Mandy Thorpe, practice educator at Martin House Children’s Hospice, explains why healthcare simulation must prepare professionals for when a child dies.

Healthcare simulation has traditionally taught professionals how to recognise deterioration, intervene quickly and save a life.

Those skills are essential. But they do not reflect every situation a healthcare professional will encounter.

In paediatric palliative care, the right outcome is not always preventing a child from dying. It may mean recognising that further invasive treatment will not benefit them, managing distressing symptoms, following an agreed care plan and ensuring they remain comfortable.

That means healthcare education must also include simulations in which the mannequin dies.

Death in a training scenario should not automatically represent failure. It can help professionals understand what excellent care looks like when the focus shifts from cure to comfort, while giving them the opportunity to rehearse decisions they may rarely face in practice.

This matters because the needs of children and young people are changing.

Medical advances have transformed what is possible for babies and children with conditions that may once have meant a very short life. More are surviving infancy, living through childhood and reaching adolescence or adulthood.

That progress should be celebrated. But living longer does not necessarily mean living with fewer healthcare needs.

Complex care

Many children require complex care over several years, involving specialist equipment, multiple medications and support from a wide range of professionals. The question is whether healthcare education has kept pace.

Research led by the Martin House Research Centre at the University of York found that the number of children and young people in England identified with life-shortening conditions rose by 163%, from 32,975 in 2001/02 to 86,625 in 2017/18.

Prevalence increased from 26.7 to 66.4 children per 10,000, with more than 95,000 projected to be living with these conditions by 2030.

Better diagnosis and recording may explain part of that rise, but advances in medicine and technology are also enabling children to live for longer. The increase has been particularly marked in Yorkshire and the Humber and the North West, while prevalence remains higher in more deprived communities.

Recent ONS data also found that infant mortality in England’s most deprived communities was more than twice the rate in the least deprived. Mortality figures do not directly measure demand for palliative care, but they reinforce the need to plan services and workforce education around the different needs of communities.

This changing picture has implications far beyond specialist children’s hospices.

As more children live longer with complex conditions, a wider range of professionals will become involved in their care. They may encounter them in hospitals, clinics, community services or during an emergency. Paediatric palliative care can no longer be treated as knowledge needed only by hospice specialists.

The professionals who attend our training are skilled, compassionate and committed. What many have lacked is the opportunity to build their understanding of children’s palliative care before they need it in practice.

Palliative care is not consistently embedded in undergraduate medical and nursing education. Some professionals can therefore enter the workforce with limited exposure to an area that may later become an important part of their role.

Not every doctor, nurse or therapist needs to become a paediatric palliative care specialist. But they need enough understanding to recognise when palliative care may help, grasp its principles and know when to seek specialist support.

They also need confidence.

Textbook knowledge matters, but it cannot fully prepare someone for a complex clinical situation. Professionals need opportunities to apply what they know, work through difficult decisions and understand their role within the wider team.

Healthcare simulation

Rehearsing situations

Simulation creates that opportunity without placing a child or family at risk.

It allows professionals to rehearse rare but significant situations, test their clinical judgement and explore how they would respond when treatment goals change. It also helps teams understand that good care is not defined solely by whether a patient survives.

Sometimes good care means responding calmly, managing symptoms well, respecting a child’s care plan and supporting the people around them.

Martin House has developed specialist simulation courses covering areas of paediatric palliative care that are not commonly included in traditional training. Our new Education Centre will allow us to expand this work and share our experience with more professionals.

But this is not simply about delivering more courses.

Workforce education must become part of the wider response to the growing number of children living with complex and life-shortening conditions. It should begin during undergraduate training and continue through induction, professional development and lifelong learning.

Children’s palliative care services need the right facilities, specialist teams and resources. But they cannot work in isolation.

Ultimately, as health professionals, we only have one chance to ensure a child or young person has good palliative care at the end of their life.

Preparing the workforce does not mean turning every professional into a hospice specialist. It means ensuring that, when they meet a child with palliative care needs, they feel equipped to respond well and know where to find support.

Medicine has advanced. Our education must advance with it.