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THE HEALTH service is a major employer of minority ethnic groups, although it has not always been an equal opportunities employer. NHS trusts are now required to ensure that their employee profile more accurately reflects the local population ( NHSE 2000 ).

The ruling in the House of Lords on assisted suicide highlights the need for education and training in end of life care and particularly communication skills (Nursing Older People, September 2009).

IN COMMON with many other parts of the UK, Lancashire has large black and minority ethnic communities, particularly a large, growing South Asian (predominantly Pakistani Muslim) population, a large proportion of whom are under the age of 15. In some areas, 51 per cent of the total school leaving population at 16 years is drawn from these communities. However, these communities remain under-represented in the healthcare professions in the area.

Last month the authors described the role of the nurse in the prison service, the need for clinical supervision, and the parameters for a project to implement a clinical supervision model in five prisons in England ( Freshwater et al 2001 ). Here, they examine some of the findings from the project, particularly in relation to practice, education and barriers to implementation.

Traditional palliative care services have focused on individuals with cancer. The NHS National End of Life Care Programme, launched in December 2003, has been working to address this anomaly and to try to enhance end of life care provision for other patient groups. This article reports on work in the area of renal failure at Westmorland General Hospital, Cumbria, where the Preferred Priorities for Care tool has been introduced to support patients nearing the end of life.

This article addresses the difficult topic of end of life care. That is care provided for someone with a life threatening condition that will result in ultimate death. The topic is relevant to all health and social care staff particularly care assistants working in care homes and the community who work with older people or people with long-term conditions. This article looks at the work being done to improve quality of care and provide choices for individuals at the end of their lives

The law allows every individual to make decisions about his/her medical treatment and the care that he/she is offered. High profile coverage in the popular media on assisted suicide and euthanasia has brought decisions made by people with terminal diseases to the forefront. However, people living with motor neurone disease (also known as amyotrophic lateral sclerosis) often lose their ability to communicate their preferences in the later stages of the disease, and have more difficulty accessing services than those individuals with other life-limiting and life-threatening conditions such as cancer. A number of systems are being put into place to improve palliative care services for all care groups. One of the tools promoted by the NHS End of Life Care programme is the Preferred Place of Care initiative. This paper provides an overview to the development of the Preferred Place of Care process and describes how it has been implemented for the benefit of people living with motor neurone disease in Lancashire and South Cumbria.

In addition to our programme of work on the global development of hospice and palliative care, the International Observatory on End of Life Care also retains a strong interest in matters of policy and evaluation relating to the UK context. We report here on work in progress relating to the Preferred Place of Care instrument, which forms a key element in the UK Department of Health End of Life Initiative.

This paper describes a survey of the educational preparation of nurses working in high, medium and low security mental health settings. Data from focus groups and interviews were also content-analysed to yield a theory of nursing in secure environments comprising of statements of competency.The competences were translated into a questionnaire and distributed to nurses working in high, medium and low security mental health settings. Respondents stated whether individual competences were part of their current practice or supervisory involvement, and the degree of importance they accorded to each competency.The competence framework received widespread support from nurses at all levels of security in relation to their role description and level of importance. Results identified issues in relation to security and how procedures in parts of the system (notably in high security) militate against therapeutic care. Noticeable differences emerged between respondents working in high and medium secure environments in relation to involvement of the patient's family and preparation for discharge. Issues of concern common to all levels of security included teamwork, balancing security and therapy, boundaries of professional practice, and clinical supervision.

The place of final care for patients with terminal illness is influenced more by resource availability than patient choice. Resources are not consistently available across the UK to provide successful palliative home care for all those that require this facility. This paper surveys the literature on home care for terminal cancer patients and outlines proposals for a new initiative in Lancashire and South Cumbria to address this issue and improve palliative care services in the community.

Last month the authors described the role of the nurse in the prison service, the need for clinical supervision, and the parameters for a project to implement a clinical supervision model in five prisons in England ( Freshwater et al 2001 ). Here, they examine some of the findings from the project, particularly in relation to practice, education and barriers to implementation.

CLINICAL SUPERVISION has been high on the nursing practice agenda in recent years ( UKCC 1996 ). While implementation in some specialist areas is more advanced, there is growing evidence to suggest that clinical supervision is now well established in many areas of nursing practice ( Bishop and Freshwater 2000, Butterworth et al 1998, Farrington 1995 ). Much of the success of the strategy The New NHS: Modern, Dependable ( DoH 1997 ), and the supporting strategies described in the documents A First Class Service ( DoH 1998a ) and Working Together ( DoH 1998b ), depends upon the ability of key players, and identified clinical leaders, to take forward the clinical supervision agenda.

As part of the UKCC Nursing in Secure Environments project, all pre-registration programme providers for mental health and learning disability were contacted and invited to complete a questionnaire concerning their involvement with, and preparation of, nurses for working in these settings. Details are provided of the analysis of these questionnaires, along with parallel data captured from the project's focus groups and from focused interviews which provided a commentary of the practitioners' views concerning the adequacy of pre-registration preparation for work in these specialised environments.

It is probably still fair to say that clinical supervision is not widely implemented throughout the nursing profession. Indeed, Butterworth (1998) has implied that the notion that clinical supervision is widespread in mental health nursing is an assumption. This article draws upon the findings of two recent studies which examine the availability and acceptance of clinical supervision in forensic mental health settings. The findings indicate that there is a low level of acceptance of clinical supervision both within the prison service and also in forensic settings. Following an exposition of the findings, this article will discuss some of the practical difficulties encountered in the systematic implementation of clinical supervision across this professional group who work within conditions that test their professional resilience.

The regulation of healthcare assistants (HCAs) is a topic which has caused widespread debate since the role has begun to develop. Although the general consensus is that HCAs should be regulated, the problem is deciding who should do the regulating. This article outlines the reasons why regulation is so important and examines the differences between various health care bodies which are preventing a decision from being made.

Social therapy is an emerging model of care for people with a personality disorder but current professional education programmes for health-care staff fail to meet the needs of both staff and patients. A project at Ashworth Hospital, in collaboration with the University of Central Lancashire, is attempting to address this issue through the development of a framework of professional occupational standards from which it is hoped academic and voational accreditation will be possible.

Les Storey examines the health care assistant's role in general practice and the key questions of delegation and accountability that practice nurses should know

Admission to a care home is a major event for many individuals and, for some, a time when they may lose their independence. It is at this juncture that they should be given the opportunity to participate in planning their future care. An advance care plan (ACP) is a means for people with capacity to document their preferences for their care and to enable providers to advocate on their behalf. Some people will have lost mental capacity before admission to a care facility, so it is essential for staff to be familiar with the complexities of the Mental Capacity Act 2005 to support residents approaching the end of life. This article outlines the processes of ACP and identifies resources available to support the introduction of ACP into care homes.

The inadequacy of some areas of palliative care provision was acknowledged in the NHS Cancer Plan (DoH 2000). Many patients would prefer to die at home, but only one quarter are able to do so because of the lack of community or specialist palliative care teams in some parts of the country. The Lancashire and South Cumbria Cancer Services Network developed an initiative to meet the educational and training needs of practitioners delivering palliative care in the community.

The aim of palliative care is to achieve quality of life and a dignified death, preferably in a place of the patient’s choosing. Good communication is vital if patients’ and carers’ wishes are to be heard and respected. Here the authors describe how a document developed to help assess an education programme has aided communication in ways that were, at times, unexpected.

CLINICAL SUPERVISION has been high on the nursing practice agenda in recent years ( UKCC 1996 ). While implementation in some specialist areas is more advanced, there is growing evidence to suggest that clinical supervision is now well established in many areas of nursing practice ( Bishop and Freshwater 2000, Butterworth et al 1998, Farrington 1995 ). Much of the success of the strategy The New NHS: Modern, Dependable ( DoH 1997 ), and the supporting strategies described in the documents A First Class Service ( DoH 1998a ) and Working Together ( DoH 1998b ), depends upon the ability of key players, and identified clinical leaders, to take forward the clinical supervision agenda.

Competency-based approaches to education and professional development have increased the need for nursing practitioners to submit their clinical practice to scrutiny through the development and assessment of portfolios. This paper examines the role of portfolio development as a method of assessing competency in and for practice and provides a brief synopsis of opposing views in relation to competency-based approaches.

The ‘preferred place of care’ (PPC)1 patient assessment tool, recently renamed ‘preferred priorities for care’, is one of three interventions promoted within the National Health Service (NHS) End of Life Care Initiative. PPC offers patients, their carers and healthcare professionals the opportunity to consider, discuss, express and record priorities for care at the end of life. Department of Health guidance highlights how ‘available evidence suggests that whilst over 50% of all patients wish to spend their final days at home, less than 20% in practice are actually able to do so’.2 Nationally, the proportion of home deaths for patients with cancer is falling, from 27% in 1994 to 22% in 2003.3 Choice over care is a fundamental tenet of government policy. A retrospective quantitative and spatial analysis of the first 100 PPC assessments identified patients’ and carers’ preferences for care and place of death at the end of life, and highlights issues for the development of PPC.

In 2003, I was involved in a series of conferences which were held in Kobe, Japan. The visit to Japan was partly funded by the Vocational Qualification Forum and International Departments of the Royal College of Nursing. During my visit, I had the opportunity to meet with many nurses and other health professionals working in a number of different cities and towns in Japan including Kobe, Kyoto, Tokyo and Osaka.