Aim The aim of the project is to support people's priorities for independence alongside care at the hospice. It has current relevance to hospices as we try to move forward with a greater focus on a rehabilitative approach to palliative care.

Background This project developed from a physiotherapy service review which identified where a supporting role could enhance people’s experience of rehabilitation within the hospice.

Across the hospice Health Care Assistants (HCAs) spend time with patients and are well placed to support patients to achieve their rehabilitation goals with supervision of the physiotherapist.

Approach used Each HCA would spend 8 weeks working alongside the physiotherapist. To demonstrate clinical skills and competence an in house training framework was followed. A placement workbook containing underpinning knowledge, activities and online resource links was developed by the physiotherapist and the Education lead. The HCA was to observe the physiotherapist in clinical situations, assist with interventions and gradually over the placement period would be able to demonstrate through assessment their knowledge and competency in seventeen identified skill areas.

Outcomes The initial placement has been evaluated and the second commenced. Challenges arose in clinical versus non-clinical physiotherapy workload and other personnel issues which overall reduced patient contact time for the HCA. This resulted in lost opportunities for the HCA to achieve the learning outcomes and have a demonstrable longer term impact on patient rehabilitation outcomes after the placement.

Conclusion The ambitious timescale of 8 weeks has been revised to 6 months. The expectation is that thiswill present ample opportunities for the development and consolidation of new skills and to demonstrate real impact on patient outcomes. Having the HCA available to support patients with therapeutic activity will enable the physiotherapist to develop activity programmes and increase the therapeutic contact for individuals to achieve their goals.