Rehabilitative palliative care in practice

Examples of innovation and good practice in rehabilitative palliative care.

Enablement-focused Wellbeing Assistant roles

In 2012, St Wilfrid’s Hospice recognised and responded to an opportunity to change their provision of assistance support across wellbeing services which provide outpatient and day therapies to people living with advanced illness. The innovation involved redesigning the roles of existing healthcare assistants to include provision of enablement, rehabilitation and holistic assessment to better meet patients’ needs in the most cost efficient way.

Creating Wellbeing Assistants was achieved through:

  • Renaming the roles as Wellbeing Assistants.
  • Adapting existing job descriptions to include explicit responsibilities pertaining to rehabilitation, enablement and holistic patient assessment.
  • Developing a programme of competencies, linked to pay incentives within the level three banding.
  • developing a training programme delivered by AHPs to equip staff with skills and knowledge required for new roles, including expectations of Wellbeing Assistants, understanding rehabilitative and enablement approaches, contribution of AHPs, nonpharmacological symptom control strategies for common symptoms such as breathlessness, simple equipment provision, therapeutic manual handing and undertaking a straightforward holistic assessment.
  • AHPs providing on the job training and support to Wellbeing Assistants to embed learning into daily practice.

Impact of Wellbeing Assistant roles:

  • Following triage by a professional, Wellbeing Assistants undertake straight forward assessments of new patients referred to Wellbeing Services – freeing up AHPs to focus on more complex or specialist assessments.
  • Wellbeing Assistants lead generic gym classes – enabling greater numbers of people to access and benefit from rehabilitation services without increased AHP resource.
  • Wellbeing Assistants demonstrate improved clinical reasoning, enablement-focused support, champion a rehabilitative approach and have greater job satisfaction.

Challenges and keys to success

The greatest challenge relates to getting staff buy-in, as many healthcare assistants don’t perceive rehabilitation to be relevant to their role. Transforming the initiative into a success required leadership from senior hospice managers to bring staff on board and a commitment from AHPs to prioritise investment of time and resources to develop Wellbeing Assistants with the knowledge that the gains will be reaped in the future.

We are seeing real benefits of the Wellbeing Assistant model, both in supporting patients’ priorities and delivering service efficiencies. Our aspiration is to increase the number of healthcare assistants trained in enablement and Rehabilitative Palliative Care to roll the model out in our inpatient unit in the future.

Emily Bowler, Occupational Therapist and Wellbeing Manager, St Wilfrid’s Hospice


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