Discovering meaning, purpose and hope through person centred wellbeing and spiritual care: framework

2. A skilled and compassionate workforce

2.0.1 Spiritual care is everyone’s business and is included in the professional standards of many disciplines within the health and social care workforce. All staff have a role to play in ensuring that the spiritual needs of individuals are recognised and met. The extent to which this is part of an individual's role will vary depending on their role and work context, but it does mean that everyone working across health and social care requires some level of knowledge and understanding of spiritual care.

Recommendation 11: The Scottish Government and NHS Education for Scotland should explore with professional bodies how spiritual care can be embedded into standards for workforce education, training, and practice.

2.0.2 A scoping study, commissioned by NHS Education for Scotland (NES) in 2020, and conducted by Faith in Older People, revealed huge variation in the delivery and content of spiritual care education for healthcare professionals involved in the study^[17]. In some cases training was included in ‘Person-centred Care’ or ‘Compassionate Care’ aspects of learning, where the uniquely spiritual or religious elements could be minimised or lost altogether; in other cases, older models of spiritual care, more aligned to religious care, were still being taught.

2.0.3 All health and social care staff should, as a minimum, should be ‘informed’ about spiritual care. Depending on an individual’s role and remit there may be the requirement for additional training.

2.0.4 The NPB agreed that using the recognised four levels of practice developed by NES would be a helpful way to consider the level of understanding an individual in a role should have regarding spiritual care. When applied to spiritual care the four levels of practice can be described as follows:

• Informed: knowledge and skills required by all staff to contribute to the delivery of spiritual care and to positively impact on their own and others’ spiritual wellbeing.
• Skilled: knowledge and skills required by ‘non-specialist’ staff who are likely to have direct contact with service users, meaning that they have a substantial contribution to make in meeting an individual’s spiritual care needs.
• Enhanced: knowledge and skills required to provide direct spiritual care interventions, increasingly role and context specific.
• Specialist: knowledge and skills to play a specialist role in the delivery of spiritual care

2.0.5 The levels of practice are usually associated with a knowledge and skills framework, which articulates the knowledge and skills required at each level. Currently, there is no such framework for spiritual care, however, there are resources which articulate spiritual care competencies and capabilities. For example, “ Enhancing Nurses’ and Midwives’ Competence in Providing Spiritual Care through Innovative Education and Compassionate Care”^[18] which aligns to the ‘skilled level.’ This could be adapted for a wider workforce.

Recommendation 12 : NHS Education for Scotland and the Scottish Social Services Council should work with partners, including education providers and service users, to support the development of spiritual care knowledge, skills and understanding across the workforce. This will include enhancing the spiritual care elements within their respective programmes and curricula and promoting access to appropriate educational resources.

2.1 Compassionate Leadership

2.1.1 Compassionate leadership which protects, supports, and promotes the wellbeing of staff has never been more necessary or urgent^[19]. There is a need to develop clear links with compassionate leadership initiatives^[20]. Strategic and executive leads within organisations are key stakeholders, who are well placed to foster the values and desired outcomes of spiritual care and spiritual care education and embed this more widely in their organisation’s culture.

2.1.2 Developing compassionate leadership approaches helps leaders hear and reflect on what staff are telling them and take necessary action to support development and help address challenges^[21]. An example of this is the use of regular reflective practice. Leaders trained in VBRP® have reported a positive impact on their ability to engage with staff, deal with highly challenging conversations, support clinical reflection and elicit professional learning without blame.

2.1.3 The Spiritual Care Professional Leads Group is well placed to promote the place of spiritual care in the delivery of local and national leadership programmes

2.2 Development of educational resources

2.2.1 Education providers place varying degrees of emphasis on spiritual care. Education providers who deliver training for health and social care staff need to determine how spiritual care can be effectively and consistently included, or enhanced, within current curriculums. Relevant qualification and accreditation bodies should be clear about the inclusion of spiritual care in the curriculum and ensure the use of appropriate assessments.

2.2.2 Development and delivery of education models need to reflect the principles of spiritual care: involvement, engagement, sharing and reflecting, beliefs, faith, and values. As such, educational and training resources and opportunities should be developed in co-operation with those who will deliver and receive spiritual care. To ensure this happens, three essential components have been identified:

• all staff need to understand how spiritual care contributes to their own wellbeing to better empathise with those for whom they care;
• resources around training need to be better disseminated and incorporated into training for all staff at different levels and in different contexts; and
• spiritual care training needs to be incorporated in the under-graduate or foundational training for the whole health and social care workforce.

2.2.3 Development of educational resources should consider assumptions and understanding of the subject and how staff can deliver spiritual care. It should also provide opportunities for those in training to reflect on what supports individuals to be well and flourish, including what gives their own life meaning and purpose.

2.2.4 There is already a wealth of existing educational resources and these should be promoted (e.g. Spiritual Care Matters)^[22]. However, there remains a need for key partners such as the Scottish Social Services Council (SSSC)^[23] and NES to develop and promote a range of flexible and accessible resources which can be contextualised and used to support continuous professional learning / development learning across the workforce.

2.3 Reflective Practice

2.3.1 There is growing evidence about the benefits of staff participating in regular reflective practice. The Health & Care Professional Council state that: “Creating the space to reflect on your practice… can help you to deal with high levels of pressure and share lessons learned”^[24].

2.3.2 Staff should be supported to access a range of opportunities for reflection, using a variety of approaches and tools. Building capacity for staff to engage with VBRP® will support the delivery of person-centred care and support staff to explore and address the professional and personal impact of their work.

2.3.3 Such reflective practice can also support the development of a culture of stewardship; where health and care professionals are supported to use evidence based practise to inform their decision making and use the resources they have available wisely^[25].

2.4 The development of spiritual care in community and social care settings - shifting the paradigm

2.4.1 The Health and Social Care Standards^[26] set out what we should expect when using health, social care, or social work services in Scotland. They aim to drive improvement, promote flexibility and encourage innovation in all aspects of person-centred care within all settings; ensuring better outcomes for everyone.

2.4.2 The National Health & Wellbeing Framework states that: Health and social care services should focus on the needs of the individual to promote their health and wellbeing, and in particular, to enable people to live healthier lives in their community. …. people using services, whether health or social care, can expect a quality service regardless of where they live”^[27].

2.4.3 The “Independent Review of Adult Social Care in Scotland”^[28] recommended the establishment of ethical commissioning to support how care is planned, designed, sourced, delivered, and monitored. The development of such ethical commissioning should ensure that models of care and commissioned services include spiritual care as an integrating aspect of holistic, person-centred care.

2.5 National Health & Wellbeing

2.5.1 To date spiritual care services have been delivered primarily within the domain of health boards. In Scotland, specialist spiritual care remains a hospital-based service with limited services in community settings. There is a growing awareness that spiritual care should be provided in wider care settings; ensuring people get the right care, in the right place at the right time.

Recommendation 13 : Public bodies who commission care and support (including future models of social care) should ensure that services meet the physical, mental, social, and spiritual needs of service users and give consideration to how spiritual care training and service delivery is appropriately costed and adequately resourced.

2.6 Shifting the paradigm

2.6.1 There is a need to challenge some of the narrative around the delivery and provision of spiritual care. As stated in the “Independent Review of Adult Social Care in Scotland; “Strong and effective social care support is foundational to the flourishing of everyone in Scotland…. We need to shift the paradigm of social care support to one underpinned by a human rights-based approach”^[29].

2.6.2 Spiritual Care Teams are ideally placed to support such a shift. Achieving such a paradigm shift in delivering spiritual care services from predominantly in acute health settings to wider care settings would have implications for spiritual care teams and current models of care

2.6.3 The result would be that individuals would be supported to make sense of their circumstances during periods of transition and change; helping them to recognise and use their personal and communal assets with a view to proactively developing their own wellbeing.

2.7 National Strategies

2.7.1 The Scottish Government’s “Framework for adults living in care homes”^[30] recognises that individuals have a range of health and wellbeing needs that extend beyond the traditional biological model of care. The importance of spiritual care as an integrating aspect of person-centred care is reflected throughout the document. There is also an acknowledgement that failure to care for the whole person can result in a decline in physical or mental health.

2.7.2 Whilst the framework is important for those living in care homes it also sets out fundamental principles for person-centred care. It is essential that care providers support staff to work in partnership with individuals to develop person-centred personal plans that consider their circumstances, characteristics and preferences including spiritual needs^[31].

2.8 What Matters?

2.8.1 National developments such as “What Matters to Me” and “Getting it right for everyone” are focused on individual care needs; ensuring that every person is empowered and involved in multi-disciplinary decision making. These approaches adopt holistic approaches to ensure that individual needs are taken into account, and that appropriate support is provided while acknowledging that a person’s needs will vary over time.

2.8.2 These developments recognise the importance of spiritual care and require staff to have open, sensitive, and effective communication with service users. Such conversations ensure that planned care is truly person centred.

2.8.3 As previously stated, this framework does not stand in isolation, but closely aligns with policy development in other areas including; “The Quality of Life Outcome Indicators” within the Promoting Excellence Framework (Dementia Framework)^[32] and the Rehabilitation Framework^[33].

2.8.4 Spiritual care has a vital role in providing opportunities for both service users and staff to consider values based healthcare^[34] allowing individuals to consider realistic treatment, care options and anticipatory care within a safe and non-judgmental environment^[35]. Drawing on values to have meaningful conversations with people will support decision making and help staff and patients to base care around what matters most to the individual. Such an approach aligns to, and supports the aims of Realistic Medicine^[36].

2.9 Developments within social care

2.9.1 It must be recognised that social care staff are highly skilled and that many staff are very experienced. Like other developments within health and social care, there is a need to recognise the role of the workforce in achieving the aims of this framework, which will only be achieved by a skilled and equipped staff^[37] who are supported to fully engage with Continuous Professional Learning and professional development.

Recommendation 14: The Scottish Social Services Council should consider spiritual care as part of the planned National Occupational Standards review and consider how spiritual care fits with the scoping review in 2023/24 and a full review in 2024/25.

2.9.2 There is a need for the development of robust workforce planning models (including education and training) in spiritual care to deliver a consistent and excellent spiritual care service across health and social care settings throughout Scotland by 2028^[38].

2.9.3 NES and SSSC developed an initial version of a National Induction resource^[39]. The resource complements organisational and local induction programmes. As this resource is developed, consideration should be given to the inclusion of spiritual care.

Recommendation 15: As the content of the National Induction Framework continues to be developed by Scottish Social Services Council and NHS Education for Scotland, learning and guidance on spiritual care should be included, to support social care workers to be equipped and confident to provide spiritual care in their new roles.

2.10 Regulation and inspection

2.10.1 The regulation and inspection of services supports the delivery of high quality care and identification of good practice, and provides the public and service users with assurance about the quality of service being delivered. It is important that the development of standards for spiritual care are not seen as an additional ask of service providers or impact the delivery of care. Rather, such developments should be seen as aligned with, and supportive of, person centred care.

Recommendation 16: The Scottish Government should explore the development of a spiritual care standard with the Care Inspectorate and Health Improvement Scotland for use in inspections.