. Achievements are summarised in the table below. Local Targets 45 people from BME communities will have been offered help with meeting their cancer and end of life care needs over 3 years of the Project 300 people from BME communities with cancer and end of life needs, or their carers, will have been provided with information to help them deal with their health or social care needs over 3 years of the Project 10 people from BME communities will have taken up of offers of help with meeting their cancer and end of life needs over the 3 years of the Outcome Target exceeded: 99 people (comprising 33 patients and their families) were offered help with meeting their palliative and end of life care needs Target exceeded: 842 people have attended 45 community engagement events. At each event people were provided with information in their community language, breaking down language barriers and extending the reach of specialist palliative care services to people who would previously not have engaged with or known about the services Target exceeded: In total, 33 people from BME communities were referred to Sue Ryder Manorlands between May 2010-July In 2010, 7 13

16 project new patient referrals were made; in 2011, 14 referrals and, in 2012, 12 new patient referrals have been received to date demonstrating an increasing trend throughout the Project of BME people being aware of, offered and utilising, specialist palliative care services from a baseline of 5 referrals in 2007 identified in the Project application 10 unemployed people from BME communities will have undertaken and achieved accredited NVQ training through the apprenticeship scheme 5 local community organisations will have hosted the Apprentices to enable BME people to be involved in delivery of services and create relationships between BME communities and service providers A further 2 local community organisations will have been recruited to enable BME people to be involved in delivery of services and create relationships between BME communities and service providers Manorlands Hospice inpatient and community services will have developed their knowledge and skills in providing culturally appropriate care Target exceeded: The Project employed 18 people. At July 2012, 13 achieved accredited training through the Apprenticeship scheme and 1 achieved a Masters award Target Achieved Organisations which provided placements to Apprentices included: Sue Ryder Manorlands In-patient Unit, Day Therapy, Unit, Community Team. Two District Nursing Teams from Bradford District Care Trust Target Achieved Community organisations - Sangat Centre, Bangladeshi Community Centre, Keighley Asian Women and Children Centre, Highfield Community Centre, Ghosiyah Cultural and Religious Centre, Madinah Mosque, held information events and/or health MOT clinics. Hospice at Home Team and Bradford Cancer Support services were also recruited as placement providers Target Achieved Redesign of the Charity s cultural awareness and diversity training has been undertaken and delivered within Sue Ryder Manorlands. This, alongside the Project activities, has raised awareness and discussions with staff to promote cultural awareness and competence in everyday practice. Aspects of service provision are being reviewed for inclusivity including food provision, menu choice and availability of psychological support and bereavement services for carers/families by providers with appropriate language skills 14

17 National Targets Evaluation Reports, prepared at 18 and 36 months, will have disseminated results through presentation at key conferences Target Achieved: Information about the Project and its progress have been disseminated through: Interim Report (December 2011) Final Report (August 2102) Articles have been published about aspects of the Project in the following publications: Palliative News Primary Health Care Local press Conference presentations and workshops have been delivered at: Royal College of Nursing Yorkshire Cancer Network Knowledge gained will help shape future services delivered by Sue Ryder Care at all six hospices and impact on Sue Ryder Care s neurological services (Needs A, B, D) Target achieved: Project exit initiatives include: 1 Apprenticeship Strategy and Approach for Health and Social Care Report prepared and presented by Project Lead to Director of People & Director of Health & Social Care. Report commissioned by Head of Organisation and People Development. 2 Project Lead working with Human Resource Department regarding recruitment and ethnic monitoring processes across Charity 3 Project lead working with Sue Ryder Corporate and Trust Fundraising teams to source and secure funding to sustain existing project and implement to other centres. One application unsuccessful and one application awaiting outcome in October Submission to DH for funding from 2013/14 for three years to implement Strategic plan for Apprenticeships across Sue Ryder Care Homes. Outcome February Submission to DH to increase sustainability of current project by securing employment of Project Co-ordinator for purposes of developing an implementation 15

18 plan and sourcing external funding 6 Circulation of Final Report to share learning and good practice. Will also increase profile of Sue Ryder Manorlands amongst service providers and commissioners 5.5 Issues for consideration The Steering Group and Charity should give consideration to: Formation of an internal working group within the Charity to discuss and fully cost the adoption of a community project model, involving community engagement and Apprenticeships, across the Charity. In order to maximise success, costing should include the development of an infrastructure to support Apprentices and access, where possible, to nationally available funding for training. Consideration will also be required about the terms and conditions of employment for Apprentices as indicated by the National Apprenticeship Service (2012), including a minimum 12 months fixed term contract, a minimum 30 hours per week and, where possible, an hourly rate of pay above the national minimum wage. Embracing the opportunity to learn from the approach taken by the Project Co-ordinator to introduce a diverse range of community engagement activities and develop community relationships. A strategy and action plan will be required within Sue Ryder Manorlands to ensure that these relationships become embedded, are sustained and developed beyond the Project. For example, priority areas for Sue Ryder Manorlands might include wider implementation of the Schools Project across local schools, encouraging community group visits to the Hospice, promoting volunteering opportunities for people from the community and identifying activities to exploit awareness raising/information giving already undertaken with local BME business owners and community groups. Service user engagement might also be developed with representatives from the BME and wider communities to inform service developments. Development of a dissemination plan to share the learning and outcomes from the Project to audiences within and external to the Charity. The strategies which will be introduced to capture practice or work-place learning and provide opportunities for wider staff engagement and organisational development to enhance cultural awareness and competence. The action learning groups, initiated as part of the Project evaluation, provided an opportunity for cross-service discussion and case review identifying possible service developments. Regular (monthly) structured opportunities for all staff within and across services to engage are required and, where possible, with representatives from service users and carers from the local (BME) communities. Development of the Charity s strategy for workforce planning, diversity management and improvements in ethnicity monitoring - including processes for monitoring of staff profiles, staff recruitment and patient referrals across the Charity. The Project had outcomes identified for monitoring its impact. This required some data to be recorded locally, for example, Apprentice profiles, training and destination data, ethnic profile of Sue Ryder Manorlands staff, response to recruitment and community engagement activities. A review of the Charity s monitoring processes is required particularly if a Charity-wide initiative is to be developed. 16

19 6.0 Recommendations Recommendation 1 Establish a Working Group within the Charity to review the outcomes of the Project, identify priorities following completion of the Project and develop an action plan which may include: a. Reaffirming the Charity s corporate social responsibility to enhance the health and sustainability of its local communities, giving consideration to adopting a Grow your own approach to deliver employment opportunities, improve equity of access to specialist palliative care services and to develop a diverse and responsive workforce to deliver culturally sensitive/competent services to improve local health inequalities b. Achieving recognition of the community project model, incorporating community engagement activities and Apprenticeships, as a potentially replicable model for sustainable workforce development involving recruitment from local communities, and those hard to reach groups, into specialist palliative care services c. Identifying and securing funding streams which enable integration of any future Apprenticeship and community engagement roles into the Charity s strategy to diversify its workforce, including access to available training funding via the National Apprenticeship Service. d. Creating indicators to test and quantify the impact of any future model in order to determine success across the Charity and to plan for the future. This Project had outcomes identified for monitoring its impact and required some data to be recorded locally. Processes to record and monitor data for any national indicators will require development centrally with associated training in Centres to ensure consistency. e. Publicising and disseminating the outcomes and learning from the Project within the Charity and to a national palliative care audience. f. Securing funding to ensure sustainability and further development of the key Project activities within the pilot site Recommendation 2 Promote learning within the Charity and to specialist palliative care services about recruitment from local communities The bespoke, local recruitment strategy developed by the Project Co-ordinator for the Apprentice Project was very successful in attracting 498 requests for information and 228 applications. This strategy should be formalised and shared to enable the Charity and national audiences to identify learning and maximise recruitment from local communities, including those considered hard to reach through usual recruitment methods. Recommendation 3 Promote learning within the Charity and for specialist palliative care services about initiating and enhancing engagement activities with BME communities. The learning from undertaking community engagement activities could be developed as a Toolkit to support/deliver training events to inform Sue Ryder Care Centres, the Charity and national audiences. Recommendation 4 Improve the Charity s monitoring of ethnic/age/gender profiles of staff and ethnicity of service users to ensure consistency across the Charity and its centres. Patient ethnicity data provided by the Charity was identified as being incomplete and for use with caution. Consistent recording practices across the Charity would have enabled an accurate picture of the impact of this Project to be demonstrated. The data indicate an increasing number of new patient referrals for BME people throughout the duration of the Project (total of 33 new patient referrals for period May 2010-July 2012) compared with the 5 received by Sue Ryder 17

20 Manorlands during 2007, a figure referred to in the DH grant application (see also Recommendation 1(d) above). Recommendation 5 Establish a working group within Sue Ryder Manorlands to: a. Review the outcomes of the Project locally and develop a plan to promote and facilitate sustainable engagement/relationships with local health teams/services and with BME/local communities - A significant number of new contacts and relationships have been created with BME communities and groups in Keighley and District by the Project Co-ordinator, Apprentices and District Nursing services. These contacts and relationships need to be sustained, continuing to raise awareness about specialist palliative care and services, breaking down barriers and maintaining the confidence of the local communities which has resulted in the increased referrals and helped to reduce health inequalities. b. Initiate the development of a Directory of Community Engagement Contacts/ Activities lead by the Project Co-ordinator to record formally and systematically key contacts in businesses, community groups and organisations and the type of engagement undertaken/preferred. Such a Directory could be used and updated by the Fundraising Department to publicise activities and encourage sustained contact enabling relationships with Manorlands and Sue Ryder to develop and become established. c. Facilitate Manorlands Management Team, including representatives from the In-patient, Day Therapy, Community, Fundraising and Volunteer Services, to identify opportunities to sustain the contacts and referral trends made through the Project. This could include initiating training programmes with local GP practices (given recent personnel changes) about referral criteria and ensuring opportunities for service user representation/involvement to further develop culturally sensitive services. d. Facilitate regular opportunities to capture and discuss informal and workplace experiences by all staff within and across services, including case review and, where possible, service users and carers, to enhance cultural awareness, cultural competence and identify further opportunities for service development. e. Evaluate the practice and service impact of the redesigned diversity training beyond reaction to, and satisfaction with, the programme. 18