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In Gloucestershire, the enhance framework aims to provide staff with training and education that enables them to:

  • Build confidence in personalised future planning conversations
  • Help people and those important to them plan for the future
  • Enhance collaborative working
  • Strengthen skills in supporting uncertainty planning

Working with people in the last year of life, or who have uncertainty about their prognosis and illness trajectory, can be emotionally and professionally demanding. It is important to recognise the value of staff undertaking this work and to support them to develop the knowledge and skills needed to manage the complexity and challenges of these situations.

The enhance framework is a suite of training resources that sets out training and development opportunities for staff in Gloucestershire who support people in the last year of life or who are living with uncertainty about their condition.

More information on other enhance programmes in Gloucestershire can be found here:

The enhance training framework brings together a wide range of materials, including online modules, podcasts, films, assessment tools, guidance documents, and national enhance resources. Training resources are available across two tiers. The focus is on three core areas:

  • Identification – recognising when someone may be in their last year of life
  • Communication – talking with people, families, and professionals in a clear and sensitive way
  • Managing Uncertainty – supporting people when care needs are complex or have changing illness trajectories

The training framework briefly summarises the aims, learning outcomes, and recommended audiences for each tier. Tier 1 introduces awareness-level knowledge for anyone who may encounter people approaching the end of life. Tier 2 builds on this with deeper skills for staff who regularly provide care and need to handle more complex situations.

The framework highlights who the training is suitable for with the below recommended actions:

  1. Watch the “Last Dance” film (as an individual or a part of a group/team)
  2. Use the accompanying “Last Dance” Film Facilitator’s Guide to support reflection and development of practice
  3. Review the enhance training resources and framework document to identify the additional resources appropriate for your role.
  4. Listen to the enhance podcasts.

This is summarised in the overview document:  Training framework table

There are a range of training resources detailed in the training framework. Below are details of the resources that have been produced specifically to support the enhance programme. 

Last Dance Film and Facilitator’s Guide

Last Dance is a short, emotive film commissioned by NHS Gloucestershire Integrated Care Board to support health and care staff to reflect on conversations about uncertainty, deterioration, and planning near the end of life.

Although the characters are fictional, the story is informed by real experiences from people receiving care, their families, and professionals. Through a series of everyday moments over several months, the film follows Trish and Dan as Trish’s health declines, highlighting missed opportunities, uncertainty, and the impact of unclear or delayed conversations. Using minimal dialogue, music, and movement, the film invites viewers to notice what is said, what is avoided, and what might have been done differently.

The purpose of Last Dance is not to provide “right answers”, but to encourage honest reflection and discussion. It aims to build confidence in recognising when someone may be approaching the last year of life, to explore how and when conversations about the future can be started, and to acknowledge the emotional complexity experienced by both professionals and families.

How the film should be used

Last Dance is suitable for anyone working in health, social care, or wider services who may come into contact with people in the last year of life, and forms part of the Gloucestershire enhance training and development offer.

Last Dance is designed to be used alongside the accompanying Facilitator’s Guide as part of self‑directed learning, team development, or facilitated group sessions. It supports reflective learning rather than assessment, and works best when used in a safe, supportive environment where participants can explore their reactions and experiences.

The film can be:

  • Watched in full to prompt initial reflection and discussion
  • Revisited in shorter scene sections using the timestamps in the Facilitator’s Guide
  • Used to support conversations about person‑centred communication, managing uncertainty, recognising the last phase of life, and shared responsibility across the multidisciplinary team

Facilitated sessions typically last at least one hour and include reflective questions, discussion, and opportunities to link learning to practice.

Sensitivity Warning: The film explores themes around uncertainty, dying and grief, and it may bring up strong or personal reactions. Viewers should feel able to pause or step away if they need to.

“Living with Uncertainty” Podcasts

The “Living with Uncertainty” podcast series forms part of the wider enhance resources, created to support health and care staff in Gloucestershire. The 3 episodes focus on: identifying uncertainty, communicating about uncertainty, and managing uncertainty in practice.

Across the episodes, the discussion is intended to be practical and multi-perspective, staff from different settings (including community, primary care, care homes and voluntary sector) share their experience and suggestions on how to support patients, their carer and colleagues who are living with or managing uncertainty.

Podcast 1: Identifying Uncertainty (link coming soon)

Sensitivity warning: this podcast discusses topics relating to end of life, death and dying.

In this episode, the speakers discuss the challenges around identifying uncertainty in different settings, the benefits it can bring and the tools available to support identifying uncertainty. The speakers also explore advocacy, personalised care, holding advance care planning conversations, as well as how joined-up working and information-sharing across the system can support people experiencing uncertainty and their supporters both during end of life and following bereavement.

Speakers:

  • Wesley Dean – Registrar, Emergency Department GHFT / Education Fellow / GP, Integrated Care Urgent Care Service, GHC
  • Rachel Bucknall – Frailty Matron, Aspen Medical Practice
  • Glenda Gill – Frailty Matron, Aspen Medical Practice

Resources discussed:

Podcast 2: Managing Uncertainty (link coming soon)

Sensitivity Warning: this podcast explores a number of topics related to frailty, death and dying.

In this episode, the speakers discuss the importance of clear communication when managing the expectations of patients, families and their carers in an uncertain situation. The speakers also cover personalised care, including advance care planning, the power of language and consider the personalised nature of resuscitation decisions.

Speakers:

  • Rob Hirst – Emergency Medicine Doctor, GHFT
  • Abi Griffith – Care Coordinator, Rowcroft Medical Centre.
  • Tanya de Weymarn – Emergency Medicine and Frailty Consultant, GHFT / Clinical Lead for End of Life, NHS Gloucestershire ICB.
  • Samantha Russell – Deputy Manager, Woodstock Care and Nursing Home

Resources discussed:

Podcast 3: Communicating Uncertainty (link coming soon)

Sensitivity Warning: this podcast explores a number of topics related to frailty, death and dying.

This podcast explores how clinicians and care professionals can have meaningful, compassionate conversations with people living with uncertainty, while keeping decisions anchored in what matters most to the individual. You will hear practical approaches to proactively introducing Advance Care Planning, ReSPECT and Lasting Power of Attorney, alongside real-world perspectives from across the community, care home and emergency department settings. Contributors share techniques such as clean language, active listening and the power of silence to help build trust, balance expectations and improve communisation with patients, carers and staff.

Speakers:

  • Sonia Vaz Fernandes – Consultant Geriatrician & Physician, GHFT / Frailty Assessment Service/Cheltenham Community Services
  • Tanya de Weymarn – Emergency Medicine and Frailty Consultant, GHFT / Clinical Lead for End of Life Gloucestershire ICB.
  • Amy Harris – Help Team Advisor; Dementia, Diagnosis & Memory Support Service, Age UK Gloucestershire
  • Sinead Blick – Registered Manager, Ashberry House, Brockworth

Resources discussed:

Study Day “Managing Uncertainty: Approaches for Practice”

Managing Uncertainty: Approaches for Practice was a skills‑focused study day held on the 16th April 2026 designed to support health and care professionals to better identify, communicate and manage uncertainty in clinical practice, particularly when caring for people with complex needs, frailty, or uncertain recovery and prognosis.

Bringing together national and local expertise from palliative care, psychology, geriatric medicine and end‑of‑life leadership, the study day explored how uncertainty can be recognised early, talked about openly, and held compassionately within clinical decision‑making. Sessions focused on practical communication skills, shared decision‑making, psychological safety, and approaches that support patients, families and professionals when the future is unclear.

The programme included a keynote on navigating uncertainty in practice, local service innovation through the PURPLE project, and interactive sessions examining psychological safety, care of older people in hospital, and the use of Clean Language to enhance conversations. A facilitated reflection workshop enabled participants to integrate learning into their own roles and settings.

The talks were filmed and links to the films can be found below, alongside the speakers’ slide packs and links to resources discussed.

Navigating the Unknown: Identification, Communication and Management of Uncertainty – Clare Fuller

This keynote explores how clinicians can better identify, communicate, and manage uncertainty for people who may be in the final years of life, focusing on compassionate conversations, shared decision-making, and practical approaches that help patients and families live as well as possible when the future is uncertain.

PURPLE Bundle – patients with uncertain recovery, planning, liaising and engaging – Dr Kate Tredgett

This talk introduces the PURPLE Bundle, a structured approach to supporting patients with uncertain recovery being implemented in GHFT, by promoting early identification, clear communication, and shared decision-making while active treatment continues. It highlights how consistent conversations with patients and families, supported by MDT working and practical tools, can improve patient experience, and care quality toward the end of life.

Psychological Safety Within and Across Teams: Safely putting our head above the parapet when advocating for the patient – Dr Julie Highfield and Dr Rachael McCarthy

This session explores psychological safety within and across healthcare teams, focusing on what helps people feel able to speak up, challenge decisions, and advocate for patients—especially when conversations feel uncomfortable. Through reflection, real examples, and practical strategies, it highlights how psychological safety supports better teamwork, staff wellbeing, and safer, more compassionate patient care.

Living with Uncertainty:  Caring for Older Patients in Hospital When Prognosis is Uncertain – Dr Helen Alexander

In this talk, Dr Helen Alexander uses real‑life experiences from her clinical practice to explore dealing with uncertainty, the tools that support decision‑making, and reflects on occasions where things might have gone better.

Using Clean Language – questions in everyday conversation – Kath Rooksby

Clean Language is a precision communication technique: a structured way of respectfully asking questions that also pushes you to really listen to what the other person is saying, and to choose your next question mindfully

Last Dance – communication discussion – Dr Brenda Ward and Sam White

This session uses the Last Dance film to explore how clinicians can navigate uncertainty and recognise opportunities for timely, compassionate conversations about future and end‑of‑life care.